Post-traumatic Stress Disorder (PTSD)

If you have gone through a traumatic experience, it is normal to feel lots of emotions, such as distress, fear, helplessness, guilt, shame or anger. You may start to feel better after days or weeks, but sometimes, these feelings don’t go away. If the symptoms last for more than a month, you may have post-traumatic stress disorder or PTSD.

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following the experience or witnessing of a traumatic event. A traumatic event is a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood.

PTSD is a real problem and can happen at any age. If you have PTSD, you are not alone. It affects nearly eight million American adults.

Who can get PTSD?

• Anyone who was a victim, witnessed or has been exposed to a life-threatening situation.
• Survivors of violent acts, such as domestic violence, rape, sexual, physical and/or verbal abuse or physical attacks.
• Survivors of unexpected dangerous events, such as a car accident, natural disaster, or terrorist attack.
• Combat veterans or civilians exposed to war.
• People who have learned of or experienced an unexpected and sudden death of a friend or relative.
• Emergency responders who help victims during traumatic events.
• Children who are neglected and/or abused (physically, sexually or verbally).

What are the symptoms of PTSD?

For many people, symptoms begin almost right away after the trauma happens. For others, the symptoms may not begin or may not become a problem until years later. Symptoms of PTSD may include:

• Repeatedly thinking about the trauma. You may find that thoughts about the trauma come to mind even when you don’t want them to. You might also have nightmares or flashbacks about the trauma or may become upset when something reminds you of the event.
• Being constantly alert or on guard. You may be easily startled or angered, irritable or anxious and preoccupied with staying safe. You may also find it hard to concentrate or sleep or have physical problems, like constipation, diarrhea, rapid breathing, muscle tension or rapid heart rate.
• Avoiding reminders of the trauma. You may not want to talk about the event or be around people or places that remind you of the event. You also may feel emotionally numb, detached from friends and family, and lose interest in activities.

These are other symptoms of PTSD:

• Panic attacks: a feeling of intense fear, with shortness of breath, dizziness, sweating, nausea and racing heart.
• Physical symptoms: chronic pain, headaches, stomach pain, diarrhea, tightness or burning in the chest, muscle cramps or low back pain.
• Feelings of mistrust: losing trust in others and thinking the world is a dangerous place.
• Problems in daily living: having problems functioning in your job, at school, or in social situations.
• Substance abuse: using drugs or alcohol to cope with the emotional pain.
• Relationship problems: having problems with intimacy, or feeling detached from your family and friends.
• Depression: persistent sad, anxious or empty mood; loss of interest in once-enjoyed activities; feelings of guilt and shame; or hopelessness about the future. Other symptoms of depression may also develop.
• Suicidal thoughts: thoughts about taking one’s own life. If you or someone you know is thinking about suicide, call 1-800-273-TALK (8255).

How can I feel better?
PTSD can be treated with success. Treatment and support are critical to your recovery. Although your memories won’t go away, you can learn how to manage your response to these memories and the feelings they bring up. You can also reduce the frequency and intensity of your reactions. The following information may be of help to you.

Psychotherapy… Although it may seem painful to face the trauma you went through, doing so with the help of a mental health professional can help you get better. There are different types of therapy.

• Cognitive behavioral therapy helps you change the thought patterns that keep you from overcoming your anxiety.
• During exposure therapy, you work with a mental health professional to help you confront the memories and situations that cause your distress.
• Cognitive Processing Therapy helps you process your emotions about the traumatic event and learn how to challenge your thinking patterns.
• Couples counseling and family therapy helps couples and family members understand each other.

Medicine, such as selective serotonin reuptake inhibitors or SSRIs, is used to treat the symptoms of PTSD. It lowers anxiety and depression and helps with other symptoms. Sedatives can help with sleep problems. Anti-anxiety medicine may also help.

Support groups… This form of therapy, led by a mental health professional, involves groups of four to 12 people with similar issues to talk about. Talking to other survivors of trauma can be a helpful step in your recovery. You can share your thoughts to help resolve your feelings, gain confidence in coping with your memories and symptoms and find comfort in knowing you’re not alone. For a list of support groups in your area, contact your local Mental Health America organization.

“[As part of my recovery from PTSD], I created a visual space for my domestic violence memories. I had a closet (in my mind) where I kept my memories. I kept memories separate, in boxes with lids on the shelves of the closet. When unwanted thoughts about the domestic violence I suffered crept into my life, I stopped the thought process by telling myself that now isn’t the time. I created an actual visual experience, in which I envisioned taking the memory, opening the closet, taking down an empty box, placing the unwanted memory or thought into the box, closing the box, labeling it and putting the box back on the shelf. Then when I had quiet time or thought I was ready to confront a specific memory, I would visualize going into the closet and taking down the labeled box with that memory. I would open the box and examine the contents. Sometimes I cried, laughed, or mourned. When I had enough, I would put the memory back into the box. I found that, over time, there were fewer and fewer boxes in my closet. And the boxes were smaller and smaller. While I haven’t quite walled the closet over, the last time I went there, the closet was all but empty.”
—Kathlene, Pennsylvania

Self-care… Recovering from PTSD is an ongoing process. But there are healthy steps you can take to help you recover and stay well. Discover which ones help you feel better and add them to your life.

Connect with friends and family. It’s easy to feel alone when you’ve been through a trauma and are not feeling well. But isolation can make you feel worse. Talking to your friends and family can help you get the support you need. Studies show that having meaningful social and family connections in your life can have a positive impact on your health and healing.

Relax. Each person has his or her own ways to relax. They may include listening to soothing music, reading a book or taking a walk. You can also relax by deep breathing, yoga, meditation or massage therapy. Avoid using drugs, alcohol or smoking to relax.

Exercise relieves your tense muscles, improves your mood and sleep, and boosts your energy and strength. In fact, research shows that exercise can ease symptoms of anxiety and depression. Try to do a physical activity three to five days a week for 30 minutes each day. If this is too long for you, try to exercise for 10 to 15 minutes to get started.

Get enough rest. Getting enough sleep helps you cope with your problems better, lowers your risk for illness and helps you recover from the stresses of the day. Try to get seven to nine hours of sleep each night. Visit the Sleep Foundation at www.sleepfoundation.org for tips on getting a better night’s sleep.

Keep a journal. Writing down your thoughts can be a great way to work through issues. Researchers have found that writing about painful events can reduce stress and improve health.

Refrain from using drugs and alcohol. Although using drugs and alcohol may seem to help you cope, it can make your symptoms worse, delay your treatment and recovery, and can cause abuse or addiction problems.

Limit caffeine. In some people, caffeine can trigger anxiety. Caffeine may also disturb your sleep.

Help others. Reconnect to your community by volunteering. Research shows that volunteering builds social networks, improves self-esteem and can provide a sense of purpose and achievement.

Limit TV watching. If watching the news or other programs bothers you, limit the amount of time you watch. Try not to listen to disturbing news before going to sleep. It might keep you from falling asleep right away.

Helping a Family Member With PTSD

If someone in your family has PTSD, it can be a hard time for family members too. Your loved one with PTSD may have symptoms that interfere with your relationship and change family life. If your loved one has PTSD, you may also be coping with these difficult feelings:

• Depressed or angry about the changes in family life.
• Fearful if your loved one is angry or aggressive.
• Reluctant to talk about the trauma or avoiding situations that might upset your loved one.
• Angry or resentful toward your loved one.
• Tired from sleep problems because of worry, depression or because of your loved one’s sleep problems.
• Isolated if your partner refuses to socialize.
• Emotional distance from your partner.

The stress of PTSD can affect all members of the family. If PTSD is affecting your family, consider contacting a mental health professional for individual, couples or family counseling. Through counseling, you can get the help you and your family needs to cope and support each other. For a referral to local services, contact your local Mental Health America organization or Mental Health America at 800-969-6642. You can also visit www.mentallhealthamerica.net.

Ask Dr. Riggs

Dr. David Riggs is an expert on trauma and PTSD and Executive Director of the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences (USUHS). Below he describes symptoms and treatment of PTSD and offers ways to talk to your family and friends about PTSD.

I’m having symptoms of PTSD, and feel like I’ve lost control of my life. Does this mean I’m a weak person?

Far from it. The reactions that we use to diagnose PTSD—things like intrusive memories, feeling distanced from other people, sleep problems, anger and anxiety, are very normal reactions to traumatic events. Almost everyone who experiences a trauma will have some of these reactions. Usually they start right after the trauma, but sometimes these reactions don’t show up until weeks or months after the event. For most people, these reactions will get better over time. But for others, they seem to hang on and may get worse. When these reactions last for at least a month, we call them PTSD.

I think I might have PTSD. Who should I talk to?

If you have just been through a trauma in the last few weeks, it is very normal to have reactions that look like PTSD. While we do not know for sure what works best to help people recover from a trauma, support from other people seems to be important. So if you can talk to family, friends, or other supportive people about the difficulties you are having, it might help. Support groups may also help.

If your symptoms persist more than a month or so, and you think you have PTSD, I would encourage you to see a mental health professional. As a first step, you might talk to your doctor or other health care provider. He or she can refer you to a mental health professional if it is appropriate. If you do seek counseling, try to seek out treatment from a provider who knows how to treat issues that arise after a trauma.

Certain things seem to set off my symptoms of PTSD. What can I do to control these triggers?

For people with PTSD, it is very common for their memories to be triggered by sights, sounds, smells or even feelings that they experience. These triggers can bring back memories of the trauma and cause intense emotional and physical reactions, such as raised heart rate, sweating and muscle tension. Because these memories and feelings are unpleasant, you may have the urge to avoid the triggers. Avoiding things that make you uncomfortable is normal and will make you feel better in the short run. But in the long run, this avoidance will make things worse. If the pattern continues, you can make your problems worse. Instead of avoiding triggers, it is probably better to learn how to manage your reactions when they are triggered. Many forms of therapy are effective in treating PTSD. Cognitive behavioral therapy, in particular, can help you learn ways to reduce and manage your reactions to triggers.

Will my PTSD symptoms ever go away?

Over the first few weeks after a trauma, you will probably see things getting better and better. However, if your symptoms have lasted for two or three months, it is unlikely that they will go away on their own. The good news is that some very good short-term therapies have been developed that can help you recover from PTSD. The most carefully studied therapies, and those that have been found most effective, fall under the general category of cognitive behavior therapy. At this time, the treatments that have been shown most effective in treating PTSD are Exposure Therapy, Cognitive Processing Therapy, and Eye Movement Desensitization and Reprocessing. These therapies combine skills training, education and strategies for coping with symptoms. A lot of studies have shown that these treatments can reduce PTSD symptoms, and many people who complete these treatments no longer have PTSD.

I’ve tried medicine, but I’m not getting any better. Is there any hope for me?

Although medicines can reduce the symptoms of PTSD, the fact that the medicine has not helped you does not mean you are stuck with the PTSD forever. You need to realize that no one medicine is going to work for everyone who has PTSD. Even medicines that are helpful with some symptoms may leave you with problems in other areas. You may be able to try a different medicine that will work better for you. Your doctor may also want to add a medicine to help with specific problems you might have. For instance, he or she may want to prescribe a sleeping pill to help with sleep problems even though you are taking another medicine for PTSD. Also know that even if medicines are able to reduce your PTSD symptoms, the symptoms are likely to come back (at least partially) when you stop taking the medicine.

If you are unable to find a medicine that helps relieve your PTSD symptoms or if you want to stop taking a medicine that has helped, there are other options for you. There are some forms of psychotherapy that have been developed specifically to treat PTSD and found very effective. Research suggests that the improvements made through therapy remain with you even after you stop seeing a therapist. Therapy may even be able to help you avoid the return of symptoms when you stop taking a medicine that has helped.

Regardless of whether you think you should try a different medicine, start an additional medicine, or stop taking medicines altogether, you should always make these decisions with your doctor.

How do I talk to my family about PTSD?

Talking to your family or other people who care about you can be hard. You may be concerned that they will think badly of you, or that you might become upset when you talk to them. You might also be worried that your family might be upset by things you tell them. Without knowing you or your family, it is very hard to tell you exactly how best to talk to them about your PTSD, but the following ideas may be helpful.

First, remember that you do not have to tell everyone at one time, and you do not need to tell everything at once. You might begin by telling one person that you are close to what is bothering you. You do not have to go into all of the details of what happened to you. Just talk about what you are feeling now. Once you are able to tell one person, it will probably be easier to talk to other people about what is bothering you. You could also share a written description of PTSD with your family, something like this publication. This can give you a way to talk about PTSD and related problems without having to focus on your own symptoms.

One important thing to remember is that when someone has PTSD, it often affects people around them as well. Family members and friends may notice that you are jumpier, anxious, depressed or not sleeping well. Also, people with PTSD tend to withdraw from people. Because of these aspects of PTSD, your family probably already knows that something is wrong. Unfortunately, they may not understand what is bothering you or why you seem so different. The fact that people with PTSD withdraw from those who care most about them is particularly problematic because the support that these people can offer to you may be really helpful in overcoming the problems that develop after a trauma. Remember that many of the PTSD symptoms that are bothering you are common reactions to trauma. They do not mean you are somehow to blame.

Despite all of this, some family members and friends may not be able to offer you the support that you would like. It may be that they don’t know what would be most helpful and that they are themselves too upset to help, or that the problems resulting from the PTSD make it too hard to be supportive. If you need more help talking to them, or if your family has a difficult time when you do tell them, you should seek help from a mental health professional who can help you cope with the specific challenges that you are having.

The PTSD brochure was reviewed by David S. Riggs, Ph.D., Executive Director, Center for Deployment Psychology, Uniformed Services University of the Health Sciences.