PTSD: Diagnosis and Treatment

What effects can a traumatic experience have, and what constitutes such an occurrence? How do the traumas one faces reverberate through their life, and what are the risk factors for post-traumatic stress disorder? Read on to find out more about the disorder’s possible causes, PTSD facts, and its diagnostic process.

What is PTSD? A Short Primer

The American Psychiatric Association (or APA) defines post-traumatic stress disorder (or PTSD) as a mental health disorder derived from exposure to a stressful or traumatic event. It was first recognized by the APA in 1980, in the third edition of its Diagnostic and Statistical Manual (DSM-III).

Initially, PTSD was listed as part of the anxiety disorders family. But like obsessive-compulsive disorder (OCD), it eventually formed its own group, with the APA listing PTSD in 2013 as part of the newly-formed trauma and stressor-related disorders family.

Both PTSD and OCD are rather unusual categories within the pages of the DSM, since both of their respective disorder families refer to a concrete or experience that must have taken place for such a definition to be considered. The case for removing PTSD from the anxiety family was further made by evidence that the disorder triggered many other emotions beyond anxiety, such as guilt, shame, and anger.

That said, the stressors family is currently the only disorders family not to be grouped by an overarching theme, such as depression or psychosis. Instead, the individual diagnosed with PTSD—or any of the other stressor disorders—must have undergone an event (or series of events) so traumatic as to understandably act as the cause for their condition.

The 12-month prevalence of PTSD among US adults is 3.5%. Outside the US, lower rates have been recorded, with European, Asian, Latin American, and African countries noting a PTSD prevalence of 0.5%-1.0%. Females are more likely to develop PTSD than males and tend to experience it for a longer duration. This gender imbalance is at least in part attributable to females’ higher likelihood of exposure to interpersonal violence.

PTSD statistics are higher for those working in vocations where exposure to trauma is generally higher. These include the police force, firefighters, and medical personnel. The highest rates of PTSD are found among survivors or rape, those who have experienced military combat or captivity, and those who have experienced ethnic/political internment or genocide.

The Debate Over Defining Trauma

For the purpose of defining its own, recognized PTSD causes, the APA lists only three types of events as potentially traumatic:

• Death.
• Serious injury.
• Sexual violence.

That said, such events do include various settings, such as a robbery, waking up during surgery, or a catastrophic natural disaster. The APA tends to acknowledge sudden events as potentially traumatic.

The APA states these and other traumatic events can either be experienced:

• Directly, by the individual themselves.
• Through seeing it happen to a loved one.
• By learning it has happened to someone they deeply care for, either violently or accidentally.
• Through repeated exposure to details from such an event, such as can be the case for first responders.

Specifying the above qualifications has brought on a great deal of criticism of the APA, over a number of points:

• Mental PTSD symptoms can also develop from additional types of destabilizing experiences, such as a divorce, incessant bullying, or a heart attack. Yet the APA has so far only recognized death, injury, and sexual violence as traumas. This was apparently done to prevent a potentially boundless PTSD diagnosis, which would dilute it of its meaning. Indeed, researchers who support the APA’s stricter guidelines have noted that a more inclusive PTSD definition would recognize American viewers watching the television coverage of the Sep. 11 attacks, as akin to the survivors who managed to escape the World Trade Center themselves.
• Not all incidents of death, injury, or sexual violence result in trauma. This means that while a certain individual may go through one of the above-mentioned violent acts and not develop PTSD, another individual might. In response to this criticism, a conversation on mental health resilience began to take place, and research on post-traumatic growth began.

PTSD Symptoms Beyond the Initial Trauma

While undergoing a traumatic experience is essential for a PTSD diagnosis, it is not its only attribute. Additional symptoms include:

• Recurring, intrusive symptoms associated with the traumatic event. Possible manifestations are:
  • Flashbacks.
  • Dreams.
  • Prolonged distress to triggers of the event.
  • Dissociative reactions, where the individual responds as if they are once again experiencing the traumatic event.
• Avoidance behavior, of both external stimuli (e.g., places, individuals, situations), and internal ones (e.g. memories of the event). Such behavior tends to expand and generalize, so that an individual with PTSD from a violent assault might begin avoiding the exact location where it happened, only to eventually avoid large areas of town or any similar locations.
• Negative mood and altered cognitive abilities associated with the traumatic event. These can include:
  • Negative emotionality.
  • An inability to experience positive emotion.
  • Trouble remembering certain details.
  • Persistent, negative, or distorted beliefs relating to the event (e.g., “I can never trust anyone again”; “It was my fault for staying”).
  • Diminished interest in certain activities.
• Over-arousal associated with the traumatic event, which can lead to:
  • Hypervigilance.
  • Irritability or reckless behavior.
  • Trouble sleeping
  • Trouble concentrating.
  • Startle response.
• Persistence of above symptoms.
• Significant distress, or functioning impairment, due to trauma.

Support for Those Facing PTSD

PTSD is not only a uniquely defined disorder, but also an extremely painful and destabilizing one. Combining potential elements of distress, dissociation, and the reliving of a terrible experience, PTSD often requires the support and guidance of trained professionals specializing in treating this condition. Such options include both medical treatments (particularly antidepressants), psychotherapy (such as cognitive-behavioral therapy and psychodynamics), and medical device treatments.