Posttraumatic stress disorder (PTSD) is a psychiatric condition that may occur in people who have experienced or witnessed a traumatic event or series of traumatic events. The individual often experience the event or events as emotionally or physically harmful or life-threatening. Examples include, but are not limited to, abuse (physical, sexual, emotional), natural disasters, serious accidents, terrorist acts, war/combat exposure, intimate partner violence, and medical illness. However, most individuals who experience traumas do not go on to develop PTSD.
Many people who are exposed to a traumatic event experience symptoms similar to PTSD in the days following the event. However, for a person to be diagnosed with PTSD, symptoms must last for more than a month and must cause significant distress or problems in the individual's daily functioning. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.
PTSD can occur in anyone of any ethnicity, nationality or culture, and at any age. The prevalence of PTSD in the U.S. is estimated to be approximately 4% of U.S. adults and 8% of U.S. adolescents aged 13-18. The lifetime prevalence in the U.S. is estimated to be 6%. PTSD risk factors include:
- Prior history of trauma (and the severity and frequency of events; perceived lack of support following event(s))
- Childhood adversity/trauma
- Female gender
- Member of a marginalized group (such as non-white, LGBTQ+, living with a disability)
- Immigrant status
Symptoms and Diagnosis
Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.
- Intrusion: Intrusive (unwanted and involuntary) thoughts such as repeated memories, distressing dreams, or flashbacks of traumatic events. Flashbacks may be so vivid that people feel they are reliving the traumatic experience or seeing it before their eyes and may cause significant fear and panic. These memories and/or nightmares may be triggered by something that reminds the individual of the traumatic event or may be spontaneous.
- Avoidance: Avoiding reminders of the traumatic event(s) may include avoiding people, places, activities, objects, and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. Additionally, they may resist talking about what happened or how they feel about it. Oftentimes, these behaviors lead to dysfunction in everyday life.
- Changes in cognition and mood: Individuals with PTSD may initially present with depressive symptoms. These include low mood (feeling sad), inability to feel happiness, and a lack of interest in activity and/or people that they used to enjoy. Additionally, individuals with PTSD may have trouble with memory; maybe be unable to remember important aspects of the traumatic event have negative thoughts and feelings leading to ongoing and distorted beliefs about themself or others (e.g., “I am bad,” “No one can be trusted”); have distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; have ongoing fear, horror, anger, guilt or shame; have much less interest in activities previously enjoyed; feel detached or estranged from others; or be unable to experience positive emotions (a void of happiness or satisfaction).
- Changes in arousal and reactivity: People with PTSD may describe being irritable and having angry outbursts, behaving recklessly or in a self-destructive way, being overly watchful of their surroundings in a suspecting way, being easily startled, or having problems concentrating or sleeping.
Dissociation
Some individuals with PTSD will have the dissociative symptoms:
- Derealization – The feeling that life is not real. Individual may describe feeling like they are in a movie or in a dream.
- Depersonalization – The feeling that one is outside of their body.
These symptoms are not required for a PTSD diagnosis and can vary in intensity across the PTSD illness.
The four tabs below provide brief descriptions of four conditions related to PTSD: acute stress disorder, adjustment disorder, disinhibited social engagement disorder, and reactive attachment disorder.
Acute stress disorder may occur after a traumatic event, just as PTSD does, and the symptoms are similar. However, the symptoms occur between three days and one month after the event. People with acute stress disorder may relive the trauma, have flashbacks or nightmares and may feel numb or detached from themselves. These symptoms cause major distress and problems in their daily lives. About half of people with acute stress disorder go on to have PTSD. Acute stress disorder has been diagnosed in 19%-50% of individuals that experience interpersonal violence (e.g., rape, assault, intimate partner violence).
Psychotherapy, including cognitive behavior therapy can help control symptoms and help prevent them from getting worse and developing into PTSD. Medication, such as SSRI antidepressants can also help ease the symptoms.
Adjustment disorder occurs in response to a stressful life event (or events). The emotional or behavioral symptoms a person experiences in response to the stressor are generally more severe or more intense than what would be reasonably expected for the type of event that occurred.
Symptoms can include feeling tense, sad or hopeless; withdrawing from other people; acting defiantly or showing impulsive behavior; or physical manifestations like tremors, palpitations, and headaches. The symptoms cause significant distress or problems functioning in key areas of a person’s life, for example, at work, school or in social interactions. Symptoms of adjustment disorders begin within three months of a stressful event and last no longer than six months after the stressor or its consequences have ended.
The stressor may be a single event (such as a romantic breakup), or there may be more than one event with a cumulative effect. Stressors may be recurring or continuous (such as an ongoing painful illness with increasing disability). Stressors may affect a single individual, an entire family, or a larger group or community (for example, in the case of a natural disaster).
An estimated 5% to 20% of individuals in outpatient mental health treatment have a principal diagnosis of adjustment disorder. A recent study found that more than 15% of adults with cancer had adjustment disorder. It is typically treated with psychotherapy.
Disinhibited social engagement disorder occurs in children who have experienced severe social neglect or deprivation before the age of two. Similar to reactive attachment disorder, it can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.
Disinhibited social engagement disorder involves a child engaging in overly familiar or culturally inappropriate behavior with unfamiliar adults. For example, the child may be willing to go off with an unfamiliar adult with minimal or no hesitation. Developmental delays including cognitive and language delays often co-occur with this disorder. Caregiving quality has been shown to mediate the course of this illness. Yet even with improvements in the caregiving environment some children may have symptoms that persist through adolescence.
The prevalence of disinhibited social engagement disorder is unknown, but it is thought to be rare. Most severely neglected children do not develop the disorder. The most important treatment modality is to work with caregivers to ensure the child has an emotionally available attachment figure.
Reactive attachment disorder occurs in children who have experienced severe social neglect or deprivation during their first years of life. It can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.
Children with reactive attachment disorder are emotionally withdrawn from their adult caregivers. They rarely turn to caregivers for comfort, support or protection or do not respond to comforting when they are distressed. During routine interactions with caregivers, they show little positive emotion and may show unexplained fear or sadness. The problems appear before age 5. Developmental delays, especially cognitive and language delays, often occur along with the disorder.
Reactive attachment disorder is uncommon, even in severely neglected children. Treatment involves a therapist working with a child and their family in order to strengthen the relationship between the child and their primary caregivers.