MSD Manual

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Overview of Posttraumatic Stress Disorder
Overview of Posttraumatic Stress Disorder
Overview of Posttraumatic Stress Disorder

    Posttraumatic stress disorder, also called PTSD, happens when some memory of a past traumatic event—like war or sexual assault—causes recurrent mental and physical distress.

    Now the Diagnostic and Statistical Manual 5th edition or the DSM 5 categorizes PTSD as a “trauma-and-stressor-related-disorder” that happens when the symptoms of an acute stress response persist for over a month.

    The main symptoms are psychological ones, for example someone might re-experience their trauma through nightmares, flashbacks, and intrusive thoughts, but these can lead to behavioral changes as well. Somebody might start to avoid environments and situations that remind them of their trauma and feel a sense of hypervigilance where they are constantly on guard or hyperarousal where they have this exaggerated startle response to the smallest of triggers.

    Not surprisingly, all of these thoughts and behaviours can lead to trouble sleeping and general irritability, which can lead to angry outbursts.

    Interestingly, this pattern is different for young children who are less likely to show distress, but instead they might use play to express their memories, sometimes acting out scenes that trouble them.

    Whether or not someone develops PTSD in response to trauma is determined by a number of different factors. For example, it’s clear that interpersonal trauma, like rape or violent muggings, are more likely to result in PTSD than accidents or environmental disasters.

    In addition, people that go through extreme trauma as children are more likely to develop PTSD in response to other traumas faced in their adult life. Having said that, if someone manages to develop effective coping strategies for trauma including having a social support network, then that can help with future traumas as well.

    As far as causes go, there are some clues about biological factors related to development of PTSD. For instance, people with dysfunctions of the hypothalamic-pituitary-adrenal axis, deficits in the arousal and sleep-regulating systems in the brain, and problems with the endogenous opioid system—which helps with pain control—have all been shown to be at higher risk for developing PTSD. PTSD has also been linked to having a family history of mood disorders or anxiety disorders. The precise mechanism, though, that ties all of these relationships together has yet to be worked out.

    Treatment for PTSD can be kind of complicated, since people with the disorder are often reluctant to to engage with the trauma in any way—in their thoughts, emotions, or in conversations, which can make treatment really hard. Research has shown that exposure therapy, which slowly exposing individuals to situations that cue recall of trauma, can be very effective.

    Group therapy is also a popular choice for individuals with PTSD, because it provides survivors with a safe place to relive their trauma in a supportive environment. In terms of medications, antidepressants, in particular selective serotonin reuptake inhibitors (or SSRIs), can help to reduce depressive symptoms that often accompany PTSD, and can help minimize flashbacks and nightmares. Anti-anxiety medications can help decrease the heightened physiological arousal often seen in people with PTSD, and finally sleep-aids can also be an helpful because lack of sleep and restlessness is such a serious problem in PTSD. In addition to this, a lot of people with PTSD self-medicate with alcohol and other substances which can actually worsen their symptoms and their overall health.

    So an important treatment consideration for both therapy and medications, is to help alleviate their symptoms while also safely managing substance abuse issues.

    So as a quick recap—PTSD usually happens after a violent interpersonal trauma and involves recurring thoughts that persist for over a month, and can be managed with effective coping strategies and medications.

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