Despite getting our attention in the media, we still haven’t made enough progress in combating the rise in PTSD in military and war veterans, and other important members of our communities. Here’s what we can do to start making real change.
For several decades now, post-traumatic stress disorder (PTSD) has become a common term in the United States and in many parts of the world. Use of the term coincided with growing awareness for the mental illness that affects several critical demographics, including sexual assault survivors and military veterans (especially those who served in Afghanistan and Iraq). Though this growing awareness has been valuable, awareness alone won’t help address the growing epidemic associated with PTSD.
PTSD is a complex condition that accounts for several nuanced understandings of how humans (and consequently, our brains) record and store memories relating to traumatic events. In the same vein, the symptoms and manifestations of PTSD can vary from person to person, depending on the precise event or events that led to the individual’s ongoing stress and trauma.
Like all forms of mental illness, PTSD is not a condition that can be ignored or written off as a rare occurrence. According to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), some 3.5% of Americans live with some form of diagnosed or undiagnosed PTSD. Meanwhile, some 9% of all Americans will receive a PTSD diagnosis over the course of their lives. In short, PTSD and its life-altering symptoms have a wide reach in today’s society.
In the near future, there is hope that individuals living with PTSD will be able to receive treatment that effectively manages their symptoms. But while those treatment methods continue to be developed, we all can improve our understanding of the condition, its symptoms, and lasting impacts. This will help promote supportive discourse around PTSD as the various stigmas and misconceptions surrounding PTSD and mental illness in general come to light.
What is PTSD?
At its core, post-traumatic stress disorder (often shortened to PTSD) is a well-known and well-documented mental disorder that can develop in reaction to an individual’s experience of a traumatic event. The precise definition of “traumatic” in this context varies from person to person, though experiences of warfare, sexual assault, and automotive collisions are common triggers for the manifestation of PTSD.
PTSD is categorized by distress that lasts more than a month and relates directly to a triggering event. During and after that one-month period, the individual may suffer from any number of disturbing thoughts and feelings that consequently trigger undesirable physical and/or mental reactions. Over time, untreated PTSD almost always impacts an individual’s quality of life directly, with those suffering from the condition often experiencing disrupted social lives and far higher-than-average risk for suicidal behavior.
Though they can occur with other forms of mental illness, PTSD is noteworthy for its focus on so-called “flashbacks” to the trigger event of trauma. These flashbacks occur both as a conscious and unconscious experience, leading to intrusive recollections and dissociative episodes. Depending on their severity, these flashbacks can cause dysfunction in an individual’s life, especially when it comes to activities in public or other uncontrolled environments.
Risk factors related to PTSD
PTSD can manifest in the wake of any event sufficiently traumatic enough to trigger a persistent and involuntary recall of the event. That being said, certain types of trauma are well-documented as risk factors for PTSD, likely because they represented a direct threat to the individual’s life.
Men are generally considered more likely to experience a traumatic event (possibly due to their historical employment in fields associated with routine trauma, such as the military). That being said, women are presently more likely to experience a “high-impact traumatic event” that leads to the onset of PTSD. Such “high-impact” events include domestic abuse and sexual assault, both of which women are statistically more likely to be victims of at some point in their lives.
The following are categories that have been studied and correlated with the onset of PTSD in a statistically significant number of individuals. However, the presence of a similar event in an individual’s life doesn’t guarantee that he or she will experience PTSD or its various symptoms. Severity and post-event treatment can impact the ultimate likelihood of PTSD manifesting in an individual.
Domestic violence of all types can lead to the manifestation of PTSD in victims. This includes single, dramatic instances of domestic violence as well as long-term patterns of domestic violence. In either case, the individual is likely to experience flashbacks, as well as other physical and mental symptoms, that recreate the experience of his or her abuse.
PTSD caused by domestic violence can be triggered by any number of events or occurrences, most of which are dependent upon the context in which the individual was victimized. For example, the individual may experience PTSD-like symptoms only in the presence of their abuser. Conversely, an individual may experience these symptoms in any future domestic relationship, regardless of whom is involved. These two modes of manifestation are not mutually exclusive, either.
Rape and sexual assault
Among all forms of trauma that are categorically known to lead to PTSD, rape (and all forms of sexual assault) carry the highest correlation between individuals living through the experience and later on receiving a PTSD diagnosis. Specifically, around 11.4% of sexual violence survivors and 19% of rape survivors later report PTSD-like symptoms or received a formal PTSD diagnosis. In other words, nearly 1/5 of all rape survivors experience some type of PTSD.
In fact, the severity and prevalence of PTSD among rape survivors has led to the further study of complicating factors that allow for this correlation, which has allowed researchers to identify a condition known as rape trauma syndrome and its specific symptoms as a type of “complex post-traumatic stress disorder.” This categorization was designed to emphasize the long lasting and escape-less nature of the trauma’s triggering event.
The likelihood of PTSD manifesting in a rape survivor can be exacerbated by several contextual factors. For example, if the individual was restrained or mortally threatened during the experience, PTSD is more likely to manifest down the road. Similarly, rape victims are more likely to experience PTSD-like symptoms if their assault was perpetrated by someone they know.
Extreme feelings of isolation have been found in individuals with PTSD triggered by rape or sexual assault. Though social and emotional isolation has been documented in many forms of mental illness, rape-related PTSD carries an even more intense isolation burden due to the tragic likelihood of victim-blaming. As such, victims of rape, in particular, must be taken at their word when describing their trauma in order to properly manage the associated psychological fallout.
In many ways, the modern understanding of PTSD comes directly from the experiences of soldiers and other military personnel in wartime. For those directly involved on the frontlines, the likelihood of mortal injury or exposure to mortal peril is greatly increased and often prolonged over the course of the deployment. As such, soldiers and military personnel are at a heightened risk for developing PTSD (often after the conclusion of their service).
In recent decades, the identification of PTSD among military veterans has been emphasized as a preventative measure while the service member reenters civilian life. Current estimates of PTSD prevalence among American soldiers (in post-Vietnam conflicts) range from around 4% to as high as 17% (depending on criteria and diagnosis requirements). This rise in preventative identification may provide better opportunities for these individuals to manage their symptoms throughout their post-service life.
Much like soldiers, refugees and other civilians displaced by war are at a higher risk for developing PTSD. This is likely due to the increased likelihood of a refugee (including children and adults) to be exposed to mortal danger or a pattern of travel that permanently disrupts stability. Symptoms of PTSD can onset at nearly any time within this population, including during and after their time as unsettled refugees.
Currently, research into the psychiatric experience of refugees has been on the rise due to the unprecedented number of refugees worldwide (with many displaced from Syria, Lebanon, Turkey, and Jordan in the wake of the Syrian civil war and ISIS incursion). Current estimates place the rate of diagnosable PTSD in this population at around 15%, a remarkably high figure compared to the 1.1% global non-refugee average.
Pregnancy and post-pregnancy
Both during and throughout a woman’s pregnancy, she is at a heightened risk for developing PTSD. This is likely the result of both the vulnerability and physical challenges associated with both carrying and delivering a child, even under desirable circumstances. Though this category of PTSD doesn’t necessarily carry unique symptoms, it does hinge strongly on the physiological connection between a mother and her child.
Generally, pregnancy-related PTSD is triggered by a traumatic occurrence during pregnancy. Though not exhaustive, several prominent triggers include extreme pain, preterm or prolonged labor, emergency C-sections, and an episiotomy. Even among women who experienced a normal childbirth procedure, rates of PTSD range from 2.8% to 5.6% at six weeks postpartum. Similar studies have found rates of women experiencing one or more PTSD-like symptoms at six weeks postpartum as high as 30.1%.
Presently, pregnancy-related PTSD is not specifically recognized by the DSM. This (along with outdated training) has led many women exhibiting PTSD symptoms after pregnancy to be misdiagnosed as suffering from postpartum depression. As such, inadequate treatment is not uncommon in this domain.
Sudden or dramatic death of loved one
The unexpected death of a loved one is often reported as one of the most common cross-cultural causes of PTSD. Though the experience does not statistically predispose an individual to experience PTSD-like symptoms, some 5.2% of people who live through such an experience develop PTSD after learning about a loved one’s death.
Compared to other triggers for PTSD, death-related PTSD affects the largest part of the population at any given time. Consequently, current estimates show that around 1 in 5 PTSD cases diagnosed worldwide can be attributed to an individual’s experience in the wake of a loved one’s death.
Though any individual can conceivably experience death-related PTSD, parents, and children, in particular, are particularly at risk. This relationship goes both ways, with children facing an increased risk of experiencing PTSD-like symptoms in the wake of a parent’s sudden death and parents becoming more likely to experience PTSD-like symptoms relating to a child’s death (either suddenly or due to a prolonged illness).
Signs and symptoms of PTSD (and how to spot them)
PTSD is most commonly understood through its various symptoms and manifestations, which can vary from person to person based upon the nature of the triggering event and treatment status. In general, PTSD symptoms can be described as involuntary and patterned on the individual’s thoughts and actions. Many specialists will diagnose an individual with PTSD if they demonstrate one or more of the following symptoms for a month or more.
The following list of possible symptoms is not conclusive, by any means. Those who believe that they are experiencing trauma-related symptoms or know someone experiencing the same should contact a trained medical professional before seeking PTSD treatment.
Flashbacks and intrusive thoughts
Traumatic flashbacks are among the most distinct and well-known symptom of PTSD. These flashbacks can take place both consciously and unconsciously, with those experiencing flashbacks often recalling the direct experiences and/or emotions surrounding their triggering trauma event. These flashbacks are almost always intrusive to a degree and can occur with or without a correlated trigger.
PTSD-related flashbacks are considered particularly visceral compared to regular memories. As such, survivors of sexual assault and former combat veterans (for example) are often able to recall with great emotional and physical acuity the moments surrounding their triggering trauma. This viscerally makes it difficult for an individual with PTSD to ignore their flashbacks, consequently causing them to relive their trauma sporadically.
Even in the absence of full-blown flashbacks, individuals with PTSD may suffer from generally intrusive thoughts related to a particularly traumatic event. Though the nature of these intrusive thoughts will vary, some individuals with PTSD report repetitive intrusive thoughts pertaining to alternative “what if” scenarios.
As an extension of the aforementioned flashbacks, individuals with PTSD are prone to experience sleep disruptions related to their experienced trauma. Most often, these take the form of nightmares that recreate the events or feelings of the trauma. Though these dreams may not be precisely identical in content (especially among children), the overall pattern of their presence may be used to indicate a broader PTSD diagnosis.
As expected, the presence of these nightmares can severely inhibit an individual’s ability to sleep soundly. In turn, these sleep disturbances can exacerbate other symptoms if treatment is not sought out.
Both physical and mental avoidance of places, people, and other details related to a traumatic event can also be seen as a symptom of PTSD. Avoidance can be both intentional and unintentional, though it almost always serves to forgo further contemplation of the traumatic event.
Avoidance is not necessarily an unhealthy behavior. Instead, avoidance can be seen as a self-preservation technique, in some cases (though it is still symptomatic of PTSD in these cases). For example, a combat veteran may actively avoid noisy, crowded public events in order to avoid triggering combat flashbacks. Similarly, victims of sexual assault may avoid a location where his or her assault occurred, as well as a known perpetrator (if they are known to the victim).
Dissociation and emotional numbness
Over time, dissociation and emotional numbness can also set in among individuals with PTSD. Like avoidance, this symptom functions to both protect and intensify an individual’s recollection of a traumatic experience (depending on the individual’s perspective). Both dissociation and emotional numbness can, over time, make it more difficult for an individual to fully cope with their trauma.
In some cases, disassociation goes hand in hand with PTSD-related flashbacks (especially those that are particularly visceral). This can cause an individual to lose temporary association with reality, causing them to take on hypervigilant, aggressive, and reckless (sometimes self-destructive) behaviors. Dissociation can also emphasize an individual’s startle response, making them irritable.
Dissociation and emotional numbness can often be seen in childhood cases of PTSD. In those cases, children may dissociate their actions and emotions from their trauma and instead recreate it through play. While this isn’t inherently harmful, this particular symptom manifestation can be used by adults to identify children in need of PTSD-specific mental health care.
Effects of PTSD
Even if they take time to fully manifest, the effects of PTSD can greatly impact the quality of life not only for those living with the condition, but also for friends, family, and associates. Listed below are a few of the noteworthy effects connected to PTSD. These effects are not connected to any one symptom and may be made more apparent or intense due to extenuating contextual circumstances. Those who begin to observe these effects in themselves or in a loved one should start a conversation and speak with a medical professional to learn if those effects can be traced back to PTSD.
Individuals with PTSD suffer a great deal of social isolation due to their condition, much like all people living with mental illness. Much of this isolation derives from century’s old stigmas that actively and passively ostracized individuals with mental illness from engaging with society at large in a predictable manner. In all cases, individuals who feel isolated as a result of their condition are more likely to fall into further mental illness, including depression.
Even under ideal conditions, the combined actions of individuals and organizations can enable feelings of isolation among individuals with PTSD. For example, a military veteran may lose companionship with friends after a deployment due to a changed psychiatric state. Similarly, survivors of sexual assault may feel increasingly isolated from a community that neither believes nor provides adequate redress for her trauma.
Isolation can also occur passively, requiring more focused attention from outside observers. In any case, isolation can be remedied through a concerted effort on social and institutional groups to create a well-connected network of resources that individuals living with mental illness can seek out.
Disrupted interpersonal relationships
PTSD, in particular, is noteworthy for its ability to disrupt interpersonal relationships. Due to the seemingly unpredictable nature of some PTSD symptoms, close friends and family members may begin to distance themselves out of an abundance of caution. While these misgivings are misplaced, their impact can still cause an individual living with PTSD to feel cut off from their interpersonal support network.
Depending on the particular context that led to an individual’s PTSD, some folks also find it challenging to trust other people in the wake of trauma. This can be especially true when overlapping circumstances connect back to an individual’s trauma, such as when an individual with PTSD seeks out a new romantic relationship after previously being severely emotionally harmed in a previous relationship. This mistrust can also make it difficult to confide in others, which can, in turn, make it difficult to communicate feelings relating to the trauma.
Increased risk for self-harm and suicide
One of the starkest and immediate effects of PTSD (even prior to diagnosis) is an increased risk for self-harming and suicidal behaviors. This can be of critical importance, especially to family members of people living with PTSD, given that it can lead to severe physical harm if left unaddressed through treatment. Also, these behaviors can be difficult to detect when they are not signaled by clear communications from the individual with PTSD.
Self-harm and suicide should be treated with purposeful caution in all cases. Individuals who begin to exhibit any behavior that could be categorized as self-harming should speak with a mental health expert as soon as possible. Similarly, those that feel suicidal (even infrequently) should immediately seek treatment or call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).
Groups commonly affected by PTSD
Just as anyone could experience trauma over the course of his or her lifetime, anyone can theoretically demonstrate PTSD-like symptoms in the wake of a traumatic experience. However, certain groups are at a higher risk for PTSD due to their circumstances. While these are not the only susceptible groups, individuals in these groups should be particularly mindful of their ongoing PTSD risk.
Survivors of sexual violence
Due to the graphic nature of their experiences, sexual assault survivors are at an increased risk for PTSD. This likelihood is highest in the immediate wake of the victim’s assault but can continue for many years after depending on how he or she copes with the trauma. Structural inadequacies – such as public disbelief of the victim’s experiences or victim-blaming – can also increase this likelihood even further and exacerbate other underlying forms of mental illness.
For centuries, soldiers have been at an increased likelihood of experiencing trauma—their own or shared with their comrades—while at war. Today, the manifestations of this trauma are often recognized as PTSD; and now proper evaluations are implemented to monitor a soldier’s mental health. Even so, military veterans, in particular, are more likely to develop PTSD as more time passes away from their traumatic experience. As such, former service members must receive an increased volume of attention in order to avoid developing PTSD.
Due to their inherently susceptible nature, children may be at a greater risk of demonstrating PTSD-like symptoms that are not as recognizable as those in adults. For example, children are more likely to demonstrate emotional numbness and repression of traumatic experiences. Similarly, they are uniquely prone to reenact aspects of their trauma through play.
Children are often less able to communicate their feelings and experiences to adults in their life, especially if they are particularly embarrassing or scary.This means that any potential signs of PTSD in children should be addressed with a medical care professional.
Common misconceptions and stigmas about PTSD
Despite increased awareness, there are still several major misconceptions about PTSD that persist in popular media.Addressing these misconceptions is one of the best ways to push back against the stigmatization of individuals with PTSD specifically and people living with mental illness in general.
Myth: Only weak people suffer from PTSD
The truth: Anyone who has experienced trauma can develop PTSD. This goes for everyone, regardless of physical capabilities or mental disposition.
Myth: Only military veterans develop PTSD
The truth: Although PTSD has gained more attention in recent years due to the study of soldiers and other military personnel returning from deployment, veterans are by no means the people who can develop PTSD. Anyone who has lived through a traumatic experience may be susceptible to PTSD.
Myth: People can “get over” trauma and eliminate PTSD symptoms
The truth: PTSD is a complex condition that an individual cannot “get over” through sheer strength of will. Instead, most people who are diagnosed with PTSD or live with PTSD-like symptoms learn to manage their symptoms through qualified treatments, such as cognitive-behavioral therapy.
This myth is particularly stigmatizing to military veterans who have been conditioned to overlook or outright ignore mental difficulties in order to maintain performative stability.
Options available for those in need
Like other forms of mental illness, PTSD, in particular, can be harmful to an individual’s quality of life if left untreated. Self-treatment and self-medication may not be holistically effective, especially compared to certified techniques provided by medical professionals. As such, those in need should consider seeking out one of the following options in order to more efficiently manage their PTSD symptoms and live a more fulfilling life:
Therapy, in its many forms, is considered among the most productive and readily available forms of PTSD treatment. Traditional forms of psychotherapy remain at the forefront of this field. Depending on the specific type of therapy chosen, the individual with PTSD may be exposed to a controlled iteration of their trauma or go through a cognitive reprocessing procedure over time.
Talk therapy has proven beneficial and the Department of Veterans Affairs (VA) reports it has a 25% higher success rate than using medication alone
Also, several emergent forms of solo therapy have become popular with specific demographics. Animal-assisted therapy, in particular, has gained attention for its promising results in managing PTSD and other mental illness symptoms among combat veterans. In all cases, therapy, in general, has been found to provide the most positive outcomes for the widest number of patients with PTSD.
Much like standard therapy, support groups have recently become a popular option for those who want to seek out structured treatment for their PTSD. As a standalone form of treatment, support groups provide an excellent method for individuals to seek out and remain in contact with others who are living with the same condition or have lived through similar experiences.
When used to supplement other forms of therapy, support groups represent one of the most promising opportunities to improve an individual’s cognitive condition while also allowing them to break through the isolation typically associated with mental illness. Support groups also tend to be particularly accessible when they are locally available.
Most medications designed to treat PTSD take the form of selective serotonin reuptake inhibitors (SSRIs for short). Commonly known as antidepressants, these medications have shown reliably modest efficiency when it comes to keeping PTSD symptoms in check. Presently, only Zoloft (sertraline) and Paxil and Seroxat (paroxetine) have received full FDA approval for treating PTSD.
These medications often come with side effects that individuals with PTSD should discuss with a primary care health professional before seeking out a prescribed regime. Also, these medications have not been shown to be any more effective alone than in conjunction with therapy. As such, their use is primarily recommended as part of a more comprehensive PTSD management plan.
How to support friends and family with PTSD
Supporting friends and family who are living with PTSD is an important step in the individual getting access to the support and treatment they need.
Those who wish to support a loved one living with PTSD should first inform themselves of the discourse surrounding the condition. This should include a particular focus on listening to the experiences of others presently living with the same condition. Along the same lines, all forms of support for a loved one living with PTSD should only be provided with that individual’s explicit consent.
Also, support for a friend or a family member should not be used as a substitute for proper treatment and attention from a mental health specialist. All forms of support in this domain should be aligned to best practices prescribed by these specialists or similar advocacy groups.