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Post-traumatic stress disorder (PTSD) is an anxiety disorder that occurs in response to a traumatic event that a person either witnessed or was directly involved in. The event will have been life threatening, leading to serious actual or potential injury.

Overview
Symptoms
Diagnosis
Causes/Why Me?
Epidemiology
Treatment Approaches
What Can I Do For Myself?
Comorbidities
Youth Specific Features
Summary
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Overview

Post-traumatic stress disorder (PTSD) is an anxiety disorder that occurs in response to a traumatic event that a person either witnessed or was directly involved in. The event will have been life threatening, leading to serious actual or potential injury. This event results in feelings of intense fear, helplessness or horror. People with PTSD will re-experience the trauma, avoid or ignore reminders of the trauma, and have persistent symptoms of increased arousal. Symptoms will persist for more than one month after the trauma. 

Symptoms

The symptoms of PTSD can be grouped into 3 sections:

1. Reliving the traumatic event:

  • Recurring and intrusive memories  of the traumatic incident
  • Recurring and distressing dreams
  • Behaving or feeling as though you are reliving the incident
  • Physiological reactions to memories
  • Intense psychological distress to cues that symbolize an aspect of the psychological event (e.g. certain people, places, etc). 

2. Avoidance or numbing:

  • Avoidance of thoughts, feelings and interactions with others related to the traumatic event
  • Avoidance of people, places and activities related to the traumatic event
  • Inability to recollect certain aspects of the traumatic event
  • Less interest or participation in activities
  • Feeling detached or estranged from others
  • Restricted range of emotion 
  • Sense of foreshortened future (e.g. will not live a normal life). 

3. Persistent symptoms of increased arousal (not present before the trauma):

  • Difficulty falling or staying asleep
  • Difficulty concentrating
  • Hypervigilance (excessive worry about safety)
  • Irritability and angry or aggressive outbursts
  • Being easily startled

Diagnosis

A person experiencing PTSD will:

  • Have experienced a traumatic event
  • Be experiencing at least one of the symptoms of reliving the traumatic event
  • Be experiencing at least three symptoms of avoidance or numbing
  • Be experiencing at least two of the symptoms of persistent increased arousal (not present before the trauma). 

PTSD is only diagnosed if the person’s life has been significantly negatively impacted by the symptoms  (e.g. socially, occupationally, etc) and if the symptoms have been prevalent for more than a month after the traumatic event.

Click here for the DSM-IV Diagnostic Criteria for PTSD. 

Why Me?

Before the trauma: Being young, having a history of maltreatment, pre-existing psychological conditions, low socioeconomic status, belonging to a minority racial group, lack of education, and a history of psychiatric disorders are all risk factors for developing PTSD.

  • During the occurrence of the traumatic event: the type of trauma and its severity as well as the person’s personal association with the event affect whether or not he/she will develop PTSD [Read More].
  • After the traumatic event: a person’s social support and ensuing life stress affect the onset of PTSD. little social support after the traumatic event, feelings of guilt and shame over the event, or experiencing other stressful life events following the traumatic event (e.g. death of a loved one) can increase the likelihood of developing PTSD [Read More].
  • People who have experienced multiple traumatic events may be more likely to develop or re-experience PTSD symptoms. For example, PTSD symptoms in reaction to a sexual trauma may only surface after a second traumatic event unrelated to the first, e.g. a vehicle accident [Read More]. 

Epidemiology 

What is epidemiology? Epidemiology is the study of the prevalence of disease in different populations and why [Read More].

The most common forms of trauma resulting in PTSD in Canada include sexual assault, unexpected death of a loved one, and witnessing someone getting badly injured or killed. Women are twice as likely as men to be diagnosed PTSD during their lifetime, with the highest risk if the traumatic event occurred between 16-20 years of age [Read More]. 

Even though women are more likely to be diagnosed with PTSD, males have a higher risk of experiencing traumatic events. Women are more likely to be subject to gender-based violence like sexual abuse and rape. Because women are more likely to develop PTSD, this suggests that sexual trauma may cause more psychological suffering than other forms of trauma (e.g. accidents, natural disasters, non-sexual assault or combat). The DSM diagnostic criteria for PTSD describe emotional and cognitive responses to the traumatic event, which can also make a PTSD diagnosis more likely for women. Even though men are at a higher risk for experiencing a traumatic event, their emotional response to the event does not seem to be the same as in women. Recent findings suggest that women are conditioned to develop a stronger response to fear-promoting stimuli [Read More]. 

Treatment Approaches

Treatment guidelines suggest that trauma-focused psychotherapy is more effective for treating PTSD than non-trauma-focused treatment. 

Cognitive Behavioural therapy (CBT)
Cognitive behavioural therapy involving education, relaxation, exposure and cognitive restructuring have been proven to produce positive results for people with PTSD. This type of therapy which specifically focuses on PTSD is called trauma-focused cognitive behavioural therapy, or TFCBT [Read More]. Exposure therapy involves exposing the person with PTSD to their traumatic event in a safe and controlled way, through mental imagery (imagining the event), writing about the event, or visiting the place where it happened in order to reduce the anxiety associated with the memory. Cognitive restructuring helps the person with PTSD think about the traumatic event and its outcomes in a realistic way, without feeling shameful or responsible for what happened [Read More].  Studies show that intensive TFCBT improves symptoms over a shorter period of time and reduces depression. 

Prolonged Exposure therapy (PE)
PE is made up of 9-12 90-minute sessions that include psychoeducation, imagined exposure to the trauma and in-vivo exposure homework. 

Stress Inoculation treatment (SIT)
SIT involves educating a person with PTSD about anxiety, and the effects that it can produce on the body and mind. This is then followed by exposure-based exercises to learn how to manage anxiety more effectively. SIT is based on the idea that one should learn to recognize what situations cause one stress in order to prevent and/or reduce PTSD symptoms. These new skills are then applied in role-playing situations and daily life [Read More].  

Group therapy
Group therapy involves sharing your personal story with others who suffer from PTSD. This can be beneficial in learning to talk about your trauma and dealing with your own memories and the emotions accompanying it (e.g. anger, fear, shame, guilt). 

Eye movement desensitization and reprocessing (EMDR)
EMDR has also been shown to be successful in reducing the effects of trauma. It involves focusing on the movement of the eyes as directed by a clinician (for example, following the clinician’s finger movements with ones eyes) while imagining the traumatic experience(s). It has been shown to lead to a decrease in distress and increased clarity of the event [Read More]. 

Pharmacotherapy
Chronic sufferers of PTSD will often be recommended to take antidepressants if psychotherapy (CBT, etc.) does not have an effect. These antidepressants work to reduce the symptoms of PTSD as well as the depression associated with the disorder. SSRI’s (Selective Serotonin Reuptake Inhibitors) have shown to be the most effective antidepressants currently prescribed [Read More]. 

What Can I Do For Myself

If you are experiencing symptoms of PTSD, seek professional help from a doctor, psychologist or therapist. Reach out to family and friends, and confide in people who you trust about what you are experiencing. Give yourself time to recover! Set realistic goals for yourself, and do not expect to get better overnight. 

Online support networks
PTSD Forum

Comorbidities

What is comorbidity?
PTSD is more likely to occur when a person has pre-existing anxiety disorders. Conversely, anxiety disorders may occur after the onset of PTSD. PTSD also has high comorbidity with other psychiatric disorders, particularly major depressive disorder and harmful substance abuse and dependence [Read More]. 

Youth-Specific Features

Of all young people who encounter trauma, 3-15% of girls and 1-6% of boys develop PTSD [Read More]. Youth will experience the same symptoms as adults: reliving the event, avoidance or numbing, and persistent symptoms of increased arousal. 

Youth-specific resources
KidsHealth
YoungMinds

Summary

Post-traumatic Stress Disorder is an anxiety disorder which is triggered by a traumatic incident. It can affect someone who experienced the trauma firsthand, or someone who was a witness to the incident. Symptoms include reliving the traumatic event, avoidance or numbing, and persistent symptoms of increased arousal. The symptoms will have been prevalent for more than one month after the traumatic event, and must not have been present before the trauma. 

Males have a higher risk of experiencing traumatic events, but women are more likely to be diagnosed with PTSD. Women are more likely to be subject to gender-based violence like sexual abuse and rape.

PTSD is more likely to occur when a person has pre-existing anxiety disorders. Conversely, anxiety disorders may occur after the onset of PTSD. PTSD also has high comorbidity with other psychiatric disorders, particularly major depressive disorder and harmful substance abuse and dependence. 

Treatment ranges from psychotherapy (CBT, SIT, PE, EMDR, group therapy etc) to pharmacotherapy (antidepressants, etc). Trauma-focused treatment has proven to be more effective than non trauma-focused treatment. 

If you are experiencing symptoms of PTSD, seek professional help from a doctor, psychologist or therapist. Reach out to family and friends, and confide in people who you trust about what you are experiencing. Give yourself time to recover! Set realistic goals for yourself, and do not expect to get better overnight. 

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