What is PTSD?
When we experience a stressful or traumatic event – such as war, sexual assault, accidents, or natural disaster – our bodies and brains go through changes to prepare and deal with that event. This is commonly called the “fight, flight, or freeze” response.
Your brain chemicals are altered and your reptilian brain – the part of the brain in charge of survival instincts and autonomic body processes – takes over. It’s a normal response that is designed to protect us. Once the traumatic event is over, our bodies should return to a normal state after a few weeks or months.
For some, their bodies and minds don’t return to normal. This is PTSD, or post-traumatic stress disorder. It is a psychological and emotional stress disorder. Anyone can develop PTSD, in fact 8% of Americans will have it in their lifetime.
PTSD Risk Factors
PTSD is not a sign of mental weakness.
The risk factors for PTSD are complex. This makes it difficult to predict who will develop PTSD. Risk factors can include specific personality traits or ways your brain responds to stress. Previously experiencing traumatic events, age, and gender can also make someone more likely to develop PTSD.
The nature of the traumatic event is a factor – very intense or long-lasting trauma, or physical injuries from the event can increase the likelihood. Half of all rape victims will develop PTSD.
The quality of your support system and what level of stress you maintain after the traumatic event also plays a role in developing PTSD. Better social support and less stress will help you process the traumatic experience and decreases the risk of PTSD.
History of PTSD
PTSD wasn’t added to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders until 1980. Prior to acceptance of PTSD as a disorder, symptoms were attributed to cowardice or weakness. From the Civil War to the Vietnam war, PTSD has been known as “soldier’s heart”, “exhaustion”, “shell shock”, “battle fatigue”, “combat fatigue”, “gross stress reaction”, or “stress response syndrome”.
The Vietnam war was a huge factor in pushing doctors to recognize PTSD as a legitimate disorder. The large number of soldiers suffering brought the public’s attention to PTSD and doctors began to diagnose it as post-Vietnam syndrome.
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Symptoms of PTSD
PTSD symptoms can crop up months or years after the traumatic event. Symptoms most commonly appear three months after the traumatic event. Symptoms can come and go. PTSD is diagnosed when the symptoms interfere with your daily life and you are still having these symptoms several months after the traumatic event.
Symptoms of PTSD are classified into four main groups:
- Recreating or reliving the event. This can happen as nightmares while sleeping or as flashbacks during the day. The person typically feels very strongly that they are back in that stressful situation and some feel like they never left.
- Avoiding situations that trigger memories of the event. People, places, or specific activities related to the traumatic event could all act as triggers.
- Hyper attentive to or on guard against potential danger. This makes a person suffering from PTSD high-strung, irritable, and angry. Minor things, like a loud shout, could startle them and make them respond violently.
- Changes in your thoughts or beliefs. This includes strong feelings of guilt that don’t make sense, memory loss, poor self-esteem, or loss of interest in hobbies.
Each of these four major symptom groups will cause emotional, relational and physical symptoms in response to the stress of the symptom cluster. These symptoms include:
- low self-worth
- depression or guilt
- dissociation or not being
- low concentration
- chronic pain
- heart problems
- increased sweating
- high or low blood pressure
- digestive issues
- problems sleeping
- trouble breathing
- racing heart, panic, or chills
PTSD and Addiction
Addiction and substance abuse can often develop as a symptom of PTSD. According to the PTSD Alliance: “50% of those who suffer from PTSD also abuse alcohol.” The PTSD Alliance also estimates that: “People with PTSD are 3x more likely to abuse drugs than people without PTSD.”
Often, the person is attempting to self-medicate to deal with the stress and trauma. They could use it to numb painful emotions or as an attempt to forget the past. Sleep disorders like insomnia are common for people with PTSD, so the drug or alcohol abuse could be an attempt to fall asleep.
When traumatic experiences happen, our brains produce endorphins to reduce pain and cope with stress. When the traumatic experience ends, our brains go through endorphin withdrawal, with symptoms like anxiety, depression, and pain. Alcohol or drugs replace the feel-good effects of endorphins temporarily.
PTSD and addiction are very closely linked for veterans. According to the Center on Addiction: “Almost one in three veterans seeking treatment for addiction also has PTSD, and over 20 percent of veterans with PTSD also have addiction. Approximately one in 10 soldiers returning from the Iraq and Afghanistan wars who were seen in a Veterans Affairs hospital have had a problem with alcohol or other drugs.”
For some soldiers dealing with injuries, drug abuse can come about from the use of opioids or pain-relieving drugs to treat combat injuries. U.S. Department of Veterans Affairs estimates the number of veterans with opioid addictions at 68,000 nationwide. Addiction from combat injury pain relief doesn’t necessarily stem from PTSD, however it is good to be aware of it.
Treatment for PTSD
Usually, treatment for PTSD and addiction needs to happen at the same time and should happen at a facility that is prepared to deal with both. The addiction treatment will look very similar to other treatment programs for drug addiction.
The two main treatment paths for PTSD recommended by the U.S. Department of Veterans Affairs are psychotherapy and medication. Studies don’t appear to show that combination therapy – use of psychotherapy and medication together – is more effective than psychotherapy alone.
The National Institute for Health and Care Excellence and World Health Organization recommends medication as a secondary treatment that should be used with trauma-focused psychotherapy.
The most helpful and effective form of psychotherapy for PTSD treatment is trauma-focused, where the memory or meaning of the traumatic event is focused on during counseling. Trauma-focused psychotherapy methods include:
- Cognitive Processing Therapy (CPT): discussing and understanding the trauma and how it changed how you think and feel. This is the standard treatment for PTSD. Through discussion with the therapist, you can identify upsetting thoughts and replace those thoughts with less stressful ones.
- Prolonged Exposure (PE): constant exposure to the memories, that trigger the PTSD until those memories no longer upset you. This may include visiting the people, places, and activities that trigger those memories – as long as those people, places, and activities aren’t dangerous.
- Eye Movement Desensitization and Reprocessing (EMDR): remembering and talking about the traumatic event while your eyes follow hand movements or sounds like hand-tapping or tones. Eye movement helps your brain process the memories so that you no longer respond to or are triggered by them.
Medication used for depression such as sertraline, paroxetine, fluoxetine, and venlafaxine – are beneficial when treating PTSD. However, this benefit is very small, and medication alone is not enough for treatment of PTSD.
Benzodiazepines are not recommended to treat PTSD, as there is very little evidence of it being beneficial and it’s thought to worsen symptoms. Prazosin can be used to reduce nightmares. Cannabis is not recommended as treatment.
Any sort of exercise will have a positive impact on mental health and can be used to help distract from painful or stressful memories or emotions, improve self-esteem, and help the sufferer feel in control. Your doctor or treatment center should help you come up with a program that is best for you.