Posttraumatic Stress Disorder (PTSD) is a psychological disorder that develops after experiencing unexpected, frightening, or traumatic events. These events can include exposure to severe injury, psychological abuse, actual or threatened death, and sexual violation. Most people experience fear and anxiety during and immediately after a traumatic event. Many trauma survivors recover naturally from these reactions over time; however, some develop PTSD symptoms. A survivor is more likely to develop PTSD when they experience multiple traumas in succession or if they remain in a traumatic situation for an extended period.

The symptoms and characteristics of PTSD include the following:

• Disturbingly re-experiencing the traumatic memory.
• Experiencing intense negative moods or having negative thoughts associated with them. For example, believing it is your fault, feeling depressed, having obsessive thoughts about the experience, or feeling anxious.
• Avoiding thoughts, feelings, and situations that remind you of the event.
• Feeling high levels of arousal after the event and feeling hypervigilant

PTSD has these core characteristics:

• It usually occurs after you go through a life-threatening event or a long-lasting trauma.
• Sexual assault, domestic violence, or child abuse all trigger trauma.
• Seeing something horrific happen to other people can also trigger PTSD.
• Doctors, police officers, and emergency workers who regularly deal with stressful situations may develop PTSD.
• Signs of post-traumatic stress can begin to appear one month or more after the event that triggered PTSD. A delayed reaction is relatively common.

Symptoms may also be significantly delayed and not surface for years after the event.

PTSD survivors often develop an acute stress response or phobias after the trauma. These psychologically adaptive reactions to trauma result from the fight-or-flight reaction designed to protect us from danger. I discuss the relationship between PTSD and these healthy and adaptive responses to danger in more detail later in this section.

Hypervigilance is a heightened state of sensory awareness accompanied by behaviors designed to detect a potential impending threat. Hypervigilance may trigger a state of high anxiety, which can eventually lead to exhaustion. Symptoms of hypervigilance include abnormally high levels of arousal, heightened sensory awareness, and continuous scanning of the environment.

Hypervigilance with PTSD can lead to behaviors that don’t appear logical from an outsider’s point of view. It is common for people who have PTSD to perform repetitive actions continuously, for example, checking doors are locked, and looking for danger. The repeated actions are an attempt by the person to reduce their fears. These actions can eventually reach such a high level that the person would be diagnosed with OCD by a mental health professional.

Flashbacks and Triggers

Triggers can include sights, sounds, smells, or thoughts that remind you of the traumatic event. Specific triggers can bring back vivid memories, making you feel like you’re living through the traumatic event all over again. Some PTSD triggers are easy to identify, such as seeing a news report of an assault. Some triggers are not as clear-cut. Survivors may not be aware of their triggers because they haven’t made the mental connection or become numb and detached to cope with the pain.

Knowing your triggers and anticipating and identifying them will help you cope more effectively. Working with a therapist can learn and adapt new techniques to make it easier for you to live through, heal from, and change how you respond to those triggers.

These emotional reactions are potent ways your body and mind help you cope with the effects of trauma. They are psychologically adaptive reactions designed to protect you from the aftermath of traumatic experiences. PTSD survivors commonly experience external reminders of the traumatic experience that lead to an acute stress response. These external reminders are called triggers. Memories of the traumatic events are called flashbacks and lead to the same acute stress response experienced during the actual traumatic event. I explore in more detail the dynamics of triggers and flashbacks (MacMillan, 2017).

Someone who experiences a traumatic event will usually have a strong emotional reaction, but not everyone goes on to develop PTSD. Let’s dig deeper into the symptoms and emotional responses of PTSD. PTSD survivors find themselves reliving the event that triggered PTSD through flashbacks and nightmares. These episodes can seem so real that it’s like the event is happening repeatedly, with flashbacks of sounds, smells, physical sensations, and emotions. Flashbacks are a terrifyingly vivid experience. Everyday objects and events can trigger waking flashbacks. A trigger might be a sound or smell associated with the event, a location, a word, or a physical sensation.

The following are common PTSD triggers:

• People: Seeing a person related to the trauma may set off a reaction, or someone may have a physical trait that’s a reminder. If someone with a beard mugged you, other bearded men might bring back traumatic memories.
• Thoughts and emotions: How you felt during a traumatic event, such as being afraid or helplessness, can trigger symptoms.
• Things: Seeing an object that reminds you of the trauma can cue your symptoms.
• Smells: Memories are closely linked to smells. Someone who survived a fire could become upset by the smoky smell of a barbecue.
• Sounds: Memories of the trauma are recalled after hearing specific noises, songs, or voices. For example, hearing a car backfire may remind a veteran of gunfire.
• Tastes: The taste of something, such as alcohol may remind you of a traumatic event.
• Places: Returning to the scene of a trauma is often a trigger. A similar situation, such as a dark hallway, maybe similar enough to activate a reaction.
• Feelings: Some sensations, such as pain, are triggers. For survivors of assault, being touched on a particular body part may lead to a flashback.
• Television shows, news reports, and movies: Seeing a similar trauma often sets off symptoms.
• Words: Reading or hearing certain words could cue your PTSD.
• Situations: You may link similar scenarios to the trauma. Being stuck in an elevator might remind you of feeling trapped after a car accident.
• Anniversaries: It’s often hard to go past a date marked by trauma without remembering it. Many survivors of the Twin Tower attacks in New York City relive the events of September 11 on the anniversary.

Why does someone who has experienced a traumatic episode relive it repeatedly? The brain forces the person to keep thinking about the incident so they are prepared if another crisis happens. Sometimes the person might relive events and think about what they could or should have done to make things turn out differently, not that they could necessarily have changed the event as it happened. Survivor guilt is common for survivors of significant traumatic events, such as a plane crash or a terror event: “Why did I survive when those other people died?”

Constantly reliving the traumatic event is exceptionally upsetting for someone with PTSD. They will generally try to avoid it by using distractions, such as not seeing close friends and relatives, or becoming emotionally numb. Avoidance and numbing are coping strategies that can take many forms, such as overworking or becoming immersed in a hobby or drug or alcohol abuse—all things that help the person manage the aftereffects of the trauma.

The third frequent indicator of PTSD is called hypervigilance, a state in which the person remains continually alert and unable to relax, as though always on the lookout for signs of danger. Often the hypervigilant form is accompanied by anxiety and insomnia. The function of the hypervigilant state is to ready the person for another impending traumatic incident. It acts as a type of reassurance that, this time, the person will be able to react in a way that helps keep them safe. Hypervigilance tends to be accompanied by chronic adrenaline production, which is the body’s way of ensuring there will be energy to spare if a crisis occurs.

Physical Symptoms

As PTSD symptoms develop, there are many possible physical, emotional, and behavioral signs. In contrast to the three typical symptoms outlined above, the additional signs vary from person to person:

• Digestive upset such as chronic diarrhea or stomach pains
• Muscle aches or pain
• Headaches
• Irregular heartbeat or palpitations
• Depression
• Anger, irritability, or aggressive behavior

The fight-or-flight response, also known as an acute stress response, is an automatic physiological reaction that occurs when faced with a mentally or physically terrifying situation. The response is triggered when the brain releases specific hormones that prepare your body to either stay to deal with a threat or run away to safety. The term represents the choice that our ancient ancestors had to make when faced with danger. Either way, they chose, the physiological and psychological response to stress prepared them to react to the threat. This reaction is still wired into us and is completely healthy and adaptive.

The body’s sympathetic nervous system activates in response to acute stress, followed by a sudden release of hormones. Cortisol is one of the hormones released in response to fear or stress by the adrenal gland. The sympathetic nervous systems stimulate the adrenal glands, and which triggers the release of adrenaline and noradrenaline hormones. Once released, these hormones rapidly increase heart rate, blood pressure, and breathing rate. After the threat is gone, it takes between 20 to 60 minutes for the body to return to its resting state.

The fight-or-flight response can happen in the face of imminent physical danger, such as closely witnessing a shooting or narrowly escaping a dangerous situation. It can also be triggered by a psychological threat, such as preparing to give a big presentation at work. By your body priming itself for action, you’re better prepared to perform under pressure. The stress created by the situation can be helpful, making it more likely that you’ll cope effectively with the threat. This type of stress can help you perform better when you’re under pressure to do well, such as on an exam or during a presentation. In cases where the threat is life-threatening, the fight-or-flight response can play a crucial role in your survival. Phobias are an example of a fight-or-flight response to a perceived threat. A person who’s terrified of heights may experience an acute response when they go to the top floor to attend a meeting. PTSD survivors experiencing flashbacks or vivid memory will experience a critical stress response and enter the fight-or-flight state. Panic attacks can occur when the flight-or-fight response becomes severe.

The physical signs of the fight-or-flight response are:

• Rapid heartbeat and breathing: Increased heartbeat and respiration rate provide critical energy and oxygen to the body to fuel a rapid response to the actual or perceived danger.
• Pale or flushed skin: As the stress response kicks in, blood flow to the skin’s surface is reduced, and more blood flows to the muscles, brain, legs, and arms. Your face may alternate between pale and flushed as blood rushes to your head and brain. The body’s blood clotting ability also increases to prepare for potential excessive blood loss in the event of an injury.
• Dilated pupils: Another typical response to fight or flight is the dilation of the pupils, which ensures more light reaches your eyes and enhances your visual awareness of the surroundings.
• Trembling: In the face of stress or danger, your muscles become tense and ready for action. This tension can result in trembling or shaking.

Diagnostic Criteria

Posttraumatic Stress Disorder (PTSD) is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events. Here are the diagnostic criteria for PTSD in simplified terms:

Exposure to Traumatic Event(s):

• Directly experiencing the traumatic event.
• Witnessing, in person, the event occurring to others.
• Learning that the traumatic event occurred to a close family member or close friend.
• Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., first responders collecting human remains).

Intrusion Symptoms:

• Recurrent, involuntary, and intrusive distressing memories of the traumatic event.
• Recurrent distressing dreams related to the event.
• Dissociative reactions (e.g., flashbacks) where the individual feels or acts as if the traumatic event were recurring.
• Intense psychological distress or physiological reactions when reminded of the traumatic event.

Avoidance:

• Efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event.
• Efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event.

Negative Alterations in Cognitions and Mood:

• Inability to remember key aspects of the traumatic event.
• Persistent negative beliefs or expectations about oneself, others, or the world.
• Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
• Feeling detached or estranged from others.
• Persistent inability to experience positive emotions (e.g., happiness, satisfaction, or love).

Alterations in Arousal and Reactivity:

• Irritable behavior and angry outbursts.
• Reckless or self-destructive behavior.
• Exaggerated startle response.
• Concentration problems.
• Sleep disturbance.

Duration:

• Symptoms must last more than a month.

Functional Significance:

• Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

Exclusion:

• The disturbances are not due to medication, substance use, or other illness.

A comprehensive assessment considers the presence or absence of symptoms and their severity, duration, and impact on functioning. Based on these assessments, psychologists can recommend treatment approaches and interventions.

The Impacts

Posttraumatic Stress Disorder (PTSD) profoundly impacts an individual's psychological, physical, and social well-being. The sequelae of PTSD stretch beyond the characteristic symptoms of re-experiencing the trauma, avoidance, and heightened arousal.

• Psychological Impacts: Beyond the primary symptoms of PTSD, individuals with this disorder often experience comorbid psychological conditions. Depression, anxiety disorders, and substance abuse are common (Kessler et al., 1995). The persistent re-experiencing of traumatic events, combined with the chronic state of heightened arousal, can lead to cognitive impairments, including difficulties in concentration and memory (Johnsen & Asbjørnsen, 2008).
• Physical Health Impacts: PTSD has been associated with various physical health problems. These include cardiovascular disease, respiratory problems, musculoskeletal issues, and gastrointestinal disorders (Boscarino, 2004). The chronic stress and hyperarousal associated with PTSD can have long-term detrimental effects on the body, potentially contributing to a decreased life expectancy.
• Social and Occupational Impacts: The avoidance symptoms of PTSD can lead individuals to withdraw from social situations, impairing relationships with family and friends (Charuvastra & Cloitre, 2008). Occupational functioning may also be compromised. Absenteeism reduces productivity, and difficulties in interpersonal relationships at work can occur (Magruder et al., 2004). Over time, the individual might become isolated, leading to a further decline in mental health.
• Impacts on Intimate and Family Relationships: PTSD symptoms can strain intimate and familial relationships. Partners with PTSD report feelings of disconnection, communication difficulties, and decreased marital satisfaction (Renshaw et al., 2011). Children of parents with PTSD are at higher risk of developing psychological disorders, potentially due to increased familial stress and genetic factors (Lambert et al., 2014).
• Economic Impact: There are also broader societal implications. PTSD can lead to increased medical and psychological treatment costs, decreased productivity, and increased disability claims, representing a significant economic burden (Greenberg et al., 1999).

PTSD affects multiple facets of an individual's life and ripple effects impact families, communities, and societies. Early diagnosis and intervention are crucial to mitigate these extensive impacts.

The Etiology (Origins and Causes)

Understanding the etiology, origins, and causes of Posttraumatic Stress Disorder (PTSD) is crucial for prevention and treatment. PTSD is unique in that its onset is tied to a traumatic event; however, not everyone who experiences trauma develops PTSD. Several factors influence an individual's susceptibility:

Type and Severity of the Traumatic Event

Not all traumas have an equal likelihood of leading to PTSD. Events that are of human design, such as combat, torture, sexual assaults, or serious accidents, are more likely to be associated with the development of PTSD compared to natural disasters (Breslau et al., 1991).

The type and severity of the traumatic event play a pivotal role in determining whether an individual develops PTSD. Specific events, particularly those caused by human actions or intent, have been shown to have a higher likelihood of leading to PTSD than other types of trauma. Let us dive deeper into this, referencing additional psychology research literature:

• Human-made vs. Natural Traumas: Traumas that result from intentional human actions, such as assault, war, or terrorism, tend to lead to higher rates of PTSD than natural disasters. This distinction is supported by studies indicating that survivors of interpersonal violence, such as rape or assault, show particularly high rates of PTSD (Kilpatrick et al., 1989). One theory is that traumas intentionally caused by another human being might violate an individual's deeply held beliefs about the world and human nature, leading to more profound psychological disturbances (Janoff-Bulman, 1992).
• Combat Exposure: Soldiers or individuals exposed to war zones face a unique set of traumatic events, including witnessing the deaths of others, being targeted in combat, or having to take another person's life. Studies have found that combat exposure's type, intensity, and duration correlate with the likelihood of developing PTSD (Dohrenwend et al., 2006).
• Sexual Trauma: Among traumatic events, sexual assaults such as rape are among the most likely to result in PTSD. Rates of PTSD in rape survivors are higher than in survivors of most other types of trauma. Factors like self-blame, societal stigmatization, and feelings of powerlessness can contribute to the severity of PTSD following sexual trauma (Resnick et al., 1993).
• Severity and Duration of the Trauma: The more severe and prolonged the traumatic event, the higher the risk of developing PTSD. This is evident in cases of torture, where the victim is exposed to extreme physical and psychological trauma over extended periods, leading to a higher prevalence of PTSD (Basoglu et al., 1994).
• Multiple Traumatizations: Experiencing multiple traumas, or "polyvictimization," especially in vulnerable developmental stages such as childhood, can amplify the risk of developing PTSD. Multiple traumatic exposures can compound the psychological toll on an individual (Finkelhor et al., 2007).

In summary, while many types of traumatic events can lead to PTSD, those resulting from human actions, particularly intentional harm or betrayal, appear to have a powerful association with the disorder. Clinicians must consider the type and context of trauma when assessing PTSD risk.

Recurring or Prolonged Trauma

Chronic exposure to traumatic events, like ongoing domestic abuse or war, can elevate the risk of developing PTSD compared to a single incident (Cloitre et al., 2009). Recurring or prolonged trauma, often called "chronic" or "complex" trauma, can profoundly impact an individual's psychological well-being. These traumas are particularly insidious as they often involve sustained and repeated exposure, increasing the risk and severity of PTSD and other related disorders. 

• Complex PTSD (C-PTSD):Repeated and prolonged exposure to traumatic events, particularly during childhood, can lead to a more severe form of PTSD known as Complex PTSD. This condition often involves additional symptoms beyond traditional PTSD, such as difficulties in emotional regulation, problems with interpersonal relationships, and negative self-concept (Herman, 1992; van der Kolk, 2005).
• Childhood Maltreatment:Continuous abuse during childhood, whether physical, emotional, or sexual, can significantly elevate the risk of developing PTSD in adulthood. These early-life traumas can alter the developing brain and lay the groundwork for heightened vulnerability to future traumas and PTSD (Teicher et al., 2003).
• Domestic Abuse:Continuous domestic abuse, be it physical, emotional, or sexual, contributes significantly to the development of PTSD. The intimate and trust-violating nature of domestic violence, combined with its often recurring nature, can lead to profound psychological distress (Golding, 1999).
• Prisoners of War (POWs) and Torture Victims:Prolonged exposure to imprisonment, especially when combined with torture or severe maltreatment, leads to high rates of PTSD among survivors. The persistent nature of the threat and the sense of powerlessness can result in profound psychological disturbances (Engdahl et al., 1997).
• Refugees and Displaced Persons:Individuals who have been displaced due to war or persecution are at elevated risk for developing PTSD, not just because of the traumas they have witnessed or experienced but also due to the chronic nature of their insecure and unstable environments (Steel et al., 2009).
• Cumulative Trauma:Experiencing multiple traumatic events across different points in life, even if they are not chronic or prolonged, can have a cumulative effect, enhancing the likelihood of PTSD development. The additive impact of various traumas can compound the psychological toll on an individual (Turner & Lloyd, 1995).

While single-incident traumas can undoubtedly result in PTSD, there is significant evidence in the psychological literature indicating that chronic and prolonged traumas, due to their sustained and often escalating nature, have a particularly detrimental impact on mental health, often manifesting as PTSD or its more severe variant, C-PTSD.

Individual Factors

Biological Factors play a pivotal role in the vulnerability and manifestation of PTSD, with significant evidence pointing towards alterations in specific brain structures and functions. Notably, the amygdala, instrumental for emotional processing, demonstrates hyperactivity in individuals diagnosed with PTSD. This hyperactivity may be responsible for intensified fear reactions (Shin et al., 2006). Similarly, the hippocampus, essential for memory consolidation, displays reductions in both size and functionality in PTSD patients. This reduction can lead to challenges in distinguishing between past traumatic events and current experiences (Gilbertson et al., 2002). Furthermore, the prefrontal cortex, which oversees executive functions and emotional regulation, is less active in those with PTSD. This diminished activity can be linked to compromised emotional regulation and increased emotional reactivity (Russo et al., 2017; Pitman et al., 2012).

Individual Genetic Factors and PTSD: Research has delved deeply into the hereditary nature of PTSD. Family studies illuminate a potential genetic component underlying PTSD. Specifically, relatives of individuals with PTSD seem to face a higher risk of manifesting the disorder themselves (True et al., 1993). Interestingly, genetic elements are believed to account for a significant proportion of variability in PTSD susceptibility. Estimates suggest that the heritability of PTSD lies in the range of 30-40% (Sartor et al., 2012). Furthermore, certain gene variations, especially those pivotal to stress responses, might accentuate the risk of developing PTSD (Binder et al., 2008).

The Role of Personality and PTSD: One's inherent personality traits and any pre-existing mental conditions can profoundly influence the risk of PTSD. For instance, characteristics like neuroticism or prior conditions such as anxiety disorders can pre-condition an individual to develop PTSD post-trauma (Breslau et al., 1995; McFarlane, 2010). A history of psychiatric disorders can further intensify this risk (Breslau et al., 1999).

Childhood Experiences and Vulnerability to PTSD: Early life can leave lasting marks on an individual's mental framework. Adverse childhood experiences, particularly neglect or abuse, substantially elevate the susceptibility to PTSD in adulthood (Felitti et al., 1998). Such traumatic early-life experiences, encompassing various maltreatment, can predispose an individual to PTSD by modulating brain development and stress response mechanisms (Dunn et al., 2017). Essentially, these traumas in formative years can prime the brain, rendering it more reactive to future traumatic events (Heim et al., 2000).

The Power of Social Support: The role of support, both its presence and absence, is crucial post-trauma. A lack of social backing following a traumatic event is a significant risk factor for PTSD (Ozer et al., 2003). In stark contrast, familial solid and social support can serve as a shield, fending off PTSD's onset. This support acts as a potent buffer, mitigating the trauma's harmful impacts, with its absence potentially speeding up the onset of PTSD (Brewin et al., 2000). Nurturing social connections can counterbalance feelings of distrust and estrangement, which are rife following traumatic events (Charuvastra & Cloitre, 2008).

Subsequent Stresses and PTSD: Life post-trauma can be a minefield, with subsequent stressors exacerbating PTSD symptoms and complicating recovery. Events like the death of a loved one, job loss, or another traumatic experience can amplify PTSD symptoms, possibly due to overwhelming coping resources or the reactivation of traumatic memories (Flory & Yehuda, 2015; Norrholm & Jovanovic, 2010).

Coping Mechanisms' Dual-Edged Nature: Coping mechanisms, particularly when maladaptive, can both respond to and magnify PTSD symptoms. Resorting to maladaptive coping, such as substance misuse or avoidance, can aggravate PTSD symptoms and impede recovery (Kumpula et al., 2011). Individuals may adopt these strategies aiming to self-medicate or sidestep trauma-induced distress. However, these methods frequently culminate in deteriorating mental health outcomes in the longer term (Ehlers & Clark, 2000; Back et al., 2006).

While trauma exposure is the primary precipitating factor for PTSD, an interplay of biological, environmental, psychological, and social factors determines who eventually develops the disorder after such exposure.

Additional Trauma Risk Factors

Experiencing a traumatic event is the primary PTSD risk factor, but other factors influence the onset of PTSD:

• Being a child or adolescent
• Being female
• Experiencing violence at home
• Having a learning disability
• Having a mental disorder before the traumatic event
• Lacking social support
• Experiencing trauma over a more extended period

Women are four times more likely than men to develop PTSD symptoms, according to the Mayo Clinic (2010). Although the reason for this isn’t entirely apparent, many experts believe it’s because women are more likely to experience interpersonal violence, such as rape, putting them at more risk.

PTSD and violence often go hand in hand. PTSD in military personnel occurs so frequently that names for the condition have existed since the U.S. Civil War, when it was called “soldier’s heart.” During World War I, it was called “combat fatigue,” and by the Vietnam era, people were calling it “shell shock.” Rates are particularly high in Vietnam veterans, with the National Institute of Mental Health (2010) estimating that about 19 percent of Vietnam vets developed symptoms after the war. PTSD was formally established as a distinct anxiety disorder in 1980 (Dryden-Edwards, 2010).

Of children who have been exposed to trauma, 3 to 15 percent of girls, and 1 to 6 percent of boys, will develop PTSD, according to the National Center for PTSD (2007).

PTSD is especially common in children and adolescents when they are exposed to violence or abuse. Up to 100 percent of children who witness the death or sexual assault of a parent eventually develop PTSD, according to the National Center for PTSD (2007), as do 90 percent of sexually abused children, and 77 percent who witness a school shooting (Mayo Clinic, 2010; National Institute of Mental Health, 2010).

Comorbidities

Three closely related mental health issues often accompany PTSD:

• Depression
• Anxiety
• Obsessive-compulsive thoughts

If you’re experiencing any of these symptoms and are in distress, you should seek professional assistance as soon as possible. The quality of your life and happiness is essential. Later in the book, I share recommendations about how to research and connect with professional resources in your community. At any time, I recommend reviewing those sections so you can begin finding the support you need to transform your life and recover. Meanwhile, let’s take a closer look at the common mental health issues that frequently occur alongside PTSD.

Depression is something everyone experiences from time to time. Life can have ups and downs, and sleep and situational factors can impact our outlook on life. But if you feel down or numb, or your mood is getting in the way of your daily activities, you might be experiencing signs of depression. Depression is also a warning sign that you could have PTSD.

Depression and PTSD share some symptoms:

• You may have trouble sleeping.
• You may get angry over small things.
• You can lose interest in people or things.

Depression has some or all of these symptoms:

• You feel sad or hopeless.
• You get no pleasure from things you usually enjoy, like hobbies or sports.
• You sleep too much or not enough.
• You feel so tired that even small tasks feel like they take too much effort.
• You have no appetite or overeat.
• You feel anxious or restless.
• You have a hard time focusing your mind and making decisions.
• You feel worthless and keep blaming yourself for things.

Anxiety commonly accompanies symptoms of PTSD. One of the most common forms of anxiety that people with PTSD experience is a social anxiety disorder. Research suggests that the link between PTSD and social anxiety is complex, stemming from multiple factors that include a person’s genes, history of trauma, and psychological vulnerabilities, like fear of being negatively evaluated by others.

Social anxiety stems from the fear of doing things in social situations that will result in embarrassment or humiliation. This type of concern is experienced as severe anxiety and sometimes results in panic attacks. Social anxiety creates the perception that the reaction to the social situation is unreasonable or more significant than it should be. People with social anxiety do everything they can to avoid the situations that trigger anxiety. As you can imagine, social anxiety symptoms interfere with many aspects of a person’s life (Renna, O’Toole, Spaeth, Lekander, & Mennin, 2018).

PTSD and social anxiety often occur together. There are several theories about why these issues are so closely related. The symptoms of PTSD may make a person feel different, as though they can’t relate or connect with others. They may have difficulties interacting with others because being reminded of the trauma is a real possibility. The tendency to avoid social situations creates a cycle that frequently results in the development of social anxiety disorder.

Many people with PTSD feel significant shame, guilt, and self-blame. These feelings may lead to social anxiety disorder. Evidence shows that social anxiety among people with PTSD stems from depression, which can lead to social withdrawal, isolation, and a lack of motivation.

It is common for people with PTSD to experience obsessive-compulsive disorder (OCD) simultaneously, and research shows the two are closely related (Renna et al., 2018). Obsessive-compulsive behaviors can be a way of coping with post-traumatic stress. The number of traumatic events an individual has experienced in their lifetime will impact the severity of a person’s obsessive-compulsive symptoms.

The symptoms of PTSD and OCD are remarkably similar:

• Recurring inappropriate, persistent, and intrusive thoughts, impulses, and images result in considerable distress and anxiety.
• Repetitive behaviors can include excessive handwashing, checking, hoarding, and regularly arranging things in exact ways.
• Mental rituals such as frequently praying, counting things, or continually repeating phrases in your mind are common.

Individuals feel as if they have to do these things because if they don’t, they will experience anxiety, and some dreaded event or situation will occur.

A significant number of people with OCD have experienced trauma in their past, and some PTSD symptoms such as hypervigilance can be very similar to OCD symptoms.

A survivor of a serious fire may understandably become obsessed with the thought of leaving their oven on and causing another fire. Similarly, someone who has experienced a burglary may repeatedly check that their doors and windows are locked. These are adaptive and understandable reactions to traumatic experiences. Once these coping actions cross the line from a natural response to obsessive-compulsive behavior, the person is significantly more likely to be experiencing PTSD.

PTSD and OCD appear to be connected because people who have experienced a traumatic event may reasonably feel anxious and have concerns about their safety. It is theorized that the compulsive behaviors may make a person feel safer and more in control, which helps them reduce anxiety in the short term. But trauma severe enough to cause the symptoms of OCD might also cause PTSD in the same individual in the long run.

Case Study

Introduction: James, a 31-year-old marketing executive, presented with symptoms of distress and acute sadness following the sudden death of his younger sister, Sarah, in a car accident three months prior. Although grief is a natural response to such events, James exhibited signs of complicated grief, manifesting in difficulty functioning in daily life.

Background: James grew up in a tight-knit family in a suburban community. He shared a close bond with Sarah, who was only two years his junior. Both siblings were inseparable, frequently sharing hobbies, friends, and family events. James had always seen himself as the protective older brother, often guiding and supporting Sarah in her life decisions.

Presenting Problem: In the weeks following Sarah's death, James experienced intense bouts of sadness, anger, guilt, and disbelief. He withdrew from social activities, took extended leave from work, and reported difficulty sleeping. He expressed feelings of guilt over not being with Sarah at the time of the accident and often ruminated on "what if" scenarios.

Clinical Observations: Upon assessment, James displayed several symptoms indicative of complicated grief and post-traumatic stress disorder (PTSD):

• Intrusive Thoughts: James frequently recounted the day he was informed of Sarah's death, describing the scene in vivid detail.
• Avoidance: He avoided places and activities that reminded him of Sarah, including family gatherings.
• Negative Alterations in Mood: James expressed feelings of detachment from others, an inability to experience positive emotions, and profound feelings of emptiness.
• Altered Arousal: He became easily startled, felt on edge, and experienced difficulty concentrating.

Intervention: James was referred to a therapist who specialized in grief and trauma. The therapy incorporated various techniques:

• Cognitive Processing Therapy (CPT): Addressed James' feelings of guilt and "stuck" thoughts related to the traumatic event.
• Exposure Therapy: Gradually and systematically, James was exposed to memories and reminders of Sarah to reduce the power these triggers held over him.
• Grief Counseling: Assisted James in navigating his grief, addressing the natural feelings of sadness, anger, and disbelief in the wake of loss.
• Mindfulness and Relaxation Techniques: To manage heightened arousal and anxiety symptoms.

Outcome: After several months of therapy, James reported a decrease in the intensity and frequency of his distressing symptoms. While he still missed Sarah immensely, he learned coping strategies to manage his feelings of loss and guilt, and he started to engage in social and work activities again.

Conclusion: This case underscores the profound impact that sudden and traumatic loss can have on an individual. While grief is a natural and expected response, certain traumatic events can lead to more complex and long-standing psychological distress, necessitating professional intervention. With targeted therapy, individuals like James can find pathways to healing and regain a sense of normalcy in their lives.

Recent Psychology Research Findings

PTSD's development and course are shaped by a multitude of interconnected factors ranging from one's biological makeup to environmental conditions. Recognizing and addressing these factors is crucial for timely intervention and treatment.

Biological Factors

• The amygdala, crucial for emotional processing, is hyperactive in PTSD patients, possibly leading to heightened fear responses (Shin et al., 2006).
• Reductions in the size and functionality of the hippocampus, vital for memory consolidation, have been associated with PTSD. This may contribute to difficulty distinguishing between past and present experiences (Gilbertson et al., 2002).
• The prefrontal cortex, responsible for executive functioning and emotion regulation, shows diminished activity in those with PTSD, possibly contributing to impaired emotional regulation and heightened reactivity (Russo et al., 2017).

Individual Genetic Factors

• Genetic factors may account for a considerable proportion of the variation in PTSD risk. The heritability is suggested to be between 30-40% (Sartor et al., 2012).
• Specific gene variations, particularly those involved in the stress response, might enhance susceptibility to PTSD (Binder et al., 2008).

Personality

• Traits like neuroticism or pre-existing conditions like anxiety disorders can predispose an individual to PTSD following trauma (McFarlane, 2010).
• A history of prior psychiatric disorders can also amplify risk (Breslau et al., 1999).

Childhood Experiences

• Adverse childhood experiences, including various forms of maltreatment, lay the groundwork for heightened vulnerability to PTSD by influencing brain development and stress response mechanisms (Dunn et al., 2017).
• These early-life traumas can prime the brain for heightened reactivity to future traumas (Heim et al., 2000).

Support After the Trauma

• Social support acts as a buffer, reducing the adverse effects of trauma. Its absence can hasten PTSD development (Brewin et al., 2000).
• Positive social interactions and connectedness can counteract feelings of alienation and mistrust, which are common after traumatic events (Charuvastra & Cloitre, 2008).

Subsequent Life Stress

• Following an initial trauma, additional stressors can amplify PTSD symptoms and delay recovery. This might be due to the depletion of coping resources or the re-triggering of trauma memories (Norrholm & Jovanovic, 2010).

Coping Mechanisms

• Maladaptive coping strategies, such as substance use or dissociation, can exacerbate PTSD symptoms and hinder recovery (Ehlers & Clark, 2000).
• These strategies might be an attempt to self-medicate or avoid trauma-related distress, but they often result in worsening mental health outcomes in the long run (Back et al., 2006).

Neuroscience and Cognition

• Recent studies have debunked the long-held belief that adult brains cannot change. Zatorre et al. (2012) showcased the brain's remarkable plasticity throughout adulthood, with potential benefits for neurorehabilitation.
• The relationship between deep sleep and cognitive processes has gained attention. Rasch and Born (2013) highlighted the role of deep, slow-wave sleep in enhancing memory consolidation.
• These discoveries advance our understanding of general brain function and inform PTSD recovery strategies. The inherent brain plasticity suggests that individuals with PTSD can benefit from tailored interventions, even years post-trauma.
• Emphasizing the importance of deep sleep may further aid in the processing and integrating of traumatic memories, promoting resilience and recovery.

Clinical and Counseling Psychology

• Technological advancements have revolutionized therapeutic interventions. Internet-based cognitive-behavioral therapies (iCBT) now provide accessible treatment options for depression and anxiety, bridging gaps presented by traditional therapy (Andrews et al., 2018).

Health Psychology

• Mindfulness, emphasizing moment-to-moment awareness, has become a potent tool in health psychology.
• Creswell (2017) highlighted its benefits: stress reduction and enhanced immune function. In the context of PTSD recovery, mindfulness promotes grounding, emotional regulation, and a break from trauma stress. PTSD survivors can benefit from mindfulness's diverse health advantages, from physiological respite to improved emotional well-being.

Treatment and Interventions

Over the years, evidence-based treatments have emerged that have shown considerable promise in alleviating the debilitating symptoms of PTSD.

One of the most widely recognized treatments is Cognitive Behavioral Therapy (CBT), particularly a subtype known as Prolonged Exposure (PE). PE encompasses repeated, controlled exposure to trauma-related cues and memories, enabling patients to confront and process their trauma rather than avoid it. Research has demonstrated the efficacy of PE in reducing the symptoms of PTSD, leading to significant improvements in overall well-being (Foa, Hembree, & Rothbaum, 2007).

Eye Movement Desensitization and Reprocessing (EMDR) involves the patient recalling traumatic memories while making specific eye movements guided by the therapist. This process is believed to facilitate reprocessing traumatic memories, making them less distressing. Multiple studies have endorsed EMDR's effectiveness, with some patients experiencing symptom alleviation after fewer sessions than traditional therapies (Shapiro, 2018).

In conjunction with psychotherapies, pharmacological interventions can also be beneficial. Selective serotonin reuptake inhibitors (SSRIs) like paroxetine and sertraline have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD and have shown efficacy in reducing its symptoms (Berger, Marmar, & Neylan, 2018).

Recently, the therapeutic potential of mindfulness and meditation practices for PTSD has gained traction. Incorporating mindfulness strategies can enhance emotion regulation, reduce symptoms of anxiety and depression, and improve overall well-being for PTSD patients (Polusny et al., 2015).

However, the best treatment approach can vary across individuals based on the nature of the trauma, coexisting health issues, and personal preferences. A combination of therapies might be employed for optimal results, often entailing a tailored plan crafted in collaboration with mental health professionals.

The field of psychology is constantly evolving, with new therapies and interventions emerging as our understanding of the human mind, brain, and behavior deepens. Some therapies integrate technology, ancient practices, or even biological interventions.

Virtual Reality (VR) Exposure Therapy involves using virtual reality technology to expose patients to traumatic or fear-inducing stimuli in a controlled environment. It is particularly promising for PTSD and phobias (Rizzo et al., 2017). The controlled setting allows for gradual exposure tailored to each patient's needs.

Neurofeedback and Biofeedback: This therapy teaches patients to control physiological functions by providing real-time feedback using electronic monitoring. It has shown potential in treating ADHD, anxiety, and other conditions by promoting self-regulation (Hammond, 2011).

Psilocybin-Assisted Therapy: Research has been growing around using psilocybin, a hallucinogenic compound found in certain mushrooms, as a therapeutic agent. Preliminary results suggest it may effectively treat conditions like depression, anxiety, and PTSD, especially when combined with therapy (Carhart-Harris et al., 2016).

Mindfulness and Acceptance-Based Therapies: Building on cognitive-behavioral approaches, these therapies promote present-moment awareness and acceptance of experiences. Examples include Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT). They are showing promise for various conditions, including mood disorders and borderline personality disorder (Hayes et al., 2006).

Technological and App-based Interventions: As technology becomes more integrated into our lives, there has been a surge in therapeutic apps and platforms offering interventions ranging from CBT to meditation. These platforms can enhance accessibility and continuous support (Torous et al., 2017).

Gut-Brain Axis and Microbiome Interventions: Emerging research suggests a significant relationship between gut health and mental health. Interventions that modify gut flora, such as probiotics, might play a role in managing mood disorders (Dinan & Cryan, 2017).

Genetic and Biomarker-Guided Therapy: As our understanding of genetics and biomarkers improves, there is growing interest in tailoring treatments based on an individual's genetic makeup or specific biological indicators. This personalized approach might optimize treatment outcomes (Bousman & Hopwood, 2016).

Conclusion

Amidst the complexities of trauma and the challenges posed by PTSD, the landscape of recovery offers hope and promise. The past decades have ushered in transformative shifts in our understanding of PTSD, shedding light on the neurobiological underpinnings and multifaceted interventions tailored to individual needs. These advancements signify a broader narrative where science and compassion converge to offer solace and solutions.

PTSD recovery and treatment have continuously evolved through innovative therapeutic interventions, advanced technology integration, and the burgeoning exploration of interconnected physiological and psychological processes. Each research study and every breakthrough further underscore the resilience of the human spirit and the unyielding quest for well-being. With advancements in research and treatment, PTSD survivors don't just manage symptoms but reclaim joy, purpose, and calm in their lives.

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