Understanding Trauma & PTSD: A Guide to Invisible Wounds

Who Can Experience PTSD? Anyone.

PTSD is a condition that affects people of all ages. No one is immune to trauma or how it affects the human brain. Depending on the person, PTSD may mean something different but be equally as impactful.

The experience of post-traumatic stress can vary depending on the trauma that the individual went through—even symptoms can vary between two people. In some cases, symptoms can appear nearly instantaneously. For others, it can take decades for symptoms to surface and be recognized. For many, there’s a delayed onset of symptoms, when the brain is no longer as preoccupied or the person has the opportunity to absorb what has happened.

There is no definitive answer to why some people who experience trauma develop PTSD and others do not. A combination of elements may cause the disorder or make individuals more susceptible to post-traumatic stress, such as:

• Exposure to trauma, including factors like the number of traumas experienced and the severity of those traumas
• Familial histories of anxiety and depression
• Emotional response (temperament)
• How your brain regulates the hormones and chemicals your body releases in response to traumatic events and stress
• Occupations like soldiers, nurses, doctors, EMTs, law enforcement, and firefighters expose some people to more trauma than others in jobs

What Events Can Lead to the Development of PTSD?

You don’t have to experience a specific trauma to develop PTSD. Many people associate this disorder with military veterans. While PTSD is common in military populations, simply witnessing an event, like a car accident, can trigger PTSD symptoms.

In these cases, painful, traumatic memories can appear out of nowhere, creating intense physical and emotional reactions. During World War I, this was referred to as “shell shock.” When the horrors of war were too much for the brain to manage, the brain, or at least part of the brain, simply shut off.

Children and teens often experience PTSD as a result of traumas that impact them, such as school shootings, domestic violence, auto accidents, neglect, or abuse. 15-43% of adolescents will experience a traumatic event, with about a quarter of those individuals experiencing symptoms of PTSD.

How Do I Recognize PTSD in Myself or Others?

With any traumatic event, it is completely normal to feel impacted. However, PTSD symptoms may interfere with the person’s ability to function in their normal settings or environment.

While there are many symptoms of PTSD, they are often dismissed as something other than post-traumatic stress disorder. If symptoms escalate over time, interfere with the ability to go about day-to-day activities, or don’t diminish with time, it may be worth talking to someone about the possibility of a PTSD diagnosis.

When considering if you or a loved one is living with PTSD, it’s important to remember that the onset of symptoms can show at any time, not just immediately after experiencing trauma. Many people have reported symptoms appearing decades after being exposed to trauma.

While military members are common among PTSD patients, women are two times more likely than men to experience PTSD, and it is often the result of trauma like domestic violence, physical abuse, or rape.

While some people are predisposed to post-traumatic stress disorder, it can impact anyone. As PTSD has many symptoms, it’s important to remember that someone may only express one of the following symptoms—or all of them.

Each affected person will have a unique experience with PTSD and may experience any of the following:

Unwanted and Intrusive Memories

When memories seem to turn against us, they can be traumatic in their own right, especially when they are memories we’re trying to forget. These unwanted and intrusive memories may look like the following symptoms:

• Reliving traumatic events over and over or having flashbacks of the event
• Recurring memories of the event while waking or sleeping
• Upsetting nightmares
• Physical and/or emotional distress triggered by sights, sounds, and even smells that remind you of the traumatic event

Avoidance

Avoidance is a common reaction to trauma but can become problematic if it’s the main method of coping, as it can interfere with your ability to heal after trauma. These are some of the symptoms of avoidance:

• Resisting thoughts or conversations about the traumatic event
• Avoiding people, places, or acts that remind you of the event

Trauma Anniversaries

It is normal for people who have experienced trauma to be upset or on edge on the anniversary of an event. It is when these reactions are severe or extreme that it indicates a deeper potential problem, such as PTSD.

Changes in Physical and Emotional Reactions

Sometimes referred to as arousal symptoms, these symptoms emerge in reaction to the trauma and include things like:

• Easily startled
• Constantly vigilant for danger
• Unable to sleep
• Inability to concentrate
• Irritability
• Anger, aggression
• Guilt and shame

Sometimes these are accompanied by self-destructive behaviors, such as drinking, using drugs, sexual promiscuity, or engaging in dangerous activities like skydiving, driving at excessive speed, and pursuing other dangerous activities.

Negative Thoughts and Moods

If you’re experiencing the following symptoms, you should reach out to someone you trust.

• Feelings of hopelessness
• Negative thoughts about yourself or the world
• Difficulty maintaining close relationships
• Feelings of detachment from friends and family
• No interest in things that once brought you joy
• Inability to experience positive emotions
• Emotional numbness
• Memory problems—even difficulty remembering key details of your trauma

PTSD symptoms may come and go over time. Seeking treatment can help you recognize certain triggers so that you can manage the emotions they bring about if you can’t avoid these triggers.

How Is PTSD Diagnosed?

There are several steps involved in fully diagnosing post-traumatic stress disorder, including a physical and psychological evaluation in addition to meeting the criteria in DSM-5 (the standard for psychiatric diagnosis). Some of the criteria established in the DSM-5 include one or more of the following factors:

• Direct experience of a traumatic event
• Witnessing others experiencing trauma
• Learning someone you love was threatened or affected by a traumatic event
• Repeated exposure to graphic details of traumatic events (such as first responders, emergency room staff, soldiers, etc.)

Also, symptoms of PTSD have to affect you longer than one month and interfere with your ability to cope and/or function in normal activities or relationships, for a formal diagnosis to be considered.

How Is PTSD Treated?

The sooner you seek treatment, the faster you can begin to feel relief and not be burdened by the symptoms of your trauma.

Two specific treatments are effective in treating PTSD: medications and psychotherapy. Both can be beneficial on their own, and combining the two types of treatment often is helpful.

Psychotherapy—talk therapy—can take place in one-to-one meetings and/or group meetings. Talk therapy helps people with PTSD in many ways.

Talking about the traumatic memories with a trained therapist can provide the patient with education about their symptoms so they don’t feel so alone and out of control.

Talking can desensitize people to their memories, which gradually allows them to stop avoiding reminders of the trauma. It can help them build skills for re-evaluating the thoughts and feelings that surround the memories. Most importantly, talk therapy can allow people to feel supported and safe.

Trauma-Focused Therapy

The most well-studied and effective types of psychotherapy for PTSD are those that are “trauma-focused,” which means that the treatment involves focusing on the specific traumatic event.

There are several types of trauma-focused treatments. Some involve exposure methods, while others involve cognitive restructuring.

Exposure Therapy

Understandably, people with PTSD are often highly reluctant to face the memories they have of the traumatic event. Therefore, they start to avoid any sort of reminders of it. This can lead to their lives becoming very constricted.

For example, if someone was involved in a serious motor vehicle accident on the highway, they may not only start avoiding that specific highway but also start avoiding being in a car or traveling anywhere outside the home. The fear becomes generalized, and their lives become all about avoidance of danger. Nowhere feels safe anymore. They feel haunted by the memories.

Exposure therapy for PTSD is a trauma-focused treatment that involves a trained professional helping a person gradually confront their distressing memories about the traumatic event over time in a safe environment.

The exposure may begin with imagining the traumatic event, talking about it out loud, and writing about it. Then, it may proceed to confronting aspects of the traumatic event in the real world (e.g., having a motor vehicle accident survivor start by just walking out to the car, then sitting in the car; over time, having them take a short drive, etc.).

Over time, with continued exposures, the thoughts and feelings come up and people become sensitized to the fear that accompanies their memories.

Cognitive Restructuring

Cognitive restructuring for PTSD is a trauma-focused treatment that concentrates on identifying and then re-evaluating thought patterns that underlie the strong negative feelings that are associated with traumatic memories.

After a traumatic event, the survivor may view themselves, other people, and/or the world differently than they did before.

For example, someone who was assaulted by a male stranger while walking through the park may have distorted beliefs as a result. They may believe it was their fault for walking alone or that any man they don’t know is a potential threat. They may come to believe there is no safe place in the world anymore.

Cognitive restructuring aims to identify the thoughts associated with a traumatic event and then teach people how to challenge the thoughts by asking: Are they accurate, and what are the facts?

Cognitive restructuring works to help people re-evaluate their thinking processes that are associated with the traumatic memories, first, by having the therapist identify and challenge trauma-related thought patterns and then by teaching the person skills to do so themselves.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a trauma-focused psychotherapy approach. It involves recalling a traumatic memory, including the thoughts, feelings, and body sensations that come up while doing so.

In some ways, it is similar to exposure treatment. What makes it different is that while recalling the traumatic memory, people are asked to focus their attention on an external stimulus that invokes side-to-side movements of the eyes. It is thought that the side-to-side eye movements help to facilitate the processing of the belief by activating both brain hemispheres.

The National Center for PTSD provides more in-depth information on trauma-focused treatments.

A Note on Treatment for PTSD

All treatments for PTSD should be done by a mental health professional who has been trained to deliver the treatment and undergone supervision of cases before doing it on their own. Everyone is different.

While there are three trauma-focused treatments (prolonged exposure, cognitive processing therapy, and EMDR) that have the most research backing them up, studies show that not all patients will respond. If one type of treatment does not work, another may.

Some PTSD specialists believe that these types of short-term, trauma-focused treatments—which can be effective in some people who have survived adult-onset, single-incident traumatic events or combat trauma—may also be effective in people who have sustained prolonged trauma during childhood.

Other PTSD specialists are concerned that trauma-focused treatments may be too overwhelming in these instances. Also, they are concerned that people who have experienced childhood abuse may have considerable difficulty trusting a therapist to take them through treatment.

Instead, they may recommend a phase-oriented treatment that involves the establishment of trust, safety, stabilization, and skills training before trauma-focused work.

Length of PTSD Treatment

Trauma-focused psychotherapy treatments typically are provided over a few months. For those who respond, a decrease in the intensity and frequency of PTSD symptoms happens fairly quickly. Some studies have shown that these effects continue to last over time.

Antidepressants can take a month or so to start being effective. Prazosin can be effective almost immediately for the treatment of nightmares.

Family Involvement in PTSD Treatment

In addition to a patient receiving medication and/or psychotherapy, it is helpful to have family members involved. Family members should be taught to recognize the symptoms of PTSD so they can understand what is happening to their loved one. They need to know that PTSD is a treatable condition so that they can lend support to relatives by reaching out and providing encouragement.

While there is no one-size-fits-all treatment for those living with PTSD, many treatments have been successful in helping people live with fewer symptoms—allowing them to live healthier, happier lives.

PTSD and Suicide

Many people who struggle with post-traumatic stress disorder also struggle with suicidal thoughts and/or behaviors.

Although it is not possible to predict suicide with any certainty, our best tool is recognition of the signs that many people exhibit when contemplating suicide. The following three behaviors should prompt you to seek immediate help for yourself or a loved one:

• Talking about wanting to die or to harm oneself
• Looking for a way to hurt oneself, such as searching online or obtaining a gun
• Talking about feeling hopeless or having no reason to live

Please seek help immediately if you or someone you love is experiencing suicidal thoughts. If you or someone you know needs help:

• Call 911 if you are thinking about harming yourself or someone else
• Talk to your doctor about your symptoms and thoughts.
• Call a suicide hotline: 988 or 1.800.273.TALK (1.800.273.8255)—if you are a veteran, press 1 after calling this number to connect you with the Veterans Crisis Line
• Text HELLO to 741-741 for free, 24-hour support from the Crisis Text Line
• Outside of the U.S., visit the International Association for Suicide Prevention for a database of resources
• Join a support group—it can be beneficial to know that others share similar experiences and understand how you feel
• Seek counseling with someone who specializes in post-traumatic stress disorder
• Call or connect with a friend or loved one
• Contact a spiritual leader

PTSD Can Be Treated—Yes, There’s Hope!

If you are overwhelmed by symptoms or negative thoughts that you suspect are related to PTSD, you should contact your health care team to discuss the possibility of a PTSD diagnosis. You can also contact a local mental health facility to get the help you need. You don’t have to struggle on your own—there is a path to recovery.

If you recognize the symptoms in a friend or loved one, you should always reach out to them and offer support. Whether they accept your help or not, knowing that you’ve offered can be incredibly helpful to those who are affected by mental health disorders.

Contributors

Matthew A. Robinson, PhD