For PTSD Awareness Day, June 27, we spoke to experts about the causes, symptoms and treatment of the illness that affects millions of people each year.
We’ve all heard the platitude that “time heals all wounds,” but the 7.8% of Americans who experience PTSD at some point in their lives are painfully aware this isn’t always the case. The illness, which is characterized by symptoms including flashbacks, intrusive thoughts, nightmares, avoidance and hypervigilance, causes a significant disruption in day-to-day life and can become debilitating if untreated.
PTSD is accompanied by myths and misconceptions. First, there’s the damaging myth that individuals with PTSD are a danger to others.
“Largely because of media, especially movie depictions, and some high-profile cases of veterans who have been traumatized becoming violent, there’s this misconception that people with PTSD are violent or dangerous,” Dr. Steve Levine, board certified psychiatrist and founder and CEO of Actify Neurotherapies told me in an interview for Crixeo. “In reality, a tiny, tiny fraction of people who suffer from PTSD are at risk for being violent. The people who suffer the most because of PTSD are, of course, those with PTSD — not the people around them.”
And in a society that embraces the adage of pulling ourselves up by our bootstraps, many people are reticent to tell family and friends that traumatic events from months or years ago are inhibiting their ability to function socially and professionally. Not everyone who experiences trauma develops PTSD, so for those who do, there’s the fear of being viewed as weak.
People with PTSD are neither dangerous nor weak — they’re dealing with a complex illness that has been in the The Diagnostic and Statistical Manual of Mental Disorders (DSM) since only 1980. The American Psychiatric Association first added PTSD to the DSM after doctors observed the symptoms in war veterans who had returned from Vietnam. Today it’s known that the condition can be caused by a wide range of traumatic events including physical and sexual violence, natural disasters, road accidents and terrorist attacks.
It’s important to note that exposure to certain events can also cause PTSD. For example, if a child witnesses their father abuse their mother but is never a direct target of the violence, he or she is still at risk of PTSD. “Until you’re a more developed person, you perceive the world as though everything is related to you. You’re the center of the universe and, because of that, everything that happens is because of you or it’s your fault,” Levine said. “So even if somebody else is the victim of physical abuse, you’re going to perceive it as if it’s because of you and it’s connected to you.”
Although anyone who experiences trauma can develop PTSD, certain people are at greater risk than others. Levine noted that people who’ve already experienced trauma, individuals without a strong support network in place, and women are more likely to develop PTSD. Past psychiatric diagnoses, especially of other anxiety disorders, are also risk factors.
Some genetic associations have been found. Research is in its early stages, but one study found that genetics may increase the risk by approximately 29% in European-American women. The same study found that the genetic risk factor for PTSD is significantly lower in men.
The hallmark symptom of PTSD is constantly re-experiencing the trauma in various ways. Flashbacks can be triggered by nearly anything that reminds a person of the trauma — places, people, activities, objects and conversations are some of the most common triggers that can jolt a sufferer back into the terrifying situation that caused their illness. At night, the trauma is often re-experienced through nightmares.
Levine told Crixeo that other symptoms include an intensified startle reaction, difficulty concentrating, trouble sleeping, irritability, hyperarousal, feeling detached from one’s own body, and avoidance of anything that reminds a person of the trauma. It’s also common for people to have trouble remembering certain aspects of the event, either large or small — and this creates another opportunity for self-blame.
“If you’re having trouble recalling the memory of the trauma, there’s more opportunity to blame oneself as the victim and to develop characteristics of negative self-esteem,” Levine said. “After somebody has experienced this trauma, they may be more socially isolated and have cut off some of their support network. So to then doubt one’s own memory only makes things worse.”
Elizabeth Renee Ostolozaga, a licensed psychotherapist who specializes in PTSD, told Crixeo that people with PTSD typically vacillate between hyperarousal symptoms and avoidance symptoms. “They kind of swing between these two poles,” she explained. “Going back to myths, people with PTSD often describe themselves as bipolar because they’ve read about the polarity that occurs in bipolar disorder and they can relate to it. So they use that word a lot.”
Although people with PTSD experience similar symptoms, no two cases of PTSD are identical. “Some of it depends on your personality traits,” Dr. David M. Reiss, a psychiatrist who for over 30 years has treated both acute and chronic PTSD, said. “For instance, people who are on the obsessive side tend to experience PTSD with more intrusive thinking and obsessive thoughts. Those who are more on the emotional, demonstrative side may have more overt emotion and tearfulness. Some of it depends on who you are and what your personality type is.”
The common thread among all PTSD patients is a significant disruption in functioning. “After a trauma, to have some moodiness may be normal. What you really want to look at is a disruption of functioning,” Reiss explained. “And it really comes down to that. It’s disrupting a person’s life, their work, their relationships. If it’s a significant disruption, or even just a disruption of sleep, it’s a disorder.”
Reiss said there’s also a misconception that every response to trauma constitutes PTSD. “Sometimes there’s anxiety, depression and grief. But PTSD as a clinical syndrome is a very specific set of symptoms in response to a specific type of trauma,” he explained. “Trauma can trigger depression or anxiety disorder, which can be very problematic, but it’s different and the treatment is somewhat different too.”
People who are dealing with any mental health issues as a result of trauma should absolutely seek medical treatment. But specific types of treatment are uniquely suited to helping those with PTSD. Levine told Crixeo the three most effective techniques are prolonged exposure therapy, trauma-focused cognitive behavioral therapy, and eye movement desensitization and reprocessing (EMDR).
Prolonged exposure therapy involves retelling the experience, either verbally or through writing, in a graded way. Patients in trauma-focused cognitive behavioral therapy work on changing behavior, feeling and thought patterns that cause difficulties in functioning. In EMDR therapy, the patient recalls traumatic images while receiving bilateral sensory input such as side-to-side eye movements or hand tapping. According to the 2013 World Health Organization practice guideline, EMDR “is based on the idea that negative thoughts, feelings and behaviors are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements.” Because it doesn’t require exposure or detailed descriptions of the trauma, EMDR is an excellent option for people who are reluctant to enter treatment because they don’t feel able to verbalize what happened to them.
Levine described PTSD as a very treatable illness. “It doesn’t mean forgetting that the trauma happened and having a clean slate. It’s more that you’ve been able to reframe the experience in such a way that it doesn’t have the same impact on you anymore, “ he explained. “So when you think about it, it doesn’t elicit that fight-or-flight response and the rest of what comes with it.”
There are different degrees of recovery. Those who reach “full recovery” no longer have symptoms at the level of diagnosable PTSD. Although full recovery is certainly possible, Levine said it’s more common to have “some” response to treatment, “which might mean that a person still has symptoms and still might technically be diagnosable as having PTSD”; however, the symptoms are far less intense and they no longer interfere with life in the way they once did. “There’s a significant improvement in quality of life,” Levine said.