Types of PTSD: From Symptoms to Treatment
Daniel Z. Lieberman, MD
December 22, 2024 at 1:57 PM
Post Traumatic Stress Disorder (PTSD)
Experiencing trauma can sometimes lead to post-traumatic stress disorder (PTSD). This serious mental health condition is marked by changes in mood, intrusive memories, avoidant behavior, and a heightened sense of alertness.
While it can feel overwhelming and impact daily life, it may be reassuring to know that effective treatment options exist to help you navigate and manage PTSD.
What Is PTSD?
PTSD, short for post-traumatic stress disorder, is a mental health condition that can occur when someone goes through or witnesses a traumatic event. When diagnosing PTSD, clinicians define a trauma as "actual or threatened death, serious injury, or violence."
While other disturbing experiences can be traumatic, they generally don't lead to a diagnosis of PTSD. If a person experiences intense distress -- like being constantly on edge or having flashbacks -- for more than a month after experiencing the trauma, it might be PTSD.
It's important to know that if you have PTSD, you're not alone. Support and resources are available to help you through.
Our guide will cover the signs of PTSD, what causes it, and how to manage and cope with the challenges it brings.
How Common Is PTSD?
Though not everyone who experiences trauma develops PTSD, it's relatively common. About nine million people in the United States are affected by post-traumatic stress disorder, with roughly 37 percent experiencing severe symptoms.
Research shows that 20 to 30 percent of those exposed to trauma end up developing PTSD.
Types of PTSD
There are a couple of subtypes of PTSD, though they're not all recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). These include acute stress disorder (ASD) and complex PTSD (CPTSD).
Acute Stress Disorder (ASD)
Acute stress disorder includes similar symptoms to PTSD -- the primary difference is the timeframe. ASD develops right after trauma occurs, within the first three days, and only lasts up to four weeks following a traumatic event or situation.
Meanwhile, regular PTSD generally appears within the first three months of a traumatic event, though it can sometimes emerge years later. If symptoms of ASD persist beyond that timeframe, the person might get a diagnosis of PTSD.
Complex Post-Traumatic Stress Disorder (CPTSD)
Complex PTSD is a form of PTSD that can develop in people who experience ongoing or long-term trauma or multiple traumas. This may include:
Childhood abuse or neglect
Domestic violence
Abuse
War
Trafficking or slavery
Life-threatening illness
In addition to the symptoms of PTSD -- which we'll outline ahead -- CPTSD also often involves feelings of worthlessness, shame, and guilt, difficulty with emotional regulation, having a hard time connecting with others, or unstable relationships.
While it isn't listed as a separate diagnosis in the DSM right now, recent research suggests complex PTSD is a distinct condition that deserves attention. This means understanding it separately and developing specific treatments to help those struggling with it.
If you think you might be dealing with CPTSD, there's support and help available that can be tailored to your needs.
What Are the Symptoms of PTSD?
PTSD can manifest differently for different people. For some, it might be hard to remember the details of the trauma, while others may find themselves feeling a lot of self-blame.
Generally, PTSD symptoms fall into a few main categories categories:
Re-experiencing symptoms
Avoidance symptoms
Cognition and mood symptoms
Increased reactivity
Let's take a closer look at these categories to understand how they might affect you or someone you know.
Re-Experiencing Symptoms
Re-experiencing symptoms of trauma can be quite varied and personal.
For instance, you might see someone who reminds you of the person who hurt you and suddenly feel a familiar intense fear. Or a particular song or smell could trigger memories of or feelings associated with the trauma.
These symptoms usually manifest as:
Flashbacks of the trauma that make you feel like it's happening all over again
Vivid nightmares related to the trauma or those involved
Intrusive memories of the trauma
It's normal for these triggers to bring back strong emotions and reactions. But know there are ways to work through these experiences with support.
Avoidance Symptoms
This category of symptoms includes avoidant behaviors related to the trauma.
For instance, someone may steer clear of things that remind them of their trauma. This can mean avoiding physical places or thoughts or feelings related to what happened.
Trauma avoidance can be disruptive to daily life, as it can interfere with someone's routine and responsibilities.
Cognition and Mood Symptoms
Dissociation and emotional numbness are common feelings that emerge with PTSD. Other mood and cognition symptoms include:
Trouble concentrating
Negative thoughts and feelings about oneself
Negative emotions about the trauma, such as ongoing shame, guilt, or anger
Feeling isolated socially
An inability to enjoy things once enjoyed and not being able to feel positive emotions
Some people with PTSD might show several of these behaviors, while others may only have one or two.
Increased Reactivity Symptoms
This category encompasses behavioral, reactive, and arousal symptoms. For example:
Hypervigilance
Startling easily
Difficulty sleeping
Emotional or angry outbursts
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Remember, post-traumatic stress disorder isn't the same for everyone. PTSD symptoms in women might present differently than in men. Pay attention to the signs and symptoms and consult a healthcare professional for a diagnosis.
Related Disorders and Complications of PTSD
Major depression is another common mental health problem that can develop after trauma. A review of multiple studies found that major depressive disorder and PTSD are very likely to occur at the same time. As many as half of patients with PTSD also struggle with depression.
Also, those who've had PTSD at some point in their lives are three to five times more likely to develop major depression than those who didn't experience post-traumatic stress disorder.
Some depressive symptoms can be similar to those of PTSD, such as trouble sleeping, emotional outbursts, and a loss of interest in activities you used to enjoy.
Post-traumatic stress disorder can also coexist with anxiety disorders, such as panic disorder, social anxiety, and generalized anxiety disorder (GAD).
Substance abuse is another frequent co-occurring disorder with PTSD.
What Causes PTSD?
The causes of PTSD are traumatic events or ongoing stressful and traumatizing situations.
Some examples of traumatic experiences that can lead to PTSD:
A history of child abuse
Physical abuse
War and military combat
A car accident or some other accident
A natural disaster
These are just examples. Other traumatic experiences could result in PTSD.
Risk Factors
Certain things may increase the likelihood of developing PTSD but aren't direct triggers -- that's what makes a risk factor different from a cause.
Risk Factors for PTSD
A few pre-trauma variables have been linked with making a person more vulnerable to developing PTSD after a trauma. These include:
Genetics. A review of twin studies suggested that PTSD is, in part, a heritable mental illness. As much as 40 percent of someone's chance of developing it is genetic. So if a close relative (like a sibling or parent) has had PTSD, your chances of getting it if you experience trauma are higher.
Intimacy. Those assigned female at birth are statistically more likely to have PTSD. Research has shown that women are two to three times as likely as men to develop it.
Hormones. A study on people who had heart attacks found that those with lower cortisol levels were more likely to develop PTSD. (Cortisol is known as "the stress hormone.") It may seem odd that lower levels of the stress hormone is a risk for PTSD, but it's thought that cortisol helps the brain manage stress.
Temperament. Some research shows that personality traits might play a role in someone's likelihood of developing PTSD after a trauma. For example, one study found that kids who react strongly to new things or situations might be more at risk.
Education level. A lower education level might be linked with a higher risk of developing PTSD.
Lack of social support and extra stress. A meta-analysis found that these environmental factors played a role in a person's chances of developing PTSD more than other pre-trauma factors.
As noted, other mental health problems, such as depression or anxiety, might make someone more susceptible to developing PTSD.
How Is PTSD Diagnosed?
To diagnose PTSD, mental health professionals look for specific symptoms that have persisted for more than a month.
They'll check for at least:
One re-experiencing symptom
One avoidance symptom
Two mood and cognition symptoms
Two arousal or reactivity symptoms
PTSD symptoms can start showing up as early as three months after the traumatic event. But sometimes, they might not appear until years later.
If you or someone you care about is struggling, reaching out to a mental health professional can be really helpful. Getting a diagnosis is a critical step toward finding the right support and beginning the journey to healing.
Treatment
How is PTSD treated? There isn't a one-size-fits-all treatment for PTSD, but there are several effective options to consider.
The main treatments typically include psychotherapy, medication, and some alternative approaches. We'll break down each of these PTSD treatments in more detail below.
PTSD Therapies
A few types of talk therapy and behavioral therapy can help people with PTSD. These include:
Cognitive behavioral therapy (CBT)
Exposure therapy
Stress inoculation training
Eye movement desensitization and reprocessing (EMDR)
Present-centered therapy (PCT)
Narrative exposure therapy (NET)
Keep reading for a rundown of each therapy type.
Cognitive Behavioral Therapy (CBT)
CBT helps patients spot and change negative thinking patterns that can lead to unhealthy behaviors. Think of it as a way to retrain your brain to think in a healthier way.
With post-traumatic stress disorder, CBT gradually helps you face and process the traumatic event, allowing you to work through it step by step.
Studies show that CBT is the most effective therapy in both short- and long-term treatment for PTSD.
Exposure Therapy
In exposure therapy, people confront their fears by engaging with the source of their trauma a little bit at a time. The idea is to start slow and gradually build up to challenge unhealthy thinking patterns that arise after triggering events.
It can include talking about the memory, writing about it, or visiting the trauma site. Research shows that exposure therapy can be as effective as cognitive processing therapy for treating PTSD.
Stress Inoculation Training
This is a specialized form of talk therapy designed specifically for PTSD. The main aim of stress inoculation training is to help individuals develop effective coping skills to manage their symptoms and handle future stressors more confidently. However, not enough research has been done on this form of therapy to allow it to be confidently recommended.
Eye movement Desensitization and Reprocessing (EMDR)
EMDR is a newer psychotherapy designed to alleviate trauma symptoms by altering how traumatic memories are stored in the brain.
It involves stimulation -- such as taps or eye movements -- while focusing on the traumatic memory to lessen its emotional impact. Eye movement desensitization and reprocessing helps address the fear and pain linked to the trauma.
Present-Centered Therapy (PCT)
Present-centered therapy is a non-trauma-focused treatment that addresses current issues rather than directly processing past trauma.
It helps people with PTSD understand how their symptoms affect daily life and teaches them effective strategies to manage current stressors and challenges.
Narrative Exposure Therapy (NET)
This form of PTSD therapy helps patients create a coherent life story, including both traumatic and positive events. Someone in narrative exposure therapy would focus on making sense of traumatic events and be encouraged to include positive life moments in their story.
According to the American Psychological Association, NET is especially useful for those who've experienced multiple traumas. It's commonly used in support group settings.
PTSD Medications
Some prescription medications show promise in treating PTSD, including:
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin-norepinephrine reuptake inhibitors (SNRIs)
Alpha-blockers
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are a type of antidepressant often used for PTSD. These medications work by optimizing serotonin -- colloquially referred to as the "feel-good chemical" -- activity in the brain.
Two SSRIs, sertraline (Zoloft) and paroxetine (Paxil), are FDA-approved to treat PTSD.
Other SSRIs are sometimes prescribed off-label to treat PTSD, meaning they're used for something they're not FDA-approved for. This includes fluoxetine (Prozac), citalopram (Celexa), and escitalopram (Lexapro).
Selective Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Providers also prescribe SNRIs -- such as venlafaxine (Effexor) and duloxetine (Cymbalta) -- to treat PTSD.
Like SSRIs, these meds act on serotonin, but they also target norepinephrine, a neurotransmitter (brain chemical) that rises during stress.
Selective serotonin-norepinephrine reuptake inhibitors are sometimes prescribed off-label to manage anxiety and depression linked with PTSD.
Alpha-Blockers
Alpha-blockers, like prazosin (Minipress®), are typically used to manage high blood pressure. These medications work by blocking the norepinephrine to help prevent blood vessels from tightening and affecting blood flow.
Sometimes, healthcare professionals prescribe alpha-blockers off-label to help with PTSD symptoms, especially recurring nightmares. Early research suggests they might be helpful, even though it's not totally clear why.
Other Treatment Options for PTSD
Beyond psychotherapy and more traditional medications, experimental and alternative approaches are emerging to potentially treat PTSD.
These include ketamine therapy and the emotional freedom technique.
Ketamine Therapy
While researchers aren't entirely sure how ketamine works for PTSD, they know it blocks certain receptors in the brain that play a key role in memory formation. It also activates receptors that stimulate the growth of healthy brain cells.
The FDA hasn't approved ketamine to treat PTSD. However, one review suggests low doses might provide relief for those with long-term PTSD (though not for people with early PTSD or service members with PTSD).
Another study showed promising findings but emphasized the need for further research into proper dosing methods, timing, and frequency of use.
Emotional Freedom Technique (EFT)
The emotional freedom technique (also known as tapping) is an evidence-based treatment involving acupressure. This method uses physical pressure on specific sensitive points of the skin to relieve pain and muscle tension.
For PTSD, a trained EFT mental health professional will teach you how to tap certain rhythms on your hands, head, face, and collarbones while you actively reframe your memories of a traumatic event.
EFT therapies may decrease cortisol levels. Studies have found that these therapies can also reduce symptoms of anxiety disorders and major depression.
Preventing PTSD
Some research shows that having strong social support could help prevent post-traumatic stress disorder. Seeking therapy and support from loved ones soon after experiencing trauma might also help someone manage symptoms more effectively.
Still, it's challenging to prevent PTSD entirely, so know that it's not your fault if you develop it.
It's also important to recognize that trauma can sometimes make it hard to fully grasp the extent of the impact, which can complicate immediate treatment.
Everyone's experience with PTSD is unique, so finding the right approach may involve trying different treatments to see what works best for you.
This article originally appeared on Forhers.com and was syndicated by MediaFeed.org
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