What Is Post-Traumatic Stress Disorder (PTSD)?

Living with PTSD can be a waking nightmare. Read about flashbacks and other signs and symptoms of post traumatic stress disorder (PTSD), along with the essential steps to take to recover.

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May 4, 2022 UPDATED
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Post-traumatic stress disorder, or PTSD, is a mental health condition that stems from experiencing trauma, by witnessing or enduring a traumatic event or events.

Many people will experience trauma at some point in their lives.

In fact, research suggests that 60% of men and 50% of women will experience at least one traumatic event in their lifetime. Of this large group, only about 3.6% will develop PTSD.

PTSD significantly alters sufferers’ behavior and hampers their ability to function. 

It can be characterized by flashbacks to the event, emotional numbness, and/or overwhelming fear that lasts long after the ordeal is over—and the symptoms can intensify over time.

If untreated, this serious mental health disorder can lead to depression, addiction, reckless behavior, and/or suicidal thoughts. 

PTSD significantly alters sufferers’ behavior and hampers their ability to function. 

High levels of stress can lead to adjustment disorders or anxiety disorders, but these are not to be confused with PTSD.

When PTSD was first officially classified as a mental disorder by the American Psychiatric Association in 1980 (though it had been evident for decades before that—more on this below), doctors made a clear distinction between "normal stressors" and "traumatic events."

Understanding that distinction is key to understanding the condition. 

What's a traumatic event? 

There is no one discrete, scientific definition of a traumatic event.

The American Psychological Association characterizes trauma as “an emotional response to a terrible event like an accident, rape or natural disaster,” which is fairly broad.

What does “terrible event” mean?

Today, we accept that what constitutes a traumatic event is subjective and can vary from person to person.

However, it wasn’t always this way. 

The push to codify PTSD in the third edition of the the Diagnostic and statistical manual of mental disorders (DSM-3) in 1980 came from generations of American soldiers returning home with “shell shock” (WWI) or “battle fatigue” (WWII) and the recent return of thousands of indelibly disturbed Vietnam War veterans.

Thus, the original classification of PTSD was strictly focused on war or combat events. It would be a while before events like sexual violence or serious accidents would qualify. 

This diagnosis was designed with veterans, victims, and innocent bystanders in mind.

To this day, many people still consider PTSD to be a soldiers’ disease.

Those who haven't experienced combat or who have never witnessed a terrible accident may be tempted to think there’s no way they could suffer from PTSD, but in the past forty years much has changed. 

Each new edition of the DSM reveals that psychologists’ definition of trauma and their application of the post-traumatic stress disorder diagnosis has broadened significantly.

It turns out, “trauma” is a more subjective term than initially imagined. 

Whether an event is traumatic depends upon who is witnessing it. 

The fact is, everyone’s psyche is different.

We assess stressors and threats internally, which means our unique psychological disposition plays a leading role in how we ultimately classify those stressors and threats.

How we digest them, as traumatic or merely stressful, determines how we respond to those experiences. 

Two people witnessing the same event may walk away with different responses.

One witness may experience trauma, the other may not.

Whether an event is traumatic depends upon who is witnessing it. 

All that’s to say, you don’t have to go to war or live through a tornado to be traumatized.

Traumatic events are often life-threatening, catastrophic and outside the realm of day-to-day life, but not always.

More common issues like domestic violence, emotional abuse, codependency and intense emotional upheaval can all lead to PTSD. 

In fact, psychologists now believe that people can develop PTSD through indirect exposure to trauma.

Simply learning about violence, death or great stress in the lives of loved ones could lead to fear and emotional confusion that alters our behavior and puts us at risk. 

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What are the symptoms of PTSD? 

PTSD symptoms generally fall into one of four categories:

1. Avoidance

This occurs when traumatized persons go to great lengths to stay away from triggers. This includes steering clear of any and all information related to the traumatic event and refusing to think or talk about it.

Folks suffering from PTSD often go out of their way to avoid places, people and activities that might bring up traumatic memories. This desperate need to avoid leads to very concrete changes in behavior that are damaging to healthy daily living, relationships and overall ability to function in the world. 

2. Negative changes in thinking and mood 

These downward shifts in mood and thinking can lead to depression, substance abuse, and suicidal thoughts. 

This can include feelings of hopelessness, detachment, emotional numbness and memory problems.

In addition to having negative thoughts about oneself and others, PTSD sufferers may struggle to enjoy activities and people they once enjoyed. They may have difficulty recalling memories, especially memories related to the traumatic event. These downward shifts in mood and thinking can lead to depression, substance abuse, and suicidal thoughts. 

3. Flashbacks 

Perhaps the most well-known symptom, intrusive memories manifest themselves in the form of flashbacks and nightmares.

These unwelcome reminders force those with PTSD to relive the event, which in turn leads to severe emotional and even physical responses.

Recurring intrusion of trauma-related memories coupled with an inability to control them can cause crippling moments of distress that have the potential to make daily life incredibly difficult. 

4. Changes in physical and emotional reactions

These are also called “arousal symptoms,” and can include being easily frightened, feeling irritable and having trouble sleeping or concentrating.

Those suffering with PTSD may be particularly prone to respond to life events with guilt and shame.

Some engage in reckless behavior.

Arousal symptoms include feeling on guard at all times.

This fear-driven state of being is physically taxing. It can also result in dangerous, life-threatening behavior. 

Trauma-induced stress, on the other hand, tends to lurk in deeper parts of our mind and reveal itself over time.

Symptoms of PTSD typically do not manifest until weeks or months after the traumatic event, though people can experience the effects of trauma after years with no symptoms.

When we are merely stressed, our response is typically instantaneous and usually diminishes with time as we process the event or resolve the stressful situation.

Trauma-induced stress, on the other hand, tends to lurk in deeper parts of our mind and reveal itself over time. Carefully considering the time between your symptoms and the event is key to making the distinction between stress or generalized anxiety and PTSD. 

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Can PTSD be cured?

Though there’s no single “cure” for PTSD, the good news is it can be treated, with some symptoms abating relatively quickly.

The treatment for PTSD can include several different therapeutic methods.

Cognitive behavioral therapy (CBT), mindfulness practice, and medication are often used in tandem to alleviate symptoms and help patients process their trauma.

EMDR, a hands-on therapy that helps patients "recategorize" memories, has shown promising results.

The stages of PTSD recovery

As with any other form of recovery, the rehabilitation from PTSD is a process, one which can take more or less time and work depending on the person suffering. Dr. Judith Herman devised a treatment for PTSD that occurs in three stages.

1. Establishing safety 

The first and most important step in the recovery process.

Until patients feel secure in their bodies and in their environments, they will be unable to confront and process their trauma.

Counselors help patients gain control of their body and emotions with symptom-management techniques. They ensure patients are sleeping, eating well, and abstaining from substance abuse.

Once emotional and physical security is established, therapists help patients gain control of their environment. That includes a safe living situation, financial security, and a self-protection plan.

Rediscovering a sense of security can be incredibly difficult and may take time, but is ultimately what allows sufferers to tell the story of their trauma and rebuild their life. 

2. Telling the story

Once patients have built a strong trust with their therapist and feel safe enough to do so, they are encouraged to tell the story of their trauma.

It’s a painful process that requires sufferers to delve into the event in as much detail as possible.

Therapists act as witnesses and allies throughout.

By telling their stories, patients confront their trauma head on and re-contextualize their experience as a historical event in their lives.

Once the event has been reframed, patients can learn to live with it and build it into a larger story of survival.

3. Rebuilding

Once the narrative of a survivor’s trauma is reclaimed, patients can begin to rebuild their lives.

With a newfound sense of security and ownership of the event, focus is turned towards the future. This means goal-setting, aspiration-building and the development of relationships.

Survivors are encouraged to carefully and actively engage with the world again, while maintaining the safety they established earlier in the process.

That could mean finding new belief systems, making new friends or reevaluating your life goals.

The idea is not to rush patients into a new life where they don’t have to think about their past trauma, but, rather, to help make their world feel safe, productive, and fulfilling again. 

The fact is, mental health support, therapy, and counseling should be available to everyone suffering from PTSD.

Concerned you may have PTSD?

Answer a few questions in our online PTSD evaluation to get personalized feedback. Talking with a therapist or counselor can help you recover.

Check out the Monarch Directory by SimplePractice to see licensed mental health professionals who specialize in clients with PTSD.

You can also browse therapists who specialize in cognitive behavioral therapy (CBT), as this therapeutic approach has been shown to help PTSD recovery.

Need to find a therapist near you? Check out the Monarch Directory by SimplePractice to find licensed mental health therapists with availability and online booking.

Article originally published Mar 16, 2022. Updated May 4, 2022.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC: Publisher.

American Psychiatric Association (APA). (n.d.). What is post-traumatic stress disorder? Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

American Psychiatric Association. (2020). Trauma and shock. Retrieved from https://www.apa.org/topics/trauma

Cortez, M. (2014). Direct v. indirect exposure to trauma: An insight to officer coping mechanisms. ScholarWorks. Retrieved from https://scholarworks.boisestate.edu/mcnair_journal/vol10/iss1/7/

Friedman, M. (2013). PTSD history and overview. National Center for PTSD. Retrieved from https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp

Herman, J. L. (1998). Recovery from psychological trauma. Psychiatry and Clinical Neurosciences, 52(S1), S105–S110. https://doi.org/10.1046/j.1440-1819.1998.0520s5s145.x

Herman, J. L. (1992). Trauma and recovery: The aftermath of violence - from domestic abuse to political power. BasicBooks.

Mayo Clinic. (2017). Adjustment disorders - Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/adjustment-disorders/symptoms-causes/syc-20355224

Seidler, G.H., Wagner. F.E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological Medicine, 36(11), 1515–1522. https://doi.org/10.1017/s0033291706007963

U.S. Department of Veteran Affairs. (n.d.) How common is PTSD in adults? Retrieved from https://www.ptsd.va.gov/understand/common/common_adults.asp

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