Post-traumatic Stress Disorder (PTSD)

Understand the diagnosis, what to do and access resources

The diagnosis for Post traumatic stress disorder (PTSD) is complex. PTSD occurs in some people who have experienced a dangerous, shocking or scary event to themselves or a loved one. For example, people can have PTSD after the death of a loved one or if a family member or friend face a traumatic experience. Reactions to these types of events vary with every person. Everyone will have traumatic events in their lives however in most cases people will recover from these events. People who continue to experience these events, even then they are no longer in danger may have PTSD. Here are a few things to consider regarding PTSD:

The diagnosis should only be made by a mental health professional after testing and evaluation
The longevity of PTSD varies per person
PTSD can occur at any age
Recovery is possible
Social support is important
People with a history of mental illness increases the risk of PTSD

What does it take to be diagnosed with PTSD?

Two specifications are noted including delayed expression and a dissociative subtype of PTSD, the latter of which is new to DSM-5. In both specifications, the full diagnostic criteria for PTSD must be met for application to be warranted. The complexity of diagnosing PTSD requires a mental health professional to assess and evaluate a full diagnosis.

Criterion A: stressor

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required)

Direct exposure.
Witnessing, in person.
Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (one required)
Persistent effortful avoidance of distressing trauma-related stimuli after the event: (one required)
Negative alterations in cognitions and mood that began or worsened after the traumatic event: (two required)
Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (two required)
Persistence of symptoms (in Criteria B, C, D, and E) for more than one month.
Significant symptom-related distress or functional impairment (e.g., social, occupational).
Disturbance is not due to medication, substance use, or other illness.
In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
Full diagnosis is not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

Recurrent, involuntary, and intrusive memories. Note: Children older than six may express this symptom in repetitive play.
Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
Intense or prolonged distress after exposure to traumatic reminders.
Marked physiologic reactivity after exposure to trauma-related stimuli.

Criterion C: avoidance

Trauma-related thoughts or feelings.
Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Criterion D: negative alterations in cognitions and mood

Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).
Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., “I am bad,” “The world is completely dangerous”).
Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest in (pre-traumatic) significant activities.
Feeling alienated from others (e.g., detachment or estrangement).
Constricted affect: persistent inability to experience positive emotions.

Criterion E: alterations in arousal and reactivity

Irritable or aggressive behavior
Self-destructive or reckless behavior
Hypervigilance
Exaggerated startle response
Problems in concentration
Sleep disturbance

Criterion F: duration

Criterion G: functional significance

Criterion H: exclusion

Specify if: With dissociative symptoms

Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
Derealization: experience of unreality, distance, or distortion (e.g., “things are not real”).

Specify if: With delayed expression

Diagnosis confirmed. Now what?

Treatment can help cure PTSD but it will take specialized care. Find a professional with experience dealing with PTSD issues and work with your medical physician to address the problems. Social support is helpful in the recovery process as well.

The main treatment for PTSD are medications and psychotherapy

The manifestation of PTSD is different for everyone so treatment is individualized. The combination of therapeutic approaches as well as medication will have to be monitored carefully and will change over time. If the person with PTSD is in a situation where the danger continues to exist it is important to address that before continuing in treatment. Those will PTSD may also struggle through issues of depression, substance abuse, suicidal thoughts or attempts and anxiety.

READ: CAUSES OF PTSD IN CHILDREN

Medication

Medication for PTSD include antidepressants which can address the issues of sadness, worry, anger and lack of feeling. If the physician providing the medication is not providing mental health therapy it is important that the two disciplines communicate about the effectiveness of the medication and therapy. Patients should always consult with their physician about additional side effects caused by medication.

Psychotherapy

Therapy may include individual treatment or participation in a group therapy approach. Treatment usually lasts around 6 to 12 weeks, however it can last longer. There is a strong correlation between success in treatment and support from family and friends.

There are various therapeutic approaches that can be implemented by a therapist during treatment. Almost all of the approaches include similar focuses including the understanding of symptoms, behavior skills, coping skills and identifying triggers. The following treatment approaches may be used in conjunction with medication to address PTSD:

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy is focused on changing the patterns of thinking or behavior which in turn changes the way the person feels. CBT works by changing a persons attitude about their behavior by evaluating the thought process. This approach is relatively short term and focuses on helping the person learn additional coping skills and strategies to work through their problems. The lesson Decision Making is a technique used in CBT.

Exposure Therapy

Exposure therapy is a method where the individual is gradually exposed to the things they were traumatized in a safe way. It can implement imagination, writing or visiting the location where the event occurred. The therapist teaches coping skills initially and then slow work with the individual to confront their fears. Exposure therapy can be a one time event or take a long time depending on the progress of the individual. The skill of Preventive Teaching is a technique used in Exposure Therapy.

Cognitive Resurfacing

This approach focuses on helping the person make sense of the traumatic experience. Sometimes people remember things differently than how they actually occurred. The person may feel guilt or shame for something they had no control over. This approach helps individuals look at the event and understand what occurred in a realistic way. The Smarter Parenting lesson Observe and Describe is a technique used by therapists in this approach. The Observe and Describe lesson will be available on the website in May 2016.

A therapist may use a combination of these techniques during treatment.

Children suffering from PTSD can benefit from learning coping skills that are reinforced in the home. Smarter Parenting recommends using Effective Communication and Preventive Teaching to help parents working with children struggling with PTSD. These two lessons are a good start and once mastered should be supported by the other skills on this website.

Customizing Effective Communication for Depression

Effective Communication will be essential in treatment and in the home. Establishing a safe environment where a child can communicate their thoughts and feelings openly will help increase the healing process and decrease stress on the child.

Tips for parents using this skill for PTSD:

Allow communication to be free from your own opinions, resolutions, answers and comments. Allow the child to communicate freely with your acknowledgement only.
Allow your child to communicate about what they want. Do not force the communication to focus on issues they are working on. They will talk about it when they are ready.
Use an activity or game on the lesson page to continue to engage your child in the communication process. This will help generalize the skill to other areas and improve their ability to remember all the steps.

Customizing Preventive Teaching for PTSD

Using Preventive Teaching will help PTSD children process their feelings before situations can trigger them. By addressing the trauma and triggers at home in a safe and neutral environment helps the child learn how to cope.

Tips for parents using this skill for PTSD:

Determine the specific things that trigger your child’s negative behaviors. Choose one specific trigger to focus on first.
Make a plan with your child to practice alternative behaviors to use in situations where they may feel triggered.
Practice the new behaviors at least 3 times or until mastered. If possible, make the practices as realistic to life as possible. Use the specific locations if possible.
Continue to practice the new behaviors. Once mastered, pick a new trigger and continue the process.

There are more parenting skills on Smarter Parenting that work in conjunction with these lessons. Continue learning more of these skills by watching our parenting lesson that will give you additional tools to be a successful parent and raise happy, successful children.

The following resources may be helpful

This booklet on Understanding the Treatment of PTSD is produced by the Veteran’s Affairs Department. The booklet is especially helpful in understanding how treatment can be beneficial.

Get help finding a Support Group online.

Information from the Help Guide helps people understand how they can help someone struggling with PTSD.