Coping with PTSD: symptoms, causes and treatments

[6 MIN READ] 

In this article: 

• Post-traumatic stress disorder (PTSD) is a psychiatric condition that can develop in anyone who’s experienced or witnessed a traumatic event or lived through a traumatic set of circumstances. 
• Symptoms of PTSD can vary depending on whether they appear in an adult or a child. They can also vary in severity and even show up as physical pain, in the form of headaches, muscle tension or nausea. 
• We spoke with Swedish behavioral health expert Jake Choiniere, M.D., who discussed some of the signs of PTSD, as well as what to do if you’re concerned that you or a loved one may be struggling with the disorder. 

Trauma can affect anyone, of any age. It can stem from an isolated event, like witnessing an accident, or a prolonged experience, like military combat or suffering abuse as a child. There’s also some evidence that trauma may be passed down intergenerationally, but Dr. Jake Choiniere, M.D., a psychiatrist at Swedish Issaquah, stresses there is much more to be understood about intergenerational trauma. 

While many people exposed to a traumatic event will experience post-traumatic stress symptoms in the days and weeks following, some will go on to develop a prolonged condition called post-traumatic stress disorder (PTSD), which is diagnosed as a mental health condition. Symptoms may not appear directly after a traumatic event, but for many the disorder can cause significant issues in personal and work relationships and the activities of daily living. There’s also some evidence that trauma may be passed down intergenerationally, but Dr. Jake Choiniere, M.D., a psychiatrist at Swedish Issaquah, stresses there is much more to be understood about intergenerational trauma.

“Some evidence suggests that some of us may be more predisposed to developing PTSD in the face of trauma, and this predisposition may have some genetic component, but which genes or genetic circumstances confer this risk is not clear, and has not lead to any useful treatments to date,” he says.

To learn more we spoke with Dr. Choiniere, about the condition, its symptoms and what to do if you think that you or a family member are struggling with PTSD. 

 What is PTSD? 

The American Psychiatric Association (APA) defines post-traumatic stress disorder as a psychiatric condition that can develop in people who’ve experienced or witnessed a traumatic event, a series of traumatic events or a traumatic set of circumstances. Although PTSD has gone by other names in the past, such as “shell shock” during World War I and “combat fatigue” after World War II, the disorder doesn’t just affect veterans. It can impact anyone, including children and teenagers, and it’s actually twice as common in women as it is in men.  It’s estimated that 7.5 million to 8 million people each year are diagnosed with PTSD, and, on average, around seven out of 100 people develop the disorder after experiencing a significant traumatic event.  

What causes PTSD? 

Certain life circumstances increase the risk of PTSD, such as jobs with higher potential to trauma exposure (e.g. military, first responders, etc,)  or living environments with a higher chance of trauma exposure (e.g. in refugee camps, war zones or high crime neighborhoods, etc.). Some of the risk factors related to the trauma itself include a larger magnitude and duration of the trauma exposure, exposure to multiple traumas, or exposure to trauma during times of otherwise high stress. Because traumatic events can be experienced differently from person to person, not everyone who experiences the same trauma will react the same way, and some people will go on to develop PTSD while others won’t.  PTSD can be rooted in a spectrum of events, including natural disasters, being the victim of a crime, war or combat or emotional abuse, including bullying.  

It’s important for families to allow space or create space for their loved ones with trauma to tell their stories, in a setting that maximizes the sense of safety. Most of the psychological interventions for PTSD are rooted in the idea that the trauma memory needs to be processed and integrated in a way that feels safe for the sufferer, such that the memories are less likely to trigger fear responses over time. - Jake Choiniere, M.D.

What are some common symptoms of PTSD? 

People with PTSD often have intense thoughts and feelings related to an experience from their past that linger for a long time. They may relive the experience through flashbacks or nightmares. They also may avoid situations or people that remind them of their past trauma and may react in negative ways to otherwise normal events, such as a car honking or an accidental touch by a stranger on the bus.  In most cases, symptoms of PTSD develop within three months of the traumatic event, but they can also appear later. Once they appear, they typically persist for months and even years.  PTSD symptoms can vary but they generally fall into four categories:

• Intrusion (or re-experiencing): The repetition of intrusive thoughts or memories, distressing dreams or flashbacks.
• Avoidance: Avoiding people, places or situations that trigger thoughts or memories of a traumatic experience.
• Alterations in cognition and mood: The inability to remember aspects of the traumatic event, a decline in interests you used to enjoy, a detachment from other people, or distorted beliefs about yourself. 
• Alterations in arousal and reactivity: Irritability or frequent outbursts, reckless or self-destructive behavior, irrational suspicion, and trouble concentrating or sleeping. 

PTSD symptoms in children and teenagers are similar to those adults. Teens may develop disrespectful or destructive behaviors, while symptoms in young children differ and may include:

• Bedwetting.
• Forgetting how to talk or becoming non-verbal.
• Acting out the event during playtime. 
• Being unusually clingy with a parent or other caregiver. 

How is PTSD diagnosed? 

To be diagnosed with PTSD, you must have experienced an upsetting traumatic event in your past. It could either have been directly experienced by you, witnessed as something happening to someone else, or something you learned happened to someone else, such as a close family member or friend. It also could be something you were repeatedly exposed to, such as a police officer or social worker regularly hearing about the details of child abuse cases. Although many people exposed to a traumatic event will have PTSD symptoms in the days or weeks following, PTSD isn’t diagnosed unless symptoms last for more than a month and affect a person’s day-to-day life. Adults must exhibit the at least one from each of the categories of symptoms listed above for at least one month to be diagnosed with PTSD. 

How does PTSD differ from other types of trauma responses, such as acute stress disorder or adjustment disorder? 

The main difference between PTSD and acute stress disorder or adjustment disorder is the duration of difficulty.  It is not uncommon to experience past traumatic stress symptom after a traumatic event, such as increased fear and anxiety, trouble sleeping, and difficult memories or dreams of the experience.  However, for most people, these symptoms generally get better over a matter of a few weeks to a month.  In PTSD, the symptoms last more than a month.  Still, most people will recover by six months to one year, but symptoms can certainly last much longer and become chronic.

How can you recognize PTSD — in yourself or in a loved one? 

People with PTSD often have intense thoughts and feelings related to an experience from their past that linger for a long time. They may relive the experience through flashbacks or nightmares. They also may avoid situations or people that remind them of their past trauma and may react in negative ways to otherwise normal events, such as a car honking or an accidental touch by a stranger on the bus. Often, PTSD involves emotional and physical discomfort, including sleep disturbance and anxiousness, especially when exposed to stresses similar to the past traumatic event or when thinking about the event. Other common indicators of PTSD are frequent flashbacks and heightened fight-or-flight sensations. In addition, PTSD commonly occurs with other, related conditions, such as depression and substance use.  

It’s important for families to allow space or create space for their loved ones with trauma to tell their stories, in a setting that maximizes the sense of safety. Most of the psychological interventions for PTSD are rooted in the idea that the trauma memory needs to be processed and integrated in a way that feels safe for the sufferer, such that the memories are less likely to trigger fear responses over time. 

A recent study found a notable uptick in PTSD among college students. PTSD, Anxiety Is Rising Among College Students (usnews.com) Any guidance for parents? 

The best thing parents can do is create the conditions in which their children feel safe and comfortable sharing their difficult experiences. This starts with a practice throughout childhood of checking our fear and reactivity when our children share things that stir discomfort in us.   We want to foster the sense that very little is off the table for discussion.  If our young adult children suffer a trauma, we don’t want a sense of shame or guilt to block them for reaching out to us. 

How is PTSD treated? 

Similar to how not everyone who experiences a traumatic event goes on to develop PTSD, not everyone diagnosed with PTSD requires treatment. In some cases, PTSD symptoms go away on their own, typically with the help of family, friends or a support group. But others need more intensive treatment to recover from the distress they sustained and continue to suffer from months or years after an event. Luckily, PTSD is treatable, and the earlier someone gets treatment, the better their chances of recovery. 

Two of the most common treatment types for PTSD are psychotherapy and medication. Most psychotherapies involve cognitive behavioral therapy techniques designed to help someone with PTSD reprocess their memory of the trauma. For people with PTSD who don’t want to expose themselves to reminders of their past trauma, other psychotherapies, such as interpersonal supportive and psychodynamic therapies, may be helpful. These treatments focus on the emotional and interpersonal aspects of the disorder. In addition, medication can help control symptoms of PTSD. Most often, certain antidepressants are prescribed, either alone or in combination with psychotherapy or other treatments, to help people suffering from PTSD. 

How important is it for mental health professionals to consider cultural differences when diagnosing and treating PTSD? 

Very important because in some cases a person’s background can create difficulty for them in even accepting the notion of having a mental health problem.  They may not want to discuss it because they unfairly blame themselves or otherwise feel shame or guilt about their experience.  Additionally, the interventions that we can offer (largely psychotherapy and medications)  may be viewed in a negative light from certain perspectives, making treatment buy-in difficult. I’ve had difficulty in the past trying to help when there are significant language and cultural barriers that make arriving at a shared understanding of the problem difficult.  People sometimes come from personal or cultural backgrounds from which discussing mental health issues is difficult.  Without a clear shared understanding, it can be difficult to agree on a treatment plan that maximizes the chance of benefit.

Learn more and find a physician or advanced care practitioner (ACP)

If you have questions about behavioral health services, Swedish is here for you. Contact Swedish Behavioral Health and Well-Being. We can accommodate both in-person and virtual visits.

If you think you or a loved one may be suffering from PTSD, talk to a health care professional, whether it’s a trusted primary care provider or a recommended counselor. If it’s an emergency situation, call the 24/7 crisis line at 988 or go to the emergency room. 

Whether you require an in-person visit or want to consult a doctor virtually, you have options. You can also connect virtually with your provider to review your symptoms, provide instruction and follow up as needed. And with Swedish ExpressCare Virtual you can receive treatment in minutes for common conditions such as colds, flu, urinary tract infections, and more. You can use our provider directory to find a specialist or primary care physician near you.

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