Trauma and Stressor Related Disorders

A somewhat surprising fact is that of people who are exposed to traumatic events, most recover over time and do not develop ongoing problems. However, survivors of traumatic events can end up suffering from a condition called posttraumatic stress disorder (PTSD) and continue to feel extreme anxiety and helplessness long after the trauma.

PTSD can develop after individuals experience events that involve actual or threatened serious injury, death, or sexual violence. PTSD can develop if individuals have experienced traumatic events directly, witnessed these events happening to others, learned about these events happening, or had repeated exposure to the details of these types of events (i.e., first responders, police officers).  Common types of traumas that are linked to PTSD symptoms include serious accidents, physical assault or abuse, military combat, natural disasters, terrorist incidents, and sexual assault or abuse.

What exactly is PTSD?

If you have experienced a traumatic event, it is important for you to understand that you are not alone. At least half of Americans have had a traumatic event in their lives. Of people, about 1 in 10 men and 2 in 10 women will develop PTSD.  Current literature estimates that 8% of the US population currently meets criteria for PTSD. There are some things that make it more likely you’ll develop PTSD — for example, it’s more common to develop PTSD after certain types of trauma, like combat and sexual assault. In the end, there’s no way to know for sure who will develop PTSD.

What is it? PTSD is more than just a collection of symptoms. The disorder is a whole that is greater than the sum of its parts, which profoundly affects those who suffer from its lives. Beyond the symptoms, many experts in the field believe that PTSD is actually a disruption in the natural recovery process that we all are capable of after one or many traumatic events. This disruption can happen for many reasons, such as being a situation in which prevents the opportunity to process the event(s), having a very intense or long-lasting trauma, or physical injury. Thus, treatment (discussed more below) is focused on removing barriers in individuals’ lives, which may be unknowingly in the way of their own, built-in recovery process.

Symptoms of PTSD:

After experiencing something traumatic, it may be difficult to do normal activities, like go to work, go to school, or spend time with your friends and family. However, most people start to feel better after a few weeks or months. If it’s been longer than a few months and you’re still having significant symptoms, you may have PTSD. For some people, PTSD symptoms may not actually appear until months or even years after the event has occurred. Symptoms may come and go over time.

There are 4 types of PTSD symptoms, but they may not be exactly the same for everyone. Each person experiences symptoms in their own way.

  1. Reliving the Event: Unwelcome thoughts about the trauma can come up at any time. They can feel very real and scary, as if the event is happening again. You may also have nightmares. Memories of the trauma can happen because of a trigger — something that reminds you of the event.
  2. Avoiding things that remind you of the event: You may try to avoid certain people or situations that remind you of the event. For example, someone who was in a major accident on a certain highway may go out of their way to take different routes or avoid driving at all. You may also try to stay busy to keep you from having to talk or think about the event
  3. Having more negative thoughts and feelings than before: You may feel more negative than you did before the trauma. You might be sad or numb — and lose interest in things you used to enjoy, like spending time with family and friends. You may feel that the world is dangerous and you can’t trust anyone. It may be hard for you to feel or express happiness, or other positive emotions. You might also feel guilt or shame about the traumatic event itself. For example, you may wish you had done more to keep it from happening.
  4. Feeling on edge: It’s common to feel jittery or “keyed up” — like it’s hard to relax. This is called hyperarousal. You might have trouble sleeping or concentrating, or feel like you’re always on the lookout for danger. You may suddenly get angry and irritable — and if someone surprises you, you might startle easily. You may also act in unhealthy ways, like smoking, abusing drugs and alcohol, or driving aggressively.

Other Disorders Related to PTSD:

Something that is often confusing to people is that it is possible to have symptoms of PTSD without actually meeting diagnostic criteria for the full disorder. Thus, symptoms are on a spectrum with only the more severe forms of the problem being what we formally call “PTSD.” However, treatments used for the full-blown problem are often used for and are effective for other, trauma-related problems that do not meet criteria for PTSD. For those with symptoms after a traumatic event, here are a couple of other disorders that they may meet criteria for:

Acute stress disorder (ASD)

Symptoms of ASD are very similar to those of PTSD, with some minor exceptions, and a diagnosis is given if symptoms are present between 3 days and 1 month following a traumatic event. For some people, symptoms of ASD will decrease after a few weeks and will not persist. For others, the symptoms continue for longer than 1 month after the trauma and a diagnosis of PTSD may then be appropriate.

Adjustment disorders

Many individuals develop emotional or behavior problems following other stressful life events that are not included in the diagnoses of PTSD and ASD. Examples of these types of stressors include marital problems, a relationship break-up or divorce, job-related difficulties or losing a job, illnesses that lead to increasing levels of disability, living in areas of high crime, etc. Adjustment disorders are diagnosed when symptoms that develop in response to these types of events involve marked distress that is greater than expected and also lead to impairment in important areas of functioning. Adjustment disorder reactions can involve predominant feelings of anxiety and/or depression, as well as changes in behavior.

Complex PTSD

In some cases people experience chronic trauma that continues or repeats for months or years. People who experience chronic trauma often report additional symptoms alongside formal PTSD symptoms, such as changes in the way that they see themselves, the world and the way they react to the environment around them. Complex PTSD is not currently a formal, separate diagnosis classification. However, we at HATC understand that cases that involve prolonged, repeated trauma may indicate a need for special treatment considerations.

How do I know if I have PTSD or another related disorder?

The only way to know for sure is to talk to a mental health care provider. The clinicians at HATC will ask you about your trauma, your symptoms, and any other problems you have. Most likely, you will be given formal assessment (paper and pencil along with structured interviews) that will help your clinician to accurately determine the nature of your difficulty and the best treatment approach as well as give you helpful feedback.

How are trauma-related disorders treated?

When PTSD isn’t treated, it usually doesn’t get better — and it may even get worse. It’s common to think that your PTSD symptoms will just go away over time. But this is unlikely, especially if you’ve had symptoms for longer than a year. Even if you feel like you can handle your symptoms now, they may get worse over time. Getting treatment can help keep PTSD from causing problems in your relationships, your career, or your education — so you can live a much better quality of life.

For those that do develop PTSD, decades of research have shown that trauma-related symptoms can be effectively treated, even many years after traumas have occurred. The psychologists at HATC have considerable experience treating individuals who have experienced a wide range of traumatic and stressful events and we provide what are called “evidence based” treatments for trauma-related symptoms.

Can a therapist really understand what I’ve been through?

Therapists can treat your PTSD whether or not they have been through trauma themselves. What’s important is that your therapist understands how you think about your experience, so she can teach you the skills you need to manage your symptoms.

Is it ever too late to get treatment for PTSD?

It’s never too late. Treatment can help even if your trauma happened years ago. Additionally, research has shown that treatment for PTSD is far more effective now than it was decades ago. If you tried treatment before and you’re still having symptoms, it’s a good idea to try again.

What if I don’t feel ready for treatment?

It’s normal to feel like you’re not ready for treatment, or to come up with reasons why now isn’t the right time, such as you can’t afford it or you’re too busy. It’s important to understand that not wanting to talk or think about the trauma can actually be a symptom of PTSD. You may never feel truly ready to get help for PTSD, but if you’re having symptoms, it’s better to get treatment now than to wait. The sooner you get treatment, the sooner you can start to feel better.

What are the treatment modalities for trauma-related symptoms used at HATC?

At HATC, 3 types of evidence based therapies that are proven to help people with trauma-related symptoms are utilized. In each of these talk therapies, you’ll meet with a therapist once or twice a week. These treatment protocols usually last for 3 to 4 months. If you have residual symptoms after your course of treatment, you and your therapist can talk about other ways to manage them.

Types of talk therapy for trauma-related symptoms:

Prolonged Exposure Therapy (PE)

PE is an empirically validated with more than 20 years of research supporting its use that is specifically designed to help clients process traumatic events and reduce trauma-induced symptoms. Numerous well-controlled studies have shown that PE significantly reduces the symptoms of PTSD, depression, anger, and anxiety in trauma survivors. In fact studies have shown PE that produces clinically significant improvement in about 80% of patients with chronic PTSD.  Currently, PE has more empirical research to support its efficacy than any other treatment for PTSD although other techniques are shown to be equally effective (e.g., EMDR and CPT).

Practitioners throughout the United States and many foreign countries currently use PE to successfully treat survivors of varied traumas including rape, assault, child abuse, combat, motor vehicle accidents and disasters.

PE instills confidence and a sense of mastery, improves various aspects of daily functioning, increases client’s ability to cope with courage rather than fearfulness when facing stress, and improves their ability to discriminate safe and unsafe situations.

Cognitive Processing Therapy (CPT)

After a trauma, it’s common to have negative thoughts — like thinking what happened is your fault or that the world is very dangerous. CPT helps you learn to identify and change these thoughts. Changing how you think about the trauma can help change how you feel. What happens during CPT? You’ll talk with your therapist and fill out worksheets about the negative thoughts and beliefs that are upsetting you. Then your therapist will help you challenge those thoughts and think about your trauma in a way that’s less upsetting.

Eye Movement Desensitization and Reprocessing (EMDR)

The effectiveness of E.M.D.R. therapy has been well established as the result of about 20 randomized controlled studies. These studies show that EMDR produces more improvement than absence of treatment, at least for alleviating the symptoms of civilian PTSD, such as those triggered by rape. The evidence that pertains to EMDR’s efficacy for other anxiety disorders is promising.

People with PTSD react with intense, negative emotional to the memory of their traumas. EMDR can help clients process trauma-related memories, thoughts, and feelings. In this treatment, people are taught to focus on specific sights, sounds, or sensations while thinking or talking about their trauma. This helps the brain effectively process traumatic memories and information. Over time, individuals can change how they react to memories and reminders of the trauma. Body sensations, emotions, negative self-directed thoughts are all important components of this treatment. Clients will be asked to focus on a particular aspect about this memory while having the client focus attention to a sound (like a beeping tone) or a movement (like your therapist’s finger moving back and forth). Gradually, the memory may become less upsetting, and clients begin to work on developing positive, adaptive thoughts about themselves in the future.

Will I be prescribed medication for trauma-related symptoms?

When you have PTSD, you may not have enough of certain chemicals in your brain that help you manage stress. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors) are medications that can help raise the level of these chemicals in your brain so you feel better. Before starting to take medication to treat PTSD, you’ll talk to a psychiatrist (a doctor who specializes in mental health). When you first start taking medication, you’ll check in with the doctor often to talk about how the medication is working. You may need to try a few different medications to find one that works. Medications can treat PTSD symptoms alone or with therapy — but only therapy treats the underlying cause of your symptoms. If you treat your PTSD symptoms only with medication, you’ll need to keep taking it for it to keep working.

Some doctors may prescribe a type of anxiety medication called benzodiazepines (or benzos) — but benzodiazepines aren’t a good treatment for PTSD. They can be addictive, cause other mental health problems, and make PTSD therapy less effective. If you’ve been taking benzodiazepines for a long time, talk to your doctor about making a plan to stop. Ask about PTSD treatments that are proven to work and other ways to manage your anxiety.

How effective is treatment?

Here’s the good news: you can get treatment for PTSD — and it works. For some people, treatment can get rid of PTSD altogether. For others, it can make symptoms less intense. Treatment also gives you the tools to manage symptoms so they don’t keep you from living your life. PTSD treatment can turn your life around — even if you’ve been struggling for years.

PTSD TREATMENT CAN CHANGE YOUR LIFE. Click here for more information on the clinical practice Guidelines for the Treatment of PTSD.

Additional Resources

National Institute of Mental Health (NIMH) – An organization with the National Institute of health dedicated to mental health research.

Army Behavioral Health – A PTSD informational website provided by the U.S. Army Medical Department for the support of Soldiers and their families.

National Center for PTSD (NCPTSD) – A center established by the U.S. Department of Veteran Affairs to improve the well-being of U.S. veterans through PTSD research and education

International Society for Traumatic Stress Studies (ISTSS) – Organization for the study of psychological trauma that promotes advancement and exchange of knowledge about traumatic stress.

Eye Movement Desensitization and Reprocessing (EMDR) International Association – The EMDR International Association (EMDRIA) is a professional association where EMDR practitioners and EMDR researchers seek the highest standards for the clinical use of EMDR therapy.

EMDR Institute, Inc. – The EMDR Institute™, founded by Dr Francine Shapiro in 1990, offers quality trainings in the EMDR™ methodology, a treatment approach which has been empirically validated in over 24 randomized studies of trauma victims. An additional 24 studies have demonstrated positive effects for the eye movement component used in EMDR therapy.