Fighting with PTSD

By Aniksha and Alicia

Vetted by Dr. Goh Boon Yeow

Post-Traumatic Stress Disorder, also known as PTSD, is a mental health condition that can emerge following exposure to or after witnessing a traumatic event. Traumatic events encompass a wide range of experiences, including natural disasters, accidents, combat, assault, or any situation evoking intense fear or horror.

According to the DSM-5 criteria to diagnose PTSD,

A. Stressor: PTSD can develop after exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event.

2. Witnessing the traumatic event happen to others.

3. Learning about a close family member or friend experiencing such events. In cases of actual or threatened death of a loved one, the event must have been violent or accidental.

4. Experiencing repeated or extreme exposure to distressing details of the traumatic event, such as in the case of first responders dealing with human remains.

B. Intrusion Symptoms: People with PTSD may experience one (or more) of the following intrusive symptoms related to the traumatic event, which begin after the event occurred:

1. Distressing, involuntary memories of the traumatic event.

2. Distressing dreams related to the traumatic event.

3. Dissociative reactions (e.g., flashbacks) where the individual feels as if the traumatic event are happening again.

4. Intense psychological distress upon exposure to cues resembling aspects of the traumatic event.

5. Strong physiological reactions when exposed to cues resembling aspects of the traumatic event.

C. Avoidance: Individuals with PTSD often persistently avoid stimuli associated with the traumatic event, as shown by one or both of the following:

1. Avoidance of distressing memories, thoughts, or feelings related to the traumatic event.

2. Avoidance of external reminders (people, places, conversations, activities, objects, etc.) that trigger distressing memories, thoughts, or feelings related to the traumatic event.

D. Negative alterations in cognitions and mood: PTSD can lead to persistent negative changes in thoughts and mood related to the traumatic event, as indicated by two or more of the following:

1. Difficulty remembering important aspects of the traumatic event due to dissociative amnesia (not related to substance use or other factors).

2. Persistent and excessively negative beliefs or expectations about oneself, others, or the world.

3. Persistent and distorted thoughts about the cause or consequences of the traumatic event, leading to self-blame or blame towards others.

4. Sustained negative emotional states such as fear, horror, anger, guilt, or shame.

5. Loss of interest or participation in significant activities.

6. Feelings of detachment or estrangement from others.

7. Inability to experience positive emotions such as happiness, satisfaction, or love.

E. Alterations in arousal and reactivity: Individuals with PTSD may show persistent changes in arousal and reactivity related to the traumatic event, as evidenced by two or more of the following:

1. Irritable behavior and outbursts of anger, often with little or no provocation, expressed verbally or physically.

2. Engaging in reckless or self-destructive behavior.

3. Hypervigilance, being highly alert to potential threats, and having an exaggerated startle response.

4. Problems with concentration and attention.

5. Sleep disturbances, such as difficulty falling or staying asleep or experiencing restless sleep.

F. Duration: The symptoms of PTSD persist for more than one month.

G. Functional significance: The PTSD symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

H. Exclusion: The PTSD symptoms are not caused by medication, substance use, or other medical conditions.

PTSD manifests differently in individuals because the origin might differ for different people. This means that the type of trauma and the coping mechanism of the individual will affect the severity of PTSD as well as the symptoms of PTSD that one will experience after a traumatic event., but common signs of PTSD include intrusive thoughts, avoidance of reminders, hyperarousal symptoms such as sleep disturbances and irritability, negative mood and thoughts, and emotional and physical reactions.

Intrusive thoughts involve recurring distressing memories of the traumatic event, causing significant distress. Symptoms may include flashbacks and nightmares. Intrusive thoughts may appear out of nowhere, at any time of day or night, causing unexpected trauma.

Avoidance behaviors are common among individuals with PTSD. They tend to avoid situations, places, or individuals that serve as reminders of the traumatic event. They may also deliberately steer clear of discussing or thinking about the event to shield themselves from distressing memories and associated emotions. They use these behaviors to distract themselves from facing the difficult thoughts and feelings that come along with remembering the traumatic event.

Negative changes in thinking and mood are prevalent in PTSD. This can manifest as difficulty experiencing positive emotions, emotional numbness, distorted blame or guilt, diminished interest in previously enjoyed activities, memory problems, and difficulty concentrating. Individuals will tend to have negative thoughts not only about themselves, but also about people around them or the world around them. They may also have the feeling of hopelessness.

Memory problems can manifest in people with PTSD where over time, they are unable to remember important aspects of the traumatic event because they avoid thinking about it and distract themselves from the event.

Another symptom of PTSD is hyperarousal which consists of having continuous nervousness, irritability, intensified startle response, difficulties with sleep and focus, hypervigilance; constantly being aware of their surroundings.

Coping with PTSD can be difficult. However, seeking professional help from a mental health expert experienced in treating PTSD is crucial, as therapies like cognitive-behavioral therapy (CBT) or eye movement desensitization and reprocessing (EMDR) can be effective in managing the symptoms of PTSD. Building a support system, improving physical health through exercise and relaxation methods, stress management, and avoiding substance abuse are also good coping mechanisms.

Essentially, PTSD can develop at any age and affect anyone who has experienced or witnessed a traumatic event. However, not everyone who experiences trauma will develop PTSD. To mitigate the symptoms of PTSD, people who have suffered from or witnessed traumatic events should seek professional help without any delay.

References

DSM-5 Criteria for PTSD | BrainLine. (2023). BrainLine. https://www.brainline.org/article/dsm-5-criteria-ptsd

What is posttraumatic stress disorder (PTSD). Psychiatry.org - What is Posttraumatic Stress Disorder (PTSD) (n.d.). https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd