Post-Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD) is a psychiatric disorder that can happen after traumatic experiences or concussions. This page covers the symptoms, diagnosis and treatment of PTSD. You can learn about various aspects of the disorder and find resources to get treatment.
Table of Contents
What is PTSD?
PTSD is a psychiatric disorder that can cause intrusive thoughts and memories about a past traumatic event, and intense negative feelings of anxiety, fear, or sadness. Without proper treatment, the symptoms can last years, and can often be heightened by exposure to reminders of the trauma. For example, veterans may see flashbacks after hearing fireworks. According to the American Psychiatric Association, “PTSD affects approximately 3.5% of US adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime.” PTSD can affect anyone, although the most common people it affects are veterans and victims of intimate partner violence (IPV) or domestic violence. Both these populations often suffer from traumatic brain injuries (TBI) as well.
Veterans
Veterans are affected by PTSD disproportionately compared to the general population. According to the Veterans Association (VA), around 12% of veterans have PTSD. Because of the nature of war, soldiers are frequently exposed to situations that may be traumatic. A study found that veterans have experienced 3.4 potentially traumatic events on average. Veterans can develop PTSD solely from a traumatic event or concurrently with a blast-related mTBI (concussion).
Victims of intimate partner violence (IPV)
While less research has been done on PTSD with IPV than veterans, the disorder is widespread for women who have experienced IPV. According to a study published in NCBI, 51-75% of women who experience IPV develop PTSD. To give a sense of the scale of the problem, 20-40% of women in the US have reported IPV. Also, IPV puts women at more risk for mental health issues, including depression and substance abuse. It is an incredibly prevalent issue.
Symptoms
According to the American Psychiatric Association, symptoms include but are not limited to:
Unwanted memories, nightmares, or repetitive thoughts about the traumatic event
Avoiding situations that remind you of the event, aversion to talking about it
Clouded or distorted memory of the event
Consistent negative thoughts about yourself
Feeling on-edge or having angry outbursts
You may experience a few or many of these symptoms.
PTSD and Concussions
The interaction between traumatic brain injuries (TBI), concussions, and PTSD is complex. According to a review by Andrew Mayer, people who have sustained a TBI are 1.5 times more likely to develop new-onset PTSD. The study looked at all severities of TBI, not just concussions, so the risk of new-onset PTSD may be different for a concussion specifically. Another study found that PTSD experienced alongside all-severity TBI is associated with decreases in memory and executive function. These decreases are caused by abnormalities in white matter tracts, the amygdala, the prefrontal cortex, and the hippocampus. PTSD and TBI can cause some of these abnormalities individually, but together they may cause an additional increase in these abnormalities. In addition, mild traumatic brain injuries (mTBI) and PTSD were also shown to have worse effects on the brain while together than on their own.
The kind of injury that caused the concussion can also affect the patient's symptoms and risk of PTSD. A study showed that veterans who experience blast-related concussions have a higher incidence of headaches and PTSD than those who experienced non-blast-related concussions.
Diagnostics
At a minimum, a PTSD diagnosis requires exposure to a traumatic event, but this exposure can also happen indirectly. Your exposure can occur in several ways:
You experience a traumatic event
You witness someone else experience a traumatic event
You learn of a loved one's traumatic experience or exposure
You are regularly or repeatedly exposed to details of traumatic events
The list is not comprehensive, and you may experience one or more of these criteria.
During diagnosis, the doctor will evaluate your symptoms and outward signs of PTSD and review the traumatic event with you. A commonly used screening tool is the PC-PTSD-5. It involves a brief set of questions, and it has been shown to be quite effective at diagnosing PTSD. The doctor will also check for other medical issues that may be causing your symptoms. PTSD may overlap in profile with some persistent post-concussive symptoms (PPCS). PPCS can cause significant mood changes, including depression, anxiety, and increased irritability. However, flashbacks, intrusive thoughts, and avoidance of potential trauma triggers found in PTSD differentiate it from PPCS. A patient may also have PTSD and PPCS from the same traumatic event.
In the future, we may be able to predict the onset of PTSD following an mTBI using neuroimaging. A study by Dr. Murray Stein and others, published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, found that volume decreases in specific regions of the brain post-mTBI could predict the onset of PTSD. The study compared MRI results taken within two weeks of the injury to tests for PTSD at 3 months and 6 months. The researchers found that volume decreases in the cingulate cortex, the superior frontal cortex, and the insula were predictive of PTSD. This study could be valuable to potentially catch PTSD before it starts in patients who have experienced a traumatic event.
Treatment
PTSD is a terrible illness to experience, but you can get better with the right support. There are several options for treatment available today, and more are being researched right now.
Cognitive Behavioral Therapy (CBT)
CBT is based on the idea that unhealthy patterns of thinking contribute to psychological problems. CBT seeks to reverse those patterns and find healthier ways of coping. According to the American Psychological Association, common strategies of CBT include:
Learning to recognize and reevaluate distortions in thinking that are causing problems
Gaining a better understanding of the behavior and motivation of others
Using problem-solving skills to cope with difficult situations
Learning to develop a greater sense of confidence in your abilities
The specific treatment plan used varies significantly between patients and will be customized to your needs. The therapist works with you to determine what kinds of thoughts contribute to your condition and figure out the best path forward. According to the American Psychological Association, CBT is very effective for treating a variety of issues, including PTSD. If you want to learn more, go to our page on cognitive behavioral therapy.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye movement desensitization and reprocessing, or EMDR, seeks to reprogram how you process a traumatic event. In EMDR, the therapist asks you to focus on memories of your trauma while following an external stimulus with your eyes, resulting in side-to-side eye movements. Often, the therapist will move their finger back and forth or use a bar with LED lights. This process helps patients change unhealthy beliefs about themself and the event and combats the body's physiological stress response. Scientists theorize that these eye movements tap into the biological systems in rapid eye movement (REM) sleep, which is fundamental to learning and reprocessing memories. A study found that EMDR is effective at treating PTSD and is often more effective than other treatment options.
Exposure Therapy
Exposure therapy is a psychological treatment that can help people confront and cope with their fears. It is used to treat a variety of problems, including phobias, panic disorders, and PTSD. Exposure therapy works by exposing patients to situations that they would typically avoid due to trauma or fear and helps them overcome that impulse. There are several different methods of exposure, including:
Exposure to a trigger in real life
Imagining the triggering situation, object, or person
Virtual reality
Over time, this treatment can lower a patient’s reaction to the feared situation, object, or person and help them reformulate beliefs about themself and their fears.
Prazosin- pros and cons
Prazosin is a blood pressure drug that can lessen the symptoms of PTSD, help with sleep problems, and reduce suicidal ideation. A 2014 study showed that prazosin is quite effective. However, a recent study found that the drug actually made sleep problems worse in many patients and did not reduce suicidal ideation. An article by Scientific American discussed the pros and cons of prazosin, saying that clinicians should still prescribe it for some patients.
Veterans Association treatment options
The VA has a PTSD app that can help you learn more about PTSD and how to manage it. It can track your symptoms and provide you with resources to deal with them, and connect you with the support you need. While it’s from the Veterans Association, it is available to the general public. The VA's National Center for PTSD is another excellent resource to learn about treatment options.
Light Therapy
Light therapy, or photobiomodulation, has been shown in several case studies to have positive effects for retired football and hockey players with a history of repetitive head impacts or concussions. The football case studies showed improvements in PTSD symptoms. Light therapy works by shining near-infrared and red light into the brain through the skull. Research showed that this therapy increased cerebral blood flow, (ATP) energy production, neuroprotection and brain repair, and reduced inflammation. However, it remains to be seen whether it could help PTSD specifically.