Many people think post-traumatic stress disorder (PTSD) is something that occurs mostly in soldiers returning home from war. Not so. In fact, PTSD affects millions of people throughout the United States, and the numbers are no doubt rising due to the pandemic.
In this Q&A, Jonathan DePierro, PhD, Assistant Professor, Psychiatry, and Clinical and Research Director, Center for Stress, Resilience and Personal Growth at the Icahn School of Medicine at Mount Sinai, explains how PTSD develops, what some of the warning signs are, and why having symptoms of PTSD is not a sign of weakness.
What is PTSD?
PTSD is a mental health condition that can develop after someone goes through a life-threatening event, like a car accident, combat, or a serious illness; or when sudden life-threatening events happen to a loved one. Seeing and hearing about human suffering and death at work over and over, like medics, nurses, and 911 dispatchers do, can also contribute to PTSD.
Jonathan DePierro, PhD
What are the symptoms of PTSD?
PTSD involves four types of symptoms that happen at the same time.
- Intrusions – reliving the event with upsetting memories, nightmares, or flashbacks where it truly feels as if the event is happening all over again
- Avoidance – trying very hard to avoid any reminders of the trauma, including talking about what happened
- Negative thoughts and emotions – feeling depressed, angry, numb, mistrustful, guilty, or ashamed
- Hyperarousal – feeling on edge, irritable, having difficulty concentrating, being easily startled, and having poor sleep
These symptoms also need to last for more than a month, be distressing, and/or cause problems for you in your life. Some people may notice changes in their mood, behavior, or relationships right after a trauma; but for others who develop PTSD, symptoms might not develop for many months.
What causes PTSD?
One of the important things to keep in mind about PTSD is that it is the result of a person being exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one or more of the following ways:
- Experiencing it yourself
- Witnessing the event(s) firsthand
- Learning it happened to a loved one
- Indirect exposure to aversive details of the trauma, usually by nature of one’s job
The American Psychiatric Association estimates that about 7 percent of adults in the United States will develop PTSD during their lives. People who do develop PTSD are not “weak.” They have experienced an event that they struggle to understand, and their bodies and brains are “stuck” replaying the event and all the upsetting emotions that come along with it.
How can you recognize the signs of PTSD in someone you know?
People with PTSD struggle to make sense of what happened to them or what they witnessed. They might have upsetting images or memories of the most upsetting parts of the trauma, even though they spend a lot of time trying to avoid anything that might remind them of what happened. The events feel too overwhelming to think or talk about. Spending time with others feels like a lot of work and more stressful, so people with PTSD might withdraw and spent a lot more time alone. Sleep and attention problems are common, because the body is so “on edge” and still reacting as if the trauma is still happening in the present moment.
We also know that people with PTSD tend to see themselves, the future, and other people in their lives through certain “mental filters.” One example is that people with PTSD often blame themselves for things that happened during the trauma, even though that does not make sense. Some of our health care workers experience “moral injury” – blaming themselves all the time for something they did or did not do during the worst of the pandemic.
How is PTSD diagnosed and treated?
If you are concerned that you may be experiencing symptoms of PTSD, speak with your health care provider. They may refer you to a mental health clinician, who can review your symptoms and make a treatment plan. You should also know that depression and PTSD often co-occur, so mention any symptoms of depression you may be experiencing to your providers so they can better understand your needs. If you are concerned about a friend or loved one, speak to them and encourage them to seek help.
Treatment for PTSD directly address avoidance, fear, and negative thoughts. Catching negative thoughts and trying to change them, to make them more realistic and helpful, is a key part of many treatments. Treatment also involves rebuilding a sense of safety that often feels so absent in people with PTSD. Some people with PTSD also find antidepressant medications to be helpful.