The Diagnosis and Treatment of Posttraumatic Stress Disorder
As a provider working in the Hampton Roads area of Virginia, I see a lot of active-duty military members, veterans, and their family members. In working with this population, trauma and PTSD are common diagnoses that I see on a daily basis. However, throughout my career, I have noticed that many individuals do not fully understand PTSD and how therapists can assist in treating its impact on daily functioning. Join me as I explore the symptoms associated with PTSD, why some develop PTSD and others don’t, treatment options, and strategies to support yourself and others in recovery from trauma.
PTSD has been widely talked about in the media, especially in the aftermath of the wars in Iraq and Afghanistan. However, the exact diagnostic criteria for PTSD are often misunderstood in the media.
The DSM-5, TR (2022) defines trauma as exposure to actual or threatened death, serious injury, or sexual violence. The DSM-5, TR (2022) further defines exposure in the following ways:
Directly experiencing the trauma
Witnessing, in person, as the trauma occurs to others
Learning that trauma has occurred to close family members and/or friends
Experiencing repeated or extreme exposure to aversive details of traumatic events
After it is determined that an individual has experienced trauma as defined by the DSM-5, TR, clinicians will then assess for the following symptoms to determine if a diagnosis of PTSD is accurate:
One or more intrusive symptoms
Recurrent, involuntary, and intrusive distressing memories of the event
Recurrent, distressing dreams related to the event
Dissociative reactions (i.e. flashbacks) in which the individual feels and/or acts as though the event were re-occurring
Intense or prolonged psychological distress when exposed to internal or external cues that resemble aspects of the event
Marked physiological reactions to internal and/or external cues that are similar to aspects of the event
One or more avoidance symptoms
Avoidance of distressing memories, thoughts, or feelings about the event
Avoidance of external reminders that cause distressing memories, thoughts, or feelings about the event
Two or more negative alterations in cognition and mood
Inability to remember an important aspect of the trauma
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
Persistent, distorted cognitions about the cause or consequences of the traumatic events that lead the individual to blame self or others
Persistent negative emotional state
Markedly diminished interest or participation in significant activities
Feelings of detachment or estrangement from others
Persistent inability to experience positive emotions
Two or more arousal symptoms
Irritable behavior and angry outbursts
Reckless or self-destructive behavior
Exaggerated startle response
Problems with concentration
It is important to note that children under 6 years old often exhibit slightly different symptoms, including wetting the bed despite being fully potty trained, forgetting how or being unable to talk, acting out the trauma through play, and being unusually clingy with a parent or other adult (NIH, 2020). Older children and teens often exhibit symptoms similar to adults. However, it is also common for older children and teens to experience thoughts related to revenge and/or to develop feelings of guilt associated with their inability to prevent injury or death (NIH, 2020).
After receiving a diagnosis of PTSD, I am often asked why it is that some people develop PTSD while others do not despite being exposed to the same traumatic event. Unfortunately, we do not fully understand why some people develop PTSD while others seem to walk away from trauma largely unaffected. However, research has found factors that seem to impact the likelihood of developing PTSD or other trauma-related disorders. Specifically, the NIH (2020) notes that risk factors in developing PTSD include sustaining an injury, witnessing the injury or death of others, childhood trauma, feelings of horror/helplessness/extreme fear, having minimal social support, a personal or family history of mental illness or substance use, and experiencing extra stressors after the trauma (i.e. job loss). Conversely, individuals who seek out social support after a trauma, learn to feel “okay” with their actions in response to the trauma, possessing adaptive coping strategies to get through and learn from the trauma, and feeling prepared and able to respond to events as they occur decreases the risk for developing PTSD (NIH, 2020).
In terms of treatment for PTSD, the APA (2020) strongly recommends using Cognitive Behavior Therapy, Cognitive Processing Therapy, or Prolonged Exposure Therapy as primary therapeutic approaches as they have been well-validated in research studies. The APA (2020) also notes that psychiatric medications, Narrative Exposure Therapy, and Eye Movement Desensitization and Reprocessing (EMDR) therapy may be considered in the treatment of PTSD. However, these approaches are not as well validated and researched.
While therapy is an important aspect of recovering from trauma, there are several things that you can do for yourself to manage your symptoms. Specifically, the NIH (2020) encourages individuals to establish and maintain routines for exercise, meals, and sleep. It is also beneficial to increase the amount of time spent with friends and family. Additionally, it can be helpful to share things that may trigger PTSD-related symptoms with loved ones. Furthermore, it is necessary to establish realistic goals and expectations for one’s recovery. Finally, it is vitally important to avoid alcohol and drug use in the wake of trauma (NIH, 2020).
Similarly, there are several things that you can do to support a friend or family member who has experienced trauma. It is extremely helpful to learn as much as you can about PTSD so that you may better understand what your loved one is experiencing (NIH,2020). Additionally, pay close attention to your loved one and listen carefully to what they are telling you so that you can learn how to avoid their triggers (NIH, 2020). Finally, invite your loved one to join you on walks, outings, and other positive sources of distraction (NIH, 2020).
In sum, PTSD does not discriminate and can impact individuals of all ages and backgrounds. However, exposure to trauma does not guarantee a diagnosis of PTSD. Rather, there are several risk factors and resilience factors that shape how each individual responds to a traumatic event. There are several treatment options available, some with more empirical support than others. Regardless of the treatment modality used, it is vitally important for individuals who have experienced trauma to seek out mental health care and social support.
About the Author
Dr. Montes is a licensed clinical psychologist and co-owner of Cognitive Behavior Therapy Center in Chesapeake, VA.
American Psychiatric Association. (2022). Trauma- and Stressor-Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed., text rev.).
American Psychological Association. (2020). Treatments for PTSD. American Psychological Association. Retrieved April 17, 2023, from https://www.apa.org/ptsd-guideline/treatments
Dimaggio, G. (2019). To expose or not to expose? The integrative therapist and posttraumatic stress disorder. Journal of Psychotherapy Integration, 29 (1) 1-5. Https://dx.doi.org.10.1037/int0000138
Glad, K. A., Stensland, S., Czajkowski, N. O., Boelen, P. A., & Dyb, G. (2021). The longitudinal association between symptoms of posttraumatic stress and complicated grief: A random intercepts cross-lag analysis. Psychological Trauma: Theory, Research, Practice, and Policy, 14(3), 386–392. https://doi.org/10.1037/tra0001087
U.S. Department of Health and Human Services. (2020). Post-traumatic stress disorder - National Institute of Mental Health. National Institute of Mental Health. Retrieved April 17, 2023, from https://www.nimh.nih.gov/sites/default/files/documents/health/publications/post-traumatic-stress-disorder-ptsd/post-traumatic-stress-disorder.pdf