When you are in a dangerous situation, it’s normal to feel fear and for your body to go into a fight or flight response. This can happen even if you are just anticipating an upcoming danger. Once the threat is gone you’re body returns to normal. This is a healthy response that protects us from harm. However, after a potentially life threatening event, this normal fight or flight response may be altered. People with Post Traumatic Stress Disorder (PTSD) continue to feel as if they are in danger long after the danger has passed. PTSD develops after someone has experienced serious harm or was in a situation that could have involved such harm. The harm may have occurred to themselves or they may have observed it or heard about it happening to someone they care about. The stressor is generally outside the range of normal human experience such as rape, torture, combat, natural disasters, or crashes among other types of trauma.
Lifetime prevalence rates for PTSD are estimated at 8.7% while 12 month prevalence rates in the U.S. are estimated at 3.5%. There are higher rates among veterans who saw combat and others whose jobs entail danger of harm or death such as first responders, fire-fighters, police or emergency personnel. The highest rates are found among people who have survived rape, military combat, captivity, or genocide. Estimated prevalence rates are lowest among older individuals.
Disorders that tend to co-occur with PTSD include:
- Bipolar Disorder
- Anxiety Disorders
- Sleep Disorders
- Substance Use Disorders
- Major Neurocognitive Disorders
Causes of PTSD
While there are many theories regarding what leads some individuals to develop PTSD while others in similar situations who don’t develop the disorder, there is little evidence for one theory over another. Some causes with the most support include:
Genetics: There is some evidence genes specifically involved in creating fear memories may play a role in the development of PTSD.
Brain Structures: Certain brain structures may play a role in PTSD development. For example the amygdala is known to be important in learning to fear certain events, situations or conditions such as touching a hot stove, along with learning what not to fear. Some research suggests the amygdala may not function optimally in individuals who develop PTSD. Another brain area which is thought to be compromised in individuals with PTSD is the prefrontal cortex which is responsible for extinguishing fear responses over time.
Temperamental Qualities: Temperamental qualities, inherited tendencies which are the building blocks for personality, have also been linked to the development of PTSD. Examples of temperamental qualities linked to PTSD include anxiety, neuroticism, introversion, and emotional reactivity. However, temperament may also protect people against developing PTSD. In particular those who desire a high activity level and are open to novelty appear to be at lower risk of developing the disorder.
Stress Hormones: It has been shown individuals with PTSD have higher levels of epinephrine and norepinephrine and lower levels or cortisol than their peers. These three hormones are responsible for the fight or flight response. This leads to the individual always remaining in fight or flight mode. This has been believed to lead to a lot of the symptoms observed in individuals with PTSD.
Traumatic Life Experience: When individuals have experienced a large amount of severe life stressors they appear to be at a higher risk of developing PTSD when later exposed to a potentially life threatening traumatic event.
Symptoms of PTSD
- Behavioral symptoms:
- Avoidance of anything physically or symbolically associated with the traumatic event
- Efforts to avoid anything causing the traumatic event to be remembered
- Self-sabotage or self-harm
- Psychological symptoms:
- Invasive disturbing memories of the traumatic event
- Bad dreams related to the traumatic event
- Flashbacks – the person feels as if they are re-experiencing it
- Intense distress caused by reminders of the trauma
- The inability to experience positive emotions
- Memory loss of parts of the traumatic event
- Developing negative beliefs about oneself, others or the world
- Incorrect or maladaptive beliefs about what caused the traumatic event such that the individual may develop the belief they themselves caused the event to occur
- Negative mood state
- Difficulty concentrating or maintaining attention
- Social symptoms:
- Feeling detached, separated or estranged from others, even those closest to them
- Irritability, anger outbursts and at times violent behavior especially when experiencing a flashback
- Lack of interest in activities once viewed as enjoyable
- Physical symptoms:
- Muscle tension and pain
- GI Problems
- Over arousal or exaggerated startle response
Effects of PTSD
The effects of PTSD can be severe and long lasting without treatment. Common effects of PTSD include:
- Self-medication with alcohol and substances
- Sleep problems
- Intrusive thoughts and memories lead to difficulty concentrating and attending
- Hopelessness, helplessness
- Suicidal thoughts or behavior
- Use of self-harm to distract from thoughts, memories or emotions
- Compromised immune system
- Low self-worth
- Emotional numbing
- Survivors guilt
- Avoidance of social situations involving individuals who didn’t have the same traumatic experiences
- Problems in family relationships
- Marital problems or divorce
- Lost time from school or work
- Being unable to get a job
- Social withdrawal
- Loss of financial security