Post-traumatic stress disorder (PTSD) is an anxiety disorder primarily characterized by the development of specific symptoms following exposure to a particularly stressful event or an extreme traumatic event involving death, the threat of death, serious injury and/or a physical threat to the affected person and/or others.
When and how does this condition usually appear?
Post-traumatic stress disorder can occur at any age, including childhood. Symptoms typically begin within three months of the traumatic incident, although there may be a delay of several months or even years before symptoms appear. The condition may appear, for example, following an abnormally disturbing experience such as sexual assault, violent personal assault, theft, being taken hostage, being incarcerated as a prisoner of war, fire, a serious car accident, etc. For some individuals, simply witnessing a violent or tragic event is enough to cause PTSD.
Are some specific characteristics of PTSD related to one’s culture or age?
Strictly speaking, there do not seem to be any specific characteristics which are related to one’s culture or age. However, it seems that higher rates of PTSD occur in regions of social unrest and/or civil war. PTSD may also occur in children, although the way in which some symptoms manifest may differ from adult cases.
What kinds of thoughts, behaviours and/or emotions may be associated with and/or observed in people suffering from PTSD?
When these individuals experience, witness or are indirectly exposed to a particularly traumatizing event, in the first moments they usually suffer intense fear, horror or a sense of hopelessness. Afterward, a range of specific symptoms and behaviours may appear, such as:
- a decrease in responsiveness to the outside world;
- recurring memories and/or dreams related to the traumatic event which are invasive, persistent and provoke a significant degree of suffering;
- avoidance of certain objects, situations and/or people that are closely or loosely linked to the traumatizing event;
- the appearance of very intense, persistent symptoms of anxiety (hyperwakefulness).
When a person suffering from PTSD is exposed to events which resemble or symbolize an aspect of the traumatic event (e.g., the anniversary of the event, cold or snowy weather for survivors of death camps in cold regions, entering any elevator for a woman who was sexually assaulted in an elevator), an intense psychological disturbance or physiological (bodily) reaction often occurs. In addition, people suffering from PTSD typically make a conscious effort to avoid thoughts, feelings or conversations related to the traumatic event and activities, situations or people that cause them to relive or recall it in memory. This avoidance of memories may include amnesia with regard to significant parts of the event (i.e., not remembering a specific aspect of the trauma).
A decrease in responsiveness to the outside world typically begins shortly after the traumatic event. Individuals suffering from PTSD may complain of a marked decrease in interest/participation in activities that used to be sources of pleasure for them. As well, they may feel detached or alienated from others and/or have a notably diminished capacity for feeling emotions (especially those associated with intimacy, tenderness and sexuality). It is also not unusual for people suffering from PTSD to feel that their future has been somehow “cut off” or “mortgaged” (e.g., they no longer expect to get married and have children or to lead a normal life).
People with PTSD display persistent symptoms of anxiety and hyperwakefulness that were not present before the trauma. These symptoms may include: difficulty in getting to sleep or remaining asleep (possibly due to recurring nightmares in which they relive the traumatic event), hyperalertness and/or exaggerated and startled reactions. Also, some people become irritable, short-tempered or have difficulty concentrating.
Besides the above, some individuals with PTSD may also recount painful feelings of guilt because they survived the traumatizing event (e.g., an airplane accident, a war) while others did not or because of what they had to do to survive. Finally, the following symptoms may occur (especially following distress of an interpersonal nature, e.g., sexual or physical abuse as a child, being taken hostage, torture):
- Self-destructive or impulsive behaviour;
- Dissociative symptoms;
- Somatic complaints;
- Feelings of ineffectiveness, shame, despair;
- Feeling different from before;
- Loss of former beliefs;
- Hostility and social retreat/withdrawal;
- Feeling constantly threatened;
- Changes in relations with others and/or in aspects of their personality.
Is a person exhibiting some of the above symptoms necessarily suffering from PTSD?
It should be noted that in order to establish a diagnosis of PTSD per se, the symptoms must persist over time (i.e., more than one month) and be clinically significant or cause problems in significant areas of life, such as social or professional functioning. Avoiding certain situations or activities symbolizing or resembling the original trauma may disrupt personal relationships and could lead, for example, to spousal conflict, divorce and/or loss of employment.
Do the symptoms of PTSD have the same duration and/or intensity for all affected individuals?
No. PTSD may, for example, be particularly severe or prolonged if the source of distress is related to actions by another person (e.g., torture, rape). In addition, the probability of developing this condition may increase in relation to the intensity and physical proximity of the source of distress. Health professionals can define the type of PTSD based on characteristics such as when the symptoms started and how long they have lasted, i.e.:
- acute PTSD (symptoms persist for less than three months);
- chronic PTSD (symptoms persist for three months or more);
- delayed onset PTSD (six months pass between the traumatic event and the onset of symptoms).
It should also be noted that the symptoms, the relative impact of reliving or re-experiencing the traumatic event, avoidance and hyperwakefulness may vary over time. The duration of symptoms is likewise variable, with a complete recovery occurring within three months in about half of cases, while many other individuals have symptoms that persist more than 12 months after the trauma.
How do health professionals diagnose an individual with PTSD?
Health professionals are generally able to diagnose an individual suffering from PTSD through clinical interviews, with the assistance of various evaluation tools (questionnaires, charts, etc.). Physicians and psychiatrists are the only professionals who can make a diagnosis. The reference used is usually the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM IV is the edition currently used most often.
How many people in the general population are afflicted by PTSD?
Studies conducted with the general public have shown incidence rates of PTSD during a lifetime to be 1% to 15.2%. However, studies of high-risk individuals (e.g., former soldiers, victims of criminal violence) have generally reported incidence rates between 30% and 45%.
Are there differences between men and women with regard to PTSD?
It has been observed that the PTSD rate seems to be higher among women than it is among men (11.3% vs. 6%). It also seems that the nature of the trauma is generally different for men and women. The risk of exposure to a traumatic event is slightly higher for men than it is for women, however.
Can a person suffering from PTSD overcome it alone?
The scientific literature on PTSD has demonstrated that it is possible for an individual suffering from the condition to significantly reduce their symptoms and return to a satisfactory level of social, professional and interpersonal functioning without professional treatment. However, professional help is important when the general functioning of an individual with PTSD symptoms is affected and/or there is a significant degree of distress associated with the condition. The treatments generally recommended and used in cases of PTSD are cognitive-behavioural therapy (CBT) (French content) and pharmacotherapy (French content).
What should be done when someone appears to be or is suffering from PTSD?
If someone appears to be or is suffering from PTSD, it’s important to suggest a consultation. It’s also important to learn more about the problem and not hesitate to ask for help when needed.
Is cognitive-behavioural therapy effective for PTSD?
Results from a number of controlled studies have confirmed that cognitive-behavioural therapy is effective for treating PTSD. Indeed, according to research, CBT is at this time the most effective psychotherapeutic approach for treating PTSD.
What techniques are used in cognitive-behavioural therapy for PTSD?
- Psychoeducation
Psychoeducation involves providing information to the person suffering from PTSD about, for example, their post-traumatic reaction, the origin of their symptoms and the factors causing the disorder. Affected individuals very often don’t understand what is happening to them and wrongly believe that it is abnormal to have such a reaction. Through psychoeducation, affected individuals will be better able to understand what is happening to them, which sometimes helps to reduce certain symptoms.
- Diaphragmatic breathing (or respiratory re-education)
Diaphragmatic breathing is one of the techniques applied to help manage anxiety. Among other things, it enables individuals to feel in control of anxiety, assists them in relaxing and reduces hyperventilation and other related symptoms as needed.
- Cognitive correction
Cognitive correction is explained to individuals suffering from PTSD and then practiced by them. This technique involves identifying and then modifying dysfunctional or problematic thinking. The goal of the technique is to reduce the worries that cause and sustain anxiety by providing information, asking questions and dealing with reality. With this technique, people suffering from PTSD are helped to better manage guilt, anger and other painful feelings as needed. This is done by providing them with information and teaching them strategies they can adopt in order to modify the dysfunctional thinking that causes unpleasant feelings.
- Problem-solving
Problem-solving is a technique that helps to better orient people suffering from PTSD with regard to the actual problems they have experienced and assists them in resolving those problems more effectively. This technique is comprised of seven steps: defining the problem, devising solutions, evaluating the pros and cons of each solution, choosing a solution or combination of solutions to apply, trying the solution(s), evaluating the results and, finally, modifying the solution(s) or applying another as needed.
- Imaginal and in vivo exposure therapy
Exposure therapy (gradual and sustained) is an important form of intervention, and it has been proven to be effective in the treatment of PTSD. The goal of the intervention is to gradually reduce the negative impact of cognitive disturbances (e.g., memories, flashbacks and nightmares related to the trauma) on the affected individual’s daily functioning. The objective is thus for these thoughts to no longer cause the individual to experience intense, painful emotional reactions and for the individual to no longer seek to avoid various situations related to these reactions. Exposure therapy (imaginal and in vivo) involves gradually exposing the person suffering from PTSD to situations (and/or places, images, sensations, noises, odours, etc.) related to the trauma and usually feared or avoided. Through this technique, the affected individual’s body becomes accustomed to no longer reacting in an intense manner to particular situations. At the beginning, the psychologist practices this therapeutic exercise with the patient. Subsequently, the latter can apply this strategy by him or herself between meetings, until the previously identified situations cause few intense emotional reactions or none at all.