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Posttraumatic Stress Disorder (PTSD)

It is estimated that 70% of adults in the United States have experienced at least one traumatic event. Of these 70% of Americans who have experienced trauma, around 20% will develop PTSD and at any given time, approximately 5% to 6% of Americans can be identified as having PTSD. 

What is Posttraumatic Stress Disorder (PTSD)?

According to the American Psychiatric Association (2022), PTSD is a diagnosable psychiatric disorder that occurs in individuals who have been exposed to traumatic events or circumstances that result in a negative impact on their mental, physical, and social functioning. While what could be considered traumatic to an individual is often subjective, some common examples of traumatic events include the following:

  • natural disasters
  • war/combat
  • sexual assault
  • childhood abuse
  • bullying
  • serious accidents such as an automobile accident

While exposure to a traumatic event is the typical precursor to PTSD, it is important to note that an individual can also develop PTSD when they have learned a traumatic event happened to a close family member or friend or if they have experienced “repeated or extreme exposure to aversive details of the traumatic event(s)” (American Psychiatric Association, 2022). For example, a police officer being consistently exposed to cases involving child abuse. 

Symptoms of PTSD are separated into four different categories:

  • Intrusion: repeated distressing memories of the event that are involuntary, recurrent nightmares, flashbacks in which the individual feels/acts as if the traumatic event is occurring again
  • Avoidance: avoiding external reminders and distress memories, thoughts, or feelings about the event
  • Negative alterations in mood and cognition: negative beliefs about oneself and the world (e.g. “The world is not a safe place”), negative emotional state (e.g. fear, anger, shame), loss of interest in hobbies and activities
  • Alterations in arousal and reactivity: irritability and outbursts of anger, hypervigilance, sleep disturbances

Where is PTSD most common?

While anyone can be exposed to trauma and develop PTSD, there are certain populations and demographics that are more likely to develop PTSD. 

  • Women are more likely to develop PTSD than men, with around 8% of women and 4% of men developing it at some point in their lives (U.S. Department of Veterans Affairs, 2023).
  • 9% of individuals aged 45-59 have had PTSD at some point in their lives compared to 6% of those aged 18-29, 8% of individuals aged 30-44, and 3% of those 60 and older National Center for PTSD, 2023)
  • Latinos, African Americans, and Native Americans/Alaska Natives in the United States are affected by PTSD at higher rates. While race alone is not a risk factor, raced-based trauma is a risk factor (American Psychiatric Association, 2022) 
  • Around 7% of veterans will develop PTSD at some point in their lives (U.S. Department of Veteran Affairs (U.S. Department of Veteran Affairs, 2023). 
  • Nearly 33% of all rape victims will develop PTSD at some point in their lives (U.S. Department of Veteran Affairs, 2022). 
  • An estimated 10-15% of first responders have been diagnosed with PTSD (Klimley et al., 2018). 

How Trauma and PTSD affect the brain?

There are three areas of the brain that are most impacted by PTSD, which include the amygdala, hippocampus, and prefrontal cortex. The stress caused by exposure to trauma can lead to long-lasting changes in these areas of the brain as well as neurochemical changes, particularly with regard to cortisol, the stress hormone, and norepinephrine, a neurotransmitter used by the sympathetic nervous system whose release is triggered by stress (Bremner, 2006). 

In individuals with PTSD, the alarm system our brain is equipped with becomes overly sensitive and in turn, is triggered more easily resulting in deficits in our thinking and memory as the brain focuses on protecting itself. The amygdala serves as the trigger to the alarm system while the prefrontal cortex acts as the “brakes” and helps to regulate emotional responses. In PTSD, the prefrontal cortex often struggles to do its job of regulating emotional responses, and our hippocampus, also known as the memory center, struggles to encode information correctly, in turn impacting an individual’s memory of an event (CHAMP, 2017). In individuals with PTSD, with an overactive amygdala, they often find themselves in constant “fight or flight” mode. 

Anger, Violence, Trauma & PTSD

Anger is a common response to trauma due to heightened arousal and in individuals with PTSD the response to a threat can become “stuck,” leaving an individual in survival mode. As such, an individual may react to stress as if their life was threatened, with an automatic response of anger and irritability (Chemtob et al., 1997). Researchers have explored posttraumatic anger and broken it down into three categories:

  • Arousal: In individuals with PTSD, heightened tension and arousal can become normal, resulting in a higher intensity of emotional and physical feelings of anger. One may feel more “keyed up” or irritable as a result. 
  • Behavior: A common response to a threat is to act aggressively in an effort to protect oneself. This not only includes physical aggression but also self-injurious behaviors and verbal aggression. 
  • Thoughts & Beliefs: Negative thoughts and beliefs can develop after exposure to trauma, such as the belief that the world is not a safe place or that others cannot be trusted. With this, there may be a greater need to control one’s surroundings, resulting in an inflexibility with others that could provoke hostility from oneself and others.   

While PTSD has been associated with an increased risk of violence, studies indicate most individuals with PTSD have never engaged in violence. There are mitigating factors such as substance use, comorbid psychiatric disorders, and age that are considered in the connection between PTSD and violent behaviors. Essentially, those with PTSD have an elevated prevalence of these risk factors that are associated with increased violence. As such, these factors must be taken into account when examining the association between an individual’s PTSD and violent behaviors. For example, in a study examining a sample of the United States population, excluding combat veterans, there was a 7% risk of violence identified in those with PTSD compared to 3% in those without PTSD. However, researchers then controlled for anger and alcohol use, and subsequent results indicated PTSD was no longer associated with an increased risk of violence (Blakey et al., 2017).

How to Treat PTSD?

There are a number of different types of treatment for PTSD ranging from traditional talk therapy to medication to more nontraditional approaches such as eye movement desensitization and reprocessing therapy (EMDR). 

  •  Talk Therapy: Individual therapy, particularly trauma-focused treatment, can be beneficial in addressing the negative cognitions associated with the trauma and resulting PTSD. The American Psychological Association strongly recommends utilizing a form of cognitive behavioral therapy (CBT) such as cognitive processing therapy (CPT) which focuses on identifying, modifying, and challenging the negative and unhelpful beliefs related to one’s trauma. 

  • Eye Movement Desensitization and Reprocessing (EMDR) Therapy: EMDR is a form of individual therapy that includes both a talk therapy aspect coupled with bilateral stimulation, which is typically therapist-directed lateral eye movements, in which an individual is asked to briefly focus on the traumatic memory while simultaneously experiencing the bilateral stimulation. The idea is that EMDR facilitates the ability to access traumatic memories and create new associations between traumatic memories and more adaptive memories and information. 

  • Medication: Psychotropic medication can be a helpful tool in regulating the negative impact that PTSD has on mood, appetite, sleep, and more. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) have proven to be the most helpful for use in the treatment of PTSD by increasing the neurotransmitter serotonin in the brain which in turn can improve mood, decrease anxiety, and regulate appetite and sleep. 

References

American Psychiatric Association. (2022). What is posttraumatic stress disorder (PTSD)? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

American Psychological Association. (2020). Summary of recommendations of the APA guideline development panel for the treatment of PTSD. https://www.apa.org/ptsd-guideline/treatments

Blakey, S. M., Love, H., Lindquist, L., Beckham, J. C., & Elbogen, E. B. (2017). Disentangling the link between posttraumatic stress disorder and violent behavior: Findings from a nationally representative sample. Journal of Consulting and Clinical Psychology. Advance online publication. doi:10.1037/ccp0000253

Bremner, J.D. (2006). Traumatic stress: Effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445-461. doi:10.31887?DCNS.2006.8.4/jbremner

Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., & Smith, G. (1997). Anger regulation deficits in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 10(1), 17-35.

Consortium for Health and Military Performance (CHAMP). (2017). How PTSD affects brain “circuitry.” https://www.hprc-online.org/mental-fitness/mental-health/how-ptsd-affects-brain-circuitry

Klimley, K.E., Van Hasselt, V.B., & Stripling, A.M. (2018). Posttraumatic stress disorder in police, firefighters, and emergency dispatchers. Aggression and Violent Behavior, 43, 33-44. 

Lee, L. (2019). PTSD and aging. PTSD Research Quarterly, 30(4), 1-15. https://www.ptsd.va.gov/publications/rq_docs/V30N4.pdf

U.S. Department of Veterans Affairs. (2023). How common is PTSD in adults? https://www.ptsd.va.gov/understand/common/common_adults.asp

U.S. Department of Veterans Affairs. (2023). How common is PTSD in veterans? https://www.ptsd.va.gov/understand/common/common_veterans.asp

U.S. Department of Veterans Affairs. (2022). Sexual assault against females. https://www.ptsd.va.gov/professional/treat/type/sexual_assault_female.asp 

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