Understanding PTSD: Causes, Symptoms, and Treatment

Many of us have heard the term PTSD or Post-traumatic Stress Disorder, but what does it mean and who does it affect? According to the US Census Bureau, approximately 13 million adults have PTSD (US Census, 2023). PTSD may occur in people who have experienced or witnessed a traumatic event, series of events or set of circumstances. Some examples can include natural disasters, serious accidents, terrorist acts, war/combat, rape/sexualassault, generational trauma, intimate partner violence and bullying. PTSD was initially known as “shell shock” during WWI and “combat fatigue” after WWII. However, PTSD does not only happen to combat veterans. PTSD can occur in anyone, regardless of age, race, nationality, socioeconomic status. When we look a little deeper into who PTSD impacts, we find that women are more likely to experience PTSD, while U.S. Latinos, African Americans and Native Americans/Alaskan Natives have disproportionately higher rates of PTSD than others.

How do we know if someone is experiencing PTSD?

Let’s break down the criteria of PTSD from the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5-TR), which is the clinical handbook for diagnosing mental health issues. PTSD is characterized by the 4 symptom clusters: Intrusion (re-experiencing), persistent avoidance of stimuli, negative alterations in cognitions and mood, and marked alterations in arousal andreactivity. (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. DSM-5™-TR. American Psychiatric Publishing; 2022.) Let's do a further breakdown of each of the four categories and what the symptoms could look like.

• Intrusion: these can be intrusive thoughts, memories, distressing dreams, or flashbacks of the traumatic event.
• Avoidance could look like avoiding reminders of the traumatic experience, including people, places, activities, situations or even objects that remind the individual of the experience.
• Alterations in cognition and mood could be inability to remember parts of the traumatic experience. This is explained by what is happening when our body goes into trauma response. There are two parts of the brain, the logical/reasoning (front part) and the instinctual/reptilian (back part). The front part of the brain is in control of logic, reason,memories, management of executive functions. While the back part of the brain is responsible for survival. When a traumatic experience occurs, the back part of our brain becomes activated to help us survive.
• We go into fight or flight mode. Fight mode would look like tight jaw, grinding teeth, urge to punch, intense anger, knot in stomach, wanting to attack the source of danger. In flight mode, your body does not believe it canfight off the danger so it flees the danger. There is an increase in hormones (adrenaline), which will allow your body to run more than normal to avoid danger. Some signs of flight could be dilated and darting eyes, numbness in legs/arms, fidgety, tense or trapped feeling. There are additional stressor responses that can occur in the body which are called freeze and fawn. When freeze happens, there is a sense of being stuck/unable to move. Staying still until the danger passes. The last one is Fawn, this occurs if fight, flight or freeze doesn’t occur. Fawn looks like over-agreement, overly helpful, or concerned with making someone else happy.

All of us experience moments of trauma, but we do not all end up with PTSD. Whenever a traumatic experience happens, our body responds in the moment (either fight, flight, freeze, or fawn), but we eventually come back down to homeostasis, our normal place. However, people who end up with PTSD get stuck on in the trauma response and do not come back down to homeostasis. What do we do when that happens? There are lots of therapeutic modalities that we can utilize when working with someone with diagnosed PTSD. Some of the most successful therapeutic modalities for treating PTSD include Prolonged Exposure, EMDR, and CPT.

What are these modalities and how do they work?

1. Prolonged Exposure (PE) is a talk therapy for PTSD, a type of cognitive behavioral therapy. PE teaches you to gradually approach the memories, feelings and situationsassociated with the traumatic experience that the person has been avoiding. Avoidance can work temporarily,but in the long run it does not help you to recover from the experience. PE allows you to face your fears and brings you back to homeostasis and you learn to manage your symptoms.
2. Eye Movement Desensitization Reprocessing is another modality used to work with your PTSD symptoms and reduce the impact of the symptoms. EMDR is another form of talk therapy that can help an individual process the upsetting memories, thoughts, feelings, and beliefs associated with the traumatic experience. Whentraumatic experiences occur, it can be difficult to make sense of what happened. EMDR is a modality thatallows you to make sense of the experience. EMDR utilizes bilateral stimulation while a person recalls their traumatic experience. The bilateral stimulation activates both the left and right side of the brain. The individual is stimulated by following a finger, light bar, tapping, or sound, that is adjusted by the clinician,while recalling the traumatic experience. EMDR is one of the most effective types of treatment for PTSD and has been researched for over 40 years.
3. The last modality we will talk about is Cognitive Processing Therapy (CPT). CPT is a type of Cognitive Behavioral Therapy that is broken into 12 (or 13 if a death is involved in the traumatic experience) sessions. CPT teaches you to assess and change your upsetting thoughts. When we change the way we think, it impacts the way we feel and the way we act. CPT involves writing the experience out and discussing and re-evaluating the narrative with your clinician.

There are many additional ways to work with PTSD symptoms, however, these three are some of the most researched and evidenced based modalities. There are some really great resources and readings that you can look into to get a better understanding of trauma, how it impacts you across the lifespan and how to manage your symptoms. Some bibliotherapies that do a nice job of breaking down PTSD are:

1. The Body Keeps The Score - Bessel van Der Kolk, MD;
2. No Bad Parts - Richard Schwartz;
3. It Didn’t Start With You - Mark Wolynn;
4. What Happened to You? -Dr. Bruce Perry
5. Waking the Tiger - Peter Levine

Some additional resources to be used include meditation, grounding techniques, somatic experience, and yoga. We have a number of clinicians at Pillars of Wellness well versed in working with clients with PTSD and trauma. Please do not hesitate to reach out to explore ways to manage your symptoms.