Post-Traumatic Stress Disorder, or PTSD, is a mental health condition characterised by the failure to recover from exposure to a traumatic event, bringing about intense, disturbing thoughts and feelings related to the experience. Contrary to the widely-held belief, victims of PTSD need not necessarily experience the traumatic event first-hand – PTSD can also arise from witnessing something shocking, terrifying or disturbing. Similarly, PTSD triggers can have a broad spectrum, and the cause differs for everyone. Not everyone has to go through extreme, drastic events such as a war to develop PTSD – the condition can also be brought on by other distressing experiences such as abuse, accidents, assaults, or even adverse health or childbirth-related experiences.
How is PTSD diagnosed?
As with most other mental health disorders, clinicians use the Diagnostic and Statistical Manual of Mental Disorders as a guideline to diagnose PTSD. The diagnostic criteria below are specific to adults, adolescents, and children older than six.
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Criterion A: Stressor
(one required)
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The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
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Criterion B: Intrusion Symptoms
(one required)
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The traumatic event is persistently re-experienced in the following way(s):
- Unwanted upsetting memories
- Nightmares
- Flashbacks
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
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Criterion C: Avoidance
(one required)
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Avoidance of trauma-related stimuli after the trauma, in the following way(s):
- Trauma-related thoughts or feelings
- Trauma-related external reminders
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Criterion D: Negative Alterations in Cognitions and Mood
(two required)
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Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
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Criterion E: Alterations in Arousal and Reactivity
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Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
- Irritability or aggression
- Risky or destructive behaviour
- Hypervigilance
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
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Criterion F: Duration (required)
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Symptoms last for more than 1 month.
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Criterion G: Functional Significance (required)
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Symptoms create distress or functional impairment (e.g., social, occupational).
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Criterion H: Exclusion (required)
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Symptoms are not due to medication, substance use, or other illness.
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Two Specifications
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Dissociative Specification
In addition to meeting the criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:
- Depersonalization: Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
- Derealization: Experience of unreality, distance, or distortion (e.g., “things are not real”).
Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although the onset of symptoms may occur immediately.
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How PTSD May Go Undetected
Not all individuals will have their condition diagnosed and recorded on paper. The pervasive misconceptions about its complex cluster of symptoms can hinder one from seeking treatment, or simply realising that one may be suffering from PTSD.
In the early onset of the disorder, attempts to weather the storm by turning to short-term coping mechanisms may include binge eating or distracting themselves with their favourite TV shows. However, this is not effective – nor is it healthy – in the long run. In addition, people with comparatively “less traumatising” experiences may feel as though they did not “earn” the diagnosis, considering that others might have gone through worse. This behaviour of downplaying one’s trauma can hold them back from seeking early treatment, as it may seem more convenient to adopt the mindset that they can quickly get over it in due course. With avoidance being the hallmark of PTSD, many victims turn to therapy only after long periods of struggling with the disorder, as if therapy were the last resort. But with delayed treatment, these individuals run the risk of having to navigate symptoms that, with earlier treatment, may never have developed in the first place.
Treatment Options for PTSD
Psychopharmacological Treatment
At present, the evidence-based pharmacological treatment for PTSD involves the use of Selective Serotonin Reuptake Inhibitors (SSRIs), which include medications such as Sertraline and Paroxetine. While there are also other medications available, these two are currently the only ones approved by the FDA for PTSD.
SSRIs play a well-recognised role in the management of mood and anxiety disorders. Their mode of action involves raising the levels of Serotonin, a neurotransmitter vital in regulating mood, anxiety, appetite, sleep, and other bodily functions.
Of course, there is no one-size-fits-all. While SSRIs are typically prescribed to treat PTSD, there are exceptions depending on the patient’s medical history. Clinicians will have to consider the patient’s response to the drugs, existing comorbidities, and personal preferences. As such, medications have to be tailored to each individual’s needs.
Cognitive Behavioural Therapy (CBT)
One of the more common forms of psychotherapy, CBT aims to tackle the maladaptive thought processes and emotions associated with one’s trauma. Trauma-focused CBT involves three main categories – exposure procedures, anxiety management procedures, and cognitive therapy. These aim to help individuals understand what they’re afraid of, learn healthy and effective coping mechanisms, and work through dysfunctional thoughts.
Moreover, having a therapist or psychologist that is trauma-informed can be of great benefit. A trauma-informed therapist is knowledgeable about trauma and can understand and empathise with how the traumatic experience could have impacted the patient. Prioritising physical and emotional safety ensures a smoother clinician-client collaboration, which in turn aids in increasing the transparency and efficacy of treatment.
Eye Movement Desensitisation Therapy (EMDR)
Eye Movement Desensitisation Therapy may be less commonly heard, but it is an efficacious, empirically validated treatment for trauma and other adverse life experiences. In a different vein from cognitive behavioural therapy, EMDR doesn’t focus on altering a client’s thought patterns or behaviours. Instead, it relies on one’s own rapid, rhythmic eye movements, allowing the brain to process memories and resume its natural healing process. Simply put, EMDR therapy involves guiding the client towards reliving triggering experiences in short phases while the clinician directs his eye movements. When the client’s attention is diverted as they recall the traumatic event, the exposure to negative thoughts and memories is less upsetting, limiting a strong or negative psychological response.
To have a more detailed read on EMDR, do check out our article: Treating Trauma With Eye Movement Desensitisation and Reprocessing (EMDR)
If you suspect that you may be suffering from PTSD, do reach out and seek early intervention for the betterment of your physical and mental health.
References:
- https://cnalifestyle.channelnewsasia.com/wellness/pstd-post-traumatic-stress-disorder-symptoms-308861 (Accessed 19/04/2022)
- https://www.brainline.org/article/dsm-5-criteria-ptsd (Accessed 19/04/2022)
- https://www.apa.org/ptsd-guideline/treatments/medications (Accessed 19/04/2022)
