One-third of people who experience severe, prolonged trauma, such as military combat, severe neglect, or prolonged sexual assault, will develop the disorder. An estimated two-thirds of people who are exposed to mass violence will develop the disorder. PTSD can also surface after acutely distressing or frightening experiences, such as violent assaults, serious auto accidents, natural disasters, or the death or illness of a close friend or family member. Previous exposure to trauma increases an individual’s risk of developing PTSD. PTSD is not typically associated with divorce or job loss.
It is estimated that 8% of Americans will suffer from PTSD at some point in their lives.
The symptoms of PTSD
PTSD is expressed by a variety of symptoms, all of which can make it difficult to live life and participate in typical daily activities. Sufferers of PTSD exhibit symptoms that fall into three categories: re-experience symptoms, avoidance symptoms, and arousal symptoms.
Re-experience symptoms occur when sufferers of PTSD have flashbacks, and relive the trauma they experienced over and over again, even when they are attempting to focus on other things. This can include symptoms like:
- Irregular but repeated flashbacks, accompanied by feelings of fear, horror, and stress that accompanied the initial traumatic event.
- Feeling as though the event is happening all over again.
- Hearing, seeing, or smelling things that remind the survivor of the event and causing them to remember the traumatic event. These particular symptoms are called triggers, and can include things like the smell of a barbeque, a dark hallway, or a certain touch.
Avoidance symptoms occur when PTSD sufferers feel numbness and detachment, and isolate themselves from people and places that might trigger old memories or reminders, often to the detriment of their physical and emotional health. This can include behaviors like:
- Avoiding crowds because they seem threatening or dangerous.
- Avoiding driving because the trauma was experienced in a car, or military convoy.
- Avoiding certain movies, television shows, or news coverage that takes place or talks about the area the trauma was experienced.
- Avoiding help by keeping busy in order to dissociate from the event in an attempt to forget it.
Arousal symptoms are categorized by feelings of irritability, edginess, as well as nightmares and difficulty sleeping. This can include symptoms like:
- Feeling jittery and paranoid, constantly on the lookout for potential signs of danger.
- Having difficulty relaxing or falling asleep.
- Having difficulty concentrating and feeling easily startled by quick movements or loud noises.
- Wanting to remain in the corners of rooms or restaurants in order to be on the lookout for potential threats; always remaining near the exits in a building or shopping mall.
Additionally, people suffering from PTSD might experience changes in long held feelings and beliefs, and changes in the way they think about themselves, or others in their life. They may have difficulty developing or maintaining positive feelings towards other people in their life, and their relationships will suffer as a result. Some people suffering from PTSD attempt to block out the traumatic event entirely, and are unable to talk or communicate about their experience at all. This is particularly dangerous, as these memories need to be addressed and de-traumatized before healing can occur.
How is PTSD diagnosed?
PTSD symptoms can begin immediately following a traumatic event. Most people who survive a significant trauma will recover, given time; however, stress-induced reactions to trauma that persist over time, or get worse as time goes by, may ultimately be diagnosed as PTSD.
There are three categories of PTSD:
- Acute PTSD is diagnosed when symptoms last between one and three months following the trauma.
- Chronic PTSD occurs when symptoms persist for three months or longer.
- Individuals suffering from delayed PTSD do not exhibit symptoms for at least 6 months following trauma. This form of PTSD is often found in adults who have experienced childhood trauma.
PTSD is not officially diagnosed until a person’s symptoms persist for at least one month and continue to cause extreme distress, including severe interference with work and home life.
Before diagnosing PTSD, a doctor will perform a physical exam in order to confirm there are no other medical problems that are contributing to a patient’s symptoms. A psychological exam will follow, in which a patient’s symptoms are discussed along with the event or events that preceded them. The American Psychiatric Association uses criteria defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to confirm a patient’s diagnosis. This manual requires an individual to have been exposed to a traumatic event that involved the actual or possible threat of death, violence, or serious bodily harm. Exposure can occur in a number of ways, including direct exposure, witnessing an experience that happens to someone else, learning a close friend or family member has experienced a dramatic event, or by repeated exposure to multiple traumatic events.
The science behind PTSD
The brain is, arguably, the most important organ in the human body. When impacted by illness or injury, it can have life-altering effects. In very rare cases, brain injuries can unlock new skills, turning an ordinary person into a savant, but more frequently the effects are devastating.
In order to treat brain injuries, it is absolutely critical to understand the underlying problem and contributing factors. With PTSD, which can manifest itself in a variety of ways and over long periods of time, this is particularly true.
Three areas of the brain are particularly important when considering PTSD: the amygdala, the hippocampus, and the prefrontal cortex.
The amygdala is the part of the brain responsible for responding, automatically, to stress and fear. It works continuously the evaluate the environment and respond accordingly. The amygdala also plays a key role in memory consolidation, and the more emotionally significant a memory is, the more active the amygdala is in coding its memory storage. In this way, the amygdala categorizes certain memories as points of reference for future reactions. Ultimately, when the amygdala recognizes danger signals, it triggers the fight-or-flight response.
The hippocampus is the part of the brain responsible for storing and retrieving memories. It works much like the hard drive of a computer. Sights, sounds, and smells associated with dangerous or frightening memories are stored here, along with more mundane information such as your home address and the color of your first car. The memory storage of the hippocampus is independent of the amygdala, but the two systems interact when emotion and memory meet.
The prefrontal cortex is the large section of your brain that sits right behind your forehead. This region of the brain is responsible for personality, cognition, rational thought, and decision making.
In the instance of a trauma, the hippocampus works quickly to calm the amygdala alarm bells. When activated, this alarm circuit triggers the hypothalamic-pituitary-adrenal axis, named for the three glands that control many processes within the body, including the digestion, energy storage, immune system response, and more. When the hippocampus can’t calm the amygdala, the prefrontal cortex takes over. Under conditions of chronic stress, the prefrontal cortex can experience dendrite atrophy and fatigue, which can lead to increased anxiety and PTSD-like behaviors.
When a person is suffering from PTSD, the circuits connecting the amygdala, hippocampus, and prefrontal cortex are not working as they should. When the override system experiences chronic stress it comes depleted and is more likely to experience malfunctions. Malfunctions can result in the hippocampus being unable to store memories correctly, and can leave the amygdala in a state of constant fear and stress.
Because symptoms of PTSD must occur for a month or longer before someone is diagnosed, a person who has very recently experienced a traumatic event may re-experience their trauma a number of times before getting help. These recurrences can occur through racing thoughts and flashbacks, but also through nightmares. This occurs because the amygdala is essentially always signaling imminent danger. Recent trauma survivors might also exhibit arousal symptoms such as irritability, hypervigilance, and jumpiness for the same reason.
While a diagnosis of PTSD indicates that an individual has experienced a severe and devastating trauma, it is possible for the brain to heal. Working with a trained medical professional to address the traumatic memories in a safe environment will begin to heal the circuits and pathways connecting the amygdala, hippocampus, and prefrontal cortex. It is incredibly difficult to recover from PTSD alone. Support from the community, family, and friends will go a long way towards helping an individual suffering from PTSD to recover.
Why do people with PTSD have sleep problems?
While many people have occasional trouble sleeping, those suffering from PTSD can experience increased anxiety and nightmares that making sleeping extremely difficult.
When a person is constantly on alert, it is difficult to have a restful night of sleep. When a person is easily startled by noise or movement, it can be nearly impossible to fall asleep in the first place. Combining these symptoms with worries over getting enough can produce a devastating cycle that leaves PTSD sufferers awake for hours on end. In addition to trouble falling asleep, nightmares are a very common symptom of PTSD. Nightmares can become so bad that they cause a PTSD sufferer to wake-up during the night, or make it difficult to fall asleep in the first place from fear of having a nightmare.
Individuals suffering from PTSD are also more likely to abuse drugs and/or alcohol. They may use these substances as coping mechanisms to deal with their symptoms, but drugs and alcohol can have detrimental effects on the sleep of a healthy person, let alone someone suffering from PTSD. Alcohol, in particular, modulates sleep cycles and increases the likelihood that an individual will wake up during the night, ultimately resulting in lower quality sleep.
Lastly, PTSD sufferers are frequently dealing with other medical problems in conjunction with their PTSD, including chronic pain or digestion issues. Physical ailments like these can also make sleep difficult.
Common sleep disorders for people suffering from PTSD
Sleep disorders, when compounded by PTSD, present differently when compared to the same sleep disorders experienced by the general population. For example, while people suffering from primary insomnia have difficulties falling asleep, they still are able to achieve sufficient sleep compared to those suffering from insomnia and PTSD related sleep loss. Generally, people suffering from PTSD have more inconsistent and erratic sleep patterns compared to a general population of individuals suffering from sleep disorders.
New research also correlates severe PTSD resulting from military service overseas to an increased risk of sleep apnea. The same research showed the risk of sleep apnea was significantly lower in service members who did not deploy. While the link between PTSD and sleep apnea remains unclear from this research, both of these disorders are responsible for a decreased quality of life.
Sleep help for people suffering from PTSD
By making minor changes to their bedroom or sleeping area, a person suffering from PTSD can increase the likelihood that they will sleep well. Attempting to sleep in an environment with a lot of noise, light, or activity will be detrimental to anyone’s ability to get restful sleep, this is particularly compounded from someone suffering from PTSD.
Some simple changes that can make a bedroom amenable to sleep include:
- Removing the TV, radio, and phone charging station out of the bedroom. It is especially critical to remove artificial blue light (tablets, laptops, cell phones).
- Using the bedroom only for sleep and sex.
- Using curtains to block out the light, and keep the room otherwise cool and quiet.
- For some people, a white noise machine can help induce sleep.
To establish a regular sleeping pattern, critical to good and restful sleep, the following healthy sleep habits should be observed:
- Establish a sleep schedule by setting a routine bedtime and wake-up time.
- Create a set of customary practices around bedtime to help with relaxation. Some examples include taking a warm bath, drinking a cup of caffeine-free tea, reading a book, or listening to some soft music.
- If night and noise are a problem, consider using a sleep mask or earplugs to block out light and sound.
- Rise at the established wake-up time everyday, even if feelings of tiredness remain. Over time, this routine will help a person fall asleep quicker and wake up without an alarm.
- On the weekends, sleep no longer than one hour past the standard wake-up time.
Certain daytime activities can help or hinder a nightly sleep cycle. For example, drinking a lot of caffeinated beverages during the course of the day can keep a person up at night. Drinking alcohol before bedtime can also inhibit good sleep, causing the sleeper to wake up more frequently during the night. Here are some other tips for how to spend the waking hours:
- Exercise during the day, but not within 2 hours of bedtime.
- Spend time outside in the sun. Sunlight helps regulate the body’s natural sleep and wake cycles.
- Avoid napping, especially in the evening.
- Avoid taking medicines that have an excitatory effect in the evening and instead take them earlier in the day (when possible according to the doctor who prescribed them).
People suffering from PTSD and having trouble sleeping because of anxiety, or frequently nightmares, might also talk to their doctor about prescribing a medication that might help reduce nightmares and other sleep problems by blocking the adrenaline hormone.
There are also many homeopathic remedies that might help some people suffering from PTSD, but in general, more evidence is needed to determine the effectiveness of these remedies. For example, the herb stramonium, which is thought to help individuals suffering from nightmares, has never been tested in a clinical trial setting.
Additional Online PTSD Resources
Are you concerned you may be suffering from PTSD? Take this quiz to learn if you may benefit from seeking professional help for PTSD.
The National Center for PTSD, located in Washington D.C. and funded by the US Department of Veterans Affairs, funds research directed at helping individuals suffering from PTSD. These research projects often seek out sufferers of PTSD and provide financial incentive to participants. In some cases, projects seek volunteers without PTSD to serve as controls.
Some current research opportunities funded by the National Center for PTSD include the following:
- A study of tobacco treatment as augmentation to Cognitive Processing Therapy for PTSD, located in Boston, MA. This study seeks to understand how tobacco use affects PTSD recovery, and is ongoing until March 2019.
- A study of Neurobiological and Psychological Benefits of Exercise in Chronic Pain and PTSD, located in Boston, Ma. This study seeks to understand the benefits of exercise to individuals suffering from chronic pain and PTSD, and is ongoing until October 2017.
- A study of Structural and Spectroscopy Pharmaco-Imaging Paradigm to Investigate the Effect of Riluzole in Patients with Post-Traumatic Stress Disorder (PTSD), located in West Haven, CT. This study seeks to determine the efficacy of a pharmacologic, Riluzole, in improving PTSD symptoms, and is ongoing until 2018.
To learn more about these and other trials, check your eligibility, or join a trial, follow the link here.
There are many forums and support groups online that engage individuals and families who are recovering from trauma or suffering from PTSD. Here are a few that might be useful:
- https://www.myptsd.com/ – Hundreds of forums and thousands of users to connect with.
- https://www.va.gov/directory/guide/PTSD.asp – Program locator for combat veterans, free regardless of enrollment status.
While PTSD is often associated with military service, it can surface following any number of traumatic events. In conjunction with a solid support system and good medical care, the following blogs may provide additional perspective and coping mechanisms for dealing with and healing from PTSD:
- Healing Combat Trauma is designed for veterans but will be useful for anyone suffering from PTSD.
- The Wounded Times is dedicated to combat veterans suffering from PTSD, and publishes contributions from around the globe.
- The Family of a Vet addresses the confluence of PTSD and TBIs (traumatic brain injuries), and is written by veterans in conjunction with their family and close friends.
For veterans and non-veterans
- PTSD Survival is written by a PTSD survivor who advocates for self-care and offers strategies for reclaiming your life after trauma.
- Heal My PTSD offers advice and strategies for dealing with the symptoms associated with PTSD and includes many personal stories from PTSD survivors.
- The Center for Mind-Body Medicine publishes contributions from dozens of experts in several fields including medicine, nutrition, and self-care, and offers a holistic approach to treating PTSD.
Twitter can be an excellent resource for connecting with people around the world. Here are a few twitter accounts that address PTSD from perspectives of healing and education:
For many individuals suffering from PTSD, working through their trauma is first step towards healing. The PTSD Workbook was written by specialists in complex trauma and is critically acclaimed. The Complex PTSD Workbook is another option for those suffering from Complex PTSD. Lastly, The Body Keeps Score has over one thousand five star reviews on Amazon and is the #1 seller in several categories of mental health scholarship, including PTSD, Psychopathology, and Psychiatry.