Explaining the Comprehensive Approach to PTSD Diagnosis

What Is PTSD?

The National Institute of Mental Health (NIMH), a subset of the NIH, states that post-traumatic stress disorder (PTSD) is “a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.”

Unlike traditional feelings of fear that only last a few seconds, this condition is characterized by a prolonged period of trauma response.

“This ‘fight-or-flight’ response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened, even when they are not in danger,” states the NIMH.

PTSD Prevalence

PTSD is most frequently associated with returning veterans from a dangerous warzone. A common misconception about PTSD is that it can only be triggered by a hazardous event such as a war. Despite this understanding, PTSD can be caused by things such as sudden loss, among many other experiences.

PTSD can be experienced at any age. Common causes of PTSD include physical or sexual assault, abuse, accidents, and disasters.

The National Center for PTSD states that 60% of men and 50% of women will experience a traumatic event in their lifetime. The National Center for PTSD also suggests that “women are more likely to experience sexual assault and child sexual abuse, while men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.”

According to the National Center for PTSD, 6% of people in the United States will have PTSD at some point. That percentage amounts to approximately 12 million adults in the US each year. Despite this number, exponentially more people will have experienced trauma.

The number jumps to 8% for women, while men develop PTSD at a rate of 4%.

Regarding PTSD in children and adolescents, the National Center for PTSD notes, “to date, no population-based epidemiological study has examined the prevalence of PTSD among children. However, studies have examined the prevalence of PTSD among high-risk children who have experienced specific traumatic events, such as abuse or natural disasters. Prevalence estimates from studies of this type vary greatly; however, research indicates that children exposed to traumatic events may have a higher prevalence of PTSD than adults in the general population.”

Causes

Because the causes of PTSD are widespread, two people experiencing the same event at the same time may have differing responses. One may develop PTSD while the other does not. There is no clear understanding of what, besides a traumatic experience, causes PTSD.

It is thought that a mix of stressful experiences, inherited mental health risks, temperament, and brain chemistry may contribute.

PTSD Diagnosis

The Mayo Clinic recommends that “if you have disturbing thoughts and feelings about a traumatic event for more than a month, if they're severe, or if you feel you're having trouble getting your life back under control, talk to your doctor or mental health professional. Getting treatment as soon as possible can help prevent PTSD symptoms from getting worse.”

According to The Mayo Clinic, PTSD diagnosis typically involves a physical exam, a psychological evaluation, and the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The physical exam rules out any non-psychological medical causes for the symptoms experienced.

Symptoms

The symptoms of PTSD vary heavily from person to person.

For most patients, the onset of PTSD symptoms typically begins within three months of the incident; however, in some instances, symptoms do not appear until several years later.

For a patient to be formally diagnosed with PTSD, the symptoms must last for a minimum of one month and interfere with daily life.

The length of this condition varies based on multiple factors — recovery can happen within six months, numerous years, or may not happen at all. For some patients, this condition becomes chronic.

Diagnosis can occur with the help of a licensed mental healthcare professional such as a psychiatrist or psychologist.

According to the NIMH, the diagnostic criterion for PTSD is experiencing all the following types of symptoms for at least one month:

• one or more re-experiencing symptoms
• one or more avoidance symptoms
• two or more arousal and reactivity symptoms
• two or more cognition and mood symptoms

Re-experiencing symptoms include flashbacks, bad dreams, or frightening thoughts that resemble the feelings experienced during or immediately after the trauma occurred.

Avoidance symptoms include avoiding thoughts, feelings, places, events, or objects related to the traumatic event. A simple example of this is avoiding driving after having been in a car accident.

Arousal and reactivity symptoms include tense feelings, being easily startled, difficulty sleeping, and outbursts of anger. Unlike re-experiencing and avoidance symptoms triggered by certain things, these symptoms are usually constant.

Finally, cognition and mood symptoms include memory issues surrounding the traumatic event, negative thoughts, feelings of guilt or blame, and loss of interest in activities.

These symptoms are characteristic of PTSD in adults. Children and teenagers with PTSD may also experience some or all these symptoms. Additional symptoms may include bed-wetting, communication issues, and clinginess.

The NIMH states that “it is natural to have some of these symptoms for a few weeks after a dangerous event. When the symptoms last more than a month, seriously affect one’s ability to function, and are not due to substance use, medical illness, or anything except the event itself, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

The intensity of PTSD symptoms varies for each patient and can even vary for one singular patient. The Mayo Clinic postulates that PTSD symptoms can intensify during periods of stress or when there are reminders of the experience.

Treatment

The primary treatment available to people with PTSD are medications and talk therapy. These may be used individually or in combination based on the patient and their condition.

Medications

The most common medications for PTSD are antidepressants used to combat feelings of sadness, worry, anger, or numbness.

Antidepressants approved for PTSD treatment in the US include SSRIs such as sertraline and paroxetine.

In addition to antidepressants, antianxiety medications may be used for PTSD treatment. Finally, the Mayo Clinic highlights prazosin, which has been shown to alleviate nightmares for people with PTSD in some patients.

“While several studies indicated that prazosin (Minipress) may reduce or suppress nightmares in some people with PTSD, a more recent study showed no benefit over placebo. But participants in the recent study differed from others in ways that potentially could impact the results. Individuals who are considering prazosin should speak with a doctor to determine whether their particular situation might merit a trial of this drug,” states the Mayo Clinic.

Psychotherapy

Talk therapy — formally known as psychotherapy — is essentially just talking to a licensed mental healthcare professional. Psychotherapy is an overarching term for multiple different therapeutic, non-medicinal methods of treatment.

The average PTSD patient undergoes 2–4 months of psychotherapy. However, this timespan varies from patient to patient, with some attending psychotherapy for the rest of their lives.

According to the NIMH, “Effective psychotherapies tend to emphasize a few key components, including education about symptoms, teaching skills to help identify the triggers of symptoms, and skills to manage the symptoms. One helpful form of therapy is called cognitive behavioral therapy (CBT).”

Exposure therapy and cognitive restructuring are both forms of CBT. Exposure therapy exposes the patient to the trauma in a gradual and controlled manner. Cognitive restructuring addresses the feelings around the trauma.

Another form of treatment for PTSD is eye movement desensitization and reprocessing (EMDR), which “combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.”

Recommendations and Future Research Directions

For the best outcomes in PTSD, the Mayo Clinic recommends the following:

• adhering to a treatment plan 
• patient education on PTSD
• self-care such as sleep, proper nutrition, and physical activity
• avoiding alcohol and drug consumption to cope with feelings
• developing a support system with family, peers, or support groups for PTSD

As the research on PTSD continues to progress, some critical areas of study include additional effective treatment methods, understanding what genes cause a predisposition to PTSD, and improved specific diagnostic criteria.