Post-Traumatic Stress Disorder (PTSD)
What Is Post-Traumatic Stress Disorder?
From time to time, we experience distressing events that briefly shake our sense of security. Yet, for some individuals, certain severe traumas may linger long after the incident has passed. These manifest as vivid flashbacks, heightened anxiety and disrupted sleep.
This persistent psychological distress is known as post-traumatic stress disorder or PTSD. It originates from deeply distressing or life-threatening events – from military combat and natural disasters to personal assaults or accidents.
PTSD is not just about the echoes of a traumatic event; it is about how the mind and body continue to react to them. Though PTSD might be a term casually thrown around in everyday conversations, its implications are profound and life-altering for those affected.
Throughout this guide, we will explore the nuances of PTSD and write about its symptoms, causes, and underlying factors that fuel this condition.
Whether you are seeking clarity, understanding, or ways to support a loved one, familiarising yourself with PTSD is the first step in a journey of empathy and awareness.
Symptoms of PTSD
Psychological Symptoms
Post-traumatic stress disorder, also called PTSD, is a mental health condition that surfaces after exposure to traumatic events.
Typically manifesting within three months post-event, though sometimes surfacing later, its symptoms are distressing and can impede one’s daily life.
The DSM-5, issued by the APA (American Psychiatric Association), has outlined specific criteria for a PTSD diagnosis.
These criteria encompass exposure to traumatic events, such as near-death experiences, grave injuries, or sexual violence. Importantly, this exposure can be direct, or even indirect as a bystander. Indeed, one can experience vicarious or secondary trauma through tales of loved ones or during professional obligations (eg as a social worker).
Furthermore, the person persistently exhibits:
Intrusion Symptoms
These remind an individual of the trauma and might include:
Flashbacks
Flashbacks transport individuals directly back to the traumatic incident, often evoking visual memories and associated sounds, scents, tastes, sensations, and emotions.
While certain environmental stimuli can act as triggers, sometimes these flashbacks surface unexpectedly. Their duration varies, from fleeting moments to prolonged hours.
Avoidance Symptoms
This involves avoiding reminders of the trauma. This could manifest as:
Negative Mood and Thinking Patterns
This can manifest as:
Emotional Arousal and Reactivity Changes
These symptoms may encompass:
These symptoms can hinder an individual’s ability to function normally in both personal and professional domains.
More importantly, to diagnose someone with PTSD – these symptoms should not be due to the use of medications, substances, or other health conditions.
Physical Symptoms
Understanding PTSD goes beyond its psychological effects. While often linked with emotional trauma, it also manifests physically in many individuals.
When overwhelmed with distress, our body secretes cortisol and adrenaline — hormones associated with the ‘fight, flight, or freeze‘ reaction.
For those with PTSD, this hormonal surge persists even without immediate threat, resulting in heightened alertness and startle responses.
Moreover, it is common for these individuals to endure symptoms similar to anxiety: headaches, dizziness, chest discomfort, and gastrointestinal issues.
PTSD-Related Conditions
Several conditions, like acute stress disorder, adjustment disorder, and disinhibited social engagement disorder (DSED), are related to post-traumatic stress disorder.
Acute Stress Disorder (ASD)
Acute stress disorder, often abbreviated as ASD, surfaces following a traumatic event.
Symptoms arise almost immediately post-trauma and generally remain for a duration between 3 days to a month. Recognising ASD is important, given its potential to evolve into PTSD if left untreated.
Adjustment Disorder
Emerging from significant life transitions or events, adjustment disorder is characterised by emotional disturbances, ranging from anxiety to depression.
Note that at TYHO, we offer services such as depression counselling in Singapore and globally.
The onset is typically within three months of the triggering event. As reactions can vary, personalised care and intervention are necessary for those affected.
Disinhibited Social Engagement Disorder
Children or adults who have early-life trauma or neglect may have a higher risk of developing disinhibited social engagement disorder.
Childhood trauma could include abuse or abandonment by parents, bullying in schools, exploitation, violence, and assault.
The most common signs of this disorder are exhibiting impulsive and maladaptive behaviours. Examples include being overly familiar with strangers, having less or no social boundaries, or being extremely sociable.
For example, if a child is extremely social, they may get friendly with strangers, impulsively go on a trip with strangers, and so on.
Managing this condition may require two major elements:
- Creating a healthy and stable environment for the child (eg social support, healthy family systems, friendships).
- Seeking therapeutic interventions (eg psychotherapy).
If you know someone with this disorder, reach out for help.
PTSD Causes and Risk Factors
Causes of PTSD
Post-traumatic stress disorder is a multifaceted mental health condition often emerging after exposure to traumatic events. While what constitutes trauma can differ individually, certain circumstances consistently stand out as PTSD triggers.
These include:
Moreover, individuals in professions such as the emergency services or the military often confront distressing situations, potentially leading to vicarious or secondary trauma.
Natural calamities, disturbing experiences in medical settings, witnessing traumatic events, or even confronting unsettling personal losses can also be the causes of PTSD.
Risk Factors of PTSD
Note: Facing a traumatic event or experiencing any one of the risk factors below does not automatically mean that the person will develop PTSD.
The main risk factors for developing PTSD include:
Childhood trauma: If a person has childhood trauma or was exposed to violent environments, they may have a risk of developing PTSD. The chance may increase if the trauma was experienced during the formative years.
- Witnessing violence or abuse: Observing harm or abuse, either firsthand or to loved ones, can be particularly triggering. During situations like this, the person may develop ‘vicarious trauma’ (ie distress from seeing someone else suffer) or survivors guilt (ie feeling guilty that the trauma happened to someone else instead of them).
- Intense emotional responses: Experiencing feelings of horror, helplessness, or extreme fear during a traumatic event may cause someone to develop PTSD later in life.
Post-trauma strain: After facing or seeing traumatic events, a person may feel and go through complex emotions and situations such as grief, physical illness, job loss, homelessness, or shame. These emotions and the impact of trauma can, in turn, lead to PTSD.
- Limited social support: A lack of social support systems, especially after facing trauma, can cause PTSD.
Psychological history: Individuals with a personal or familial background of mental health conditions or substance misuse may be more vulnerable.
What Is Complex PTSD (CPTSD)?
CPTSD is a type of post-trauma stress. Common symptoms of CPTSD include:
- Flashbacks
- Extreme alertness to everyday sounds and movements
- Emotional dysregulation (ie unable to manage or control emotions)
- A feeling of worthlessness
- Detachment from reality (eg dissociation and derealisation)
People with CPTSD may struggle with uncontrollable anger or find it challenging to trust the people and world around them.
Moreover, these people may also avoid getting close to anyone and avoid looking for friendships or romantic partners.
People with CPTSD have a strong belief that they are ‘different’ or that their trauma is incomprehensible to others.
The avoidant behaviour makes it hard to find social support. Hence, people with CPTSD may also suffer from loneliness and depression.
What Causes Complex PTSD?
A single factor usually does not cause CPTSD. In other words, a mix of personal, societal, and environmental factors may play a role in the onset of this condition.
Moreover, the causes and symptoms of this condition are so complex that it may not be the same for every individual.
Hence, the best person to help you or someone with CPTSD is a professional therapist.
Some of the common causes of CPTSD include:
- Childhood abuse
- Domestic violence
- Witnessing or experiencing violence for a long time
- Kidnapping or wartime captivity
There are higher risks of developing CPTSD if the trauma occurs early, persists for a long time, or is caused by someone intimately known (eg family, friends, or relatives).
Treatment and Prevention
Symptoms of PTSD can affect daily life activities, social relationships, and professional performance. Fortunately, the condition is manageable with the appropriate psychological interventions.
A professional Singaporean counsellor or an expert online who has experience with PTSD can help you. Counsellors can guide individuals with personalised therapeutic plans.
Research shows that the most effective type of treatment is a combination of psychotherapy, medications, and social support.
Some people with PTSD who seek therapy may still be in traumatic situations, such as abusive relationships. Hence, it’s important to manage the condition only through professional support.
This is because an expert can help address the ongoing trauma and help overcome past negative experiences.
Additionally, it is common for those with PTSD to suffer from conditions like depression, panic disorder, substance misuse, or even struggle with passive suicidal tendencies (eg suicidal thoughts).
Psychotherapy
Post-traumatic stress disorder (PTSD) affects many people after they experience a traumatic event. PTSD can occur even during distress or extreme stress.
Psychotherapy (ie talk therapy) is an effective intervention that can help people understand, manage, and overcome their trauma.
During therapy, a therapist may use approaches that are trauma-focused. Some of the common therapy modalities used include:
- Trauma-focused cognitive behavioural therapy (TF-CBT)
- Dialectical behaviour therapy
- Narrative therapy
- Schema therapy
The above tools help people recognise what triggers their PTSD. A Therapist may also teach essential coping skills that a person can use to handle these triggers.
Within trauma-focused CBT, there are two main techniques: exposure therapy and cognitive restructuring.
Exposure Therapy
Therapists may use exposure therapy to help people overcome aspects of their trauma gradually.
To do so, the professional may use structured therapeutic plan and techniques so as to prevent causing further harm.
This might mean talking about the event or visiting related places with the support of a Therapist. The goal is to reduce the fear and distress these memories cause.
Cognitive Restructuring
This approach is a tool commonly used in cognitive behavioural therapy (CBT).
This approach helps people think about their trauma with more clarity.
Sometimes, people remember events in a way that makes them feel guilty or ashamed, even if it is not their fault. This is true, especially if the event was distressing.
Restructuring their thoughts (ie replacing their thoughts with facts) helps the person see the event more realistically.
In short, psychotherapy offers valuable tools for those with PTSD, helping them move towards a more peaceful state of mind.
Medications
Taking medications along with psychotherapy can be highly effective in managing PTSD.
Some people may prefer meds, whereas others may wish to seek only talk therapy. What works for you depends on your physical health issues, the intensity of the problems, your personal preferences, and your doctor’s and therapist’s recommendations.
Below are some ways medications can help:
- Depression and PTSD: If you are experiencing symptoms of depression with your PTSD, antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) like sertraline or venlafaxine, might be prescribed.
- Sleep issues: PTSD can lead to sleep disturbances (eg you may either have trouble falling asleep or waking up). In such cases, certain medications can improve the quality and duration of sleep.
- Preference over talking treatments: Some people may initially feel uncomfortable seeking psychotherapy, as it may involve sharing deeply personal information. Hence, these people can start treatment with medications and eventually seek therapy.
Do note that medications are usually not the primary treatment for PTSD. Consult a therapist or doctor for a diagnosis and therapeutic plan suited to your needs.
Other Treatment Options
In recent years, the understanding and treatment of PTSD have evolved significantly.
Ongoing research shows that alternative treatments are also effective in managing conditions like PTSD.
Some of the alternative treatment options are:
- Eye Movement Desensitisation and Reprocessing (EMDR)
- Art therapy
- Family therapy
- Group therapy
- Support groups
Family therapy is a type of psychotherapy where all family members attend therapy sessions together.
During counselling with family, you can expect to improve your familial relationships and work on personal and family issues.
Managing PTSD
Self-help tips can help you manage your symptoms.
For example, rhythmic breathing can help you stay calm when you find yourself having flashbacks or uncontrollable thoughts about the trauma.
You can carry a small reminder of the present moment, something like a keyring or a card should be helpful. When you find yourself panicking, try to ground yourself by looking at and engaging with your physical reminder.
Wrap yourself with warm blankets (or heavy blankets), watch your comfort movie, and maintain a diary to document and identify your triggers.
Remember that these techniques might offer support, but you might have to explore and see what personally works best for you.
The mentioned self-care tips should not be used as the primary management plan. However, working on self-care along with psychotherapy can be extremely helpful!
Finding Professional Support
Below are some tips to have a smooth therapy experience:
Think about location, session times, and fees. Try to plan all the logistics in advance to save time and energy before your first therapy session.
Visit our reviews page to find out what people are saying about TYHO Therapists.
Do not hesitate to ‘interview’ potential therapists or have an initial session to gauge your comfort level. The key is to feel comfortable talking about your thoughts and feelings.
Look into the different types of therapeutic plans available. You can also have a conversation with your therapist to decide what works best for you. On our website, you can research about the different issues and approaches to improve your therapy experience with us!
Try to get suggestions from your friends, family, or even your doctor.
Look for a therapist who has specific training or certifications in trauma or PTSD.
Lastly, trust your gut. If something feels off or you believe the therapist is not a good fit, it is okay to look for someone else instead.
Frequently Answered Questions
Do I have PTSD?
Wondering if you might have PTSD? Ask yourself these questions:
1) Did something really scary or upsetting happen to you?
2) Do you think about that event often, even when you do not want to?
3) Do loud noises or surprises make you jump more than they used to?
4) Are you avoiding places or people that remind you of that event?
5) Are you finding it hard to sleep or focus since then?
6) Have these feelings been around for more than a month, making everyday tasks difficult?
Remember, answering ‘yes’ to these questions does not mean you definitely have PTSD. If you are worried and relate to the above symptoms, it is best to have a talk with a professional therapist or counsellor about how you are feeling.
How does PTSD affect your life?
PTSD deeply affects daily life for anyone who experiences traumatic events. It can:
Cause emotional distress
Harm physical health
Lead to problems at work
Strain personal relationships
Children show different symptoms, such as:
Re-enacting the trauma in play
Clinging to adults excessively
Lose certain skills, like talking or toilet use
Can PTSD occur in children and teens?
Children and teenagers, too, can experience this condition, albeit with manifestations that differ considerably according to age.
Responses for those six and under might range from bedwetting, even after learning toilet training, to a heightened attachment to adults.
As children age, particularly between 5 and 12 years, the expression of trauma can be observed in their drawings, play activities, and narratives. However, flashbacks might be less common.
Once they reach adolescence, between 12 and 18 years, reactions to traumatic events can morph into disruptive behaviours, impulsiveness, or even aggressive tendencies.
Child psychologists can recognise these signs. Understanding the underlying causes is necessary, as childhood PTSD can significantly impact their development, mental well-being, and interpersonal relationships. These symptoms may develop into challenges in adulthood if unaddressed.
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