What is PTSD?

Whenever I explain PTSD to my patients, I always begin by breaking down the term. PTSD stands for posttraumatic stress disorder. That is, after (post-) a trauma occurs, there is an increase in stress and related symptoms. Disorder implies that these symptoms negatively affect one’s ability to perform at school or work, manage tasks at home, participate in relationships in healthy and value-driven ways, or participate in other important areas of one’s life. PTSD involves four sets of symptoms: intrusive symptoms, avoidance, negative thoughts and feelings, and an increase in physical arousal and reactivity following the event. 1

Intrusive Symptoms

Intrusive symptoms are just that – intrusive! They are unwanted, and distressing, and can occur quickly and automatically. They include unwanted memories of the event that may pop into one’s mind, nightmares, or the experience of strong emotions or physical reactions (e.g., heart racing, sweating) to trauma reminders. For example, it is common for Veterans who served in combat to have strong reactions to loud noises after returning stateside. Loud noises in Iraq or Afghanistan often meant danger, like gunfire, a grenade, or a bomb. While serving in the military, the body learned that loud noises meant danger. After returning home, the body may not readily know or learn that loud noises in the United States, like from fireworks, are often objectively safe (depending on one’s environment), and that the body does not need to respond so strongly. Similarly, a survivor of sexual assault may experience fear and notice they their heart races if they view a sexually violent scene on TV or in a movie.

Avoidance

Individuals with PTSD also tend to avoid thoughts or feelings about the trauma because they are so painful to remember. Avoidance may occur through distraction, hyper-productivity and logging long hours at work, drinking or using other substances, bingeing TV, videogaming or phone scrolling, compulsive cleaning, or any other behavior that may serve the purpose of capturing one’s attention and filling brain space so that there is less room for distressing memories to pop up. Avoidance can also pertain to not telling others or talking about the event and of people, places, activities, objects, or situations that are trauma reminders. For example, a survivor of a serious car accident may avoid the intersection where the wreck occurred or avoid driving altogether.

Negative Thoughts & Feelings

Individuals with PTSD also experience depressive-like symptoms, which can include having strong negative feelings, difficulty experiencing positive feelings like joy and love, and a lack of interest in hobbies or other activities that they used to enjoy before the traumatic event occurred. This cluster of symptoms also includes strong negative beliefs about oneself (e.g., “It’s all my fault”), other people (e.g., “no one can be trusted”), or the world (e.g., “I have to be on guard at all times”). These beliefs may develop as interpretations of one’s posttraumatic reactions and to keep oneself safe. For example, if someone was assaulted by a close friend, they may notice anxiety in close relationships after the trauma. That is, close friends may remind the body of the close friend who perpetrated the assault, and lead to a conditioned fear response. The mind may interpret this reaction as “this person can’t be trusted.” This friend may be trustworthy, but the body is trying to keep itself safe. If they believe that this person or people, in general, cannot be trusted, then they protect themselves from being hurt again. However, this belief may be an overcorrection and cause one to distance themselves from all people, even those who are trustworthy and those who could participate in a supportive or intimate relationship.

Changes in arousal and reactivity

This final cluster of symptoms represents the physical stress of PTSD. PTSD involves a conditioned and overactive fight-flight-or-freeze response. That is, the body has learned that dangerous events can happen after the traumatic event occurred and may try to stay vigilant to detect harm from happening again in the future. However, the post-trauma body is often overly sensitive to anything that smells like danger and is often represented as an overactive car alarm. A sensitive car alarm may accurately detect a car break-in but may also sound if someone simply brushes up against the car. The alarm is overfiring and cannot detect a real from a perceived break-in. Similarly, a post-trauma body may be overly jumpy to benign, sudden, or loud noises or quickly resort to irritable or angry outbursts that are not in proportion to the actual interaction or situation. Other symptoms in this cluster include self-destructive behavior, hypervigilance, difficulty concentrating, and trouble sleeping.

If you identify with these symptoms, there is so much hope! Effective treatments for PTSD exist. Reach out today to inquire further, to schedule an initial consultation or PTSD assessment, or to hear more about PTSD treatment. I would love to hear from you and look forward to serving you.

1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).