In this series, I discuss some of the psychological diagnoses or terms that have filtered out to the public consciousness, and gotten twisted up along the way. The important thing to keep in mind is that this website, like any website, cannot tell you whether you actually do or do not have a mental illness or whether you do or do not need mental health treatment. My goal is to cut down on the miscommunications that can happen between client and therapist. As always, my disclaimer applies.
What is PTSD?
Posttraumatic Stress Disorder is a condition that can occur after a traumatic event. Note that I say a condition, not the condition.
PTSD has 5 distinct symptom clusters:
- Exposure to a traumatic event
- Intrusion symptoms, like nightmares, flashbacks, or triggered intrusive memories.
- Avoidance of trauma reminders
- Negative alterations in mood or thoughts related to the trauma
- Increased arousal
PTSD is a unique psychiatric diagnosis in that the etiology, or cause, of the illness is the key determining feature. You can be depressed because of upbringing, or genetics, or brain injury, or bad luck, or any number of precipitating causes. Diagnostically it doesn’t matter. But for PTSD, it’s specified that it starts with a traumatic event. This makes the course, or timing, of the illness really important. Less than 1 month is considered an “Acute Stress Disorder” or, really, just normal recovery from a traumatic event. For it to be PTSD, it has to stick around.
“Normal recovery from a traumatic event” is a pretty sticky phrase, too. If you survive a harrowing psychological ordeal, you shouldn’t feel weird or ashamed if you aren’t fully “over it” by 1 month. But you also shouldn’t feel weird or ashamed about asking for help at that point – or even before! – which is why we have a diagnostic category to fit you.
Beyond this, the hallmarks of PTSD are the avoidance behaviors and the persistence of the traumatic experience. Experts like to call PTSD a condition of “non-recovery”, which is to say the natural process of returning to a resting state for some reason does not occur. The person continues to act as though they are still in danger, even though the danger has passed. Part of this is that the trauma memory always feels like it’s at the “tip of their brain”, forcing itself into consciousness with minimal reminders. As a result, people naturally begin to avoid those reminders – both external things, such as sights or smells related to the event, and internal experiences, like positive emotions that they may try to numb out.
Why You Don’t Have PTSD
I want to make this especially clear here – just because I’m saying you don’t have PTSD, doesn’t mean I don’t think anything is wrong with you. Earlier, I foreshadowed by saying that PTSD is a condition, not the condition, that can result from trauma. Depression, Borderline Personality Disorder, OCD, and Specific Phobias can all stem from traumatic experiences. It’s entirely possible that you have one of those.
Phobias especially can stem from a traumatic event. Say you survive a plane crash. Now, if you absolutely refuse to ever step foot on a plane again, but your day-to-day is not affected, that’s a phobia, not PTSD. If, on the other hand, you feel like you can’t ever relax and you can’t stop thinking about the crash, that’s PTSD. If suddenly the other plane crash survivors start dying in overly elaborate accidents, that’s the plot of Final Destination.
Another reason you may not have PTSD is that you may not have experienced a trauma. I’m going to quote the psychology bible (the DSM) here to say that a trauma is (and only is):
Exposure to actual or threatened death, serious injury, or sexual violence…
It goes on to specify what kinds of exposure qualify – it can happen to you, you can witness it happening, it can happen to a loved one suddenly and unexpectedly, or you can see the effects of it over and over (like a first responder seeing human remains over and over).
That means that if what happened to you doesn’t fit into these categories, it doesn’t count. Lose a loved one to cancer? Not trauma. Your wife suddenly divorces you and takes the house, kids and Xbox? Not trauma. Lose a testicle? If you thought you were going to die, trauma! If not, not a trauma. This isn’t to say that these events aren’t horrible, or that they can’t lead to a mental illness. They just don’t conform to our textbook definitions of traumas, so what they lead to might be grief, or any of the other conditions I listed above.
Even if you do have one of these things happen to you, that doesn’t mean that you have PTSD. In fact, up to 90% will experience some form of traumatic event in their lifetime, but only up to 15% of people will experience PTSD. That 15% makes PTSD one of the most common mental illnesses, but the point remains that most people that experience a trauma don’t develop PTSD.
Nobody chooses to have PTSD. There are a lot of things that can determine the difference between recovery from a trauma and developing PTSD. Genetics, upbringing, the number and severity of the traumatic experiences, the support a person receives after the trauma, and many other factors can influence the development of PTSD. Those avoidant behaviors that are one of the hallmarks of the condition are also one of the key factors that can impede recovery. If, for whatever reason, the individual never has a chance to process the thoughts and feelings that stem from the trauma, it’s much much harder for them to recover from it.
What if you do have PTSD?
It’s important with PTSD treatment to be realistic about the goals. While there is some early research into tampering with memories, no current treatment can erase what happened. There’s also no realistic way to go back to being the person you were before the trauma. The people I talk about above who experience a trauma and don’t develop PTSD, that experience may still fundamentally change them. PTSD treatment can’t undo the trauma, but it can make the PTSD symptoms go away.
In fact, therapy is pretty good at making PTSD symptoms go away! Some of the foremost experts on trauma treatment, the Department of Veterans Affairs, give a great rundown of three of the premier treatments for PTSD (Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, and Prolonged Exposure) here, and they state that PTSD symptoms completely remit in over half off the people who complete the treatments.
What these treatments do is attack the avoidant behaviors that both cause and sustain the PTSD syndrome. This kickstarts the natural recovery process that for whatever reason never took place after the trauma. They each have different ways of going about it, and some will speak to you more than others, so as always I encourage you to do some research.
There’s early research into various other treatments for PTSD, like Acceptance and Commitment Therapy, STAIR, and even using
methylenedioxymethamphetamine (MDMA or Ecstacy) in conjunction with therapy for treatment-resistant PTSD, but these are all very early. Really, the go-to treatments work very well – even those who don’t see their symptoms entirely go away tend to see massive improvements. Some even experience Posttraumatic Growth, or improvements to their life or functioning as a result of the traumatic experience. They find a way to turn the horrible thing that happened to them into something positive.