People with PTSD can be helped by psychotherapy and medications. Medications like antidepressants can lower anxiety and help with sleep problems and nightmares.
Symptoms of PTSD should last for more than a month and seriously interfere with work, life, or relationships to be considered PTSD. Symptoms include intrusive, unwanted and recurring memories, distressing dreams and flashbacks.
Trauma-Focused PTSD
The most common of the PTSD types is diagnosed using criteria from the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980). This version included symptoms related to numbing or denial, as well as irritability and reckless behavior. More recent versions of the DSM have included more specific behavioral symptoms, including hypervigilance and avoidance.
A person with trauma-focused PTSD will experience memories of the traumatic event that trigger fear and anxiety. They will often try to cope with these fears by avoiding people, places and activities associated with the event. This can lead to a very restricted life. A healthcare professional needs to understand a person’s trauma history and their response to it to recommend the most effective PTSD treatment.
Trauma-focused PTSD treatments include prolonged exposure and cognitive processing therapy (CPT). Both techniques encourage the person to confront thoughts, feelings and events that trigger distressing memories. The goal is to make these memories less upsetting over time. Other methods used in this type of PTSD treatment include mental imagery, writing and visiting places that remind the person of the traumatic experience. Virtual reality technology can also be used to help people overcome their fears.
Many of these trauma-focused treatments have been shown to work in clinical trials. Research has found that they can be delivered in various formats, from individual psychotherapy to group CPT. Several of these therapies can be done by telemedicine, which is convenient for many people living in rural areas.
Avoidance PTSD
People with avoidance PTSD may struggle to cope with anxiety and fear. This leads to avoiding people, places and situations that remind them of their trauma. This can make it hard to get through the day or develop meaningful relationships. It can also cause the person to resort to other unhealthy coping mechanisms, such as self-medication with drugs or alcohol. Avoidance behavior can worsen PTSD symptoms in the long run.
Symptoms of avoidance of direct and indirect trauma experiences can cause PTSD. Direct experiences can include having a traumatic experience, such as a sexual assault or a car accident. Indirect experiences can include seeing someone else experience a traumatic event, such as a friend or family member being seriously injured or killed in the war. It is unclear why some people with a traumatic event don’t develop PTSD while others do.
When a person is diagnosed with avoidance PTSD, they need to understand their symptoms and how to treat them. They should work with a mental health professional who specializes in trauma. This professional can help them to learn healthier ways to manage their PTSD symptoms. For example, they can encourage the person to write down the situations, people or places they avoid on paper. Then, they can organize those situations, people or places based on how much distress and fear they cause.
Dissociative PTSD
Dissociative PTSD, also known as dissociative identity disorder, is characterized by periods of feeling detached from reality and disconnected from your emotions. This is a common defense mechanism that people who have experienced long-term trauma use to cope with their emotional and physical pain. It can start as early as childhood and typically form after someone lives through a severe traumatic experience like a war zone or natural disaster.
Dissociation is a normal part of the human mind and can be a positive coping mechanism for dealing with trauma. However, dissociation can become problematic when it’s used to avoid traumatic memories or feelings or when the person cannot manage their stress levels. Dissociation is also more likely to develop in people who were abused or neglected as children. This is because the underlying personal identity still develops during childhood, making them more susceptible to dissociation.
Adding dissociative PTSD to the DSM-5 will encourage research into this condition’s prevalence, symptomatology, and neurobiology. It’s believed that the underlying cause of dissociative PTSD is hyper-inhibition of limbic brain regions.
Treatments for dissociative PTSD typically include medication and cognitive behavioral therapy (CBT). A new approach to treating complex PTSD with dissociation was developed by Cloitre and colleagues,42, who recommend using skills training in emotion regulation before exposure-based CBT.
Social PTSD
When a person experiences repeated, intense and prolonged trauma, they may develop PTSD-like symptoms that prevent them from functioning in key areas of life. Symptoms may include emotional distress, difficulty concentrating or withdrawing from friends and family, a lack of interest in activities once enjoyed or even physical manifestations like heart palpitations.
People with Social PTSD often have significant distress related to negative social interactions or relationships and experience feelings of shame, guilt or self-blame when faced with their own or others’ negative reactions to them. They also experience difficulty regulating their emotions and may have trouble trusting others or maintaining healthy relationships.
This type of PTSD can be difficult to diagnose as it isn’t well-researched and could involve symptoms similar to PTSD or other mental health disorders. For this reason, a mental health professional must evaluate a patient’s symptoms, including their duration, to determine if a diagnosis of Social PTSD is appropriate.
PTSD is treatable, and the APA and VA/DoD have published guidelines to recommend treatments with the highest level of evidence. Therapy can be done on a one-to-one basis or in group therapy and is typically provided over a few months. Some therapies focus on changing a patient’s thinking, while others work with the body to release anxiety. Medications can be used to manage the side effects of some therapies.
