Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder occurs after a person is exposed to a traumatic event such as threatened death, serious injury, or sexual or physical violence, either directly or by witnessing it firsthand. The person experiences a range of symptoms, which we review below:

Symptoms of post-traumatic stress disorder

Intrusive symptoms

These arise from triggers that make the person feel as though they are back in the actual moment of the trauma and at the height of the painful situation. They may have nightmares at night, while distressing memories may assail them during the day. They fluctuate between intrusive, frightening recollections of the traumatic event and efforts to avoid it. These symptoms flood the body with emotionally charged material that triggers panic, activating anxiety and increasing psychological stress.

Intrusive memories are accompanied by physical arousal that lowers the victim's threshold for frustration and reaction, causing both to be reached more quickly. As a result, many ordinary, everyday triggers can cause episodes of anxiety, panic, and anger.

Avoidance symptoms

The traumatized person tries to avoid triggers that they consciously associate with the traumatic event. This includes avoiding situations or stimuli that recall the trauma, such as war films for war survivors or sex for rape survivors; avoiding actions, places, and people that recall events connected with the trauma; forgetting; losing interest in activities related to the event; feeling alienated or detached from the surroundings; feeling numb and limiting emotional expression; and adopting a pessimistic view of the future, to the point of withdrawing from life.

Two avoidance strategies aim to reduce symptoms of distress as much as possible in the context of trauma:

1. Avoiding or trying to avoid thoughts, memories, and feelings.
2. Avoiding or trying to avoid external triggers—people, places, conversations, actions, objects, and situations.

Depression and a reduced ability to experience pleasure

After a traumatic event, some people experience an unstable mood and a disturbed, chaotic, and overwhelmed inner world, accompanied by negative changes in cognition and event-related mood states that appear or worsen afterward. For example:

1. A survivor may have difficulty recalling important details of the trauma, similar to dissociative amnesia. This is a persistent difficulty reconstructing many aspects of the event itself in memory.
2. Persistent, distorted perceptions of the event's causes or consequences lead to blaming oneself or others.
3. Survivors often develop negative and exaggerated beliefs and ideas about themselves, other people, and the world: “I am not good enough,” “I am worth nothing,” and “I cannot trust people.” Children who experienced sexual abuse during childhood may have great difficulty trusting others in adulthood. Examples of persistent negative feelings experienced after trauma include fear, anxiety, guilt, inferiority, shame, and terror.
4. Survivors lose interest in or stop participating in activities that express vitality and growth, such as relationships, love, and even enjoyable food.
5. Survivors experience feelings of detachment and alienation, such as dissociation, a dissociative state expressed through behavioral, emotional, and cognitive signs, and a chronic sense of emptiness. They need strong, intense stimuli to feel alive and may engage in risky behaviors to feel something that ends the numbness.
6. Some survivors have persistent difficulty accessing positive emotions, experiencing pleasure, or distinguishing between pleasure and pain.

Heightened physiological arousal

After trauma, some people experience symptoms such as difficulty sleeping, feeling tense, difficulty concentrating, persistent agitation to the point of angry outbursts without prior provocation, verbal or physical aggression toward people or objects, dangerous or self-destructive behavior, hypervigilance, and exaggerated responses.

These symptoms may appear shortly after the painful experience. Sometimes they emerge after a latency period of months or even years, which is known as post-traumatic stress disorder with delayed onset.

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