What Is PTSD?

 

 

 

 

 

https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

 

What Is Posttraumatic Stress Disorder?

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.

PTSD has been known by many names in the past, such as “shell shock” during the years of World War I and “combat fatigue” after World War II, but PTSD does not just happen to combat veterans. PTSD can occur in all people, of any ethnicity, nationality or culture, and at any age. PTSD affects approximately 3.5 percent of U.S. adults every year, and an estimated one in 11 people will be diagnosed with PTSD in their lifetime. Women are twice as likely as men to have PTSD. Three ethnic groups – U.S. Latinos, African Americans, and American Indians – are disproportionately affected and have higher rates of PTSD than non-Latino whites.

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.

A diagnosis of PTSD requires exposure to an upsetting traumatic event. However, the exposure could be indirect rather than first hand. For example, PTSD could occur in an individual learning about the violent death of a close family or friend. It can also occur as a result of repeated exposure to horrible details of trauma such as police officers exposed to details of child abuse cases.

• Symptoms and Diagnosis

  Symptoms and Diagnosis

  Symptoms of PTSD fall into four categories. Specific symptoms can vary in severity.

  1. Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are re-living the traumatic experience or seeing it before their eyes.
  2. Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.
  3. Alterations in cognition and mood: Inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others (e.g., “I am bad,” “No one can be trusted”); distorted thoughts about the cause or consequences of the event leading to wrongly blaming self or other; ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to exprience positive emotions (a void of happiness or satisfation).
  4. Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving recklessly or in a self-destructive way; being overly watchful of one's surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.

  Many people who are exposed to a traumatic event experience symptoms similar to those described above in the days following the event. For a person to be diagnosed with PTSD, however, symptoms must last for more than a month and must cause significant distress or problems n the ndividual's daily functioning. Many individuals develop symptoms within three months of the trauma, but symptoms may appear later and often persist for months and sometimes years. PTSD often occurs with other related conditions, such as depression, substance use, memory problems and other physical and mental health problems.

  (See information on Acute Stress Disorder below.)
• Treatment

Related Conditions

Acute Stress Disorder

Acute stress disorder occurs in reaction to a traumatic event, just as PTSD does, and the symptoms are similar. However, the symptoms occur between three days and one month after the event. People with acute stress disorder may relive the trauma, have flashbacks or nightmares and may feel numb or detached from themselves.  These symptoms cause major distress and problems in their daily lives. About half of people with acute stress disorder go on to have PTSD.

An estimated 13 to 21 percent of survivors of car accidents develop acute stress disorder and between 20 and 50 percent of survivors of assault, rape or mass shootings develop it.

Psychotherapy, including cognitive behavior therapy can help control symptoms and help prevent them from getting worse and developing into PTSD.  Medication, such as SSRI antidepressants can help ease the symptoms.

Adjustment disorder

Adjustment disorder occurs in response to a stressful life event (or events). The emotional or behavioral symptoms a person experiences in response to the stressor are generally more severe or more intense than what would be reasonably expected for the type of event that occurred.

Symptoms can include feeling tense, sad or hopeless; withdrawing from other people; acting defiantly or showing impulsive behavior; or physical manifestations like tremors, palpitations, and headaches. The symptoms cause significant distress or problems functioning in important areas of someone’s life, for example, at work, school or in social interactions. Symptoms of adjustment disorders begin within three months of a stressful event and last no longer than six months after the stressor or its consequences have ended.

The stressor may be a single event (such as a romantic breakup), or there may be more than one event with a cumulative effect. Stressors may be recurring or continuous (such as an ongoing painful illness with increasing disability). Stressors may affect a single individual, an entire family, or a larger group or community (for example, in the case of a natural disaster).

An estimated 5% to 20% of individuals in outpatient mental health treatment have a principal diagnosis of adjustment disorder. A recent study found that more than 15% of adults with cancer had adjustment disorder. It is typically treated with psychotherapy.     

Disinhibited social engagement disorder

Disinhibited social engagement disorder occurs in children who have experienced severe social neglect or deprivation before the age of 2. Similar to reactive attachment disorder, it can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.

Disinhibited social engagement disorder involves a child engaging in overly familiar or culturally inappropriate behavior with unfamiliar adults. For example, the child may be willing to go off with an unfamiliar adult with minimal or no hesitation. These behaviors cause problems in the child’s ability to relate to adults and peers. Moving the child to a normal caregiving environment improves the symptoms. However, even after placement in a positive environment, some children continue to have symptoms through adolescence. Developmental delays, especially cognitive and language delays, may co-occur along with the disorder.

The prevalence of disinhibited social engagement disorder is unknown, but it is thought to be rare. Most severely neglected children do not develop the disorder. Treatment involves the child and family working with a therapist to strengthen their relationship.   

Reactive attachment disorder

Reactive attachment disorder occurs in children who have experienced severe social neglect or deprivation during their first years of life. It can occur when children lack the basic emotional needs for comfort, stimulation and affection, or when repeated changes in caregivers (such as frequent foster care changes) prevent them from forming stable attachments.

Children with reactive attachment disorder are emotionally withdrawn from their adult caregivers. They rarely turn to caregivers for comfort, support or protection or do not respond to comforting when they are distressed. During routine interactions with caregivers, they show little positive emotion and may show unexplained fear or sadness. The problems appear before age 5. Developmental delays, especially cognitive and language delays, often occur along with the disorder.

Reactive attachment disorder is uncommon, even in severely neglected children. Treatment involves the child and family working with a therapist to strengthen their relationship.

See Anxiety disorders

*From Diagnostic and Statistical Manual of Mental Disorders, (DSM-5) American Psychiatric Publishing, 2013

References

• Bichitra Nanda Patra and Siddharth Sarkar. Adjustment Disorder: Current Diagnostic Status. Indian J Psychol Med. 2013 Jan-Mar; 35(1): 4–9.
• National Library of Medicine: MedlinePlus. Adjustment Disorder.  
• American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth edition. (DSM-5)
• American Academy of Child and Adolescent Psychiatry. Facts for Families:  Attachment Disorders.

Physician Review By:

Felix Torres, M.D., DFAPA, MBA
August 2020

Coping After Disaster, Trauma

Find resources and important steps to take to begin coping with stress that follows a tragedy.

Learn More

Expert Q & A: PTSD

Find answers to your questions about PTSD written by leading psychiatrists.

View More

Patient Stories: PTSD

Read patient stories about PTSD and learn how to share your story.

View More

The American Psychiatric Association (APA) is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA's web resources, please contact us at 202-559-3900 or [email protected] for assistance.

 

 

 

 https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd

Post-Traumatic Stress Disorder (PTSD)

Definition

Post-traumatic stress disorder (PTSD) can develop after exposure to a potentially traumatic event that is beyond a typical stressor. Events that may lead to PTSD include, but are not limited to, violent personal assaults, natural or human-caused disasters, accidents, combat, and other forms of violence. Exposure to events like these is common. About one half of all U.S. adults will experience at least one traumatic event in their lives, but most do not develop PTSD. People who experience PTSD may have persistent, frightening thoughts and memories of the event(s), experience sleep problems, feel detached or numb, or may be easily startled. In severe forms, PTSD can significantly impair a person's ability to function at work, at home, and socially.

Additional information about PTSD can be found on the NIMH Health Topics page on Post-Traumatic Stress Disorder.

Prevalence of Post-Traumatic Stress Disorder Among Adults

• Based on diagnostic interview data from National Comorbidity Survey Replication (NCS-R), Figure 1 shows past year prevalence of PTSD among U.S. adults aged 18 or older.¹  
  • An estimated 3.6% of U.S. adults had PTSD in the past year.
  • Past year prevalence of PTSD among adults was higher for females (5.2%) than for males (1.8%).
• The lifetime prevalence of PTSD was 6.8%.²

Figure 1

Past Year Prevalence of Post-Traumatic Stress Disorder Among Adults(2001-2003)

Bar chart with 7 bars.

Data from National Comorbidity Survey Replication (NCS-R)

The chart has 1 X axis displaying categories.

The chart has 1 Y axis displaying Percent. Range: 0 to 6.

End of interactive chart.

Post-Traumatic Stress Disorder with Impairment Among Adults

• Of adults with PTSD in the past year, degree of impairment ranged from mild to serious, as shown in Figure 2. Impairment was determined by scores on the Sheehan Disability Scale.³
• Impairment was distributed evenly among adults with PTSD. An estimated 36.6% had serious impairment, 33.1% had moderate impairment, and 30.2% had mild impairment

Figure 2

Past Year Severity of Post-Traumatic Stress Disorder Among U.S. Adults(2001-2003)

Pie chart with 3 slices.

Data from National Comorbidity Survey Replication (NCS-R)

End of interactive chart.

Prevalence of Post-Traumatic Stress Disorder Among Adolescents

• Based on diagnostic interview data from National Comorbidity Survey Adolescent Supplement (NCS-A), Figure 3 shows lifetime prevalence of PTSD among U.S. adolescents aged 13-18.⁴
  • An estimated 5.0% of adolescents had PTSD, and an estimated 1.5% had severe impairment. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria were used to determine impairment.
  • The prevalence of PTSD among adolescents was higher for females (8.0%) than for males (2.3%).

Figure 3

Lifetime Prevalence of Post-Traumatic Stress Disorder Among Adolescents (2001-2004)

Bar chart with 7 bars.

Data from National Comorbidity Survey Adolescent Supplement (NCS-A)

The chart has 1 X axis displaying categories.

The chart has 1 Y axis displaying Percent. Range: 0 to 10.

End of interactive chart.

Data Sources

References

1. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 2: 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.
2. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.
3. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27. PMID: 15939839
4. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. PMID: 20855043

Statistical Methods and Measurement Caveats

National Comorbidity Survey Replication (NCS-R)

Diagnostic Assessment and Population:

• The NCS-R is a nationally representative, face-to-face, household survey conducted between February 2001 and April 2003 with a response rate of 70.9%. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured lay-administered diagnostic interview that generates both International Classification of Diseases, 10^th Revision, and DSM-IV diagnoses. The DSM-IV criteria were used here. The Sheehan Disability Scale (SDS) assessed disability in work role performance, household maintenance, social life, and intimate relationships on a 0–10 scale. Participants for the main interview totaled 9,282 English-speaking, non-institutionalized, civilian respondents. Post-traumatic stress disorder (PTSD) was assessed in a subsample of 5,692 adults. The NCS-R was led by Harvard University.
• Unlike the DSM-IV criteria used in the NCS-R and NCS-A, the current DSM-5 no longer places PTSD in the anxiety disorder category. It is listed in a new DSM-5 category, Trauma- and Stressor-Related Disorders.

Survey Non-response:

• In 2001-2002, non-response was 29.1% of primary respondents and 19.6% of secondary respondents.
• Reasons for non-response to interviewing include: refusal to participate (7.3% of primary, 6.3% of secondary); respondent was reluctant- too busy but did not refuse (17.7% of primary, 11.6% of secondary); circumstantial, such as intellectual developmental disability or overseas work assignment (2.0% of primary, 1.7% of secondary); and household units that were never contacted (2.0).
   
• For more information, see PMID: 15297905 and the NIMH NCS-R study page.

National Comorbidity Survey Adolescent Supplement (NCS-A)

Diagnostic Assessment and Population:

• The NCS-A was carried out under a cooperative agreement sponsored by NIMH to meet a request from Congress to provide national data on the prevalence and correlates of mental disorders among U.S. youth. The NCS-A was a nationally representative, face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States. The survey was based on a dual-frame design that included 904 adolescent residents of the households that participated in the adult U.S. National Comorbidity Survey Replication and 9,244 adolescent students selected from a nationally representative sample of 320 schools. The survey was fielded between February 2001 and January 2004. DSM-IV mental disorders were assessed using a modified version of the fully structured World Health Organization Composite International Diagnostic Interview.

Survey Non-response:

• The overall adolescent non-response rate was 24.4%. This is made up of non-response rates of 14.1% in the household sample, 18.2% in the un-blinded school sample, and 77.7% in the blinded school sample. Non-response was largely due to refusal (21.3%), which in the household and un-blinded school samples came largely from parents rather than adolescents (72.3% and 81.0%, respectively). The refusals in the blinded school sample, in comparison, came almost entirely (98.1%) from parents failing to return the signed consent postcard.
• For more information, see PMID: 19507169 and the NIMH NCS-A study page.

NIMH Information Resource Center

Available in English and español

  Phone:  1-866-615-6464
  Live Online Chat:  Talk to a representative
  Email:  [email protected]
 Hours: 8:30 a.m. – 5 p.m. ET, M-F

Mail:  National Institute of Mental Health
Office of Science Policy, Planning, and Communications
6001 Executive Boulevard, Room 6200, MSC 9663
Bethesda, MD 20892-9663

 

 

U.S. Department of Veteran's Affairs

 https://www.ptsd.va.gov/

 National Center For PTSD

According to their website, they "...are the World's leading research and educational centre of excellence on PTSD and traumatic stress"