Have you ever had a traumatic experience? It’s an experience that causes severe mental or emotional stress or physical injury. Trauma’s effect on your mental health can manifest into any number of disorders. One of the more common is post-traumatic stress disorder, or PTSD.
About 8 million American adults have PTSD during a given year. Each one of these adults will have undergone their own kind of trauma.
In most cases, PTSD is brought on by exposure to a serious accident, combat, sexual violence, or physical abuse. For some, PTSD is the result of survivor guilt. Not only does the survivor have feelings about the experience that left others dead, but they have mixed emotions about being the only one who survived it. Other traumatic events that can lead to PTSD include natural disasters and other near-death experiences.
Getting through such intense, life-changing events doesn’t automatically mean you’ll develop PTSD. There are several steps that must be taken before a doctor gives you a PTSD diagnosis. And there are a few different types of PTSD your healthcare professional may consider. Based on the trauma you experienced and your symptoms, your doctor will come up with the best treatment plan for you.
Types of PTSD
PTSD symptoms can present themselves in many ways, creating combinations that are unique to you. You may also experience symptoms that aren’t typically associated with PTSD. These variations are what characterize the different types of post-traumatic stress disorder.
1. Complex PTSD
The symptoms of complex PTSD are not explicit in DSM-5, like they were in DSM-IV. The National Center for PTSD offers a clearer understanding. They suggest that complex PTSD is a diagnosis that describes a cluster of symptoms. This cluster of symptoms is also known as Disorders of Extreme Stress Not Otherwise Specified (DESNOS).
Complex PTSD comes from long-term trauma. You’ve been held captive physically or emotionally. Chronic or prolonged trauma includes situations like:
- Concentration camps
- Prisoner of War (POW) camps
- Child exploitation
- Long-term child abuse (sexual or physical)
- Long-term domestic violence
If you experience complex PTSD, you may have trouble regulating your emotions. That can lead to explosive anger or even suicidal thoughts. You may frequently relive the traumatic events or feel detached from your own mental being (dissociation). Your perception of yourself can change, leading to extreme guilt or shame. This can cause you to isolate yourself from others or lose trust in people. You might become preoccupied with the relationship you have to the perpetrator of your trauma or start thinking about revenge.
The National Center for PTSD asserts that “standard evidence-based treatments for PTSD are effective for treating PTSD that occurs following chronic trauma.”
2. Comorbid PTSD
Comorbid PTSD is when you meet all the criteria for PTSD and exhibit symptoms of another disorder. The American Academy of Family Physicians says “…at least one additional psychiatric disorder is present in 88.3 percent of men and 79.0 percent of women who have a history of PTSD.”
They also say, “Women who have PTSD are 4.1 times as likely to develop major depression and 4.5 times as likely to develop mania as women who do not have PTSD.” Men aren’t off the hook either. Men with PTSD are 6.9 times as likely to develop depression and 10.4 times as likely to develop mania. Plus, more than half of men with PTSD have comorbid alcohol use disorder.
A review published in Dialogues in Clinical Neuroscience explains the risk factors of PTSD comorbidity:
On one hand, people internalize and are more vulnerable to developing major depressive disorder (MDD) with PTSD. “…people who report high levels of neuroticism are prone to react to everyday stressors and challenges with anxiety, worry, irritability, and sadness (i.e. negative affect).” These people are also less likely to reach out to others for support. They may also be less able to seek out experiences that could brighten their mood.
On the other hand, people externalize. That’s “…characterized by high levels of negative affectivity and low levels of constraint (also known as high impulsivity).” These people “are more likely to have comorbid substance-use disorders, and report higher aggression scores.”
There are several overlapping symptoms of depression and PTSD:
- Sleep problems
- Trouble focusing
- Loss of pleasure in activities you once enjoyed
- Increased irritability
Overlapping symptoms can mean treatment that helps with your PTSD may also improve your depression.
Just a few of the disorders that can co-occur in people with PTSD are:
Because comorbid PTSD varies so much from person-to-person, treatment isn’t one-size-fits-all. It will address both disorders and their specific symptoms.
3. Dissociative PTSD
This is a new subtype of PTSD, debuted in DSM-5. To be diagnosed with dissociative PTSD, you must meet all PTSD diagnostic criteria. There are eight criteria, including:
- Being exposed to a stressor
- Exhibiting distinct, prolonged symptoms because of that stressor
- Avoiding people or places that remind you of the stressor
- Experiencing negative changes to your mood
Your doctor will likely diagnose you with PTSD if your symptoms:
- Are not a result of medication or substance abuse
- Last more than one month
- Interfere with your daily life
People with dissociative PTSD experience depersonalization and derealization:
- Depersonalization – You have out-of-body experiences that make you think, “This isn’t happening to me.”
- Derealization – You experience events that are simply not real. This kind of dissociation can cause you to space out or be unable to remember anything for a period of time.
People with dissociative PTSD tend to have a history of early life trauma. This could explain why you may also have flashbacks to a traumatic event related to your PTSD or feel like you’re briefly losing touch with your environment.
The best course of treatment for dissociative PTSD is to find a therapist who specializes in trauma and dissociation. You’ll learn coping strategies to keep you present. These might include grounding techniques that teach you to reconnect with your five senses as soon as you feel like you’re slipping into a flashback or derealization. It’s also important to identify your triggers—the people, places, and things that cue you to have a flashback or space out. Knowing your triggers will help you and your therapist find ways to cope.
Once you’re diagnosed, there are different ways PTSD can be treated. That’s why the type of PTSD is important information. Understanding the history of your trauma and how you’re processing it can help your mental health professional create the right course of treatment for your needs.
Options for treatment include:
Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy is a form of one-on-one talk therapy. During these sessions, your therapist will help you recognize how negative thoughts may influence your behavior. They will also teach you how to cope with your thoughts and feelings. By changing your thinking pattern, you can effectively change your behavior.
Exposure therapy is exactly as it sounds. In a controlled environment, you’ll be faced with the people, places, or things that trigger your negative thoughts, anxious feelings, or destructive behavior. Exposure therapy can be intense, but it’s used to help you overcome the trauma without any risk of danger.
Transcranial Magnetic Stimulation (TMS)
Transcranial magnetic stimulation is a non-invasive, FDA-approved treatment option that stimulates brain cells in your ventromedial prefrontal cortex (vmPFC). Brain-imaging studies suggest that PTSD patients have reduced brain activity in the vmPFC.
By stimulating this area, you not only “turn on” your vmPFC, but you may help control your amygdala. The amygdala is responsible for your survival instincts and the way you express certain emotions, including fear. TMS for PTSD can help restore balanced activity throughout the brain, leading to symptom relief with almost no side effects.
Eye Movement Desensitization and Reprocessing (EMDR)
Developed specifically for PTSD sufferers, EMDR is an integrative psychotherapy treatment. It’s been scientifically proven to help treat victims of trauma.
With EMDR, you’re guided by a trained therapist who desensitizes you to your triggers. The therapist may lead you through a set of eye movements, finger-tapping, or other forms of stimulation to shift focus away from your trauma.
Anxiety and depression medications are common prescriptions for PTSD. Selective serotonin reuptake inhibitors (SSRIs) are approved by the FDA for treatment of PTSD. Like any other medication, there are side effects of antidepressants and anti-anxiety formulas that you may want to avoid.
From Trauma to Treatment
Not everyone who endures trauma will develop post-traumatic stress disorder. But if you experience symptoms of PTSD, it’s important to seek help. For a non-invasive, medication-free treatment option, talk to your doctor about TMS. Because TMS has been FDA-approved to treat depression, it can be especially beneficial for anyone suffering from comorbid PTSD with MDD. Whatever you do, don’t waste time. Treatment for PTSD is always within reach.