PTSD - What Causes Post Traumatic Stress Disorder and Why It's Important to Talk About it

What is PTSD?
Post-Traumatic Stress Disorder (or PTSD) is a significant mental health condition that arises after a person experiences or witnesses a traumatic event. These events can range from war, accidents, and natural disasters to personal trauma like abuse, assault, or other life-threatening situations. PTSD is not limited to any age or ethnic group, and anyone who experiences trauma may develop symptoms of PTSD. It is predicted that at least 3.9 percent of the global population (around 300 million people) has experienced symptoms of PTSD at some point in their lives. PTSD can lead to severe emotional and physical distress, causing impairment in every aspect of one’s life, from personal and familial relationships to career stability and overall well-being.

Can children and adolescents have PTSD?
Children and adolescents are particularly vulnerable to the development of PTSD, as they are at a stage in their lives when their personality and brain are not yet fully developed. The consequences of PTSD can be more significant in this age group because this stage has a significant effect on a person’s future. Common traumatic events in this age group include bullying, abuse (sexual and other physical abuses), or even witnessing distressing incidents.

Recent research, such as the 2019 study published in The Lancet Psychiatry, highlights the shocking prevalence of PTSD among adolescents. This study found that by age 18, one in every 13 young people has experienced symptoms of PTSD. Considering the severe outcomes of PTSD at a young age, this data is alarming and emphasizes the need for serious action for the future of mental health in society. This high prevalence underlines the importance of early screening and intervention at a young age, as the longer mental disorders go unrecognized, the more entrenched their symptoms may become. The same Lancet study also found that PTSD among adolescents often goes undiagnosed or is misattributed to other behavioral or emotional difficulties. As discussed earlier, the consequences of untreated PTSD in this population are severe, often resulting in academic struggles, social isolation, substance abuse, or co-occurring mental health conditions like depression and anxiety, which in turn severely impact one’s overall well-being.

What types of trauma can lead to PTSD?

• Any life-threatening event or event that threatens physical harm can cause PTSD. These events may include:
• Sexual abuse or violence (does not require a threat of harm)
• Physical abuse
• Natural or man-made disasters, such as fires, hurricanes, or floods
• Violent crimes such as kidnapping or school shootings
• Motor vehicle accidents, such as automobile and plane crashes
• PTSD can also occur after witnessing violence. These events may include exposure to:
• Community violence
• Domestic violence
• War
• Finally, in some cases, learning about these events happening to someone close to you can cause PTSD.

Can PTSD be treated?
Fortunately, PTSD is treatable, and with the right interventions, most people with PTSD can recover or significantly reduce their symptoms. The prognosis of PTSD with treatment varies based on the severity of symptoms, the presence of comorbid mental health conditions, and the effectiveness of the treatment.

Treatment for PTSD usually includes a combination of psychotherapy and medication. Cognitive-behavioral therapy (CBT), particularly trauma-focused CBT, is considered one of the most effective approaches for treating PTSD. Exposure therapy, another type of CBT that helps individuals face and process their traumatic memories, can also lead to significant improvements.

Medications such as antidepressants, for example, sertraline and paroxetine, are often prescribed to manage symptoms of anxiety, depression, and intrusive thoughts associated with PTSD. These medications can be particularly beneficial when combined with psychotherapy, providing a comprehensive treatment approach.

What happens if PTSD remains untreated?
Symptoms of untreated PTSD can persist for years or even decades after the traumatic event. People with PTSD may experience persistent symptoms such as intrusive thoughts, nightmares, emotional numbness, irritability, and hypervigilance. These symptoms can interfere with work, relationships, and social functioning, often leading to a downward spiral of isolation and avoidance of situations that might trigger distress.

The most concerning consequence of long-term and untreated PTSD is the risk of developing additional mental health conditions, including depression, anxiety, substance use, and even suicidal behavior. One study found that over 50% of people with PTSD will contemplate suicide at some point in their lives. PTSD has also been associated with increased rates of cardiovascular disease and chronic pain disorders, which further exacerbate the individual’s suffering.

What are the signs and symptoms of PTSD?
PTSD can have a wide range of symptoms that vary in severity from person to person. The hallmark symptoms of PTSD in adults fall into four categories:

1. Intrusive Thoughts: These include flashbacks, nightmares, and intrusive memories of the traumatic event, which cause significant distress and disrupt daily life.
2. Avoidance: Individuals with PTSD often go to great lengths to avoid reminders of the traumatic event, including places, people, or activities that may trigger distressing memories.
3. Negative Thoughts and Mood: PTSD can lead to feelings of hopelessness, guilt, or shame. Individuals may also feel detached from others, lose interest in previously enjoyed activities, or struggle with emotional numbness.
4. Hyperarousal and Reactivity: Symptoms such as being easily startled, feeling on edge, irritability, angry outbursts, and difficulty sleeping are common in individuals with PTSD.

These symptoms can be highly disruptive and often worsen over time if left untreated. They can also lead to destructive coping mechanisms, such as substance abuse or self-harm.
PTSD in children and adolescents may have a different set of symptoms. Clinical reports suggest that elementary school-aged children may not experience visual flashbacks or amnesia for aspects of the trauma. However, they do experience "time skew" and "omen formation," which are not typically seen in adults.

Time skew refers to a child mis-sequencing trauma-related events when recalling the memory. Omen formation is a belief that there were warning signs that predicted the trauma. As a result, children often believe that if they are alert enough, they will recognize warning signs and avoid future traumas.

School-aged children also reportedly exhibit post-traumatic play or reenactment of the trauma in play, drawings, or verbalizations. Post-traumatic play is different from reenactment in that post-traumatic play is a literal representation of the trauma, involves compulsively repeating some aspect of the trauma, and does not tend to relieve anxiety.

An example of post-traumatic play is an increase in shooting games after exposure to a school shooting. Post-traumatic reenactment, on the other hand, is more flexible and involves behaviorally recreating aspects of the trauma (e.g., carrying a weapon after exposure to violence).

PTSD in adolescents may begin to more closely resemble PTSD in adults. However, there are a few features that have been shown to differ. As discussed above, children may engage in traumatic play following a trauma. Adolescents are more likely to engage in traumatic reenactment, in which they incorporate aspects of the trauma into their daily lives. In addition, adolescents are more likely than younger children or adults to exhibit impulsive and aggressive behaviors.

Can PTSD be prevented after exposure to trauma?
Not everyone exposed to trauma develops PTSD, so it is safe to assume that certain steps can be taken to reduce the risk of PTSD after a traumatic event. Immediate intervention, such as psychological first aid (PFA), has proven to help individuals process the trauma and reduce the likelihood of long-term psychological consequences.

Social support is another critical factor for preventing PTSD after trauma. Research shows that individuals with strong support systems, whether through family, friends, or community, are less likely to develop symptoms of PTSD. Encouraging trauma survivors to talk about their experiences in a safe and supportive environment can be beneficial in helping them process their emotions.

Is PTSD the only consequence of severe trauma?
Besides PTSD, children and adolescents who have experienced traumatic events often exhibit other types of problems. Fear, anxiety, depression, anger and hostility, aggression, sexually inappropriate behavior, self-destructive behavior, feelings of isolation and stigma, poor self-esteem, difficulty trusting others, substance abuse, and sexual maladjustment are some other significant mental consequences of trauma, which are especially more pronounced in children and adolescents.

Authored by:

Dr. Alireza Sarmadi
Family Physician

Reference:

https://link.springer.com/article/10.1007/s40653-024-00611-y

https://www.bbc.com/news/education-53097289

https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967

https://www.ptsd.va.gov/professional/treat/specific/ptsd_child_teens.asp#three

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30031-8/fulltext

https://www.bbc.com/news/health-47317891