post-traumatic stress disorder or ptsd is a disorder that like ocd has captured the public's interest to the extent that most people have heard of it and have some concept of what it is however there's much more nuance to the disorder than many people realize while it's common to think of ptsd as being any combination of difficult life experience plus psychiatric pathology this isn't actually the case instead ptsd is a rather narrowly defined disorder with very specific signs and symptoms in fact this particular constellation of signs and symptoms is so linked to traumatic events that it has been seen throughout history under various other names including railway spine for victims of the frequent railroad collisions that occurred in the early 1800s shell shock in world war one and combat stress reaction in world war ii to learn more about how ptsd is defined let's look at the diagnostic criteria for this disorder that are found in the dsm handily for learning these criteria for ptsd can be captured in the acronym trauma first the t is for trauma exposure to a traumatic event is required for a diagnosis of ptsd and the signs and symptoms must not have been present prior to this event so what exactly defines an event as traumatic trauma is defined as an event that is violent or life-threatening to the extent that it evokes feelings of fear helplessness and terror in the person experiencing it common examples of trauma include war combat violence assault crime terrorism and accidents the nature of the trauma has important considerations for the development of ptsd as less than 10 percent of people experiencing a non-intentional trauma such as a car accident develop ptsd while nearly 50 percent of those experiencing intentional trauma such as assault or rape do the trauma can be a single event as in a car crash or it can be chronic such as childhood abuse although chronic trauma tends to produce a different set of signs and symptoms next the r is for re-experiencing people with ptsd often re-experience their trauma in various ways this primarily takes the form of flashbacks which are sudden and unexpected re-experiencing episodes of the trauma flashbacks are not thoughts so much as experiences and our experience is occurring in the here and now someone in the midst of a flashback tends to experience it in highly emotional and sensory ways including specific images sounds or smells rather than verbal or narrative memories flashbacks can either be cued by certain stimuli that are reminiscent of the trauma such as a war veteran hearing helicopter or uncued occurring seemingly at random or out of the blue re-experiencing can also occur in the form of nightmares which are common in individuals diagnosed with ptsd with over 70 percent of people with this condition reporting frequent nightmares compared to only five percent of the general population the content of the nightmares is often related to the trauma itself though this is not required by any means nightmares are impairing as they can result in poor quality sleep or even attempts by the patient to avoid sleep due to anxiety about having more nightmares next the a is for arousal people with ptsd often develop a state of increased awareness of and anxiety about their surroundings known as hyper arousal patients may engage in constant scanning of their environment for possible clues to the presence of any danger a pattern known as hypervigilance to a certain extent this makes sense as having lived through a life-threatening situation will naturally make someone more cautious however hyperarousal transitions from being harmful rather than helpful when it becomes persistent and generalized occurring most of the time and in most settings regardless of whether there is a reason to be fearful or not for example someone who is robbed while traveling in another country may begin carrying protection with them at all times and keeping these at their side before answering the doorbell at home or may have trouble going to the grocery store for fear of being attacked because the fear response is constantly switched on people with ptsd often experience the same symptoms that are seen in chronic states of anxiety as captured in the miserable mnemonic that we talked about in the video on anxiety including muscle tension irritability trouble with sleep low energy restlessness and difficulty with attention next the u is for unable to function the re-experiencing hyper-arousal and avoidance pattern experienced by people with ptsd can be incredibly impairing people with ptsd often find themselves unable to concentrate at work or have no interest in maintaining relationships with other people who can't understand the experiences that they have been through leading to difficulties in maintaining a job and keeping an adequate social support system next the m is for month by definition ptsd is a chronic disorder meaning that the trauma-related symptoms must be present for a certain period of time in the dsm this period of time is defined as at least one month to be clear this does not mean that symptoms have to be present in the first month after the trauma occurs in fact a delayed onset is most characteristic of ptsd with nearly 80 of those who eventually receive this diagnosis not showing any symptoms within the first month after the trauma finally the second a is for avoidance people with ptsd will often go to great lengths to avoid people places or things associated with their trauma so as not to trigger a flashback for example someone with ptsd from a construction-related accident may try to avoid tall buildings while someone who is kidnapped while walking out of a friend's house at night may find it difficult to return to that part of town avoidance can go beyond physical avoidance to include a more psychological avoidance of emotions known as numbing emotional numbing helps to protect against strong negative emotions such as fear helplessness and anxiety but it can also rob the patient of their ability to experience positive emotions as well such as joy satisfaction and love this results in a flattening of affect which can impair one's ability to interact with other people and engage in meaningful relationships from a diagnostic standpoint simply asking two questions have you experienced a life-threatening or violent event and if so does the memory of this event interfere with your life can be a very sensitive test for ptsd people who answer no to both of these questions are quite unlikely to have ptsd while those who answer yes should be further evaluated to understand the nature of their dysfunction and whether they would qualify for this diagnosis together the signs and symptoms in the trauma mnemonic lead directly to the distress and dysfunction that makes ptsd a disorder let's turn our attention to learning more about the data behind ptsd including who gets it what happens once they get it and what forms of treatment work the best exposure to trauma is common and the majority of people will experience at least one traumatic event in their lifetime however not everyone exposed to trauma will develop ptsd for example while 20 of soldiers exposed to combat do develop ptsd the other 80 do not in non-military populations up to 60 percent of people experience at least one major trauma in their lives but only around eight percent go on to develop ptsd this gives ptsd an overall rate of about three percent of the population any given time with up to ten percent of all people having had the disorder during their lifetime this makes it a relatively common syndrome as far as psychiatric pathology goes women are affected twice as often as men even after accounting for significant differences in the nature of trauma experienced by its gender such as things like domestic violence being more common in women than men unlike other psychiatric disorders that we've discussed so far the age of onset of ptsd is quite variable logically this makes sense as traumatic events are generally unplanned and occur on a haphazard basis however while the traumatic events that cause ptsd occur randomly the signs and symptoms that result do seem to have an age-related pattern with children under the age of 10 and adults over the age of 55 being very unlikely to develop ptsd for whatever reason when people younger than 10 or older than 55 experience trauma they rarely develop ptsd at least not in the textbook sense as defined in the trauma mnemonic however they may still be more prone to developing other forms of psychiatric pathology such as depression or anxiety following a trauma in terms of why some people develop ptsd following a trauma and others do not this is a complex topic that requires more time to dive into i encourage you to watch the video on my channel on this very topic i'll put the link in the description below suffice it to say that the nature of the trauma seems to matter as much as the attributes of the person experiencing it with things like pre-existing mental disorders and poor social support predicting a much higher rate of developing ptsd without treatment ptsd is chronic and enduring with about fifty percent of people having continued symptoms and impairment over a five-year period in the other fifty percent of cases the severity of ptsd symptoms will decrease over time the distinction between intentional and non-intentional trauma that we brought up earlier appears to be important for the prognosis of ptsd as symptoms related to non-intentional trauma like an accident often decrease with time while those associated with intentional trauma like an assault remain constant or even increase as time goes on specific treatments for ptsd have been shown to be effective at reducing the distress and disability related trauma the most effective form of treatment for ptsd is trauma-focused cbt in particular a form of cbt known as exposure therapy helps to overcome all three symptom domains specifically re-experiencing hyperarousal and avoidance by encouraging patients to intentionally come into contact with places and things that remind them of their traumatic experiences such as driving a car in the area where an accident previously occurred while being within a supportive environment with therapists and other people going through similar experiences this helps them to re-encode these memories in a way that is less likely to cause flashbacks and more likely to be remembered as part of their personal life story that they have overcome exposure therapy for ptsd is very effective with large and lasting effects even after the therapy has been completed medications can be helpful as an adjunct to psychotherapy with serotonin boosting medications being the most effective type however they are generally not preferred as a first-line treatment given that they are not only less effective than cbt but also produce effects that last only as long as a treatment does with symptoms returning after the drug is stopped in addition to serotonergic medications another drug known as prazesin has been shown to be helpful for preventing ptsd related nightmares when taken before bed prazosin works by blocking the sympathetic nervous system in its associated fight or flight response allowing the patient to enter into a more physically and psychologically restful state of sleep conversely it's worth pointing out that benzodiazepines should be avoided in ptsd while they rapidly reduce the anxiety and arousal associated with this disorder in the long term they actually worsen many outcomes including higher rates of depression aggression and substance abuse following a trauma in summary you can remember the three most effective treatment strategies by thinking of post-traumatic stress being treated with prazesin therapy and serotonin before we wrap up let's talk about a few other disorders that are also related to trauma but differ from ptsd in some key ways first is acute stress disorder as mentioned before the majority of people with ptsd do not experience symptoms within the first month after the trauma with the delayed onset being the typical pattern however some people do experience severe symptoms that begin almost immediately following a traumatic event as noted by the m in the trauma mnemonic you cannot diagnose ptsd until the symptoms have been present for at least one month in these cases a diagnosis of acute stress disorder can be given instead while one might assume that acute stress disorder is basically pre-ptsd this is not the case many people who are diagnosed with acute stress disorder will go on to develop ptsd after the month has passed but not all of them do therefore the presence of acute stress disorder immediately following a traumatic event does not guarantee that the patient will later develop ptsd nor does its absence guarantee that they won't next it's important to point out that ptsd is not the only disorder with a clear relationship to trauma while trauma increases the risk for nearly all types of mental disorders including things like depression and anxiety these disorders can and do occur in the absence of trauma in contrast there is a group of disorders that tend to occur almost exclusively in the context of trauma specifically not only ptsd like we've talked about but dissociative disorders cluster b personality disorders and somatoform disorders as well we'll cover these in future videos but for now just know that while ptsd is the only one that has trauma in the name these other disorders can and should be on your differential when working with patients who are suffering as a result of traumatic experiences these other forms of pathology seem to be particularly common in people who have been exposed to chronic trauma especially when it occurred in a developmental period like someone who endured years of childhood abuse you can remember these using the acronym ptsd which stands for personality disorders trauma related disorders somatoform disorders and dissociative disorders in this way it's revealed that ptsd is just one possible manifestation of trauma while it's important to maintain a narrow definition of ptsd as a disorder of re-experiencing hyperarousal and avoidance it's equally important to remember that people who have experienced trauma but instead manifest their experience through dissociative disorders somatoform disorders or personality disorders deserve just as much empathy validation and treatment as someone who experiences textbook ptsd try your best to strike a balance between keeping a strict definition of ptsd while also having compassion and empathy for people who suffer from trauma in other ways and that's it this was definitely a complex topic so thanks for hanging in there if nothing else i hope i've convinced you that ptsd is much more than simply any combination of difficult life experience plus psychiatric pathology if you're interested in learning more check out my book memorable psychiatry which includes an in-depth discussion of the differential diagnosis of ptsd as well as more information about the underlying pathophysiology in the meantime consider subscribing for more videos like this thanks again for watching see you again soon