Post-traumatic Stress Disorder (PTSD) (cont.)
What Are PTSD Symptoms and Signs?
After a trauma in which you think you might die, see someone die, or become seriously injured, and you feel intense fear, helplessness, or horror, it is very common to become distressed and anxious. You may have trouble sleeping, have nightmares, think about the trauma a lot, try to avoid the site of the trauma, and/or try to avoid feelings at all and become more numb. When these symptoms occur shortly after the trauma, and they are severe enough to impair functioning, acute stress disorder is diagnosed. For most people, this distressing period passes within about four weeks. PTSD is diagnosed when these symptoms continue to interfere with daily life and persist more than a month after the initial trauma.
There are four main types of symptoms related to PTSD:
- Re-experiencing: intrusive memories, nightmares, and/or flashbacks of the trauma
- Avoidance: trying to avoid thoughts, feelings, situations, or people who might remind you of the trauma
- Negative changes in thinking and mood: Symptoms may include inability to remember parts of the traumatic event, negative beliefs and feelings about one's self, inability to enjoy pleasurable activity, or excessive self-blame for the trauma or its consequences. Those with PTSD may show emotional detachment, social isolation, and loneliness.
- Changes in arousal or reactivity: Problems can include always being on alert (hypervigilance), trouble sleeping, agitation, irritability, hostility, difficulty concentrating, exaggerated startle response, or heightened reactivity to stimuli. People with PTSD may also be more likely to engage in reckless or risky behaviors.
There are also other symptoms and diagnoses often associated with PTSD:
- Panic attacks: a feeling of intense fear, which can be accompanied by shortness of breath, dizziness, sweating, nausea, and a racing heart
- Physical symptoms: chronic pain, headaches, stomach pain, diarrhea, tightness or burning in the chest, muscle cramps, or low back pain
- Feelings of mistrust: losing trust in others and thinking the world is a dangerous place
- Problems in daily living: having problems functioning in your job, at school, or in social situations
- Substance abuse: using drugs or alcohol to cope with the emotional pain
- Relationship problems: having problems with intimacy or feeling detached from your family and friends
- Depression: persistent sad, anxious, or empty mood; loss of interest in once-enjoyed activities; feelings of guilt and shame; or hopelessness about the future (other symptoms of depression may also develop)
- Suicidal thoughts: thoughts about taking one's own life
PTSD is often associated with other psychiatric and physical problems.
- A majority of men and women with PTSD also have another psychiatric disorder. Nearly half suffer from major depression, and a significant percentage suffer from anxiety disorders, and social phobia.
- They also are more likely to engage in risky health behaviors such as alcohol abuse and drug abuse.
- Veterans who have been diagnosed with psychiatric conditions have a significantly higher prevalence of all cardiovascular disease risk factors (tobacco use, hypertension, dyslipidemia, obesity, and diabetes) than those without mental health diagnoses.
Children and adolescents also experience trauma and may develop PTSD. Children and teenagers still have the same four categories of symptoms. However, the physical, emotional, and anxiety symptoms of PTSD may be different than those seen in adults.
Following the trauma, children may initially show agitated or confused behavior. They also may show intense fear, helplessness, anger, sadness, horror, or denial. Children who experience repeated trauma may develop a kind of emotional numbing to deaden or block the pain and trauma.
- For children with PTSD, the re-experiencing symptoms may appear with
- having frequent memories of the event, or in young children, play in which some or all of the trauma is repeated over and over (This reenacting play is not always seen as distressing in children);
- having upsetting and frightening dreams, although it is not always clear that the nightmares are related to the trauma;
- developing repeated physical or emotional symptoms when the child is reminded of the event; or
- experiencing flashbacks, or dissociative episodes, when they feel like the event is happening again.
- Children with PTSD avoid situations or places that remind them of the trauma. They may also become less responsive emotionally, depressed, and more detached from their feelings than their peers. They may avoid people or conversations that remind them of the trauma, resulting in social isolation or withdrawal.
- The negative changes in thinking and mood are characterized by more negative emotions such as fear and sadness, less interest in activities they used to enjoy, and reduced expression of positive emotions like excitement and happiness.
- Arousal and reactivity changes more often appear as irritable and angry outbursts -- often without warning -- that may be accompanied by aggressive, hostile, or destructive behavior. Affected children will also commonly have sleep problems (including insomnia and disrupted sleep), are easily startled, and may have trouble with concentration and focus.
In addition to these core symptoms of PTSD, children may also show the following symptoms:
- Worry about dying at an early age
- Having physical symptoms such as headaches and stomachaches
- Acting younger than their age (for example, clingy or whiny behavior, thumb-sucking, or starting to wet the bed again)
Medically Reviewed by a Doctor on 9/11/2017
Michael J. Peterson, MD, PhD
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