Post-traumatic Stress Disorder (PTSD): An Overview
Written by Courtney Coleman, Edited by Hannah Ryu, Edited by Han Trieu
Table of Contents
Post-traumatic stress disorder (PTSD) is a mental health condition that may develop as a result of experiencing or witnessing one or more traumatic events [1]. It was previously categorized as a form of anxiety disorder; however, with the release of The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), it has since been reclassified within a new category of Trauma- and Stressor-Related Disorders [1]. Examples of events that may lead to the development of PTSD include, but are not limited to, the following [2]:
War
Combat
Physical abuse
Bullying
Psychological abuse
Rape
Sexual assault
Intimate partner violence
Acts of terrorism
Torture
Serious accidents
Medical procedures
Natural disasters
Historical trauma
It is important to note that experiencing one or more traumatic events does not guarantee that someone will develop post-traumatic stress disorder, and why some individuals do develop PTSD while others do not remains poorly understood [3].
Affected Populations
While more commonly associated with veterans, PTSD can occur in anyone regardless of race, ethnicity, nationality, culture, gender, or age [3]. Approximately one in eleven individuals will be diagnosed with PTSD in their lifetime, and in adolescents ranging in age from thirteen through eighteen, the lifetime prevalence of PTSD is 8% [3].
PTSD also disproportionately affects several populations. As of this writing, the likelihood of women experiencing PTSD is twice that of men [3]. “Three ethnic groups – U.S. Latinos, African Americans, and Native Americans/Alaska Natives – are [also] disproportionately affected and have higher rates of PTSD than non-Latino whites” [3].
PTSD Symptoms and Effects on Daily Life
Individuals living with post-traumatic stress disorder often experience the following symptoms: intrusive memories, avoidance, negative changes in thinking or mood, and/or changes in physical and emotional reactions [4].
Intrusive memories cause the individual to experience recurring, unwanted memories of the traumatic event(s) at any time [4]. This often forces the individual to repeatedly recall and relive the trauma, a symptom known as re-experiencing [5]. These intrusive memories are very distressing and can often cause the individual to experience the same level of intense fear that occurred at the time of the event(s) [5]. A form of this is known as flashbacks, which is a common occurrence among those living with PTSD [5]. Flashbacks are when someone feels as though they are enduring the traumatic event(s) as if it is presently happening [5]. These flashbacks can be so vivid that the individual is able to see the event before their very eyes and feel as though they are reliving the traumatic experience(s) [5]. Consequently, they may exhibit behaviors as if they are currently in danger, such as running away from their present surroundings, shouting, crying, or trembling, to name a few. During these flashbacks, they may also provide inappropriate answers to questions, such as stating their age as being how old they were at the time of the event rather than their current age. Intrusive memories also often manifest as disturbing nightmares that are associated with the traumatic event(s), and as a result, someone living with PTSD may have trouble sleeping or even be afraid to fall asleep [4,5]. Intrusive memories may occur as the result of experiencing a trigger, which is something that reminds the individual of the traumatic event(s) [5]. This may be something that the individual sees, hears, smells, or feels, such as a news report, accident, loud sound, or an accidental touch [5]. Any of these triggers may lead to an individual experiencing severe emotional distress, and it may even provoke a physical reaction, such as placing their hands in front of them in anticipated defense [4]. These physical reactions can occur within a spectrum, with an example of a more minor manifestation being flinching and a more severe example being the loss of awareness of present surroundings [6]. Physical symptoms may also occur, examples of which are pain, headaches, nausea, and/or vomiting [5].
As a result of these distressing intrusive memories, individuals may exhibit avoidance, which is when they try their best to avoid activities, situations, environments, or other people that trigger memories of the traumatic event(s) [5]. Avoidance may also include being reluctant, or completely refusing, to talk about the traumatic experience(s), or putting a great deal of effort into avoiding remembering or thinking about it [4,5]. For example, someone living with PTSD may avoid crowds due to not feeling safe; avoid driving if they experienced, or witnessed, an accident; or avoid watching television and movies that contain content associated with their traumatic event(s), such as violence, intimacy, natural disasters, or war-related topics [5]. Individuals with PTSD may also purposely lead overly busy lives, as well as avoid seeking help, as a means of trying to avoid remembering or communicating the traumatic event(s) that occurred [5].
Constantly living and dealing with the intrusive thoughts, as well as with the traumatic event(s) in general, can often lead someone with PTSD to experience alterations in thinking, mood, cognition, beliefs, and feelings [2,4,5]. These symptoms can manifest in numerous ways, but what frequently happens is that the traumatic experience(s) cause an individual’s outlook towards themselves and the world to change [4,5]. As a result, they may have negative thoughts about themselves, others, or the world in general [4,5]. They may wrongly blame themselves, or others, and/or believe that the world is a dangerous place and that no one can be trusted [1,2,5,7]. Individuals with PTSD may also feel hopeless about the future; feel detachment or estrangement from family or friends, as well as in social situations; lose interest in activities that were once enjoyed; feel emotionally numb; find it difficult to experience positive emotions; and experience memory problems, such as dissociative amnesia, which is an inability to recall key aspects of the traumatic event(s) [4,5]. Additional symptoms often also include chronic, distressing emotions, such as ongoing “fear, horror, anger, guilt, or shame” [7]. As a result, someone with PTSD may self-isolate [5,6].
As previously mentioned, it is common for those with PTSD to exhibit physical reactions when experiencing a flashback; however, it is important to note that changes in physical and emotional reactions can occur independently [4]. These symptoms commonly manifest as hyperarousal, which is when someone with PTSD experiences a heightened watchfulness for danger, as well as feelings of restlessness, uptightness, intense anxiety, and/or worry [4,5]. This may lead to a general state of hypervigilance, particularly in relation to their surroundings, which often manifests as being overly watchful for danger and constantly monitoring their surroundings in a suspecting manner [2,6]. As a result, someone with PTSD may feel as though they want, or need, to have their back against a wall in certain environments, such as in a restaurant or waiting room, in order to feel safer [5]. Individuals with PTSD are also frequently easily startled or frightened, which often leads to behaviors such as an exaggerated fear response to loud or unexpected noises, as well as to surprise [4,5]. Additional symptoms may also include the following: sudden anger or irritability, including angry outbursts; behaving in an aggressive or violent manner; depression; anxiety; changes in appetite or significant weight gain or loss; and suicidal ideation [4,5]. Those with PTSD are also at risk for exhibiting self-destructive or reckless behaviors, such as self-injury, or reckless and aggressive driving [4,5,6]. They may also participate in unhealthy methods of coping, such as the use of recreational drugs, overuse of alcohol, or inappropriate use of prescription medications [5].
Understandably, the combined effects of living and dealing with the traumatic experience(s), PTSD, and the aforementioned symptoms frequently have direct, negative consequences on an individual’s quality of life. Often, someone who has PTSD will have difficulty functioning in their daily lives, such as in social situations, with their family, at their place of occupation, in an academic environment, and/or when participating in recreational activities [5,6]. They may also have difficulty maintaining close relationships, or they may even avoid relationships altogether as a result of feeling unsafe around others and/or not being able to feel positive or loving emotions towards others [4,5,6].
PTSD Diagnostic Criteria
It is important to distinguish the difference between a response to a traumatic experience that warrants a diagnosis of PTSD and a response that does not qualify as PTSD. Following a traumatic event, it is normal to experience a state of shock, negative or exaggerated thinking, distressing memories, and upsetting emotions when encountering something that acts as a reminder of the trauma [5]. Most of the time, these feelings decrease in intensity with time, but for some, these feelings remain persistent and severe [5]. Symptoms of PTSD often occur shortly after the traumatic event, and in most instances, these symptoms disappear within the first several weeks or months following the traumatic experience; however, for others, these symptoms can remain for many years, particularly if the individual does not receive treatment [5]. The severity in which someone experiences symptoms of PTSD can remain fairly stable; however, it may wax and wane in its intensity, with some periods of time consisting of more mild symptoms and others marked by an increase in their severity [4]. This worsening of symptoms may occur as the result of a period of general stress or due to experiencing a trigger [4].
For someone to be diagnosed with PTSD, symptoms must be experienced for longer than one month and significantly affect their ability to function in their daily life [2]. In most instances, symptoms develop within the first three months following the traumatic event, but it is also possible for symptoms to not develop until later [2]. It is important to note that PTSD often develops with other physical and mental health conditions, and it increases the risk of acquiring additional medical problems in the future [2].
To be diagnosed with PTSD, one must meet either of the following diagnostic criteria as defined by The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5). Two separate diagnostic criterias exist, one for those ages seven years and older, and a preschool subtype for ages six and younger.
PTSD Diagnostic Criteria: Ages Seven Years Through Adult [7]
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
1. Avoidance of, or efforts to avoid, distressing memories, thoughts, or feelings about, or closely associated with, the traumatic event(s).
2. Avoidance of, or efforts to avoid, external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about, or closely associated with, the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
3. Hypervigilance.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep, or restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
Specify whether:
With dissociative symptoms: The individual’s symptoms meet the criteria for post-traumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted). Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
Specify whether:
With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
PTSD Diagnostic Criteria: Children Ages Six Years and Under [8]
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
1. Directly experiencing the traumatic event(s).
2. Witnessing, in person, the event(s) as it occurred to others, especially primary caregivers.
3. Learning that the traumatic event(s) occurred to a parent or caregiving figure.
- Note: Witnessing does not include events that are [witnessed] only in electronic media, television, movies, or pictures.
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
- Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
- Note: It may not be possible to ascertain that the frightening context is related to the traumatic event.
3. Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Such trauma-specific reenactment can occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to reminders of the traumatic event(s).
C. One (or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s), must be present, beginning after the event(s) or worsening after the event(s):
Persistent avoidance of stimuli
1. Avoidance of, or efforts to avoid, activities, places, or physical reminders that arouse recollections of the traumatic event(s).
2. Avoidance of, or efforts to avoid, people, conversations, or interpersonal situations that arouse recollections of the traumatic event(s).
Negative alterations in cognitions
3. Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion).
4. Markedly diminished interest or participation in significant activities, including constriction of play.
5. Socially withdrawn behavior.
6. Persistent reduction in expression of positive emotions.
D. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects (including extreme temper tantrums).
2. Hypervigilance.
3. Exaggerated startle response.
4. Problems with concentration.
5. Sleep disturbance (e.g., difficulty falling or staying asleep, or restless sleep).
F. Duration of the disturbance is more than one month.
G. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers, or with school behavior.
H. The disturbance is not attributable to the physiologic effects of a substance (e.g., medication, alcohol) or another medical condition.
Subtypes — Specify whether presentation of the disorder is:
• . With dissociative symptoms — The individual's symptoms meet the criteria for PTSD, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
• Depersonalization – Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body, or of time moving slowly).
• Derealization – Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
- Note: To use this subtype, the dissociative symptoms must not be attributable to the physiologic effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
• With delayed expression — If the full diagnostic criteria are not met until at least six months after the event (although the onset and expression of some symptoms may be immediate).
Complex PTSD
It is important to mention an additional subtype of PTSD, proposed by Dr. Judith Herman in 1988, termed complex post-traumatic stress disorder (C-PTSD or CPTSD) [9]. This subtype was proposed because there was, and continues to be, some thought that a diagnosis of PTSD does not fully represent the severity of the psychological effects that result from long-term exposure to trauma [9]. Consequently, CPTSD was proposed in order to distinguish between those who experience a single traumatic event, such as a natural disaster or car accident, and those who experience long-term traumatic events occurring over a much longer duration of months to years, such as child abuse or intimate partner violence [9]. Currently, the DSM-5 does not recognize CPTSD as a formal diagnosis due to too little supporting evidence to distinguish CPTSD as a diagnosis distinct from PTSD; however, the 11th edition of the International Disease Classification (ICD-11; 6) developed by the World Health Organization does formally recognize CPTSD as a diagnosis, proposing the following diagnostic criteria [9]:
WHO PTSD Diagnostic Criteria [9]
1. Re-experiencing the traumatic event(s).
2. Avoidance of thoughts, memories, activities, etc. that serve as reminders of the [event(s)].
3. Persistent perceptions of heightened current threat.
WHO CPTSD Diagnostic Criteria [9]
1. Fulfill the diagnostic criteria for PTSD in addition to experiencing:
1) Affect dysregulation.
2) Negative self-concept.
3) Disturbed relationships.
Effects on Family and Friends
The negative effects of PTSD are not limited exclusively to just the individual who has experienced the traumatic event(s) firsthand, as it often also has negative effects on their family and friends. This is because those experiencing PTSD often exhibit heightened emotions and reactions, which can cause a variety of difficulties for friends and family members, especially since someone with PTSD may become easily angered, hostile, or withdrawn [5]. Family and friends of an individual who is experiencing PTSD may notice sudden changes in their loved one’s behavior and find this to be concerning and confusing, particularly if the person with PTSD is exhibiting reckless behaviors, a dramatic change in personality, or behaving out of character [5]. They may also notice that their friend or loved one has become very difficult to deal with, and this may, understandably, cause family and friends to feel frustrated because they do not understand why their friend or loved one behaves in the way that they do [5]. Some may even believe that they have done something wrong to cause this change in their loved one’s behavior or believe that their friend or “loved one no longer loves or cares about them or their family” [5]. Consequently, friends and family may feel unloved or abandoned [5]. It is important to note, however, that individuals with PTSD are unable to control these changes in their disposition or reactions, and the behaviors that they exhibit are not related to friendship or family dynamics [5].
Family and friends may find it difficult to cope with having a loved one who lives with PTSD, and while this may evoke a positive emotion, such as sympathy for their loved one, family and friends may also find that they are experiencing a range of negative emotions, such as depression, anxiety, guilt, avoidance, shame, and/or anger [5]. They may also experience other negative effects of dealing with someone who has PTSD, such as feeling detached or disconnected, or experiencing a strained relationship, financial strain, conflict, issues sleeping, health issues, caregiver burden, and even drug and/or alcohol abuse [5]. Additionally, family and friends may find it very distressing that their loved one experienced a traumatic event, or events, to begin with, and this may lead friends and family to question their own safety [5]. Consequently, family and friends may feel as though no one can be trusted, and this may cause them to develop a negative outlook towards the world, other people, or the future [5]. Furthermore, family and friends may also wonder if their loved one will ever return to normal, and therefore, they may mourn that the version of the person that they know and love has changed [5]. This may lead to additional frustration because it is common for those with PTSD to not seek help due to a variety of reasons, a few of which may be the PTSD symptoms themselves, stigma or preexisting assumptions associated with seeking treatment for a mental health condition, and/or doubt that treatment will be able to help [5].
Treatments
Treatments for PTSD consist of talk therapy, as well as medications [10]. In the case of talk therapy, sessions usually last approximately three-to-four months and consist of any of the following forms, as outlined in Figure 1 [11]:
Figure 1: Talk Therapy Treatments for PTSD. Source: U.S. Department of Veteran Affairs | PTSD: National Center for PTSD. (n.d.-e). Talk Therapy - PTSD: National Center for PTSD. www.ptsd.va.gov. https://www.ptsd.va.gov/understand_tx/talk_therapy.asp
Regarding medications, recommended pharmaceuticals for PTSD consist of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which are antidepressant medications [12]. There are four SSRIs/SNRIs that are recommended for reducing the symptoms of PTSD: Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine (Prozac), and Venlafaxine (Effexor) [12]. Other antidepressant medications may also be utilized for treating PTSD; however, these four are considered to be the most effective [12].
It is important to mention that there are some medications that are not recommended for treating PTSD, such as benzodiazepines, which are anxiolytic drugs [13]. While they may be used in the short-term to help manage issues related to PTSD, such as problems with sleep and anxiety, they are not recommended for the long-term treatment of PTSD due to their long-term side effects, such as feeling unable to handle stressful situations without the medication, risk for accidental overdose, or becoming dependent on the medication [14].
How to Help Your Loved One
It can be very distressing to watch your loved one suffer and be unsure of how to help them, particularly if they are reluctant to discuss the traumatic event(s) and/or seek help [5]. One way to help your loved one is to remind them that you care and are willing to offer a listening ear [5]. Should the individual with PTSD choose to confide in you about their traumatic experience(s), the following strategies may be used to ensure that they continue to feel safe disclosing their experiences and feel heard [5]:
1. Show that you are paying attention.
a. This may be illustrated with certain body language, such as slightly leaning forward, making eye contact, and/or occasionally nodding.
2. Encourage the person to continue speaking.
a. This may be accomplished by repeating the emotions that the individual is communicating, or waiting until they pause and asking relevant or open-ended questions.
3. Be supportive.
a. This may be done by listening without judgement, mentioning their strengths, staying focused on what they are saying, or giving advice when requested.
In addition, there are several strategies that would not be helpful and should be avoided, such as interrupting; interjecting your experience; changing the subject; passing judgements; minimizing their experiences; imposing opinions or unwanted solutions; or making inappropriate facial expressions, such as eye rolling [5].
Along with offering your loved one a listening ear, you may gently and respectfully encourage them to seek help by offering resources, normalizing mental healthcare, and reminding them that help exists and healing is possible [5].
Crisis Hotlines and Resources [15]
Childhelp National Child Abuse Hotline (800) 422-4453
Crisis Text Line Text HOME to 741741
Disaster Distress Helpline Online Peer Support Communities
Disaster Distress Helpline Videophone for American Sign Language Users (PDF, 180KB)
Nacional de Prevención del Suicidio (888) 628-9454
National Domestic Violence Hotline (800) 799-7233
National Grad Crisis Line (877) 472-3457
National Sexual Assault Hotline (800) 656-4673
National Suicide and Crisis Lifeline 988 Chat online
National Suicide Prevention Lifeline (Options for Deaf and Hard of Hearing) For TTY Users: Use your preferred relay service or dial 711 then 988 Chat online
Substance Abuse and Mental Health Services Administration National Helpline (800) 662-4357
Veterans Crisis Line 988, then PRESS 1 Text 838255 Chat online
References
1. Pai, A., Suris, A., & North, C. (2017). Posttraumatic Stress Disorder in the DSM-5: Controversy, Change, and Conceptual Considerations. Behavioral Sciences, 7(4). https://doi.org/10.3390/bs7010007
2. American Psychiatric Association. (2020, August). What Is Posttraumatic Stress Disorder (PTSD)? Psychiatry.org; American Psychiatric Association. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
3. U.S. Department of Veteran Affairs | PTSD: National Center for PTSD. (2014). How Common is PTSD in Adults? - PTSD: National Center for PTSD. Va.gov. https://www.ptsd.va.gov/understand/common/common_adults.asp
4. Mayo Clinic. (2018, July 6). Post-traumatic Stress Disorder (PTSD) - Symptoms and Causes. Mayo Clinic; Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
5. U.S. Department of Veteran Affairs | PTSD: National Center for PTSD. (n.d.-f). Understanding PTSD. Www.ptsd.va.gov. Retrieved March 26, 2023, from https://www.ptsd.va.gov/apps/craftptsd/lesson04/04_001.htm
6. Substance Abuse and Mental Health Services Administration. (2014). Understanding the impact of trauma. Nih.gov; Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK207191/
7. Center for Substance Abuse Treatment (US). (2014). Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD. www.ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/?report=objectonly
8. McLaughlin, K. (2019). Posttraumatic stress disorder in children and adolescents: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. Uptodate.com. https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-children-and-adolescents-epidemiology-pathogenesis-clinical-manifestations-course-assessment-and-diagnosis
9. U.S. Department of Veteran Affairs | PTSD: National Center for PTSD. (n.d.-b). Complex PTSD - PTSD: National Center for PTSD. www.ptsd.va.gov. https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp#subone
10. U.S Department of Veterans Affairs | PTSD: National Center for PTSD. (2014). PTSD Treatment Basics - PTSD: National Center for PTSD. Va.gov. https://www.ptsd.va.gov/understand_tx/tx_basics.asp
11. U.S. Department of Veteran Affairs | PTSD: National Center for PTSD. (n.d.-e). Talk Therapy - PTSD: National Center for PTSD. www.ptsd.va.gov. https://www.ptsd.va.gov/understand_tx/talk_therapy.asp
12. U.S. Department of Veterans Affairs| PTSD: National Center for PTSD. (2014). Medications for PTSD. Va.gov. https://www.ptsd.va.gov/understand_tx/meds_for_ptsd.asp
13. U.S. Department of Veteran Affairs | PTSD: National Center for PTSD. (n.d.-d). Medications - PTSD: National Center for PTSD. www.ptsd.va.gov. https://www.ptsd.va.gov/understand_tx/medications.asp
14. U.S. Department of Veteran Affairs | PTSD: National Center for PTSD. (n.d.-a). Benzodiazepines and PTSD - PTSD: National Center for PTSD. www.ptsd.va.gov. https://www.ptsd.va.gov/understand_tx/benzos_ptsd.asp
15. American Psychological Association. (2021). Crisis hotlines and resources. Apa.org. https://www.apa.org/topics/crisis-hotlines
This post is not a substitute for professional advice. If you believe that you may be experiencing a medical or mental health emergency, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research is constantly evolving. This post contains information that was last updated on March 30, 2023.
Courtney Coleman is a master's degree candidate in biology at Harvard and Co-President of Students vs Pandemics.
Hannah Ryu is a senior at Wellesley College, majoring in Biochemistry and English, and pursuing the pre-med track. She is also Co-President of Students vs Pandemics.
Han Trieu is a junior at UC San Diego, majoring in Psychology with an emphasis in Human Health and minoring in Biology. She is also Vice President of Students vs Pandemics.