PTSD: Education & Awareness

Written By MHA Staff

June is PTSD Awareness month. PTSD stands for Post Traumatic Stress Disorder, which is a mental health diagnosis that affects about 9 million adults in the United States (source). A person can develop PTSD after experiencing or witnessing a traumatic event or serious injury (source).

What is PTSD and what causes it?

The human brain is adapted to perceiving and responding appropriately to threats, which many may know as "fight or flight." When someone experiences a traumatic event, it can disrupt the brain's ability to assess threats, leading to the entire nervous system becoming affected and causing a person to feel unsafe or hyper-vigilant. It is estimated that about 50% of people will experience trauma at some time in their lives, and most people who experience a traumatic event will experience short-term distress. However, about 20% who experience trauma will go on to develop PTSD (source).

PTSD can affect many different people. Even though PTSD is commonly associated with military service, it can come from any traumatic event, which is an event that has the "capacity to cause fear, helplessness, or horror as a response to the threat of injury or death" (source). It is important to remember that a traumatic event may affect different people differently. Just because two people experience the same or similar traumatic event, does not mean they will be impacted the same way. Some examples, but not an exhaustive list, of traumatic events are:

  • Car accidents

  • Assault

  • Diagnosis of a chronic or life-threatening illness

  • Interactions with or within medical facilities

  • Military service or combat

  • Abuse

  • Working in a place where someone is exposed to distressing images, stories or events

  • Natural disasters

  • Bullying

  • Birth and pregnancy

  • Any events where an individual was in fear for their life

PTSD develops when the brain and body are affected by a traumatic event in such a way that causes the brain to "suspend" normal functioning and disrupts its ability to file memory properly. When a person experiences a traumatic situation, the brain sends signals to the body to pause normal operations (such as digestion) to prepare the body for a fear response (fight or flight). Along with normal bodily functions being disrupted, the part of the brain responsible for conscious decision making a memory is also "shut off." This is why many people who have experienced traumatic events may have fuzzy recollections or disorganized memories of the event. Furthermore, when memories are stored in the brain, it is processed in a way that can be stored. However, during a traumatic event, this process is disrupted and is sometimes stored randomly and fragmented in a variety of places in the brain. (Source.)

These improperly stored memories can be triggered by external sensory stimuli (smells, sounds, etc.), which can trigger an event where the brain is not able to recognize the event as a memory, but rather as something that is happening right now. This is commonly referred to as a "flashback." Flashbacks are distressing and can reoccur for years after the traumatic event. Flashbacks are the brain attempting to properly refile the traumatic memory, but because it becomes difficult to distinguish what is happening in the present during a flashback, the body reacts as it normally would to stress, including entering a state of hypervigilance.

To learn more about why PTSD occurs and how it impacts the body and mind, click here.

Symptoms of PTSD

Every case of PTSD is uniquely experienced. As stated above, symptoms of a traumatic event usually alleviates after a few weeks. When symptoms continue for longer than a month and impact a person's daily life, they may be diagnosed with PTSD.

Symptoms can change over time where sometimes they are more noticeable and harder to cope with, even if the individual seems to have been managing the symptoms well previously. Some people have constant severe symptoms of PTSD while pothers may only experience symptoms when in a stressful situation or experience a reminder of the traumatic event.

Common symptoms include (source/source):

  • Re-experiencing symptoms include flashbacks (a feeling where the event is happening right now), reoccurring memories and nightmares related to the event, distressing intrusive thoughts or images, and physical sensations such as sweating, trembling, and pain.

  • Avoidance symptoms involves avoiding certain people or places that remind you of the trauma or avoiding talking about the event. This includes staying away from places, events, or objects associated with the traumatic event, the feeling that you must keep yourself busy all the time, using substances to avoid memories, feeling emotionally numb, feeling detached from your body, being unable to remember details of the traumatic event, or changing routine due to avoidance.

  • Mood and feeling symptoms look like trouble remembering parts of the traumatic event, feelings of distrust toward others, distorted thoughts about the trauma that lead to feelings of blame and guilt, overwhelming negative emotions, disinterest in activities the person originally participated in, feeling unsafe, difficulty experiencing positive emotions.

  • Reactivity symptoms look like irritability, anger, constantly being alert or on guard, being jumpy or easily startled, difficulty sleeping, and difficulty concentrating.

Symptoms can also manifest in someone's behavior. This may involve substance abuse, relationship problems (such as feeling detached from friends and family), depression, and suicidal thoughts.

CPTSD

Complex PTSD or CPTSD is typically thought to be caused by the continuous experience of trauma over long periods of time. Examples of ongoing trauma are (source):

  • Physical and emotional abuse

  • Systematic forms of discrimination such as racism, sexism, homophobia, transphobia, and other forms of marginalization

  • Sex work and human trafficking

  • War and being a prisoner of war

  • Ethnic cleansing such as forced migration and concentration camps

When ongoing trauma is experienced in childhood, the brain is still developing and they do not have the coping skills needed. This can lead to thinking the trauma they are experiencing is normal.

According to Mental Health America, there are seven areas of life that CPTSD can have an impact on:

  • Attachment - Trouble forming healthy boundaries, tend to isolate, and distrust other people

  • Biological/Physical - Experiences of chronic pain, lack of coordination, and other problems

  • Emotional regulation - Difficulty labeling or expressing feelings

  • Dissociation - Memory loss, feeling detached from mind or body, and difficulty knowing what is real

  • Behavioral control - Difficulty with impulse control, trouble with rule following or making decisions, anger problems, eating disorders, and misusing substances

  • Thinking - Difficulty concentrating, learning, or completing tasks

  • Self-concept - Feelings of not knowing oneself, having low self-esteem or body image, dealing with guilt and shame

Someone with CPTSD, will have some symptoms associated with PTSD with additional symptoms that impact emotions, self-esteem, and relationships (source). Another symptom someone with CPTSD might experience is something called “emotional flashbacks” (source). An emotional flashback is when a person has “intense feelings that [they] originally felt during the trauma, such as fear, shame, sadness or despair. [The person] might react to events in the present as if they are causing these feelings, without realising that [they] are having a flashback” (source).

When it comes to CPTSD within the field of mental health, there are a couple of things to be aware of. First, CPTSD is a relatively new term within the the field (source). Professionals have disagreed about whether the additional affects associated with CPTSD are a form of PTSD or a separate condition entirely. As such, professionals have disagreed on what to call the collection of symptoms that is CPTSD.

Second, CPTSD may be misdiagnosed as other mental health disorders, specifically BPD (source). Borderline personality disorder, also called BPD, is a personality disorder that affects a person’s sense of self, their relationships with others, and day-to-day life. Some of the symptoms of BPD are similar to the symptoms associated with CPTSD. For example, with both disorders, a person might experience intense and overwhelming emotions. Since BPD and personality disorders deserve their own post, the most important take away here is that if you or a loved one is diagnosed with something that doesn’t align with yours/their experiences or symptoms, keep talking with your mental health provider to make sure the treatment you are receiving is the right fit for you. If the provider does not seem to be listening to you or your loved ones, it may be time to seek a referral for a second opinion. To learn more about BPD, check out these websites:

It is important to remember that trauma is inherently complex and has the capability of affecting everyone differently. An individual person may be experience both PTSD and CPTSD from two different traumatic events. Some research has shown that some people who have had multiple or long lasting trauma have developed PTSD while those with single trauma develop CPTSD. The type or duration of the trauma does not make it easier to diagnose one over the other. If anything, this shows that trauma has a unique impact on a person and can lead to different mental health symptoms and outcomes.

Coping with PTSD & CPTSD

There both self-care and professional care methods for addressing PTSD & CPTSD. It is important to note that people with CPTSD might find PTSD treatment helpful, but that CPTSD may need more long-term care (source). Additionally, if someone is seeking care for either diagnosis, it is also important to get support for other comorbid conditions like depression, substance use, or dissociation.

Here is a non-exhaustive list of support for both disorders:

Coping with Flashbacks

A flashback can occur in both PTSD and CPTSD diagnoses. They are distressing and cause the individual to experience sensations, stimuli, and even visuals that make the person feel or believe they are “back” in the moment their traumatic experience occurred. Here is how you can cope through a flashback (source):

  1. Focus on breathing. When the brain believes there is a threat to life (such as in a traumatic event or a flashback), it can disrupt normal breathing and thus increase feelings of panic. Concentrate on breathing steady and slow. One method is to breathe in for five seconds and out for five seconds.

  2. Carry something to root you in the present. This object can be something to look at or touch to remind yourself where you are presently. This can be something you carry in a bag or that you always have with you anyways. For some, this can be a piece of jewelry, a key, or some other object that is easy to access at any time.

  3. Tell yourself that you are safe. Reminders that the trauma is over and that you are safe can be difficult to recall when experiencing a flashback. Try writing down helpful phrases to recall in an easily accessible place, such as a phone or journal, that you can reach in times of a flashback.

  4. Self-soothing. When having a flashback, try to find ways to comfort yourself. For some, it is curling up in a blanket, cuddling with a beloved pet, listening to music, or watching a comfort film.

  5. Track symptoms in a journal. Keeping track of what happens leading up to, during, and after a flashback can help you spot triggers and patterns. Tracking can even help you find early signs of a flashback or conditions where flashbacks are more likely. MHA National has a helpful guide on how to journal here.

  6. Utilize grounding techniques. Grounding is a technique you can use to help you stay connected to the present moment and cope with flashbacks and distressing thoughts. There are many different grounding techniques, including some listed here. The Community Resilience Model also has a grounding technique available on their iChill app. iChill can be downloaded on your smartphone or can be accessed through your computer browser here.

Understanding Triggers

Triggers are certain sensations, experiences, and stories that remind someone with PTSD or CPTSD of the traumatic event(s) and can cause distressing flashbacks and other symptoms. These can be sensory (smells, sounds, etc.) and physical (places, books, films, etc.), but can also be broader like specific language used (words or sentences that remind you of the trauma). Other triggers can be significant dates, such as anniversary dates of the traumatic event.

Once triggers are identifies, it can become easier to cope with them or develop boundaries to help avoid triggers. Here is a worksheet to help with boundary development.

Know Your Helplines

There are many helplines in the US that can help someone work through a crisis. There is often an assumption that someone must be actively suicidal to access these resources, but a crisis can include non-suicidal responses as well. Whether you are experiencing a suicidal crisis or not, reaching out help lines can be an effective tool for coping through high-stress event. Here are some helplines:

  • Suicide and Crisis Lifeline: Call or text 988. Available 24-hours, for anyone in emotional distress.

  • Veterans Crisis Line: Call 988, then press 1 or text 838255. Available 24-hours for veterans in emotional distress or family/friends of veterans needing a crisis responder.

  • National Sexual Assault Hotline: Call 1-800-HOPE. Available 24-hours resource for victims from counseling to legal advice. Online chat available here.

  • National Domestic Violence Hotline: Call 1-800-799-SAFE (7233) or 1-800-787-3224 (TTY). Available 24-hours and offers anonymous access to shelters and domestic violence programs as well as legal advocacy, public education, and training. Text option available by texting “START” to 88788 or chat online available here.

  • Crisis Text Line: Text 24/7 for support during emotional crisis. Text “Start” to 741-741.

  • LGBTQ National Hotline: Available Monday - Friday, 2:00 pm - 11:00 pm EST. and Saturdays, 12:00 pm - 5:00 pm. Call 888-843-4564. For more info click here.

Other Resources

MHA Staff

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