Post-Traumatic Stress Disorder (PTSD)

How Do Clinicians Define “Trauma”?

Traumatic events are specifically defined as they pertain to the PTSD diagnosis. Trauma is defined as having directly experienced, witnessed, or confronted with actual or threatened death, serious harm or injury, or sexual violence. Some examples of traumatic events follow below:

  • Directly experiencing military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, a terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, or severe automobile accidents.
  • Witnessing serious injury or unnatural death of another person due to violent assault, accident, war, or disaster, or a dead body or body parts.
  • Learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associates.

Note that a life-threatening illness or medical condition is not considered a trauma unless it involves sudden, accidental, or catastrophic events. Also note that an event that occurred to your close family member or friend is considered a trauma when it is violent or accidental (e.g., personal assault, suicide, serious accident or injury).

What is Post-traumatic Stress Disorder (PTSD)?

PTSD is a disorder defined by four sets of symptoms that are common following a serious trauma, but persist in individuals who eventually develop PTSD.  These symptom clusters include (a) re-experiencing symptoms, (b) avoidance symptoms, (c) negative disturbances in mood and cognitions, and  (c) arousal symptoms.  Re-experiencing symptoms include having frequent unwanted thoughts about a previous trauma, feeling as though the trauma were happening again, and having intense physical and emotional reactions to trauma. Avoidance of thoughts, feelings, situations, people, places and other reminders of trauma are thought to be the main driver of PTSD symptoms.  Avoidance provides short-term relief from PTSD symptoms, but also serves to maintain PTSD symptoms in the long-run.  Disturbances in mood, thoughts, and beliefs are common following traumatic experiences and may include an inability to recall important aspects of what happened, negative trauma-related beliefs about one’s self, or viewing others and the world as more dangerous than they actually are, feeling disconnected from others, loss of interest in previously enjoyed activities, and emotional numbing, which commonly involves feeling a restricted range of positive emotions, but this often also extends to negative emotions (e.g., feeling unable to cry, or feeling numb after an intense acute period of distress). Finally, arousal symptoms include a range of both emotional and physical signs of anxiety, sleep disruption, irritability and outbursts of anger, difficulty concentrating, an exaggerated startle response, and prolonged periods of feeling “on edge”.

How common is PTSD?

Although the majority of the general population (~60%) will be exposed to a traumatic event, and PTSD symptoms are common following exposure to trauma, the lifetime prevalence of PTSD is approximately 7 to 8%.

What are the risk factors for developing PTSD?

Individual characteristics that have been shown to increase risk for PTSD include being female, having lower socio-economic status, lower intelligence, less education, prior psychiatric history, history of abuse or childhood adversity, and a family history of psychiatric illness (Brewin, Andrews, & Valentine, 2000; Ozer, Best, Lipsey, & Weiss, 2003). Trauma characteristics associated with developing PTSD include the level of distress and feelings of unreality that occur during trauma exposure, feelings of helplessness and loss of control. Also, interpersonal traumas in which an individual is victimized by a perpetrator (e.g. sexual or physical assault) are more likely to lead to PTSD than other traumas (e.g., accidents or natural disasters).

How is PTSD treated, and how effective are existing treatments?

Based on a review of the existing literature on evidence-based treatments for PTSD, the National Institutes of Health (NIH) have endorsed exposure-based treatments, including Prolonged Exposure (PE), as the most effective form of treatment for PTSD. There is also some evidence that anti-depressants (i.e., selective serotonin re-uptake inhibitors, or SSRIs) are beneficial, but these benefits appear to exist only during treatment, and medications are generally less effective than exposure based treatments in the long-term.

Links to additional PTSD-related information:

Information on Post-traumatic Stress Disorder (PTSD) from the Anxiety and Depression Association of America (ADAA).

Information on PTSD from the Association of Behavioral and Cognitive Therapy.