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What Are the 5 Signs of PTSD? 4 Phases, Symptoms, Treatment

Medically Reviewed on 1/6/2022

The 5 signs of PTSD include exposure, intrusion symptoms, avoidance, altered mood, and altered reactivity.

Symptoms of post-traumatic stress disorder (PTSD) can have a significant effect on your daily life. They usually appear within the first month of a traumatic event. However, in a small percentage of cases, symptoms may not appear for months or even years.

Some people with PTSD have long periods when their symptoms are less noticeable, followed by periods when they worsen. Others have persistent, severe symptoms.

To be diagnosed with PTSD, a person must exhibit the following five types of symptoms:

  • Exposure: Exposure to actual or threatened death, serious injury, or sexual violence in more than one of the following ways (may be multiple events):
    • Directly witnessing the event
    • Seeing the event firsthand as it happened to others
    • Learning that the traumatic event occurred to a close family member or close friend; if actual or threatened death of a family member or friend, the event must have been violent or accidental
    • Excessive or repeated exposure to aversive details of the traumatic event (first responders collecting human remains or police officers repeatedly exposed to details of child abuse); does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is related to work
  • Intrusion symptoms: One or more of the following is associated with the traumatic event, beginning after the traumatic event occurred:
    • Recurrent, involuntary, and intrusive distressing memories of the traumatic event; in children, repetitive plays in which themes/aspects of the traumatic event are expressed may occur
    • Recurrent distressing dreams in which the content and/or effect of the dream is related to the traumatic event; in children, frightening dreams without recognizable content may occur
    • Dissociative reactions such as flashbacks occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings; in children, trauma-specific reenactment may occur in the play
    • Intense or prolonged psychological distress due to being exposed to internal or external cues that represent or resemble a traumatic event
    • Physiological responses to internal or external cues that represent or resemble an aspect of the traumatic event
  • Avoidance: Persistent avoidance of stimuli associated with the traumatic event, beginning after the traumatic event, as demonstrated by one of the following:
    • Avoidance of (or attempts to avoid) distressing memories, thoughts, or feelings about or related to the traumatic event
    • Avoidance of (or attempts to avoid) external reminders (people, places, conversations, activities, objects, and situations) that evoke distressing memories, thoughts, or feelings about or closely associated with the traumatic event
  • Altered mood: Negative changes in cognitions and mood associated with the traumatic event, beginning or worsening after the traumatic event, as evidenced by two of the following:
    • Inability to recall a critical aspect of the traumatic event
    • Due to dissociative amnesia rather than other factors such as a head injury, alcohol, or drugs
    • Negative beliefs or expectations about oneself, others, or the world that are persistent and exaggerated (“I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My entire nervous system is permanently ruined,” etc.)
    • Persistent, distorted beliefs about the cause or consequence of the traumatic event, leading the individual to blame themselves or others
    • The negative emotional state that persists (fear, horror, anger, guilt, or shame)
    • Significantly reduced interest or participation in important activities
    • Feelings of detachment or estrangement from others
    • Inability to experience positive emotions consistently (happiness, satisfaction, or love)
  • Altered reactivity: Changes in arousal and reactivity associated with the traumatic event that began or worsened after the traumatic event, as evidenced by two of the following:
    • Irritable behavior and angry outbursts (typically with little or no provocation) typically manifest as verbal or physical aggression toward people or objects
    • Impetuous or self-destructive behavior
    • Hypervigilance
    • Exaggerated startle reaction
    • Concentration problems
    • Sleep deprivation (difficulty falling or staying asleep or restless sleep)
  • 4 phases of PTSD

    Post-traumatic stress disorder (PTSD) is the emergence of a set of reactions in people who have witnessed a traumatic event that may have threatened their life or the safety of others. 

    PTSD is a serious mental health problem that interferes with people’s daily lives. However, it is rarely discussed.

    PTSD is divided into four stages:

  • Impact: The impact phase usually occurs shortly after the individual has experienced or witnessed the traumatic event in question.
    • It can last for as little as a few hours or as long as several days depending on the severity of the event.
    • Individuals who are affected typically experience the following symptoms:
      • Shock
      • Fear
      • Helplessness
      • Guilt
      • Anxiety
      • Hypervigilance
  • Rescue: During this stage, the individual begins to come to terms with what has occurred.
    • It is about acknowledging what has occurred in some capacity.
    • They are, however, still dealing with the initial shock and distress.
    • They usually go through various difficult emotions and mental and physical effects, which are:
      • Denial
      • Confusion
      • Anxiety
      • Flashbacks
      • Nightmares
      • Despair
      • Hopelessness
      • Sadness
      • Anger
      • Numbness
  • Intermediate recovery: The intermediate recovery phase is defined by adjusting and returning to normal life.
    • Furthermore, this stage frequently entails dealing with new and ongoing adversities, as well as being humbled by an outpouring of love and support or disappointed by a lack of it.
    • It can ultimately be divided into two substages:
      • Altruism: The affected person is astounded by the outpouring of love and support from others so much so that they are inspired to act and help others as well. They may be hesitant to express any negativity because they do not want to appear ungrateful for all that has been done for them.
      • Disillusionment: Instead of being overwhelmed by love and support, the person is disappointed by the lack of a response. However, one may feel the effects of this substage when the support fails, and they realize they are on their own to deal with the rest of the mess. Physical symptoms such as fatigue and/or sleep disturbances may occur, as well as stress reactions such as irritability.
  • Long-term reconstruction: This phase is all about rebuilding and dealing with personal post-event issues.
    • As a person enters this stage, they may become concerned about their future, which can manifest as
      • Fear
      • Resentment
      • Depression
  • Because PTSD can have long-term effects on mental and emotional well-being, it is critical to talk about the event and come to terms with the trauma one has experienced.

    • If a person’s PTSD is not properly treated, symptoms can last for years after the event.
    • If the event’s emotions and memories are not processed, they can have serious mental health consequences.

    Memory processing with the assistance of a mental health professional is critical to long-term recovery.

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    What are the treatment options for PTSD?

    There are different treatment options for post-traumatic stress disorder (PTSD), including:

    Psychotherapy

    Psychotherapies for PTSD will concentrate on the traumatic event rather than on your past life. They will assist you with the following tasks:

    • Acceptance
    • Remembering the event
    • Putting your experiences into words
    • Feeling safer

    Sessions are usually held at least one time a week with the same therapist and last at least 8 to 12 weeks. Although sessions typically last an hour, they can occasionally last up to 90 minutes.

    Trauma-focused cognitive-behavioral therapy (TF-CBT)

    • This is a type of talking therapy that can assist you in changing your ways of thinking. This can help you feel better and behave differently over time.
    • This is typically delivered one-on-one, but there is some evidence that TF-CBT can be delivered in groups.

    Eye movement desensitization and reprocessing (EMDR)

    • This method uses eye movements to assist the brain in processing traumatic memories. You will be asked to recall the traumatic event and how it affects your thoughts and feelings. You will be asked to perform eye movements or receive “bilateral stimulation,” such as hand tapping while doing so.
    • This has been shown to reduce the intensity of emotions associated with a traumatic memory, thereby aiding in the resolution of the trauma.
    • EMDR is typically administered in 8 to 12 sessions lasting 60 to 90 minutes each.

    Other types of talking therapies may be useful for people who do not respond well to EMDR or TF-CBT to target specific symptoms (poor sleep).

    Medication

    If you’ve tried other treatments for PTSD and they’re not working, your doctor may prescribe antidepressants.

    • Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can help reduce PTSD symptoms. Moreover, antidepressants can help if you have depression.
    • If SSRIs do not work for you, you may be given another medication but only on the advice of a mental health specialist.

    There is evidence that TF-CBT and EMDR are the most effective first-line treatments. 

    Medication can be beneficial for people who do not want or cannot easily access talking therapies. Wherever possible, TF-CBT or EMDR should be offered before medication.

    What are the recovery and risks for PTSD?

    • The risk and recovery of a person with PTSD are heavily influenced by social phenomena.
    • According to studies, people who have been exposed to human-caused traumatic events, such as combat veterans, are more likely to develop PTSD than people who have been exposed to other types of traumas.
    • During childhood, the child’s proximity to its caregiver modulates coping skills and determines the child’s sense of safety following trauma.
    • It is difficult for people to open up about their trauma, especially during the first visit. PTSD influences the onset and progression of many physical illnesses.

    Awareness of signs and symptoms of PTSD is critical for people and doctors to begin early treatment and reduce the burden of the illness on the person’s and survivors’ families.

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    Medically Reviewed on 1/6/2022

    References

    Image Source: iStock Images

    PTSD: 5 signs you need to know: https://rogersbh.org/about-us/newsroom/blog/ptsd-5-signs-you-need-know

    What Is Posttraumatic Stress Disorder? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

    Symptoms: https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms

    Post-Traumatic Stress Disorder: https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd

    Identifying and Managing Posttraumatic Stress Disorder: https://www.aafp.org/afp/2013/1215/p827.html

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