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Post-Traumatic Stress Disorder: A primer for mental health  professionals

Elsewhere on this website you will find fact sheets addressing disaster-related stress and resiliency. Most people experiencing disasters will recover and resume normal functioning, but some will go on to develop a constellation of symptoms that collectively is referred to as Post-Traumatic Stress Disorder. This fact sheet is intended to highlight some of the key points of this struggle and prepare mental health professionals to screen and refer for treatment patients experiencing this disorder.

• Disasters are sufficiently unusual and traumatic to predispose some people who experience them to post-traumatic stress disorder.

• Some people will experience a short-term acute stress disorder characterized by dissociation and other PTSD-like symptoms, but not develop PTSD.

• Vulnerability for PTSD is complex and debated, but it is clear that no one predictor serves to discriminate who will develop PTSD from who will not. In general, the likelihood of a person developing PTSD depends on:
• Previous history of trauma
• Intensity of the present trauma
• Personal loss or injury
• Proximity to the traumatic event
• Degree of control and emotional response to the disaster
• Amount of post-disaster support

• Symptoms of PTSD occur in the following dimensions:
• re-living symptoms
• avoidance symptoms
• numbing symptoms
• arousal symptoms

1. Re-Living Symptoms:
The traumatic event is persistently re-experienced in one or more of the following ways:

• Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
• Recurrent distressing dreams of the event.
• Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).
• Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
• Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

2. Avoidance & Numbing Symptoms:
The individual also has persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by 3 or more of the following:

• Efforts to avoid thoughts, feelings, or conversations associated with the trauma.
• Efforts to avoid activities, places, or people that arouse recollections of the trauma.
• Inability to recall an important aspect of the trauma.
• Significantly diminished interest or participation in significant activities.
• Feeling of detachment or estrangement from others.
• Restricted range of affect (e.g., unable to have loving feelings).
• Sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span).

3. Arousal Symptoms:
Persistent symptoms of increased arousal (not present before the trauma), as indicated by 2 or more of the following:

• Difficulty falling or staying asleep.
• Irritability or outbursts of anger.
• Difficulty concentrating.
• Hypervigilance.
• Exaggerated startle response.

The disturbance, which has lasted for at least a month, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• Comorbidity, or other problems commonly associated with PTSD, include:
• Substance abuse, or dependence
• Feelings of hopelessness, shame, or despair
• Vocational problems
• Relationships problems including divorce and violence
• Physical symptoms, those typically associated with anxiety

• Children can develop PTSD too. Young children may have separation difficulties, or suddenly regress around toilet training or other developmental tasks. Children of early elementary school age (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event. The presentation of PTSD in adolescents is more similar to that in adults.

• Onset of PTSD is also a bit complicated, as symptoms usually start soon after the traumatic event, but they may not emerge as the syndrome until months or years later. They also may come and go over many years.

• The course of PTSD is also complicated, in that about half (40% to 60%) of those who develop it get better at some time. But about 1 out of 3 people who develop PTSD always will have some symptoms.

• Various treatments are available, including psychotherapy and medication.

Becoming acquainted with PTSD as a mental health professional can help you detect and respond to it as it presents in some patients who have experienced disasters.

Web Links

Part of SAMHSA’s Training Manual for Mental Health and Human Service Workers, this section explains how various age, socioeconomic, and ethnic groups react to disasters and assesses each group’s risks for long-term mental health implications.

This fact sheet by the National Center for Posttraumatic Stress Disorder provides a general overview of PTSD, including a summary of its causes, symptoms, and treatment.

This fact sheet gives more specific descriptions of the symptoms of PTSD as categorized by reliving, avoidance, and arousal.

This page has an annotated list of reference guides and articles on the treatment of PTSD.