Understanding Posttraumatic Stress Disorder

What is posttraumatic stress disorder  (PTSD)?

According to the Diagnostic Statistical Manual of Mental Disorders (American Psychiatry Association, 2013), individuals exposed to a severe traumatic event(s), whether directly or indirectly, may develop a mental health condition known as posttraumatic stress disorder (PTSD). A traumatic event is defined as exposure to:

• actual or threatened death,
• serious injury, and
• sexual violence,
• learning of a traumatic event that happened to a close family member/friend.

Traumatic events can include but are not limited to combat, violent physical or sexual assault, disasters (natural or man-made), childhood abuse, etc. Exposure to a traumatic event(s) can cause the affected person to experience feelings of horror, helplessness, and/or fear long after the event has passed. Individuals affected by PTSD experience persistent reactions when reminded of the traumatic event(s) they experienced. It is a prevalent mental health condition that can be challenging to treat. PTSD is not exclusive to adults; it also affects children and adolescents. However, symptomology in children may present differently than in adults. For example, children may re-enact trauma in their play to make sense of the incident. The good news is that several different screening/assessment tools are available in combination with a thorough clinical interview to diagnose adults and children with PTSD.

What symptoms are associated with PTSD?

Exposure to a traumatic event(s) can impact one’s psychological and biological systems. The impact PTSD has on a person goes beyond just the brain; it also affects the rest of the nervous system. The presentation of PTSD symptoms may look different from person to person. These symptoms can be chronic or fluctuate over time. Symptoms of PTSD may include:

• intrusive re-experiencing (flashbacks, nightmares),
• autonomic hyperarousal (sleep disruption, aggression, easily startled, fight or flight),
• cognition and mood alterations (self-blame, withdrawal, negative emotions), and
• avoidance (avoid remembering a traumatic event, avoiding a trigger).

Symptoms must persist for over one month, involving a re-experiencing and avoidance symptom, and disrupt daily functioning to meet the criteria for a PTSD diagnosis. Then, a mental health professional such as a psychologist, therapist, or psychiatrist can render a PTSD diagnosis.

Do other conditions present with PTSD?

It is not uncommon for individuals who have PTSD to experience other mental health conditions. PTSD often presents with other psychiatric conditions, such as mood disorders, anxiety disorders, substance abuse disorders, and suicidal ideation. In situations where PTSD co-exists with other conditions, the symptoms can overlap. Aside from mental health conditions, PTSD may also present with physical health conditions. The physical health conditions associated with PTSD may include gastrointestinal issues, somatic disorders, cardiovascular disease, and pain disorders.

What are the treatment options for PTSD?

PTSD can be disabling and severely impact one’s quality of life if left untreated. Treatment options for PTSD may involve psychotherapy and/or pharmacotherapy. Psychotherapy is the initial form of treatment rendered for PTSD. It consists of applying psychological (counseling) methods to facilitate a psychological or behavioral change in a person. There is an extensive amount of evidence-based psychotherapy techniques in use today. A few of the psychotherapy techniques are:

• cognitive behavioral therapy (CBT),
• prolonged exposure therapy (PE),
• eye movement desensitization and reprocessing therapy (EMDR),
• group therapy, and
• interpersonal therapy.

It is common for psychotherapy to be used in conjunction with pharmacotherapy (medication) at times. Pharmacotherapy involves using pharmaceutical products (medication) to treat PTSD symptoms. Medication can help relieve some PTSD symptoms, which can assist in the effectiveness of psychotherapy. The common types of medication used to treat PTSD symptoms may include:

• tricyclic antidepressants,
• selective serotonin reuptake inhibitors (SSRI), and
• serotonin potentiator.

Adjunct methods of treating PTSD are available such as yoga, animal therapy, exercise therapy, and acupuncture. Continual growth and research in the medical and psychiatric fields are leading to expanded treatment options for PTSD. Since people react to trauma differently, not everyone who experiences trauma will develop PTSD.

How do PTSD and the legal system interrelate?

The criminal justice system is a system comprised of law enforcement, courts, and corrections. When a person is being alleged of a crime, they have an opportunity to prove their innocence. When a person is alleged of a crime, they are referred to as a “defendant.” A defendant will work with a defense attorney to advocate for their innocence. The defense attorneys may use PTSD (if one is diagnosed with PTSD) as a basis for defense strategy. Defense attorneys may use PTSD to prove diminished capacity (diminished actuality or imperfect self-defense), self-defense, and even sentencing mitigation. The court system has upheld PTSD as a defense basis if the testimony meets both Daubert and Frye admissibility standards. In cases where PTSD is being used as a factor in criminal proceedings, defense attorneys, prosecutors, or the court system may use the expertise of a forensic psychologist. A forensic psychologist uses scientific evidence to evaluate the defendant’s mental health condition, as it applies in criminal cases. The forensic psychologist can offer the defense attorneys, prosecutors, or the court expert testimony on clinical elements of PTSD as it pertains to the defendant or on PTSD in general (depending on the expert’s role in the case). The court will decide whether they will allow expert testimony from a forensic psychologist.

When to seek emergency help?

If you need immediate help, please call 911, or your local emergency number, if you or someone you know is thinking about self-harm or suicide.

• 988 Suicide & Crisis Lifeline (Call or Text 988)
• Veterans Crisis Line (1-800-273-8255, Press 1 to talk)
• Text Hello to 741741

For non-emergency services in LA County (the entry point for mental health services with the Los Angeles County Department of Mental Health).

• LACDMH ACCESS LINE: 800-854-7771

If you are interested in a psychological evaluation by one of our psychologists at Vienna Psychological Group, book your free 30-minute consultation here.

To learn more about mental health and forensic psychology, check out our blog library here and our podcast, The Forensic Psychologist Podcast, hosted by Dr. Vienna on Spotify and Apple Podcasts.

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This blog aims to answer general questions and assist readers in better understanding PTSD. This blog is not intended to provide medical or legal advice.

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.

Berger, O., McNiel, D. E., & Binder, R. L. (2012). PTSD as a criminal defense: a review of case law. The journal of the American Academy of Psychiatry and the Law, 40(4), 509–521. https://pubmed.ncbi.nlm.nih.gov/23233473/

Taylor-Desir, M. (2022). What is posttraumatic stress disorder? American Psychiatric Association. https://psychiatry.org/patients-families/ptsd/what-is-ptsd