Post-Traumatic Stress Disorder: When You Can’t Forget

Post-traumatic stress disorder (PTSD) occurs in many people after living through a traumatic experience. It includes symptoms of re-experiencing the traumatic event, avoidance, and hyper arousal.

Some authors suggest that, throughout our lives, we experience from 1 to 5 traumatic events (Breslau, 2004). Other authors point out that around 50% of people experience at least two traumatic events.

But what is PTSD really and how? We talk about all this!

Post-Traumatic Stress Disorder (PTSD): Early Research

The concept of post-traumatic stress disorder (PTSD) refers to a series of alterations that occur as a consequence of exposure to a major stressor.

The importance of this disorder is not recent, but rather it began to be studied in the 19th century. In fact, it began to acquire relevance in psychopathology manuals as a result of the great wars and their psychological consequences on soldiers.

Thus, it was first studied in this war context and, little by little, it was seen how there were other types of stressors that could become traumatic factors and cause PTSD. Among these stressors we find situations such as: sexual assaultsfirestraffic accidents, situations of abuse, tortureterrorist attacks, etc.

What exactly is PTSD?

In the current DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders ; APA, 2013), PTSD is defined as a trauma- related disorder , involving exposure to actual or life-threatening injury, serious or sexual violence in one (or more) of the following ways:

  • Direct experiencing of the traumatic event or events.
  • Witnessing, in person, the event as it happens to others.
  • Being aware of an event (or more than one) that has happened to someone close or to a friend. In cases of actual or threatened death of a family member or friend, the event or events must have been violent or accidental.
  • Repeatedly experiencing or extreme exposure to aversive details of the event. For example: emergency personnel collecting human remains, police officers repeatedly exposed to details of child sexual abuse, etc.

Symptoms of Post-Traumatic Stress Disorder

Beyond the trauma, in order to talk about PTSD, the person must experience a series of characteristic symptoms. These symptoms include:

Intrusive symptoms associated with the traumatic event

These symptoms must appear after the event occurs. They include:

– Recurring, involuntary and intrusive memories of the event that cause discomfort. In children older than 6 years, this symptom can be expressed in repetitive games where characteristic themes or aspects of the trauma appear.

– Unpleasant dreams of a recurring nature, who’s content and/or affect are related to the traumatic event. In children there may be terrifying dreams of unrecognizable content.

– Dissociative reactions such as flashbacks, where the person acts or has the feeling that the traumatic event is occurring. Children can re-enact the traumatic event during the game.

– Intense psychological distress when exposed to internal or external stimuli that symbolize or recall an aspect of the traumatic event.

– Physiological responses when exposed to internal or external stimuli related to the traumatic event.

Avoidance of stimuli associated with trauma

On the other hand, in post-traumatic stress disorder there is also a persistent avoidance of the stimuli associated with the trauma that was not present before it. This avoidance is expressed through symptoms such as:

– An effort to avoid thoughts, feelings, or conversations about the traumatic event.

– Avoidance or efforts to avoid external memories (for example: people, places, activities, situations…) that arouse negative memories, thoughts or feelings or those related to the traumatic event.

Negative alterations in cognitions or affects

These alterations occur in cognitions or affects related (or associated) with the traumatic event. They begin or worsen after the event occurs and are manifested through a series of symptoms:

– Difficulty remembering an important aspect of the traumatic event. It is usually caused by dissociative amnesia.

– Persistent negative beliefs or expectations about oneself, others or the world (for example: “I am bad”, “the world is very dangerous”, etc.).

– Persistent distorted cognitions about the cause or consequences of the traumatic event that lead the person toe (or to blame others).

– Persistent negative emotional states, such as: fear, horror, shame…

– Intensely diminished interest or participation in activities important to the person.

– Indifference or distance from others.

-Persistent inability to experience positive emotions. For example: inability to experience joy or love.

Alterations in activation

Another characteristic symptom of post-traumatic stress disorder is the alterations in the activation (arousal level) of the organism and in the reactivity associated with the traumatic event. Like the previous ones, they start or worsen after the event occurs.  They manifest themselves through symptoms such as:

– An irritable behavior or outbursts (with little or no provocation) that are expressed through physical or verbal aggression towards people or objects.

– Self-destructive or reckless behaviors.

– Exaggerated startle responses.

– Problems concentrating.

– Sleep problems, such as: difficulties falling asleep (insomnia), staying awake, refreshing sleep…

The symptoms described last more than 1 month and cause significant discomfort or deterioration in the person’s daily functioning. Furthermore, it is important to know that such symptoms are not attributed to the physiological effects of a substance or to another medical condition. That is, they come exclusively from the experience of the traumatic event.

Psychological treatment of PTSD

How is PTSD approached from psychotherapy? There are different psychological techniques to address post-traumatic stress disorder. One way to classify them is based on the focus of the intervention. Thus, we can distinguish three types of treatment for PTSD:

– Treatments focused on the past: they place the focus of the intervention on the trauma. They seek the processing of traumatic memories, emotions, beliefs and bodily sensations. They include EMDR, hypnosis…

– Treatments focused on the present: they focus on learning skills (interpersonal, cognitive and behavioral) that improve the functioning of the person. They include relaxation, meditation…

– Mixed treatments: they combine treatment strategies focused on the past and the present. They include Beck’s cognitive therapy and other therapy modalities.

In this article we are going to talk about the treatments focused on the past because they are one of the most used for PTSD.

Treatments focused on the past

In this group there are four validated therapies, according to the Guide to Effective Psychological Treatments, by Marino Pérez (2010):

Prolonged exposure therapy

Foe’s prolonged exposure therapy (2007) is a treatment package that includes, in addition to live exposure to avoided situations and imaginative exposure to trauma memories, the following techniques:

– Cognitive restructuring (modification of thoughts) of the beliefs that the world is dangerous and that there is no control.

– Training in relaxation and breathing.

– Psych education.

Rapid eye movement treatment, desensitization and reprocessing (EMDR)

Shapiro’s EMDR (2002) combines imaginative exposure to trauma with bilateral stimulation through eye movement, auditory, or tactile stimulation. Its goal is to make it easier for the person to process the trauma, as it is considered to have been dysfunction ally encoded in memory.

Narrative exposure therapy

It tries to facilitate the integration of the trauma in the autobiographical memory of the patient, combining exposure, cognitive therapy and the testimony of the traumatic experience.


Clinical Hypnosis for the Treatment of PTSD is from Spiegel (1988). It is used for dissociative symptoms, in order to recover memories, restore the connection of affection and memories and enable the transformation of traumatic material.

Psychological debriefing

This is a brief preventive technique that takes place shortly after the traumatic event. Its objective is to prevent subsequent consequences through the normalization of reactions and preparation for possible future experiences.

Did you know that women are more vulnerable to developing PTSD? This is so, although, curiously, the rates of exposure to traumatic events are higher in men.

According to authors such as Tolling and Foe (2006), this may be due to a multitude of variables such as the probability of developing PTSD associated with certain events  (for example, rape) or the lifetime prevalence of this event.

PTSD is a serious disorder that deserves to be treated through psychotherapy and, in some cases, pharmacotherapy as well. If you think you have PTSD, don’t hesitate: ask.

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