Post-traumatic Stress Disorder: The Different Types

Most people are likely to have experienced a traumatic event at some point in life, however, not all trauma advances into a Post Traumatic Stress Disorder (PTSD). There are certain criteria to meet before a mental health professional can diagnose the trauma response behaviors with PTSD.

Often associated with veterans, PTSD can affect anyone after being directly or indirectly exposed to a traumatic event, with the intensity ranging from mild to severe. There are 4 types of PTSD:

1. Normal Stress Response.
2. Acute Stress Disorder.
3. Uncomplicated PTSD
4. Complex PTSD or known as C-PTSD.

PTSD Defined

Post Traumatic Stress Disorder or PTSD is a chronic mental health condition formed when someone is exposed to a traumatic event and finds it hard to recover. It can be a direct experience, where they are the object of the traumatic event, or they witnessed the event. Or indirect, where they did not experience it but learned in detail that someone went through a horrible and traumatic event. The symptoms of this trauma response fall into four categories: intrusion, avoidance, negative mood changes, hyperarousal, or a heightened reaction to life experience.

During the American Civil War, this mental health condition was called a Soldier’s Heart. In World War I, it is referred to as Shell Shock. While in World War II, PTSD was called Combat Fatigue. Today, the fifth edition of the Diagnostic and Statistical Manual (DSM-5) lists it under the Trauma- and Stress-Related Disorders category. PTSD is the only form of anxiety that which an external event is a part of the diagnostic criteria.

PTSD may develop from life-threatening events, such as war, natural disaster, a homicide attempt, a terrible accident, or critical surgery. Additionally, in repeated cases, intense exposure to maltreatment during childhood, community violence, or abusive relationships including domestic violence, are a high risk to develop post-traumatic stress disorder.

According to DSM-5 the four criteria and the symptoms to indicate that trauma has developed into a PTSD include:

1. Re-experiencing the traumatic event in the form of flashbacks, intrusive thoughts, or nightmares. Flashback is when someone keeps reliving the event as if it happens again and again with little to no control over it. While intrusive thoughts come in the form of unwanted, distressing thoughts that can disrupt one’s daily experiences.
2. Hyperarousal with heightened response to a particular stimulus that brings back the memory of the traumatic event. Whether it comes out as extremely jumpy or hypervigilance when exposed to a reminder, insomnia, irritability, or anger outburst. We may also see this symptom in the form of reckless or self-destructive behavior.
3. Negative cognition mood. This symptom leads to distorted beliefs about the world, about oneself, or others. When someone experiences PTSD, there is a shift in belief in trust, safety, and power.
4. Avoidance is where someone tries to avoid the memory and the fear created by withdrawal from social life, dissociation, numbing, or anhedonia. Basically actively avoiding people, places, or situation that potentially triggers the memory, with either conscious effort or an automatic response.

While the 2 compulsory symptoms of PTSD are:

• The signs have to last for a minimum of 1 month.
• There has to be a stressor where the person has either directly experienced the traumatic event, or witnessed it, or an indirect experience where a person learned an aversive detail of a traumatic event.

Normal Stress Response

After exposure to an alarming, shocking, or threatening life event that shakes, and leaves a person with trauma, naturally, the person is likely to struggle with physical or emotional stress. Stress responses may be different from one to another. Nonetheless, it comes from a part of the brain that controls the fight, flight, or freeze response, called the amygdala.

When another part of the brain perceives threats or danger, the amygdala is activated, and the automatic process begins, including the production of stress hormones. The normal stress responses include heart rate increases, blood pressure increases, muscle twitching, nausea, or tunnel vision, which is a loss of peripheral vision. And as the real or perceived threats disappear, the amygdala deactivates, and the stress level gradually reduces.

PTSD, however, causes the amygdala to be overactive, triggering the stress response even in the absence of threats. In addition, there is a shift in beliefs in trust, safety, and power, which may manifest as heightened vigilance or hyperarousal in response to a life event.

Acute Stress Disorder

DSM-5 defines acute stress disorder as stress behaviors that establish as a response to a specific fear. It is a temporary psychological stress post a traumatic experience. Therefore Acute Stress Disorder (ASD) is highly correlated with PTSD, where ASD development is defined with the same criteria as PTSD. This type of disorder also characteristically experiences re-experiencing the traumatic event, intrusive and negative thoughts of unwanted memories, and avoidance behavior.

The discrepancy between Acute Stress Disorder and PTSD is that self-destructive behavior is not listed in the common symptoms. And in ASD the symptoms appear immediately after 3 days and last for a month following the event, while PTSD may appear after a long period following the event and commonly last longer. Regardless of the difference, several clinical studies show that the occurrence of Acute Stress Disorder developing into PTSD is rather high.

Uncomplicated PTSD

This type is when a single traumatic circumstance happens, but leaves a deep scar and shows symptoms that meet the DSM-5 PTSD criterion. This is what we commonly refer to as PTSD.

Complex PTSD

If uncomplicated PTSD is commonly developed from a single traumatic event, complex PTSD or C-PTSD develops from multiple trauma experiences or prolonged exposure to traumatic events. Therefore childhood trauma is one of the main causes of someone having C-PTSD. Whether it is an experience of emotional neglect from a caregiver, abandonment of a parental figure, or repeated abusive treatments which built a constant feeling of unsafe and helplessness as a child.

Other traumatic events that potentially lead to C-PTSD are feeling helpless in a toxic relationship where someone is repeatedly abused experiencing being belittled, degraded, or gaslighted for a significant period of time. Being a victim of bullying is another situation that may leave a person with trauma with a high likelihood to develop a complex PTSD.

Comorbidity

PTSD is highly correlated with anxiety and is often comorbid with depression. The pain from the past, the constant fear, and the recurring symptoms can break someone’s spirit. Apart from these two mental health conditions, the signs may overlap with Borderline Personality Disorder.

Coping with Post-traumatic Stress Disorder

The constant fear that keeps coming back, continuously having to be on guard, and frequently feeling helpless and hopeless is painful and frustrating. The pain may feel unbearable, but there are ways to cope.

Learn About PTSD and Anxiety

The first step is to learn about PTSD and anxiety as the responses are forms of heightened anxious feelings. Through a better understanding, individuals experiencing PTSD will have a better awareness of their feelings, will be able to identify their triggers, and take the steps to heal.

Anxiety Management Techniques

Diaphragmatic breathing. PTSD makes an individual feel anxious throughout the day, and may also trigger panic. In the situation where the anxiety is heightened or panic attacks, a person tends to have irregular breathing, either short, fast breathing or hyperventilation due to rapid, deep breathing. Thus, this calming breathing technique helps to pull the individual away from the edge.

Grounding techniques. Especially during flashbacks, where the individual is brought back to the traumatic event and loses attachment to the present moment. This technique helps to bring them back by attaching the senses to the things and situations in the present.

Exposure to reduce the avoidance symptoms. Understandably, the individual has a strong drive to avoid anything that reminds them of the terrifying moment. However, studies show that the fear grows bigger as the person avoids it. Exposure therapy pushes someone to face the fears one step at a time and unlearns the distorted belief. And this therapeutic effort can be a part of self-help, but in a moderate to severe PTSD condition it is recommended to work on this with a psychotherapist.

List Available and Reliable Resources to Help During a Crisis

There are many helplines for veterans, victims of domestic abuse, or victims of sexual assault where the individual can reach out. They are trained to help people in crisis. Apart from that, other resources can include building a support system. Explain the situation to family or close people and tell them how best to help you. Oftentimes, the individual only needs someone to stay and let them know that they are safe.

How a Therapist Can Help

If you or your loved ones are showing symptoms of PTSD, it is highly encouraged to get treatment from a mental health professional. Therapists have a systematic clinical procedure to do an interview and assessment, in order to diagnose and determine the level of severity. Using PTSD Checklist for DSM-5 (PCL-5), the therapist will score the result with the Clinician-Administered PTSD Scale (CAPS-5).

During the psychotherapy sessions, the therapist will help identify the triggers and assist to unload the burden from the hidden wound with talk therapy. A Prolonged Exposure therapy, which is the gold standard in PTSD treatment, will be given correctly and the progress measured. Furthermore, the therapist is able to aid you to unlearn the negative beliefs and build more helpful thinking patterns with cognitive-behavioral therapy (CBT).

Another common treatment for PTSD is Eye Movement Desensitization and Reprocessing (EMDR), where the therapist assesses the eye movement. Despite still a controversy, this technique has been proven to reduce the symptoms. Mental health professionals work with you to identify which treatment(s) may be the best for you.

Get Started with 7 Cups

Some resources available at 7 Cups to support the healing journey include:

• 1-on-1 chat with a listener. Please note that listeners are not therapists, and they are here to volunteer their time to be there for others. Thus it is best to discuss with the listener how the support chat can best support you, and if the listener is able to provide the support.

• Join group support sessions, to receive and give support. It is best to join sessions provided by the Trauma Support subcommunity or Sharing Circle sessions.

• Traumatic experiences guide for a better understanding of the pattern of trauma and getting self-help tips.

• Growth Paths for trauma will help you learn the steps to manage the anxiety from the traumatic event.

For more support, join our empathetic community, chat with a free, trained listener, or start affordable online therapy today.

Biography

Tiara Nurhalida has always been fascinated with writing, neuromarketing, and human behavior. She is learning more about different mental health topics and active listening at 7 Cups. Since graduating from the Content Development and Marketing Program at the 7 Cups Academy, she is interested to contribute more towards the 7 Cups Content areas.