Post Traumatic Disorder:

What it is, It’s Symptoms Screening It, and Treating It.

Post-traumatic stress disorder (PTSD) is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. It is natural to feel afraid during and after a
traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. This “fight-or-flight” response is a typical reaction meant to protect a
person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems
may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened, even
when they are not in danger.

Signs and Symptoms Of PTSD
Most people commonly associate PTSD with wars and combat. However, PTSD can affect
people who have experienced any type of dangerous event and something that causes sudden
shock like the sudden, unexpected death of a loved one, can also cause PTSD. Not every
traumatized person develops chronic or even short-term (acute) PTSD. Not everyone with PTSD
has been through a dangerous event. Most symptoms of PTSD usually begin early, within 3
months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last
more than a month and be severe enough to interfere with relationships or work to be considered
PTSD. Recovery from PTSD varies as some may recover within 6 months, while others have
symptoms that last much longer. In some people, the condition becomes chronic.

To be diagnosed with PTSD, an adult must have the following criteria for at least 1 month:

At least one re-experiencing symptom: Re-experiencing symptoms may cause problems in a
person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings.
Words, objects, or situations that are reminders of the event can also trigger re-experiencing
symptoms. These symptoms can include Bad dreams and Frightening thoughts.

At least one avoidance symptom: Staying away from places, events, or objects that are
reminders of the traumatic experience. Avoiding thoughts or feelings related to the traumatic
event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These
symptoms may cause a person to change his or her personal routine. For example, after a bad car
accident, a person who usually drives may avoid driving or riding in a car.

At least two arousal and reactivity symptoms. Arousal and reactivity symptoms include:
Being easily startled; Feeling tense or “on edge”; Having difficulty sleeping; Having angry
outburst. Arousal symptoms are usually constant and make a person feel stressed or angry. These
symptoms make daily task such as sleeping, eating or concentrating difficult to accomplish.
Arousal and reactivity symptoms include; Being easily startled, feeling tense or “on edge”,
having difficulty sleeping, and having angry outbursts.

At least two cognition and mood symptoms. These symptoms include; Trouble remembering
key features of the traumatic event, Negative thoughts about oneself or the world. Having
distorted feelings like guilt or blame. Loss of interest in enjoyable activities. Cognition and mood
symptoms can begin or worsen after the traumatic event but are not due to injury or substance use. These symptoms can make the person feel alienated or detached from friends or family
members.

It is natural to have some of these symptoms after a dangerous event. When people have very
serious symptoms that go away after a few weeks, it is called acute stress disorder. When the
symptoms last more than a month, seriously affect one’s ability to function, and are not due to
substance use, medical illness, or anything except the event itself, they might be PTSD. Some
people with PTSD do not show any symptoms for weeks or months. PTSD is often accompanied
by depression, substance abuse, or one or more of the other anxiety disorders.

Do children react differently than adults?
Children and teens can have extreme reactions to trauma, but some of their symptoms may not
be the same as adults. Symptoms sometimes seen in very young children (less than 6 years old),
these symptoms can include: Wetting the bed after having learned to use the toilet. Forgetting
how to or being unable to talk. Acting out the scary event during playtime. Being unusually
clingy with a parent or other adult. Older children and teens are more likely to show similar
symptoms to those seen in adults. They may also develop disruptive, disrespectful, or destructive
behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They
may also have thoughts of revenge.

Risk Factors
Anyone can develop PTSD at any age. This includes war veterans, children, and people who
have been through a physical or sexual assault, abuse, accident, disaster, or other serious events.
According to the National Center for PTSD, about 7 or 8 out of every 100 people will experience
PTSD at some point in their lives. Women are more likely to develop PTSD than men, and genes
may make some people more likely to develop PTSD than others.

PTSD Screening Instruments
Below is a list of PTSD screens, that is, brief questionnaires that may identify people who are
more likely to have PTSD. A positive response to the screen does not necessarily indicate that a
client/patient has Posttraumatic Stress Disorder. However, a positive response does indicate that
a patient may have PTSD or trauma-related problems, and further investigation of trauma
symptoms by a mental health professional may be warranted.
Primary Care PTSD Screen for DSM-5: The Primary Care PTSD Screen for DSM-5 (PC-
PTSD-5) is a 5-item screen that was designed for use in primary care settings. The measure
begins with an item designed to assess whether the respondent has had any exposure to traumatic
events. If a respondent denies exposure, the PC-PTSD-5 is complete with a score of 0.
Davidson Trauma Scale (DTS) Provides a quick and accurate measure of Posttraumatic Stress
Disorder (PTSD) symptoms, the DTS assessment is a 17-item, self-rating scale that takes
respondents only 10 minutes to complete. Each item corresponds to a DSM-IV™ symptom of
PTSD, and each symptom is rated in terms of frequency and severity. The DTS assessment can
be used to screen clients at initial evaluation, evaluate psychopathology in trauma victims, assess
the effectiveness of treatment, and predict treatment success. The scale covers all types of trauma: accident, combat, sexual, criminal assault, natural disaster, torture, burns, loss of
property, near death experiences, and bereavement.

SPAN: The SPAN is a four-item self-report screen derived from the Davidson Trauma Scale. Its
name is an acronym for the four symptoms assessed (startle, physically upset by reminders,
anger, and numbness). The four items that make up the SPAN are the items from the DTS that
best distinguished a sample of patients with PTSD from a sample of patients without PTSD.
SRINT: SPRINT screen is a brief, global assessment for post-traumatic stress disorder (PTSD)
that assesses symptoms of intrusion, avoidance, numbing and arousal, and related aspects of
PTSD (somatic distress, stress vulnerability and impairment in function). Developed by Connor
& Davidson (2001) for use with adults (18+ years), its design followed a need for a less time
consuming, yet structured PTSD-specific measure.
Trauma Screening Questionnaire (TSO) is a questionnaire developed for screening of
posttraumatic stress disorder. This self-reported assessment scale consists of 10 items, which
cover one of the main signs of PTSD. Each item is answered with binary yes or no responses.
PLEASE NOTE: Screens are to be used to determine possible problems, and positive cases and
should be followed up by assessment with a structured interview for PTSD.

Treatments and Therapies
The main treatments for people with PTSD are medications such as anti-depressants and
psychotherapy, (“talk” therapy). Psychotherapy involves talking with a mental health
professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group. Talk
therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows
that support from family and friends can be an important part of recovery.
Many types of psychotherapy can help people with PTSD. Some types target the symptoms of
PTSD directly. Other therapies focus on social, family, or job-related problems. The therapist
may combine different therapies depending on each person’s needs. Effective psychotherapies
tend to emphasize a few key components, including education about symptoms, teaching skills to
help identify the triggers of symptoms, and skills to manage the symptoms. One helpful form of
therapy is called (CBT) Cognitive Behavioral Therapy CBT can include: Exposure therapy. This
helps people face and control their fear. It gradually exposes them to the trauma they experienced
in a safe way. It uses imagining, writing, or visiting the place where the event happened. The
therapist uses these tools to help people with PTSD cope with their feelings. Cognitive
restructuring. This helps people make sense of the bad memories. Sometimes people remember
the event differently than how it happened. They may feel guilt or shame about something that is
not their fault. The therapist helps people with PTSD look at what happened in a realistic way.

Conclusion: Everyone is different, and PTSD affects people differently, so a treatment that
works for one person may not work for another. It is important for anyone with PTSD to be
treated by a mental health provider who is experienced with PTSD. Some people with PTSD
may need to try different treatments to find what works for their symptoms.

Jim Katsoudas