Post-Traumatic Stress

What Is Post-Traumatic Stress (PTS/D)?

PTS is a common, normal, and often adaptive response to experiencing a traumatic or stressful event.

Both PTS and PTSD are associated with feeling fearful and/or nervous, avoiding the activity or place associated with the traumatic event, and nightmares. However, there are significant differences in symptom intensity, duration, and treatment.

PTSD is a clinically diagnosed psychiatric disorder that can occur following the experience or the witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adulthood or childhood.

Symptoms include flashbacks, nightmares, severe anxiety, uncontrollable intrusive thoughts, and emotional numbing after the event.2,4,6

PTS in Veterans: High Prevalence Among Military Personnel5

Military service members and veterans from recent conflicts and combat are a population of special concern.

Since September 11, 2001, the U.S. has deployed more than 2.7 million men and women to support combat operations in Iraq and Afghanistan.7

According to the Department of Defense’s 2015 evaluation of U.S. military casualty statistics5:

  • Among deployed troops, there have been over 138,000 new diagnoses of PTSD from 2000 to June 2015, as well as 40,000 diagnoses among troops not yet deployed.
  • The incidence of PTSD has increased since 2000, with a peak in 2011 and 2012.
  • Post-deployment, PTSD prevalence in U.S. infantry personnel has averaged 10%-20%, often coexisting with depression, substance misuse, and other concerns.8

Further, military personnel with a history of mild traumatic brain injury (TBI) have an increased risk for developing PTSD.9,10

Among U.S. Army infantry soldiers returning from Iraq, 43.9% of those who reported a TBI with loss of consciousness also reported symptoms of PTSD.

New Diagnoses of PTSD among deployed troops, from 2000 to June 2015

Approximately 8 Million Adults in the US Have a Diagnosis of PTSD2

PTS may be exacerbated by more frequent or severe exposures to trauma, and risk increases with history of trauma and stressors, personal or family history of psychopathology, and low social support.11

  • In addition to being prevalent in military veterans, PTS is seen in first responders, rape and battery victims, and abused children.

Among people 13 years of age and older, 5.7% will develop PTSD during their lifetime.4 PTS is more prevalent in young adults, women, and African Americans, and high rates are also seen in Hispanics and Caucasians.

  • Women are more than twice as likely as men to develop PTSD during their lifetime, and three times as likely to develop the disorder annually.1

  • 3.7% of Americans ages 13 years of age and older have a diagnosis of PTSD every year

  • 5.7% of Americans 13 years of age and older develop PTSD during their lifetime

  • Over 138,000 new PTSD diagnoses among deployed military personnel from 2000-2015

10-20%
average post-deployment PTSD prevalence
in U.S. infantry personnel

The PTS Spectrum Has Been Defined, Providing a Useful Framework for Thinking About Diagnosis and Treatment12

Diagnostic Criteria

DSM-5 Diagnosis: Because our understanding of PTS constantly evolves, the DSM-5 was updated to assess four categories/clusters of PTSD symptoms13:

  • Re-experiencing the traumatic event such as in spontaneous memories, recurrent dreams, flashbacks, or other psychological distress related to the event
  • Avoidance of distressing memories, thoughts, feelings, or external reminders of the event
  • Negative cognition and mood, including persistent and distorted blame of self or others and persistent negative emotional state
  • Alterations in arousal and reactivity such as in reckless or destructive behavior and hypervigilance

Read more about the difference between PTS & PTSD

PTSD Is Highly Comorbid with Depression, Anxiety Disorders, and Suicidality14

Comorbidities: PTSD can greatly impact patients’ health in terms of increased risk for cardiovascular disease, hypertension, hyperlipidemia, and obesity, among other conditions – not to mention a number of psychological disorders.1,15

In particular, when TBI and PTSD co-occur, symptoms may be difficult to delineate.

There Are High Unmet Needs – But Also Opportunities for Improvement – in Both Diagnosing and Treating PTSD

Diagnosing and then treating PTSD can be nuanced due to the complexity and timing of PTS presentation, with patients having multiple symptoms arising from the symptom clusters.16

  • PTSD symptoms may start within 3 months of the traumatic event, but sometimes emerge years later.
  • PTSD may be substantially underdiagnosed due to comorbidities and substance abuse, stigma associated with the diagnosis, lack of awareness among physicians and patients, and a lack of screening tools.
PTSD Infographic, PTSD Facts Infographic

Further Reading – Suggested PTS Resources

Post-Traumatic Stress on Wikipedia

U.S. Department of Veterans Affairs; National Center for PTSD

Mayo Clinic: Post-Traumatic Stress Disorder

References

  1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62:617-627.
  2. US Department of Veterans Affairs. National Center for PTSD. “How common is PTSD in Adults?”. Accessed in 2020. https://www.ptsd.va.gov/understand/common/common_adults.asp.
  3. Mayo Clinic. Post-traumatic stress disorder. 2014. http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540.
  4. Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21:169-184.
  5. Congressional Research Service. A guide to U.S. military casualty statistics: Operation Freedom’s Sentinel, Operation Inherent Resolve, Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. August 7, 2015. www.crs.gov, http://news.usni.org/tag/oef.
  6. US Department of Health and Human Services. National Institutes of Health. Post-traumatic stress disorder (PTSD). NIH Publication no. 08 6388. Bethesda, MD: National Institute of Mental Health. 2012. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml.
  7. Ramchand R, Rudavsky R, Grant S, Tanielian T, Jaycox L. Prevalence of, risk factors for, and consequences of posttraumatic stress disorder and other mental health problems in military populations deployed to Iraq and Afghanistan. Curr Psychiatry Rep. 2015;17:37.
  8. RAND Center for Military Health Policy Research. Invisible wounds of war: psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corporation; 2008. http://www.rand.org/pubs/monographs/MG720.html.
  9. Bryant RA, Friedman MJ, Spiegel D, Ursano R, Strain J. A review of acute stress disorder in DSM-5. Depress Anxiety. 2011;28:802-817.
  10. Centers for Disease Control and Prevention. Report to Congress. Traumatic brain injury in the United States: epidemiology and rehabilitation. Atlanta, GA: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention; 2014. http://www.cdc.gov/traumaticbraininjury/pdf/TBI_Report_to_Congress_Epi_and_Rehab-a.pdf.
  11. Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull. 2003;129:52-73.
  12. US Department of Veterans Affairs. VA/DoD Clinical Practice Guidelines. Management of post-traumatic stress disorder and acute stress reaction. 2010. http://www.healthquality.va.gov/guidelines/MH/ptsd/.
  13. Posttraumatic Stress Disorder. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition ed. Washington, DC: American Psychiatric Association; 2013.
  14. US Department of Veterans Affairs. National Center for PTSD. http://www.ptsd.va.gov.
  15. Coughlin SS. Post-traumatic stress disorder and cardiovascular disease. Open Cardiovasc Med J. 2011;5:164-170.
  16. US Department of Veterans Affairs. National Center for PTSD: Complex PTSD. https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp.
  17. https://www.ptsd.va.gov/understand/common/common_adults.asp#:~:text=About%207%20or%208%20out,have%20gone%20through%20a%20trauma.
  18.  https://www.ptsd.va.gov/understand/common/common_adults.asp#:~:text=About%206%20of%20every%2010,to%20witness%20death%20or%20injury.
  19. Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593-602.
  20. Kessler, R.C., Berglund, P., Delmer, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6): 593-602.
  21. Shalev, A. Y., S. Freedman, T. Peri, D. Brandes, T. Sahar, S. P. Orr, et al. Prospective study of posttraumatic stress disorder and depression following trauma. American Journal of Psychiatry, Vol. 155, No. 5, 1998, pp. 630–637.
  22. Panagioti M, Gooding PA, Tarrier N. A meta-analysis of the association between posttraumatic stress disorder and suicidality: the role of comorbid depression. Compr Psychiatry. 2012;53:915–30. Accessed at: https://www.ncbi.nlm.nih.gov/pubmed/22483367
  23. Kulka, R.A., Schlenger, W.A., Fairbanks, J.A., Hough, R.L., Jordan, B.K., Marmar, C.R., … Cranston, A.S. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
  24. Maher MJ, Rego SA, Asnis GM. Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management. CNS Drugs. 2006;20(7):567–90. https://www.ncbi.nlm.nih.gov/pubmed/16800716
  25. Tanielian, T. & Jaycox, L. (Eds.). (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation. Accessed at: https://www.rand.org/content/dam/rand/pubs/monographs/2008/RAND_MG720.pdf
  26. Tanielian, T. & Jaycox, L. (Eds.). (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation. Accessed at: https://www.rand.org/content/dam/rand/pubs/monographs/2008/RAND_MG720.pdf
  27. https://www.mentalhealth.va.gov/docs/data-sheets/2019/2019_National_Veteran_Suicide_Prevention_Annual_Report_508.pdf
  28. Tanielian, T. & Jaycox, L. (Eds.). (2008). Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: RAND Corporation. Accessed at: https://www.rand.org/content/dam/rand/pubs/monographs/2008/RAND_MG720.pdf