What Is PTSD?

When confronted with a potentially traumatizing event, our brains are quite adept at taking a snapshot of that situation and remembering the circumstances under which we were faced with death or serious harm. At some point we may be presented with similar circumstances, and our bodies react in preparation to deal with the threat again. This is commonly known as our "fight or flight" response.

If the fight or flight response is activated by events that truly are life-threatening, the usefulness of the response is evident. It could indeed keep us safe. However, if this response continues for a period of time beyond the threat, it can become maladaptive. PTSD leads a person to over-generalize the fight or flight response to threats such that even benign events (e.g., a car backfire) signal danger. People with PTSD may continue to respond to triggers (or reminders of the life-threatening event) as if their life is in danger even when it is not². And PTSD may be exacerbated in a crisis, making a difficult situation even more problematic, both for the person with PTSD and others.

PTSD Basics

PTSD most commonly occurs after direct exposure to a traumatic event, but can also occur by being a witness to traumatic events, learning of the accidental or violent death of a close relative or friend, or through repeated or extreme exposure to aversive details of traumatic events, usually in the course of professional duties.

To receive a PTSD diagnosis, a person must have symptoms in the following four clusters for at least a month, with noted decreases in functioning:

• Intrusion symptoms.
  Intrusive memories of traumatic events can come back at any time via any number of reminders or "triggers" (e.g., sounds, smells, visual cues). These reminders commonly cause emotional (e.g., fear, anger) and/or physical (e.g., racing heartbeat) reactions. In extreme situations, "flashbacks" of the event may occur. This happens when the person feels as though he or she is actually back at the time and place of the traumatic event(s).
• Avoidance symptoms.
  Because remembering traumatic events is so distressing, those with PTSD may try to avoid people, places, activities, thoughts, and feelings that remind them of the traumatic event(s).
• Negative alterations in cognitions and mood.
  These changes can take the form of emotional numbing or having difficulty feeling; forgetfulness; estrangement from others; or negative views of oneself and the world. For instance, a person may find it hard to express emotions or may detach from his or her emotions. He or she may use substances or activities to feel numb. Someone may find it difficult to remember pieces of the trauma or the entire event, whether he or she wants to remember or not. The person may stop feeling excitement or interest in activities or things for which he or she used to have interest.
• Alterations in arousal and reactivity.
  A person with PTSD may respond by frequently being overly alert, "keyed up" or jittery, overly attuned to danger, or quick to get agitated or react aggressively to others. Anger may be his or her response to feeling threatened even when not really in danger.

Why Recognizing PTSD Matters

There are several reasons why it is helpful to be able to recognize PTSD symptoms.

First, having an overall understanding of the PTSD can help you to recognize that there may be something more affecting what is taking place. For instance, if you see one PTSD symptom (e.g., exaggerated startle response) in a person at the scene, it might help you look for, or ask about, other symptoms that may be impacting behavior (e.g., extreme lack of sleep). Additionally, keep in mind that over three-quarters of men and women with PTSD have co-occurring diagnoses, most commonly substance abuse and depression³.

Second, knowing the symptoms of PTSD can help you identify when some other problem may be happening. For example, auditory hallucinations (or "hearing things") that are not connected to a traumatic event are not usually part of PTSD. If a person in crisis appears to be hearing voices and is not having a flashback to the traumatic event, then this symptom might indicate a psychotic disorder, such as schizophrenia.

Third, you may be in a unique position to assist Veterans (or anyone) with PTSD. If you recognize symptoms as potentially being indicative of PTSD, you may be able to help Veterans get connected with services using a crisis line, Veterans' programs, or treatment resources^4,5. Treatments for PTSD (psychotherapy and medication) are among the most effective available for any of the mental health problems.