Posttraumatic Stress Disorder (PTSD)

The Definition of Trauma

A trauma is an unexpected, unpreventable event for which the person experiencing it is unprepared. It is not so much the event that determines whether something is traumatic to someone – rather, it is the person’s experience of the event.

Trauma differs from stress in that trauma is stress run amuck. Stress dysregulates our nervous systems – but for only a relatively short period of time. Within a few days or weeks, our nervous systems calm down and we revert to a normal state of equilibrium. This return to normalcy is not the case when we have been traumatized.

One way to tell the difference between stress and trauma is by looking at the outcome – how much residual effect an upsetting event is having on our lives, relationships, and overall functioning. Traumatic distress can be distinguished from routine stress by assessing how quickly upset is triggered, how frequently upset is triggered, how intensely threatening the source of upset is, how long upset lasts, and how long it takes to calm down.

Psychological trauma can result from events long-recognized as traumatic, including:

Natural disasters (earthquakes, fires, floods, hurricanes, etc.)
Man-made disasters (plane crashes, forest fires, bridge/mine collapses, train derailments, etc)
War/terrorist incidents
Physical assault, including rape, incest, molestation, domestic abuse
Serious bodily harm
Serious accidents such as automobile or other high-impact scenarios
Experiencing or witnessing horrific injury, carnage or fatalities
Falls or work/sports injuries
Surgery, particularly emergency
Serious, life-threatening illness
Hearing about violence to or sudden death of someone close
Military combat
Childhood abuse

It is acknowledged that early life trauma creates a vulnerability for experiencing future traumatic responses.

There is no clear explanation as to why some people experience post-traumatic stress reactions and others do not, but it is likely that one or more of these factors are involved:

Severity of the event
Individual’s personal history
Larger meaning the event represents for the individual (which may not be immediately evident)
Coping skills, values and beliefs held by the individual (some of which may have never been identified)
Reactions and support from family, friends, and/or professionals
Repeated exposure to traumatic events (i.e., as with first responders)

PTSD is a condition that can develop after someone has experienced trauma. Anyone can become traumatized. Even professionals who work with trauma, or other people close to a traumatized person, can develop PTSD symptoms. Developing symptoms is never a sign of weakness.

Symptoms should be taken seriously, and steps should be taken to heal, just as one would take action to heal from a physical ailment. And just as with a physical condition, the amount of time or assistance needed to recover from emotional trauma will vary from one person to another. PTSD is diagnosed when a person experiences a traumatic event(s) and exhibits a number of these diagnostic criteria across these four clusters:

Intrusion symptoms

Intrusive memories of the traumatic event
Bad dreams/nightmares about the traumatic event
Flashbacks or a sense of reliving the event
Feelings of intense distress when reminded of the trauma
Physiological stress response to reminders of the event (pounding heart, rapid breathing, nausea, muscle tension, sweating)

Avoidance

Avoiding thoughts, feelings, or conversations associated with the trauma
Avoiding activities, places, or people that remind you of the trauma

Negative Alterations in Cognition and Mood

Inability to remember important aspects of the trauma
Loss of interest in activities and life in general
Feeling detached or estranged from other people
Persistent negative beliefs about self, others, and the world
Distorted cognitions leading to self-blame or blaming others
Persistent negative emotional state (fear, horror, anger, guilt, shame)
Persistent inability to experience positive emotions

Alterations in Arousal & Reactivity

Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hypervigilance, or being constantly “on guard”
An exaggerated startle response, or jumpiness
Reckless or self-destructive behavior

While not diagnostic of PTSD, the following co-occurring conditions/responses are often noted when someone has been diagnosed with PTSD. Sometimes these responses can be delayed for months or even years after the event, such that, often people do not even initially associate their symptoms with the precipitating trauma.

Physical

Eating disturbances (more or less than usual)
Sleep disturbances (more or less than usual)
Sexual dysfunction
Low energy
Chronic, unexplained pain

Emotional

Depression, spontaneous crying, despair and hopelessness
Anxiety
Panic attacks
Fearfulness
Compulsive and obsessive behaviors
Feeling out of control
Irritability, angry and resentment
Emotional numbness
Withdrawal from normal routine and relationships

Cognitive

Memory lapses, especially about the trauma
Difficulty making decisions
Decreased ability to concentrate
Feeling distracted
ADHD symptoms

Common personal and behavioral effects of emotional trauma:

Substance abuse
Compulsive behavior patterns
Self-destructive and impulsive behavior
Uncontrollable reactive thoughts
Inability to make healthy professional or lifestyle choices
Dissociative symptoms (“splitting off” parts of the self)
Feelings of ineffectiveness, shame, despair, hopelessness
Feeling permanently damaged
A loss of previously sustained beliefs

Common effects of emotional trauma on interpersonal relationships:

Inability to maintain close relationships or choose appropriate friends and mates
Sexual problems
Hostility
Arguments with family members, employers or co-workers
Social withdrawal
Feeling constantly threatened

The Special Case of First Responders

Research shows first responders – police officers, firefighters, paramedics/EMTs, and dispatchers – develop PTSD at rates two to four times higher than the general population, with prevalence often ranging from 10% to over 30% depending on occupation.

Some of the factors contributing to their higher risk include:

Cumulative trauma exposure: Police, firefighters, EMTs, and dispatchers encounter repeated traumatic events over years, creating a “dose‑response” effect that increases PTSD likelihood. simplypsychology.com
Routine exposure to severe incidents: Nearly 80% of first responders report experiencing traumatic events on the job. mhstats.org
Occupational culture and stigma: Fear of career impact and confidentiality concerns reduce help‑seeking, worsening symptoms. simplypsychology.com+1
High burnout rates: About 42% of emergency service workers report burnout, which correlates with increased PTSD susceptibility. mhstats.org

Consequences of these elevated PTSD rates include:

Higher suicide risk: First responders are 50% more likely to die by suicide than in the line of duty. simplypsychology.com
Comorbid conditions: High rates of depression, anxiety, insomnia, substance use, and cardiovascular disease. zipdo.co
Impact on family and career: Relationship strain, early career exit, and reduced quality of life. neurolaunch.com

Effective Treatments: evidence‑based CBT therapies show strong outcomes when tailored to first responder culture, including Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE).

Please read more about PTSD at the source documents that I have used here: National Center for PTSD (www.ptsd.va.gov and www.ptsd.va.gov/disaster_events/for_providers/rescue_response_workers.asp), HelpGuide.org (www.helpguide.org/mental-health/ptsd-trauma), HealingResources.info (www.healingresources.info), Simply Psychology (www.simplypsychology.com/articles/ptsd-in-first-responders), National Institute of Mental Health (www.nimh.nih.gov), the Anxiety Disorders Association of America (www.adaa.org), and Mental Health Stats (mhstats.org/first-responders/ptsd/).

If you are having difficulty after experiencing a trauma, with or without PTSD symptoms, I have extensive experience with PTSD and would welcome the opportunity to talk with you about your experiences. Please e-mail me at Karen@Psychologist-NH.com.