Sadly, there's been a lot of trauma this month: college rape, accidental deaths and mass shootings. Today, June 27th, is National PTSD Awareness Day, so it’s a perfect time to discuss PTSD, a mental health disorder that can develop after trauma. As a PTSD psychologist, I’ve heard quite a few inaccurate beliefs about PTSD from patients and others over the years. It’s time we cleared some of that up so that we can best support those who are suffering from symptoms related to trauma. First, it’s important to understand what PTSD is...then proceed with checking your facts:
DIAGNOSTIC CRITERIA FOR PTSD (DSM-5):
10 MYTHS of PTSD
1. “PTSD is untreatable. You have it forever.”
NOT TRUE. PTSD is very responsive to treatment if it’s the right kind of treatment. To find the right kind, you need to look at what the research says. Cognitive processing therapy and prolonged exposure (both related to cognitive-behavioral therapy) have been shown to work very well in 12 sessions or less and are the gold-standard of treatment. In these treatments, a therapist helps a patient face the reality of a situation, process difficult emotions, examine unrealistic thoughts that maintain difficult emotions, and make adjustments to be more realistic, balanced and healthy.
2. “It’s all in their head / they just need to relax.”
WELL….. Yes, it is in the head because the brain is in the head, and inside the brain, you can find the amygdala (previous blog post all about this), which drives the fear response. And yes, relaxation helps but the fear response is not directly in your control. So it’s not that simple. The brain is stuck in looping physiological/emotional/behavioral automatic responses to reminders of the trauma. These responses reinforce unrealistic thinking and avoidance behavior, which reinforce the fear response, and the cycle continues. Therapy intervenes to reverse what’s happening and recalibrate the brain.
3. "Those who are weak get PTSD / PTSD means you’re weak or less than a person.”
NOPE. This one is surprisingly common along with other stigma related to mental health issues. If you fall in a way that breaks your arm, no one will deny that the arm is broken and it would be ridiculous to judge/blame someone for that or not see a doctor. Mental health issues are similar: things in our environment or physiology can trigger responses that change the way the brain works and we suffer problems because of that. Posttraumatic stress is a normal response to an abnormal event (trauma). We have to acknowledge that process and apply the correct treatment so that things can get back in line again.
4. “People with PTSD are dangerous/will lose control.”
NOPE AGAIN. This stereotype has been perpetuated by the media and sensationalized in movies. It is true that people with PTSD may have difficulty managing their emotions, might be quick to get irritable because the nervous system is on edge, and might have a strong reaction to reminders of the trauma, but violence and psychosis is rarely present in PTSD. Someone with PTSD might fear losing control because the fight-or-flight reaction can be very automatic and overwhelming, but the reality is that they are still in control in ways they may not realize and the scariest part is simply the idea of losing control.
5. “PTSD happens immediately after a trauma. If it doesn’t, you won’t get it.”
NOT TRUE. It can sometimes take months or years before symptoms of PTSD appear. There are many reasons for this. Sometimes people move forward quickly and keep themselves busy…when things slow down and they become less distracted later on, symptoms may pop up. Or, an additional stressful event may cause shifts in the way you think about a previous trauma, which then might bring about distress. PTSD can only be diagnosed if symptoms are still sticking around one month after the trauma so immediate posttraumatic stress reactions are considered normal and not yet PTSD.
6. “If too much time has passed, there’s nothing you can do about it.”
DEFINITELY NOT TRUE. Because PTSD is maintained by certain thoughts and behaviors, it can be worked on at anytime. The biggest problem with allowing PTSD to stick around over time is the effects that it has on parts of life. PTSD can have a negative impact on relationships and other roles, which can really get someone off-track over time. It can also have a negative impact on physical health because it puts chronic stress on the body. It’s best to get treatment early so that those things don’t become more of an issue, but treatment has been shown to be effective at any point.
7. “The only way to get better is to erase what happened.”
IMPOSSIBLE. We cannot erase memories. If we’re able to push them down, it’s probably for a limited amount of time. Then they start popping up again and become more out of our control. Therefore, we have to face them, really look at them, feel all the feelings associated with them, and then move through them. The memory will never go away, but how you feel about the memory and how you relate to it will change. That’s how to gain control over the memory rather than it having control over you.
8. “PTSD is just a military thing / All vets come back with PTSD.”
NEGATIVE. PTSD happens as a result of trauma, and trauma can happen anywhere to anyone. In addition to combat and war, trauma can be things like accidents, assaults, violence, rape, bodily injury, neglect, and natural disasters. In fact, most of the research on PTSD has been conducted in civilian populations. The lifetime prevalence of PTSD might be lower than you think as well: it’s about 14% for those in the military and 7% for the general population (10% in women; 4% in men).
9. “Getting treatment will damage my career.”
HMMM…. We know that stigma does exist...that's why this blog post exists. However, it is entirely possible to see a professional outside of the system if you don’t want people to know about it. Mental health treatment is confidential, and no one has to know you’re in it, not even your insurance company. Also, you may not know for sure what your employer’s perceptions actually are. Maybe they would view seeking treatment as a positive, proactive move to prevent personal and career problems down the road. If the concern is about damage to career, it’s important to realize that letting PTSD or other mental health issues stick around might cause the most damage in the long run.
10. “Anything can be traumatic & cause PTSD.”
AND…..NO. Many events can be stressful, but there are specific factors that need to be met for a trauma in PTSD. Actual or threatened death, serious injury or sexual violence all fall under “trauma” if they were directly experienced, witnessed in person, or in some cases, witnessed through indirect exposure. If there was not a threat of serious injury to yourself or others, then it’s likely the event wasn’t a trauma but just a highly stressful event. Anxiety symptoms can absolutely arise after a stressful event. Like PTSD, anxiety and phobias have symptoms that are very difficult to manage AND are very responsive to cognitive behavioral therapy.
------
Looking for treatment? If you’re military: San Antonio is home to the world’s largest PTSD research consortium, STRONG STAR, at UT Health Science Center. Leading PTSD researchers and clinicians provide free treatment to active duty military and veterans. Patients can be seen outside of the system so there is no concern about how the diagnosis will affect their record. Top-of-the-line care is provided in 12 sessions. People outside the military can find a therapist who offers PTSD treatment by entering your zip code in the Therapist Finder tool on Psychology Today. I also offer completely confidential individual treatment for PTSD and other things, and can see clients over video if you're in another part of Texas. Contact me for more info.
DIAGNOSTIC CRITERIA FOR PTSD (DSM-5):
- A traumatic experience occurred (threat of death or serious injury to self or others)
- Experience of each of the following symptom clusters:
- Intrusions/re-experiencing = thoughts that pop up about it, flashbacks, nightmares, feeling as if it is happening again
- Avoidance = avoiding people, places and things that are reminders of it; avoiding thoughts and emotions about it
- Negative changes in thoughts & mood = changes in the way the person thinks about themselves, others and the world; persistent negative mood states
- Hyperarousal = feeling hyperalert/on-guard; difficulty sleeping; irritability; inability to relax
- Symptoms are around for more than a month after the trauma
- Symptoms cause significant distress or impairment
- Symptoms are not caused by medication, substance abuse or other illness
10 MYTHS of PTSD
1. “PTSD is untreatable. You have it forever.”
NOT TRUE. PTSD is very responsive to treatment if it’s the right kind of treatment. To find the right kind, you need to look at what the research says. Cognitive processing therapy and prolonged exposure (both related to cognitive-behavioral therapy) have been shown to work very well in 12 sessions or less and are the gold-standard of treatment. In these treatments, a therapist helps a patient face the reality of a situation, process difficult emotions, examine unrealistic thoughts that maintain difficult emotions, and make adjustments to be more realistic, balanced and healthy.
2. “It’s all in their head / they just need to relax.”
WELL….. Yes, it is in the head because the brain is in the head, and inside the brain, you can find the amygdala (previous blog post all about this), which drives the fear response. And yes, relaxation helps but the fear response is not directly in your control. So it’s not that simple. The brain is stuck in looping physiological/emotional/behavioral automatic responses to reminders of the trauma. These responses reinforce unrealistic thinking and avoidance behavior, which reinforce the fear response, and the cycle continues. Therapy intervenes to reverse what’s happening and recalibrate the brain.
3. "Those who are weak get PTSD / PTSD means you’re weak or less than a person.”
NOPE. This one is surprisingly common along with other stigma related to mental health issues. If you fall in a way that breaks your arm, no one will deny that the arm is broken and it would be ridiculous to judge/blame someone for that or not see a doctor. Mental health issues are similar: things in our environment or physiology can trigger responses that change the way the brain works and we suffer problems because of that. Posttraumatic stress is a normal response to an abnormal event (trauma). We have to acknowledge that process and apply the correct treatment so that things can get back in line again.
4. “People with PTSD are dangerous/will lose control.”
NOPE AGAIN. This stereotype has been perpetuated by the media and sensationalized in movies. It is true that people with PTSD may have difficulty managing their emotions, might be quick to get irritable because the nervous system is on edge, and might have a strong reaction to reminders of the trauma, but violence and psychosis is rarely present in PTSD. Someone with PTSD might fear losing control because the fight-or-flight reaction can be very automatic and overwhelming, but the reality is that they are still in control in ways they may not realize and the scariest part is simply the idea of losing control.
5. “PTSD happens immediately after a trauma. If it doesn’t, you won’t get it.”
NOT TRUE. It can sometimes take months or years before symptoms of PTSD appear. There are many reasons for this. Sometimes people move forward quickly and keep themselves busy…when things slow down and they become less distracted later on, symptoms may pop up. Or, an additional stressful event may cause shifts in the way you think about a previous trauma, which then might bring about distress. PTSD can only be diagnosed if symptoms are still sticking around one month after the trauma so immediate posttraumatic stress reactions are considered normal and not yet PTSD.
6. “If too much time has passed, there’s nothing you can do about it.”
DEFINITELY NOT TRUE. Because PTSD is maintained by certain thoughts and behaviors, it can be worked on at anytime. The biggest problem with allowing PTSD to stick around over time is the effects that it has on parts of life. PTSD can have a negative impact on relationships and other roles, which can really get someone off-track over time. It can also have a negative impact on physical health because it puts chronic stress on the body. It’s best to get treatment early so that those things don’t become more of an issue, but treatment has been shown to be effective at any point.
7. “The only way to get better is to erase what happened.”
IMPOSSIBLE. We cannot erase memories. If we’re able to push them down, it’s probably for a limited amount of time. Then they start popping up again and become more out of our control. Therefore, we have to face them, really look at them, feel all the feelings associated with them, and then move through them. The memory will never go away, but how you feel about the memory and how you relate to it will change. That’s how to gain control over the memory rather than it having control over you.
8. “PTSD is just a military thing / All vets come back with PTSD.”
NEGATIVE. PTSD happens as a result of trauma, and trauma can happen anywhere to anyone. In addition to combat and war, trauma can be things like accidents, assaults, violence, rape, bodily injury, neglect, and natural disasters. In fact, most of the research on PTSD has been conducted in civilian populations. The lifetime prevalence of PTSD might be lower than you think as well: it’s about 14% for those in the military and 7% for the general population (10% in women; 4% in men).
9. “Getting treatment will damage my career.”
HMMM…. We know that stigma does exist...that's why this blog post exists. However, it is entirely possible to see a professional outside of the system if you don’t want people to know about it. Mental health treatment is confidential, and no one has to know you’re in it, not even your insurance company. Also, you may not know for sure what your employer’s perceptions actually are. Maybe they would view seeking treatment as a positive, proactive move to prevent personal and career problems down the road. If the concern is about damage to career, it’s important to realize that letting PTSD or other mental health issues stick around might cause the most damage in the long run.
10. “Anything can be traumatic & cause PTSD.”
AND…..NO. Many events can be stressful, but there are specific factors that need to be met for a trauma in PTSD. Actual or threatened death, serious injury or sexual violence all fall under “trauma” if they were directly experienced, witnessed in person, or in some cases, witnessed through indirect exposure. If there was not a threat of serious injury to yourself or others, then it’s likely the event wasn’t a trauma but just a highly stressful event. Anxiety symptoms can absolutely arise after a stressful event. Like PTSD, anxiety and phobias have symptoms that are very difficult to manage AND are very responsive to cognitive behavioral therapy.
------
Looking for treatment? If you’re military: San Antonio is home to the world’s largest PTSD research consortium, STRONG STAR, at UT Health Science Center. Leading PTSD researchers and clinicians provide free treatment to active duty military and veterans. Patients can be seen outside of the system so there is no concern about how the diagnosis will affect their record. Top-of-the-line care is provided in 12 sessions. People outside the military can find a therapist who offers PTSD treatment by entering your zip code in the Therapist Finder tool on Psychology Today. I also offer completely confidential individual treatment for PTSD and other things, and can see clients over video if you're in another part of Texas. Contact me for more info.
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