What Myths About PTSD Need to be Debunked?

After exposure to a terrifying event, some people experience the devastating impacts of post-traumatic stress disorder, more commonly known as PTSD. This is an anxiety disorder that is experienced by people who have witnessed or lived through a traumatic event.

Triggers for PTSD can come from involvement in a war, a natural disaster, a terrorist attack, sexual assault or a serious accident, to name a few. PTSD can manifest as nightmares, flashbacks, adverse responses to triggering stimuli, feelings of intense fear, detachment and social isolation.

PTSD-related biological and cognitive processes may also contribute to the development of sexual dysfunction, according to a 2015 review article published in The Journal of Sexual Medicine. The review looked at studies on military veterans with PTSD and found that the disorder can cause sexual complications.

PTSD and sexual desire compete for the same neurological networks. This is why medications used to treat sexual dysfunction can lead to flashbacks and panic attacks in people who suffer from PTSD, the study found.

Sexual arousal is much like the physiological experience of fear, and after these associations have been forged with the experience of trauma, it can be difficult to separate them. The researchers wrote that PTSD contributes to sexual dysfunction by disrupting an individual's sense of safety and ability to trust others. Thus, they may associate something sexually arousing with a threat.

What is PTSD?

PTSD is a psychological condition that occurs in response to exposure to a traumatic or extremely stressful event, such as war, a serious car accident, sexual assault or physical violence. Sufferers may experience flashbacks, nightmares, fear and disturbing thoughts related to the traumatic event.

PTSD can be debilitating. Many people who struggle with it feel detached from others and try to avoid potentially triggering places, objects or circumstances.

"PTSD includes a wide range of symptoms that can come about after somebody goes through a traumatic situation, a series of traumatic events or even situations that just triggered their brain to believe that they were in serious physical or emotional danger," said Will Barone, Psy.D., a clinical psychologist in Berkeley, California.

A lot of people think PTSD can only be caused by what many consider very serious traumas: going to war, being assaulted, long-term physical abuse and the like. Not true.

"While those things also can cause PTSD, similar changes in the brain and behavior can be caused by more insidious situations, including things like emotional abuse, neglect and even interpersonal challenges," Barone said.

This makes sense from an evolutionary perspective because the parts of our brain that drive PTSD symptoms were developed at a time when interpersonal difficulties could lead to being shunned by a tribe, something that was equivalent to a death sentence.

"We have come a long way from there as a society, but our brains have not caught up in many ways," Barone said.

While many people can go through traumatic events without developing PTSD, other people can be affected by the traumatic events and challenges of life.

"For these people, following the traumatic events, their brain starts to go through multiple physical and functional changes to start making it hyperalert and hypervigilant to the possibility of things being dangerous around them," Barone said. "This system basically says, 'I saw this situation where you were threatened, so now my job is to turn up my functioning to make sure that does not happen again.'

"While some vigilance and awareness to potential dangers can be helpful, this level of hypervigilance can cause major problems and can greatly impact a person's functioning and quality of life," he said. "These changes can lead to a range of different symptoms, and people can experience it totally differently."

The types and stages of PTSD

PTSD is defined by its symptoms. However, those symptoms can vary widely by person. No two PTSD cases look exactly alike. For this reason, there are no different specific types of PTSD. However, there are four main types of PTSD symptoms.

The following symptom types may not be the same for everyone; everyone experiences symptoms in their own way:

1. Re-experiencing symptoms. This happens when something reminds the person of trauma, and they experience that fear or anxiety again. Common examples include nightmares, flashbacks and frightening thoughts.
2. Avoidance symptoms. A person may change their routine to avoid places or objects that remind them of the traumatic experience. For instance, if a man witnessed someone get stabbed on a subway, he may avoid riding the subway because it reminds him of the stabbing. People with avoidance symptoms may also avoid talking about the traumatic experience or try to stay occupied so they don't have free time to think about it.
3. Arousal and reactivity symptoms. These symptoms can cause people to be extremely anxious, jittery or irritable. They may lead to insomnia and difficulty concentrating.
4. Cognition and mood symptoms. These are negative changes in beliefs and feelings. The person with these symptoms may blame themselves or others. They may feel a strong sense of guilt, shame or anger. They may have trouble finding the fun in things they used to enjoy or have intimacy issues with their partner.

In her book "Trauma and Recovery," psychiatrist Judith Herman discusses the stages and phases of trauma treatment. Phase one is about establishing safety.

"This is where you're trying to help people stop harming themselves if they're hurting themselves in one way, getting clean and sober, getting adequate sleep, eating well, and setting boundaries in relationships," said Megan Spence, Psy.D., a clinical psychologist in Corte Madera, California. "It's all about emotion regulation, increasing positive emotions, decreasing negative emotions, helping people with what to do when they're feeling really distressed."

The second phase involves undergoing trauma-focused treatment. This is where PTSD patients discuss, in detail, their trauma history in specific but gentle and gradual ways.

The third phase is called reintegration.

"That is where people are focusing on, 'This thing happened to me. It was real. It changed me. I've done a lot of therapeutic work on it. And now, what kind of life do I want to live? How do I want to create a meaningful life for myself?'" Spence said.

That could mean thinking about what they want to do with their career. It could be fostering healthy relationships. People are focusing on having less of an inner critic voice and more of a self-compassionate voice, so that might mean working on body image issues, eating healthy and working out. A lot of these things go to the wayside when people have PTSD.

Within those three phases, there's an evidence-based treatment. These are treatments that have been widely studied and found to be very effective at reducing symptoms of PTSD.

The first phase includes dialectical behavioral therapy (DBT), cognitive behavioral therapy (CBT), and acceptance and commitment therapy (ACT). Mindfulness is also used. This includes meditation.

Within the second phase, there's eye movement desensitization and reprocessing (EMDR), cognitive processing therapy (CBT) and prolonged exposure (PE). These are the widely recognized evidence-based treatments, Spence said.

Within the third phase, it's back to ACT, and maybe mindfulness and CBT.

"It depends," Spence said. "That one is a little less defined than the first two."

Recent recognition of PTSD as a mental disorder

In 1980, PTSD was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), the third edition of the handbook used by clinicians as a guide to the diagnosis of mental disorders. The PTSD diagnosis filled a critical gap in psychiatric practice.

The historically significant change ushered in by the PTSD concept was the stipulation that the agent that caused the disorder (i.e., a traumatic event) was outside the individual instead of an inherent individual weakness.

Twelve years after PTSD's inclusion in the DSM, it was also adopted in the World Health Organization's (WHO)International Classification of Diseases. As of the DSM-5 (the latest edition), PTSD is now considered a "trauma and stressor-related disorder." Previously, it was considered an anxiety disorder. It was reclassified because it has a variety of clinical presentations.

Two new subtypes were included in the DSM-5: the dissociative subtype and the preschool subtype. The dissociative subtype includes individuals who meet full PTSD criteria but also exhibit either depersonalization (a state in which one's thoughts and feelings seem to not belong to oneself) or derealization (a feeling that one's surroundings aren't real).

The preschool subtype applies to children ages 6 and younger. This subtype has fewer symptoms because it is difficult for children this age to report their inner thoughts and emotions. As a result, it has a lower threshold to meet full PTSD criteria.

PTSD facts, stats and studies

About 6 percent of the population will have PTSD at some point in their lives, according to the U.S. Department of Veterans Affairs (VA).

Approximately 12 million adults in the U.S. have PTSD during a given year.

About 8 percent of women develop PTSD at some point in their lives, compared to 4 percent of men.

PTSD is most common among U.S. adults between the ages of 45 and 49, at 9 percent, according to research.

African Americans, Latinos and Native Americans are disproportionately affected and have higher rates of PTSD than Caucasian populations.

According to a study the leading cause of PTSD is sexual violence, at 33 percent, with 94 percent of rape victims developing symptoms within two weeks of their traumatic experience.

Six weeks of cognitive behavioral therapy (CBT) can reduce symptom severity by about 50 percent in up to 46 percent of patients with PTSD, one study found.

Myths and misconceptions about PTSD

Here are four common myths and misconceptions regarding PTSD.

Myth: Only soldiers and war veterans get PTSD.

PTSD does not just affect those who served in the military. The condition is recognized among survivors of sexual assault, health crises, natural disasters, mass shootings, accidents and many other traumatic events.

"Oftentimes, people who have trauma histories can minimize them," Spence said.

People might think they can't have PTSD because they're not a veteran or they didn't grow up in a rough neighborhood, Spence said. People may also think they can't have PTSD because they're married, have a job and have children, but that doesn't mean they can't be affected. This is not true. PTSD can affect anyone.

Myth: PTSD always occurs immediately after the traumatic event.

PTSD can show up well after trauma has happened. It may be many years later.

"The symptoms don't necessarily show up right away," Spence said. "For example, I've treated mothers who are raising a child of the same age that they were when something really horrific happened to them. Maybe they've gone about their business, and because of the avoidance, maybe felt like they were fine for a long time, and all of a sudden, they have this kid that's like a visual reminder of themselves at a particular age, and suddenly, these memories start showing up that are really scary."

Myth: PTSD victims can't function and live fulfilling lives.

A common myth is that people with PTSD can't live full lives.

"There are plenty of people out there who have struggled with PTSD who hold down a job, have families, all these things," Spence said. "And there's all different forms of trauma."

People may think that, because they have PTSD, they're broken forever.

"PTSD is super highly treatable," Spence said. "It responds the best to therapy. Some of the symptoms may not go away entirely, but people can definitely function and reduce symptoms over time."

Myth: People with PTSD are violent and dangerous.

Although associated with PTSD, violence is not a common symptom of the disorder.

A common myth is that people with PTSD are a ticking time bomb waiting to explode. There is a sense that all people with PTSD are unstable.

While individuals with PTSD are more likely to be irritable, PTSD has a wide range of symptoms, and the idea that everyone with PTSD is hot-tempered and violent is a mischaracterization. People with PTSD are more likely to exhibit avoidance symptoms, leading them to be socially withdrawn and hesitant to put themselves in a situation that could trigger memories.