Repeated and invasive memories of the traumatic event are the most common symptom of PTSD Table 01. You may have recurrent and intrusive recollections of the event, or recurrent distressing dreams during which the event is replayed. In rare circumstances, you may experience a state of disconnection from self, time, or external circumstances (dissociative state) that lasts from just a few seconds to several hours or days. Portions of the traumatic event may be re-lived during these periods. You may feel and behave as though you are experiencing the event in that moment. Intense psychological stress or physiological reactivity often occur when you are exposed to events resembling or symbolizing an aspect of the traumatic event. For example, if you were attacked in an elevator, entering an elevator may trigger intense stress. Anniversaries of the event may also trigger stressful memories.
Additional symptoms that may occur with PTSD include nightmares, outbursts of anger, chronic physical problems such as headache or irritable bowel, a preoccupation with possible unknown threats, and an inability to relate to others.
Table 1. Symptoms of PTSD
Repeated dreams or recurrent flashbacks of the eventa Traumatic dreams, sleeping problems Psychological numbing Intense distress if exposed to anything resembling the event Outbursts of anger A preoccupation with possible unknown threats Chronic physical symptoms such as pain, headache, irritable bowel Efforts to avoid people or activities that may arouse recollection of the trauma Feelings of guilt No sense of a future
a Children may not directly remember the event, but may recall a single image or express their fear by repeatedly playacting an event or action. Children's dreams, while frightening, may have no specific content.
Symptoms of PTSD can be acute, chronic, or delayed. Acute symptoms last less than three months; chronic symptoms last longer. Delayed symptoms start at least six months after the traumatic event.
Not everyone who lives through an intense trauma will develop PTSD. Though it is not known why some people are more susceptible to PTSD, certain correlates have been observed. Women are more likely to develop PTSD than are men. Individuals with a history of depression and anxiety conditions are at greater risk of developing PTSD. Persons with a history of childhood abuse are also at increased risk. Family history of psychiatric illness also predicts increased risk of developing PTSD. Keep in mind that these factors alone do not cause PTSD; exposure to extreme trauma causes it.
The severity, duration, and closeness of your exposure to the trauma are the most important factors affecting your likelihood of developing PTSD. There is some evidence that social supports, family history, childhood experiences, personality variables, and preexisting mental disorders may influence whether or not you develop PTSD. However, you can develop PTSD even if you don’t have any predisposing conditions; particularly if the traumatic event was especially extreme.
Recent immigrants may be at increased risk for PTSD. Recent immigrants from areas of considerable civil unrest or social conflict may have increased rates of PTSD. Due to their vulnerable political status, they may be especially reluctant to discuss experiences of torture and trauma. Other groups at risk of exposure to extreme trauma are military personnel exposed to combat, victims of natural disasters, and those involved in rescue missions.
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