Introduction

Right now, there are 12 million people living with post-traumatic stress disorder (PTSD) in the U.S. PTSD is a mental health diagnosis that is given to some people who have dealt with a “shocking, scary, or dangerous event.” Individuals don’t necessarily have to go through the event. For instance, a 911 operator could be diagnosed with PTSD due to the traumatic nature of the calls they take. Or a diagnosis could stem from the trauma of a loved one dying without warning. There are a lot of different traumas that can lead to PTSD.

What are the symptoms?

PTSD symptoms fall into four categories: “intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions.” Examples of intrusive memories are ongoing unwelcome memories of the trauma, flashbacks, dreams, or nightmares about what happened, and extreme emotional or physical responses when a person is reminded of what happened. People can be triggered by things such as sights, sounds, smells, or thoughts, and suddenly feel that they are back in the midst of the traumatic event.

Two examples of avoidance symptoms are attempting to stop thinking or talking about the trauma and staying away from places, activities, or people that make you think of it.

When it comes to negative changes in thinking and mood, symptoms might be: feeling pessimistic about yourself, others, or the state of the world, hopelessness, issues with memory, problems connecting with other people, experiencing emotional numbness, not caring about things you used to care about, and having trouble being happy.

Symptoms of changes in physical and emotional reactions are getting startled or scared easily,  being constantly on the lookout (also known as hypervigilance), engaging in potentially harmful behavior (e.g., substance abuse), issues with sleep or concentration, problems with anger, and issues with guilt or shame.

 

Diagnosis and worsening symptoms

A person must experience several of these symptoms for at least a month to be diagnosed. There needs to be at least one symptom from the intrusive memories category, at least one from the avoidance category, at least two from negative changes in thinking and mood, and at least two from changes in physical and emotional reactions. Those symptoms need to lead to “clinically significant distress or impairment in social, occupational, or other important areas of functioning.” In addition, the symptoms cannot be due to substances or other medical issues.

Symptoms can vary in intensity over a period of time. If a person is feeling anxious about something else, they might experience worse symptoms. If they are struggling with reminders of the traumatic event, things might feel worse. When something awful happens on a national or global scale, people with PTSD are more likely to experience flashbacks, nightmares, or intrusive memories. Substance abuse might also exacerbate symptoms.

Risk and recovery factors

Because far more people experience trauma than develop PTSD, researchers have tried to understand what risk factors might be involved in getting the disorder. Those risk factors include:

  • Dealing with severe or ongoing trauma
  • Undergoing trauma during childhood
  • Working at a job where a person sometimes or often deals with traumatic events
  • Experiencing other mental health issues
  • Substance abuse or misuse issues
  • Missing a support structure
  • Genetic disposition to mental health issues
  • Developing an injury during the traumatic event
  • Witnessing someone else getting injured or die

Factors that help with recovery after trauma:

  • Looking for and getting support from loved ones
  • Attending a support group
  • Developing a sense that you can deal with potentially dangerous events
  • Knowing how to cope with negative things in a healthy way
  • Having the capacity to act and respond effectively when you’re scared

Talk therapy and medication

The most common treatment for PTSD is cognitive behavioral therapy (CBT). It concentrates on the link between thoughts, emotions, and actions; focuses on existing issues and symptoms; and works on altering patterns of thoughts, emotions, and actions that are behind issues with functioning. CBT is an umbrella term for a number of different therapies.

Two of the narrower types of therapy that help with PTSD are exposure therapy and cognitive restructuring. In exposure therapy, people are slowly exposed to trauma in a safe manner. They may go back to the spot where the trauma happened, pretend they are there, or write about it. There are even battle simulators that some veterans have gone through.

Another form of therapy that works well for PTSD is EMDR (Eye Movement Desensitization and Reprocessing). It focuses on treating mental health issues that occur because of traumatic memories. A person shifts their eyes in a certain way and processes those memories at the same time.  It was first developed specifically for PTSD. A person tends to need fewer sessions of EMDR than CBT to get the same result.

Cognitive restructuring assists people in realizing what actually happened. They might have remembered it in a certain way, and this type of therapy helps them clarify what they went through. It can potentially clear away any shame or guilt attached to the experience.

Some people with PTSD take medications to help with their symptoms. The two most likely types are antidepressants and anti-anxiety meds. Not everyone will respond to medication, and sometimes there are side effects that are hard to deal with.

How to care for yourself

People who are dealing with PTSD can also do a number of things for themselves apart from therapy. First of all, there are the factors that help with recovery after trauma that was mentioned above. Also, mindfulness meditation is incredibly helpful. Meditation can be done with a group or on one’s own. Exercise can help focus the mind.

Helpful ways to deal with PTSD include journaling, grounding exercises, watching a favorite movie, enjoying music, reminding themselves that they are not experiencing the trauma in the present, spending time with a pet, and holding onto something that reminds them of their current (not past) life.

LGBTQ+ populations and PTSD

“LGBTQ+ individuals are nearly four times more likely to experience violent assault…than their cisgender (a person whose gender identity is the same as their sex assigned at birth), heterosexual counterparts.” This means that this population is more likely to develop PTSD. Up to “48% of LGB individuals and 42% of transgender and gender diverse individuals meet criteria for PTSD.” (People who are gender diverse use many different labels or no labels at all, but the most common label is nonbinary.) Compare that to 4.7% of the cisgender and heterosexual population who develop PTSD.

LGBTQ+ people have to deal with a significant portion of the population that thinks they are wrong or evil. In the last few years, there has been a significant uptick in bills and laws that target transgender people and drag culture (which sometimes overlap). Scores of youth have been kicked out of their homes because they didn’t hide that belonged to the LGBTQ+ community. There have always been people who would prefer that LGBTQ+ folks would just go back into the closet and stay there.

Writer Richie Jackson, who as a gay man during the 1980s was constantly afraid that he was going to be infected with HIV, shared in his piece “In Gay We Trust: How Do We Tackle PTSD in the LGBTQ+ Community?” that “the doom that I felt back then is my shadow and it continues to follow me wherever I go.” This is all very traumatizing and stressful.

Providing therapy for the LGBTQ+ community

So how should PTSD be tackled in the LGBTQ+ community? Like the general population, CBT and EMDR are helpful. Mental health providers need to make sure that they are providing the best possible care to the community. They can do that by:

  • Making sure they focus on excellent communication with their clients.
  • Warmly welcome and include their clients by posting waiting room signs that are inclusive.
  • Requesting information from all clients about their preferred name, orientation, and gender identity.
  • Being cognizant of and knowing how to help with situations that are unique to the community, such as being assaulted, being kicked out of the house, and feeling that they cannot tell people about who they are, all because of them being part of the community.
  • Be aware that some clients may have gone through mental health “treatment” that involved judgment and shaming of who they are and who they love.

Black, Indigenous, and other People of Color individuals and PTSD

Some groups who make up Black, Indigenous, and other People of Color (BIPOC) have higher rates of PTSD than white people. “The lifetime prevalence of PTSD was highest among Blacks (8.7%), intermediate among Hispanics and Whites (7.0% and 7.4%) and lowest among Asians (4.0%).” BIPOC individuals looked for mental health treatment less often than white people. They are less likely to receive the right type of treatment for PTSD. Compared to others, they are at an increased risk of struggling with the disorder after dealing with a traumatic event.

There are a number of traumatic events that particularly affect BIPOC individuals deeply, such as police violence, stressful medical or childbirth situations, racial harassment, and incarceration. There’s a link between racial discrimination and higher rates of mental health disorders. Risk factors for PTSD in these communities include witnessing racial traumas, stigmatization, and microaggressions.

Providing therapy for the BIPOC individuals

CBT and EMDR are also helpful for BIPOC individuals. Mental health providers should be aware of the following when treating ethnic minorities:

  • How people react to trauma and their symptoms can differ depending on their culture
  • During assessments, make sure to ask for information on immigration history, spirituality, language, health literacy, family structure, and experiences of racism.
  • Be aware of the cultural context in which the trauma happened, how that event was interpreted by the individual and those around them, and what coping skills they might have learned from their culture.
  • Look outside what the Diagnostic and Statistical Manual for Mental Disorders-5 might say about types of traumatic events involved in PTSD. These events might include racial trauma and situations related to immigration.
  • Know the obstacles that BIPOC individuals face when it comes to treatment. There can be increased mental health stigma, less ability to get treatment, problems with paying for it, wariness around providers, thoughts that providers are prejudging them, and inclination to go to family or spiritual leaders for support.
  • In order to keep clients coming back to therapy, providers should find ways to foster trust and mutuality, include culturally relevant touchstones of recovery (such as spiritual health and bettering support systems), and have frank talks about how the individual and the provider are distinct or the same culturally.

Conclusion

PTSD is a serious disorder that can affect different populations disproportionally. It is complex and luckily there are a number of different effective treatments available out there. If you are having symptoms of PTSD, please reach out to your doctor, contact the Suicide and Crisis Line for resources by calling or texting 988, or talk to a spiritual leader or a loved one you trust to help you. Two great websites for finding the right provider for you that will likely take your insurance are Psychology Today and Good Therapy. PTSD symptoms can feel overwhelming, but you can find peace.

For other blogs in my Understand Mental Health series, check out Understanding Schizophrenia and Understanding Bipolar Disorder.