What are the types of PTSD?
- Victim-related trauma
- Natural-disaster trauma
- Survivor trauma
- Perpetrator guilt
- PTSD not otherwise specified
What Is PTSD?
Mental health professionals use a document from the American Psychiatric Association in order to diagnose disease. According to the Anxiety and Depression Association of America (ADAA), 7.7 million American adults, ages 18 and older, have developed PTSD. Roughly 8 percent of people in the United States will develop PTSD. This document, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), defines PTSD as an anxiety disorder that is triggered by exposure to:
- Actual death
- The threat of death
- Serious injury
- Sexual violation
The National Institute of Mental Health says symptoms of PTSD can appear right after the episode ends, or they can emerge months or even years later. Those symptoms can include:
- A sense of isolation
- Intruding, scary thoughts
- Avoidance of people or things that remind the person of the event
- Feelings of guilt
- Increased need for sleep
- Fights with loved ones
- Thoughts of suicide
- Suicide attempts
- Cutting or other self-harming behaviors
Living with PTSD is not easy, and some people with the disorder turn to drugs and alcohol to make symptoms less severe. Unfortunately, drugs and alcohol tend to make PTSD symptoms stronger. When the drugs wear off, people can feel more anxious and upset than they did before they drank. Some PTSD symptoms, like anger and hostility, can be amplified by the presence of drugs.
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People with PTSD might have some or all of these symptoms, but the PTSD they have might not be similar. In fact, some medical professionals believe there are specific subtypes of PTSD that can impact people. These subtypes are all considered part of the PTSD illness, but those who have these subtypes might need different treatments or therapies in order to get better.
Authors writing for Current Psychiatry suggest that there are five different PTSD subtypes:
- Victim-related trauma: People with this type of PTSD were either witnesses of a criminal attack, or they were the victims of the attack. That attack might involve physical violence, such as a beating or a fight, or it might involve sexual abuse, including rape. Robberies, carjackings, kidnappings, and terrorist attacks can also spark this form of trauma.
- Natural-disaster trauma: Earthquakes, tornadoes, hurricanes, and flooding are rarely caused by human intervention. They take place due to a natural process over which humans have very little control; however, these incidents can leave behind dozens if not thousands of victims. While the event unfolds, people may fear for their lives and the lives of the people they love. Survivors may have this form of PTSD.
- Survivor trauma: Some incidents that spark PTSD involve one victim and one antagonist, but sometimes, the event has more than one victim. And sometimes, only one person survives the incident. When that happens, people might have a very specific form of PTSD that is tied to the fact that they lived through the event while others did not.
- Perpetrator guilt: Most forms of PTSD involve the thoughts and feelings of a person who was helpless in the face of fear, but people in this subtype had at least something to do with the event. They may have planned it and participated in it, while realizing that they made a terrible mistake. Or they may have been caught up in the moment, and then realized the error days or months later.
- PTSD not otherwise specified: Some traumatic events come with ripples that can touch people hours or days after the issue has been resolved. These people might clean up after tornadoes, collect bodies from crime scenes, comfort rape victims, or listen to their loved ones discuss a traumatic event. These people were not direct witnesses, but they can be profoundly touched by the things they experience in the aftermath of the event.
In an overview in Psych Central, authors offer up a description of one other PTSD subtype. Here, they say some people with PTSD can experience a sense of unreality, as though the things they see and feel simply aren’t real. They might:
- Think the rooms they are sitting in are on a movie set
- Smell things or hear things others can’t hear
- Feel as though their bodies are unusual or strange
- Get the sense that they have been dropped in the wrong body
- Feel as though they don’t really know the people around them
Some authors suggest that people with PTSD can differ from one another if their trauma has been caused by:
- A single event: Someone who has lived a placid life punctuated with just one type of trauma would fit into this category.
- Multiple incidents of the same type of trauma: Someone who has encountered the same type of trauma, inflicted multiple times over a period of months or years, would fit into this category. Children subjected to ongoing child abuse, or people who serve in the military on long tours of duty, would fit into this category.
- Multiple incidents of different types of trauma: Someone who has been touched by two, three, or more different types of trauma would have this PTSD subtype. People like this might live through an earthquake, for example, and then be subject to a crime weeks or months later.
PTSD and Substance Abuse Are Closely Related
People who have developed PTSD are five times more likely than people without PTSD to develop a substance use disorder. A 2008 study reported that 50 percent of people living in inpatient substance abuse treatment facilities will meet the criteria for co-occurring PTSD. Another study reported that people with PTSD are reportedly 14 times more likely to struggle with addiction.
Many people who develop problems with alcohol or drugs do so because they are self-medicating PTSD symptoms; however, abusing substances will make symptoms of any mental illness, including PTSD, much worse. Additionally, abusing drugs or alcohol can increase the risk of suffering a traumatic event, like abuse or an accident, which increases the risk of developing PTSD or experiencing increased symptoms.
Veterans are one of the most studied demographics who struggle with PTSD and co-occurring drug or alcohol abuse. One study examining veterans three to four months after returning from deployment found that 27 percent abused alcohol and a significant association between how life-threatening combat was and the rate of alcohol misuse. Those who experienced more severe combat situations had 93 percent higher odds of screening positive for alcohol abuse. Among Vietnam-era veterans, 41.4 percent were found to have both a substance use disorder and, later, PTSD.
Women are another group at elevated risk for developing co-occurring PTSD and substance abuse. The National Institute on Drug Abuse (NIDA) estimates that as many as 80 percent of women entering treatment for drug abuse have a history of sexual abuse, childhood trauma, or physical assault.
People who struggle with co-occurring PTSD and substance abuse are more likely to experience other issues, including:
- Worse physical health, leading to chronic conditions
- Poor social functioning and worsened relationships with friends and family
- Higher rates of suicide attempts
- Legal problems
- Financial problems and job instability
- Increased risk of additional violence or abuse
- Trouble adhering to treatment
Treatment for PTSD
Understanding what type of PTSD a person has is a key part of the healing process. That’s because PTSD therapists attempt to break down a traumatic event into chunks, so they can understand it and help the person to process it. Therapists must do that analysis before they can determine the person’s PTSD type. Therefore, typing is part of the early part of the therapeutic process. It’s here when therapists are working to understand just what happened, and how the person feels about it.
With typing in hand, therapists can use talk therapy to help people heal. According to Mayo Clinic, types of therapy used in PTSD programs include:
- Cognitive Behavioral Therapy (CBT): This therapy is designed to help people to understand how their thoughts and opinions influence the way they behave. Once negative thoughts and destructive patterns are identified, the team works on developing skills people can use to change their thoughts. By changing thoughts, they can change behavior.
- Exposure therapy: This type of therapy is designed to help people face the people, places, and things they find frightening, so they can learn to cope with those things without losing control. This therapy moves in a controlled manner, so people have the opportunity to become accustomed and acclimated to their triggers before they face them head on.
- Eye Movement Desensitization and Reprocessing (EMDR): This therapy is specifically designed for people with PTSD. The developer of the therapy found that side-to-side eye movements, performed while the person thinks about the trauma, seem to help people process their memories. Those movements allow the trauma to resolve, so the symptoms of PTSD become less intense.
Some PTSD therapists use all of these therapies at the same time, while others provide just one or two solutions, depending on the needs of clients.
In addition to talk therapy, a mental health provider might also use prescriptions to assist with PTSD symptoms. The Trauma Center suggests that medications used in PTSD therapy can include:
- Antidepressants, such as Paxil or Zoloft: These therapies are designed to alter chemical levels in the brain, reducing feelings of sadness and anxiety. For people with PTSD, they may also reduce feelings of irritability, anger, impulsivity, and obsession.
- Anti-anxiety medications, such as Xanax or Ativan: For people with severe symptoms of arousal, these drugs can help. They are sedating, which allows people to feel more at ease.
- Adrenal drugs, such as Clonidine: These medications help to lower arousal levels overall, which can help people to control memories and nightmares.
Some of these medications can be abused, and others can spark addictions. That is an issue medical teams must closely monitor as they help people with PTSD.
Life with PTSD can be incredibly difficult, but treatment can make a big difference. Discussing the issue, and taking medications as needed, can help the past to stay in the past, allowing people to have a brighter future. People with PTSD should get that help. They will be glad they did.