A Guide to Caring for Patients With PTSD

December 9, 2021 , Updated on June 22, 2022 · 6 Min Read

The number of people with PTSD is rising. This guide suggests ways nurses can support their patients and improve successful outcomes.

A Guide to Caring for Patients With PTSD
Credit: Boy_Anupong | Moment | Getty Images

Introduction

Post-traumatic stress disorder (PTSD) is a mental health condition associated with exposure to a traumatic event or events. According to the National Institute of Mental Health, 3.6% of all adults were diagnosed with PTSD from 2001 to 2003.

In 2022, according to The Department of Veterans Affairs (DVA), 6% of the population is diagnosed with PTSD at some point in their life, and 12 million adults in the U.S. have PTSD in any year. In light of the rising PTSD diagnoses, nurses must be prepared to care for patients with PTSD.

On this page, we discuss the diagnosis, symptoms, and treatments for PTSD. We also suggest ways nurses can support patients with the condition.

What Is PTSD?

PTSD is not a sign of weakness. It can happen to anyone exposed to a traumatic event. Events can include personal assaults, disasters, accidents, and combat.

PTSD can develop even as a witness to a trauma that happens to someone else. The diagnosis can be challenging and may be complicated by mental health conditions such as depression and anxiety.

What Is the Clinical Practice Guideline?

The American Psychological Association (APA) developed clinical practice guidelines. These recommend psychological and pharmacological treatment modalities for adults with PTSD. The recommendations were based on a systematic review of the evidence for treatment.

The guidelines provide a structure and consistent recommendations for treatment. While they contain a variety of options, the writers note the guidelines do not address alternative or complementary treatments for adults, or treatment in children.

Symptoms of PTSD

It is not unusual for survivors or witnesses of a traumatic event to have intrusive thoughts or trouble concentrating afterward. These often fade within the first month. These can become clinical symptoms of PTSD.

To meet the diagnostic criteria determined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5-TR, the symptoms must be present for more than one month and must interfere with the patient's life.

The symptoms must fall into four categories to qualify as PTSD. Each category can have a variety of symptoms, and the severity can vary.

Intrusion

Thoughts the patient cannot control.

Avoidance

Patients avoid any object or situation that reminds them of the traumatic event.

Alterations in thinking and mood

The patient's mood and thought patterns are vastly different from before the traumatic event(s).

Alteration in arousal and reaction

The patient may experience hypervigilance or a difference in how quickly they become angry, irritable, or frustrated.

Symptoms manifest in other ways beyond the above categories. People with PTSD might experience:

Common symptoms include:

  • Intrusive or recurrent memories of the trauma
  • Flashbacks so vivid they think they are reliving the experience
  • Avoidance of trauma reminders
  • Feeling sad, angry, or numb
  • Feeling "on edge," or other changes in reactivity or arousal
  • Hypervigilance, or enhanced alertness
  • Jumpiness
  • Difficulty sleeping and concentrating
  • Changes in thinking and mood
  • Changes in physical and emotional reactions
  • Reticence to talk about the experience
  • Inability to remember important parts of the experience
  • Distorted beliefs about themself
  • Self-blame about the trauma
  • Ongoing fear, horror, and shame
  • Detachment or estrangement from friends and family
  • Unable to experience positive emotions
  • Behaving recklessly or self-destructively

You can assist an individual in a PTSD crisis by helping them to feel safe in their environment. Many living with PTSD may also have comorbid depression and anxiety, it is also important to reassure them and communicate clearly.

Statements that minimize their feelings, compare them to others, or create shame are likely to aggravate the symptoms. For example, do not say:

  • "You are acting crazy/overreacting."
  • "What's wrong with you?"
  • "Other people have been through worse things."
  • "Stop acting like that."
  • "What you went through wasn't that bad."

Treatment Options

A variety of treatment options help patients gain greater control over their lives. Patients can seek treatment from psychotherapists, psychiatrists, and outpatient clinics dedicated to treating people with PTSD.

A correct diagnosis is crucial to proper treatment. Related psychological disorders can make diagnosis challenging. These conditions include acute stress disorder, adjustment disorder, disinhibited social engagement disorder, and reactive attachment disorder, which is a diagnosis in children.

During the PTSD diagnostic process, a specialist determines the symptoms and timeline, and may sometimes speak with close friends and family to get a complete picture of how the symptoms affect their everyday activities.

Diagnosis

There have been numerous studies assessing the prevalence of PTSD. These studies measure the proportion of people with PTSD at a specific period of time, which is different from studies measuring incidence. Incidence is the measurement of the probability that PTSD will occur in the population.

These are measurements in the study of epidemiology, which determines the distribution of a medical condition in the population. Epidemiology identifies the distribution, patterns, and determinants of a specific health condition.

For example, one of the first epidemiological studies on PTSD estimated the prevalence in military personnel who served in Afghanistan or Iraq. The researchers found that three months after deployment, there was a 12.9% prevalence in infantry soldiers who served in Iraq, where there was high-intensity combat. By comparison, there was a 6.2% prevalence in soldiers deployed to Afghanistan where there was low-intensity combat

Epidemiological studies help to understand the origin of PTSD, which can then be used to identify prevention and treatment modalities. Three types of trauma are recognized by the U.S. Department of Veterans Affairs that lead to PTSD:

1. Abuse and sexual trauma

This includes intimate partner violence, child abuse, child sexual abuse, sexual assault, and human sex trafficking.

2. War and military

This includes experiencing or witnessing traumatic events during times of conflict, peacekeeping, or training. The DVA recognizes the role ethnicity and race play in understanding the impact a traumatic event may have on a person.

3. Disaster and terrorism

This includes people who experience or witness the event, and those who respond to the disaster. There are typical phases of reaction to a disaster or terrorist-type attack. This can include natural disasters and mass violence events, such as mass shootings. The number of mass shootings in America rose significantly from 2019 to 2021, increasing from 417 to 693.


Several risk factors affect whether someone develops post-traumatic stress disorder. One study identified 14 risk factors for PTSD, including childhood abuse and the family's psychiatric history.

An individual's previous traumatic experiences, such as car accidents, rape, or other act of violence, increase their susceptibility to developing PTSD. This includes a personal history of physical, psychological, substance, or sexual abuse.

Researchers have found that people with a family history of depression or PTSD also have an increased risk of developing the condition after a traumatic event. Other factors that play into the potential risk are the severity of the trauma, a younger age of the individual, gender, lack of social support, and ongoing chronic stress.

Criteria from the DSM-5 helps diagnose PTSD. One criterion is if the patient was exposed to an event involving an actual or possible threat of death, violence, or serious injury. To meet the DSM-5 criteria, the evaluating provider must find:

Criteria A: Stressor

There needs to be at least one triggering event

Criteria B: Intrusive symptoms

There must be at least one intrusive symptom, such as nightmares, flashbacks, physical reactivity, or emotional distress

Criteria C: Avoidance

There must be at least one avoidance of trauma-related stimuli

Criteria D: Negative alteration in cognition or mood

There must be at least two symptoms of negative thoughts or feelings that got worse after the event

Criteria E: Alteration in arousal and reactivity

These symptoms may be present but are not required for diagnosis

Criteria F: Duration

Symptoms must last for more than one month

Criteria G: Functional significance

Symptoms must create functional impairment or distress

Criteria H: Exclusion

Symptoms must not be related to substance use, medication, or other underlying medical condition

Patients with PTSD might have co-occurring disorders. These are mental health conditions that may occur at the same time, differ in severity, and the severity can change over time. Patients with a co-occurring combination of disorders may have more severe challenges and require longer periods of treatment.

According to the DVA, nearly 80% of people diagnosed with PTSD will have a co-occurring mental health condition. These can include:

  • Sleep disorders such as chronic insomnia or nightmares. These are symptoms of PTSD, but they tend to become independent issues.
  • Substance abuse may be present in nearly half of patients with PTSD.
  • Moral injury is the distressing psychological aftermath of perpetrating, failing to prevent, or witnessing an event that contradicts deeply held beliefs.
  • Neurocognitive problems may occur and include cognitive impairment or dementia in older adults.
  • Physical problems may be related to exposure to the traumatic event, such as broken bones or traumatic brain injury.

Data from epidemiological surveys have found that a substantial percentage of individuals with PTSD meet the criteria for three or more psychiatric diagnoses. The degree of overlap in symptoms may contribute to the underdiagnosis of PTSD.

Major depression and other depressive disorders may be an independent consequence of exposure to a traumatic event.

Substance use disorders may develop when an individual attempts to self-medicate. Withdrawing from substances exaggerates the symptoms of PTSD and perpetuates the substance use.

In addition to factors that increase the risk of developing PTSD, some people can reduce their risk by exhibiting resilience factors. These include seeking out support, effective coping strategies, and being prepared and able to respond before a traumatic event.

Treatment and Therapy

Treatment helps patients gain a greater sense of control over their life. Treatment can include psychotherapy and medication. While medications are an effective adjunctive therapy, it is optimal to administer them with psychotherapy. The most effective antidepressants used for PTSD include:

  • Venlafaxine (Effexor)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)

Psychotherapy helps support patients on their recovery journey. While some patients are unwilling to get help, when symptoms last longer than a year, they often do not resolve on their own.

Fortunately, it is never too late to get help. Much of the cognitive therapy used for PTSD can improve symptoms years after trauma.

There are four commonly recommended types of psychotherapy for PTSD:

1. Cognitive Behavioral Therapy (CBT)

This form of treatment emphasizes the core principles that psychological problems are often based on unhelpful ways of thinking and patterns of behavior.

CBT helps people to learn different ways of coping, to relieve PTSD symptoms by using strategies that change thinking patterns. The therapist and client develop a treatment strategy and coping skills that focus on moving forward.

2. Cognitive Processing Therapy (CPT)

This is a type of CBT that focuses on the role that thinking plays in the emotional response and behavior after exposure to a traumatic event. The goal is to encourage the patient to express their emotions and promote balance between the events, themselves, and the world.

3. Cognitive Therapy (CT)

This form of cognitive therapy is based on the idea that problems are the result of faulty ways of thinking, and the objective is to identify those patterns and replace them with adaptive patterns. The therapy is brief and goal-oriented to help the patient reshape their beliefs and actions, and modify their behavior.

4. Prolonged Exposure Therapy (PE)

This therapy helps people with PTSD confront fear. Avoidance can help reduce fear in the short term, but psychologists recognize that avoidance increases fear of the object, activity, or situation.

Exposure therapy is done in a safe environment with a therapist to help reduce fear. This should not be practiced independently without a psychotherapist. There are different modalities to expose the patient, pace the therapy, and support the patient through the situation.

PTSD has a global effect on people's health and behavior. Only through competent treatment and care can patients emerge on the other side more in control of their future.

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