Post-traumatic stress manifests differently in every individual. Some people experience nightmares, flashbacks, or anxiety attacks. Others become hyper-vigilant, withdrawn, or depressed. The persistent pattern of psychological distress linked to post-traumatic stress disorder (PTSD) is unpredictable and often, overwhelming.
Individuals with PTSD can feel broken after experiencing or witnessing trauma, Deborah Beidel, a clinical psychologist and researcher who studies post-traumatic stress in first responders, survivors of violence, and military veterans, tells Inverse.
But the idea that one is irrevocably “broken” after undergoing trauma is a false one, Beidel says.
“Yes, you are definitely changed because of what happened to you, but that doesn't mean that you are changed negatively and completely,” she says. “People can get over PTSD and get their lives back.”
Here, Inverse explains how post-traumatic stress can hijack the brain — and reveals how people can recover.
The shock of trauma
Environmental threats trigger the body’s fight-or-flight system. When threatened, the body becomes flooded with hormones like cortisol and adrenaline, which cause one to become alert, ready to meet the threat — or run from it. This is often partnered with sweating, heavy breathing, and tuning into environmental cues.
Second-by-second, the brain takes in countless details of the event, including sounds and smells you may not even be conscious of. All of these details can become part of the traumatic memory, Beidel says.
“It's not just what we see,” Beidel says. “It's what we hear, what we smell, what we feel. All of those things become part of the trauma memory as it is in our brain.”
A threat can morph into a traumatic event, inducing hyper-arousal and spiking anxiety — a cascade that is difficult to reverse. In the hours and days post-trauma, it can be extremely difficult for people to relax or sleep. And sleep, particularly REM sleep, plays a crucial role in storing the traumatic memory, Beidel says.
“So what happens is this very frightening event doesn't really ever get filed away in long-term memory,” Beidel says. “It stays in the front of the brain for days afterward. You can't help but think about it. You're constantly worrying about it. You feel hyper-vigilant all the time.”
This cascade of symptoms is known as post-traumatic stress. A person may be diagnosed with PTSD after the symptoms persist for more than a month and disrupt daily life, whether professionally or personally. One in five people will develop PTSD after experiencing trauma. The rate is higher for first responders, police officers, and firefighters.
Not everyone with PTSD will have obvious symptoms, but related changes can occur within the body. PTSD can affect brain function, causing individuals to feel less sharp, more irritable, and worse at remembering things, Beidel says. But these changes don’t “make anyone totally incapable," she says.
What’s in a name?
Over the course of history, PTSD has been called different things at different times. Past monickers include a soldier’s heart, war neurosis, or shell shock.
The push to give it a name that includes “disorder” stems from the idea that the word signifies how severe the condition can be, Beidel says. It's not something that you just shake off.
It is not just that you feel a certain way, she says. Rather, those feelings impact your behavior in some way. When people experience emotional distress to a point where they cannot function properly in work or family life, it’s time for treatment.
In 1980, the American Psychiatric Association officially added PTSD diagnosis to the third edition of the Diagnostic and Statistical Manual of Mental Disorders, the manual clinicians use to diagnose all mental health and psychiatric conditions. Receiving a PTSD diagnosis can bring people relief and help them understand their symptoms, as well as open up options for treatment and financial compensation.
"Putting a name on it, I think, makes people feel better."
The fact there is an official name for PTSD, is crucial, and allows survivors to acknowledge they aren’t struggling alone, Beidel says.
“It's the not knowing, ‘Do I have something, do I not have something?’ that I think for most people is the worst,” she says. “Putting a name on it, I think, makes people feel better.”
But the diagnosis can also carry stigma and societal baggage. The word “disorder” can be equated by some with something faulty or defective, or even a personal failure.
“There are a lot of people who still think, ‘Well, if you were a strong enough person wouldn’t get depressed, you wouldn't get anxious, you wouldn't get post-traumatic stress disorder or whatever it might be,’” Beidel says.
This notion is false, she says. But to reduce some of this persistent stigma, some physicians, organizations, and patients are pushing for a rewording — advocating to rename the condition post-traumatic stress injury instead.
The road to recovery
If left untreated, PTSD symptoms can persist for months, years, and even decades after trauma. But people should not feel prisoner to their PTSD, Beidel says. They can confide in others, and may benefit from treatment.
Conventional PTSD treatments typically include cognitive-behavioral therapy, or “talk therapy,” relaxation techniques, problem-solving therapy, exposure therapy, and a form of psychotherapy called eye movement desensitization and reprocessing (EMDR).
The aim of treatment is to give patients a sense of control, help them achieve their goals, and develop stress or fear management techniques. Therapy helps “retrain the brain,” Beidel says.
Beidel runs a PTSD treatment program in Florida called UCF Restores. After undergoing treatment at UCF Restores, 66 percent of military personnel and 76 percent of first responders no longer meet the diagnostic criteria for treatment — a higher success rate than other conventional therapies. UCF Restores offers the intensive, three-week treatment for free to individuals who qualify.
For example: One first responder Beidel worked with had answered to the call of a young boy drowning in a pool. The boy died, and the responder suffered from trauma as a result. The responder had a son of a similar age, and seeing that child triggered anxiety flashbacks. But with the help of exposure therapy, the responder was able to get their anxiety under control and ultimately recover.
“If you go to a very gritty traffic accident and the radio is still playing a particular song and now every time you hear that song you have a flashback to that scene, we would play that song and as you do it repeatedly, your brain will learn that it's just a song,” Beidel says, describing the exposure therapy process.
“One time the song was associated with something bad but after treatment, the song is no longer a signal that something really bad is about to happen.”
Exposure therapy and EMDR can help patients repackage their traumatic memories. But the process isn’t always comfortable. People with PTSD typically try to avoid triggering thoughts or images. Therapy forces them to face those threats.
“It's completely counterintuitive to what most people think they should do when they have a bad image in their head,” Beidel says. “They think they should put it out of their head.”
But her research indicates if you don’t address the disruptive thoughts, they will likely keep recurring. They won’t just go away on their own. And by getting appropriate treatment, people can grow stronger and more resilient than they were before the trauma.
That’s where post-traumatic growth comes in. It’s a relatively new area of research and is described as a positive change experienced as a result of a struggle. The idea is that struggle can sometimes open up new opportunities for interpersonal strength and appreciation for life. Essentially, it involves a life-changing psychological shift — but not everyone who has PTSD will in turn experience this growth.
Approximately 7 or 8 out of 100 Americans will have PTSD at some point in their lives, but there are treatments that can help them get to a place of peace.
- The National Suicide Prevention Lifeline can be reached at 1-800-273-TALK (8255). The Crisis Text Line offers free, 24/7 support to anyone, in any type of crisis; text 741741.
- The American Psychiatric Association and National Alliance on Mental Illness offers resources and guidance for people dealing with PTSD and their loved ones.
- The United States Veterans Association National Center for PTSD offers support for veterans and their families.