Breaking the Silence: National PTSD Awareness Month

June is National Post-Traumatic Stress Disorder (PTSD) Awareness Month—a vital time to deepen public understanding, reduce stigma, and ensure individuals affected by PTSD have access to the support and resources they need.

PTSD is a serious mental health condition that can develop after experiencing or witnessing a traumatic event, impacting millions of people each year. While its effects can be deeply personal, the responsibility to understand and support those living with PTSD extends beyond the individual, as it’s equally important for families, colleagues, and communities to recognize the signs, offer meaningful support, and help create pathways to healing.

What Is PTSD?
PTSD is a psychiatric condition that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, serious accident, terrorist act, war/combat, sexual violence, or other violent personal assault. Unlike normal stress responses that fade over time, PTSD involves persistent, intrusive symptoms that can significantly impair a person's ability to function in daily life.

The condition was first formally recognized in the psychiatric community in 1980, though the symptoms have been documented throughout history under various names like "shell shock" during World War I and "combat fatigue" during World War II. Today, we understand PTSD as a complex neurobiological response to trauma that can affect anyone, regardless of age, gender, or background.

PTSD develops when the brain's natural recovery process following trauma becomes disrupted. Normally, acute stress reactions to traumatic events diminish over time as the brain processes the experience. However, in PTSD, the brain remains stuck in a state of high alert, as if the danger is still present, even when the person is safe.

The Scope of PTSD
The statistics surrounding PTSD reveal the widespread nature of this condition and its significant impact on individuals and society. According to the U.S. Department of Veterans Affairs, about 6 out of every 100 people (or 6% of the U.S. population) will have PTSD at some point in their lives, which translates to approximately 9 million Americans currently affected by PTSD.

The severity of PTSD symptoms varies considerably among those affected. Research from the National Institute of Mental Health indicates that about 37% of Americans with PTSD have severe symptoms, while 36.6% of adults experience serious impairment, 33.1% have moderate impairment, and 30.2% have mild impairment. These statistics underscore that PTSD exists on a spectrum, with some individuals experiencing mild symptoms that may not significantly interfere with daily functioning, while others face severe, life-altering challenges.

Among adolescents, an estimated 5.0% had PTSD, with an estimated 1.5% experiencing severe impairment. This highlights that PTSD affects not just adults but also young people, often during critical developmental years.

Certain populations face a higher risk of developing PTSD. The U.S. Department of Veterans Affairs reports that PTSD affects 11% to 23% of veterans, significantly higher than the general population rate. About 1 in 3 survivors of sexual assault will develop PTSD, making sexual violence one of the highest-risk trauma types for PTSD development.

The variability in PTSD prevalence rates across different studies reflects the complexity of measuring this condition. The literature provides very different results, ranging from 2.5% to 74%, depending on the population studied, diagnostic criteria used, and methodology employed.

Understanding PTSD Symptoms
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), organizes PTSD symptoms into four main categories. The subcategories include symptoms of intrusion, avoidance, negative alterations in cognitions and mood, and marked alterations in arousal and reactivity. Understanding these symptom clusters helps both professionals and the public recognize when someone may be struggling with PTSD.

1. Intrusive Memories and Re-experiencing
This involves unwanted, distressing memories and experiences related to the traumatic event. The traumatic event is persistently re-experienced through unwanted upsetting memories, nightmares, and flashbacks.

Flashbacks are particularly distressing symptoms where the individual feels or acts as if the traumatic event(s) were recurring, with reactions that may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings. During flashbacks, people may lose touch with their current reality and feel as though they're reliving the trauma.

Nightmares related to the traumatic event can severely disrupt sleep patterns and contribute to chronic fatigue and other health problems. These aren't ordinary bad dreams but vivid, terrifying experiences that often mirror aspects of the original trauma.

Intrusive thoughts can occur at any time, causing sudden, unwanted memories of the traumatic event to flood a person's consciousness. These thoughts can be triggered by seemingly innocent reminders in the environment.

2. Avoidance
People with PTSD often go to great lengths to avoid reminders of their traumatic experience. This can include avoiding specific places, people, activities, objects, or situations that serve as reminders of the trauma. They may also avoid thoughts, feelings, or conversations about the traumatic event.

While avoidance might seem like a logical coping strategy, it often becomes problematic when it significantly restricts a person's life. For example, a car accident survivor might stop driving entirely, or someone who experienced workplace violence might avoid returning to work or similar environments.

3. Negative Alterations in Cognition and Mood
This symptom cluster involves persistent negative changes in thinking patterns and emotional states. People with PTSD may develop distorted negative beliefs about themselves, others, or the world. Common thoughts include "I am permanently damaged," "the world is completely dangerous," or "I cannot trust anyone."

Emotional numbing is another common symptom, where individuals lose the ability to experience positive emotions like happiness, satisfaction, love, or joy. This emotional blunting can be particularly distressing for family members who may feel shut out or rejected.

Persistent negative mood states, including sadness, fear, horror, anger, guilt, or shame, are also characteristic of this symptom cluster. Many people with PTSD experience survivor guilt, questioning why they survived when others didn't, or blame themselves for the traumatic event.

4. Alterations in Arousal and Reactivity
This symptom cluster involves changes in physical and emotional reactivity. People with PTSD often experience hypervigilance—a state of enhanced alertness where they constantly scan their environment for potential threats. This can be mentally and physically exhausting.

Exaggerated startle response means that people with PTSD may react intensely to unexpected noises or movements that wouldn't typically alarm others. Sleep disturbances are extremely common, including difficulty falling asleep, staying asleep, or restless sleep.

Irritability and anger may manifest as verbal or physical aggression, often seeming disproportionate to the situation. Concentration problems can affect work, school, or daily activities, making it difficult to focus on tasks or remember important information.

Reckless or self-destructive behavior might include excessive drinking, drug use, reckless driving, or other dangerous activities that seem out of character for the individual.

The Impact on Daily Life and Relationships
PTSD can profoundly affect every aspect of a person's life. Work or school performance may suffer due to concentration problems, absenteeism related to symptoms, or avoidance of certain situations. Relationships often become strained as people with PTSD may become emotionally distant, irritable, or unpredictable.

Family members and friends may struggle to understand why their loved one seems different, why they avoid certain activities, or why they seem constantly on edge. This can lead to frustration, confusion, and relationship conflicts, further isolating the person with PTSD.

Physical health can also be significantly impacted. Chronic stress associated with PTSD can contribute to various health problems, including cardiovascular disease, gastrointestinal issues, chronic pain, and sleep disorders. Many people with PTSD also struggle with substance abuse as they attempt to self-medicate their symptoms.

Medications can also be helpful, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications can help reduce symptoms of depression, anxiety, and intrusive thoughts commonly associated with PTSD.

Alternative and complementary approaches are increasingly being integrated into PTSD treatment, including mindfulness-based interventions, yoga, acupuncture, and equine-assisted therapy. While these shouldn't replace evidence-based treatments, they can be valuable additions to a comprehensive treatment plan.

Breaking Down Barriers to Treatment
Despite the availability of effective treatments, many people with PTSD don't receive the help they need. Common barriers include stigma associated with mental health treatment, concerns about being perceived as weak, lack of awareness about available treatments, and practical obstacles like cost, transportation, or time constraints.

Cultural factors may also play a role, as some cultures may view mental health problems differently or have different expectations about how trauma should be handled. Language barriers and lack of culturally competent providers can further complicate access to care.

For many, the symptoms of PTSD themselves create barriers to treatment. Avoidance symptoms may make it difficult to seek help, while trust issues might make it challenging to form therapeutic relationships. Concentration problems can interfere with engaging in therapy, and emotional numbing might make it hard to feel motivated to change.

Supporting Someone with PTSD
If someone you care about has PTSD, your support can make a significant difference in their recovery.  

Education is the first step—learning about PTSD helps you understand what your loved one is experiencing and why their behavior might have changed.

Be patient and understanding. Recovery from PTSD takes time, and there may be setbacks along the way. Avoid pushing your loved one to "get over it" or return to their pre-trauma functioning quickly.

Encourage professional help without being pushy. You might offer to help research treatment options or accompany them to appointments if they're comfortable with that support.

Take care of yourself as well. Supporting someone with PTSD can be emotionally draining, and you'll be better able to help if you maintain your own mental and physical health.

Learn about triggers and help create a safe environment when possible. This doesn't mean avoiding all potential triggers, but being aware of what might be particularly difficult for your loved one.

Moving Forward: Hope and Healing
While PTSD can be a devastating condition, recovery is possible. With appropriate treatment, support, and time, people with PTSD can learn to manage their symptoms and reclaim their lives. Many individuals not only recover from PTSD but also experience post-traumatic growth—positive psychological changes that can result from struggling with trauma.

The key message of PTSD Awareness Month is that no one has to face PTSD alone. Whether you're someone struggling with PTSD symptoms, a family member trying to provide support, or a community member seeking to understand, help is available.

If you or someone you know is struggling with PTSD, reaching out for professional help is a sign of strength, not weakness. Recovery is a journey, and every step forward matters.