Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Disorder

Do you or someone you know have PTSD or cPTSD? You are not alone and it can get better.

What is Post Traumatic Stress Disorder (PTSD)?

Joe (48 year old Air Force veteran): "Living with PTSD is like having life ramped up to an 8 or 9 all the time. I feel like I am constantly in combat mode and hyper aware of my surroundings. I always feel in danger and cannot relax."

Soldier bandaging a dog's foot in the Belgian trenches of the First World War 1917.

You don't have to be a military veteran to get PTSD. PTSD can be caused by living through any severe traumatic event. The strong emotions invoked by the event can result in PTSD.

PTSD is a psychiatric and metabolic disorder that can develop in people who have experienced or witnessed a traumatic event. Traumatic events can be any life trauma including illness, natural disasters, childhood or adult abuse, religious trauma, neglect, sexual abuse, harassment, bullying, domestic violence, a severe accident, a terrorist act, war/combat, physical assault or rape or even being threatened with death, sexual violence or serious injury. You can develop PTSD from seeing someone else getting hurt or experiencing trauma. It can occur from a single incidence or multiple events.

People with PTSD have an inability to inhibit their fear responses. They tend to re-experience or relive traumatic memories over and over again as if it is the first time it happened. Brain scans show that they are reacting to old traumas as if they are just experiencing them. Brain regions involved in PTSD are vital to memory function (Bremner 2007).

Besides reliving the bad experience, those with PTSD may show avoidance, numbing, and hyperarousal. In addition, they cannot control their psychophysiological responses to trauma-associated stimuli (Michopoulos et al. 2016). Psychophysiologic is the study of how mental responses influence physical responses.

About 6.8% of the population will develop PTSD at some point in their life and about 12% of veterans have PTSD. The National Institute on Mental Health estimates that 3.6% of USA adults, around 8 million people, had PTSD in the last year. People can have mild, moderate or severe PTSD.

If you have PTSD you are not alone. This disorder is treatable and people recovering from PTSD show brain regeneration. Treatments that work promote new brain cells (neurogenesis) in animal studies, improve memory and increase hippocampal volume (Bremner at al. 2006). The hippocampus plays a large role in learning and memory. For more on how to heal your brain see Brain Boosters.

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Learn how service dogs can reduce PTSD symptoms.

What is complex (or childhood) post-traumatic stress disorder (C-PTSD, CPTSD, cPTSD)

CPTSD is a subset of PTSD and has many of the same symptoms. It occurs in people who experience prolonged or repeated traumatic events in childhood. This can include physical or sexual abuse, religious trauma, domestic violence, neglect, or protracted separation/abandonment from caregivers.

Verbal and/or physical abuse in childhood can cause low adult mental well-being (Bellis et al. 2025). Being exposed to adversity in childhood can even change your epigenetic profile (DNA methylation) (Lussier et al. 2023). This can influence your health and disease risks.

Since cPTSD develops in young people, it can warp a person's sense of self and reality. People with cPTSD may show different symptoms than those with mainstream PTSD.

Do you have cPTSD?

1) Emotional dysregulation: do you have difficulties controlling your emotions, especially negative emotions like shame, guilt, sorrow, anxiety or worthlessness? Do you have problems self smoothing?

2) Dissociation: do you feel disconnected from reality? Do you feel like you are separate from your body or mind, or that you aren't real?

3) Interpersonal problems: do you have difficulty in building and maintaining relationships? Do you have trust, social interactions or attachment issues?

4) Negative self-concept: do you have a negative or twisted view of yourself? Do you feel like you are broken or different from others? Do you feel helpless?

C-PTSD has a long-term impact on adult functioning: Untreated cPTSD can last into adulthood. If you are an adult with untreated cPTSD you may have problems with relationships, overall mental health, work or academic performance, and ability to live a happy and meaningful life.

Treatment for PTSD

According to research based clinical guidelines, the most effective treatments for PTSD are trauma-focused cognitive behavioral treatment, such as prolonged exposure (PE) and cognitive therapy (CT), and Eye movement desensitization and reprocessing (EMDR).

Exposure therapy is effective for treating PTSD in people who are in the military (McLean et al. 2022). The goal of exposure therapy is to help people reduce their fear and anxiety. The end goal is to try to limit eliminating avoidance behavior and to increase quality of life. Exposure therapy is done by actively confronting whatever the person fears. Confrontation and exposure teach the brain that anxiety and fear will alleviate on its own after a while. There are several methods but prolonged exposure may be the best for PTSD.

Prolonged exposure (PE) takes 8-15 sessions (90 minutes each) and is a combination of techniques. The person with PTSD is educated about trauma and told what they will be doing in the therapy; they learn how to control their breathing (this is interoceptive exposure); they practice in real life (this is in vivo exposure); and they recount and revisit their trauma to reprocess it (this is imaginal exposure).

If you are not ready to seek professional treatment or you don't have the financial means to do so, you can start helping yourself by looking over the information in this website and other online sources. For immediate relief please look over the benefits of nature therapy. Only one hour in nature quiets your fight, flight or freeze response immediately. For more on this see how a walk in nature quiets the amygdala.

Blue light treatment is another treatment people can try on their own for PTSD. Kilgore et al. 2022 reported that morning exposure to blue light in people with PTSD was associated with improvements in sleep duration. They also had an increased volume of the left amygdala when compared with people treated with amber placebo light. The changes in the amygdala volume were directly correlated with sleep improvement.

See more about blue light therapy in our webpage on how the brain heals.

Check out the Brain Boosters and Feed Your Brain for strategies to break the inflammation cycle can help you heal as well.

Arnold Goodwin - Child Labor - Finishing collars instead of playing ball c1912. Illustration made for an article “Child Labor and the Home”.

Four Major Signs of PTSD

1) Reliving the event through vivid memories, nightmares or flashbacks. Remembering the traumatic event often evokes the same intense feelings and sensations of the original event.

One of the main symptoms of PTSD is that the person is unable to let go of the traumatic memory and the remembrance does not become less vivid with time (Boe et al. 2010).

The recollection seems to be trapped in time and does not undergo the normal processing that lessens the emotional impact of memories over time. Memories of normal events are recalled as stories that change over time without accompanied vivid emotions.

In addition, PTSD may significantly impacts the initial acquisition and learning phases of memory (Samuelson 2011). This may be due to damage to the hippocampus. You may have difficulty concentrating or remembering things.

Sometimes certain events act as a trigger for reliving the memory. For example, fireworks may recall memories of gunfire and war for a combat veteran. A person shouting may cause a victim of C-PTSD to run for shelter. For people with PTSD, it can seem like these events are currently taking place.

Larissa (39 year old Army veteran) "A flash or a sharp bang and suddenly I am back there watching the explosion occur over and over. It is like I am transported back in that moment in time; with the same sounds, pains and view. It never gets easier."

Middleton Manigault - The Rocket c1909 oil on canvas.

2) Avoidance of places or things that remind you of the traumatic event (avoiding triggers). This also includes trying to avoid talking about or thinking about the event.

This leads to some people frantically trying to keep their minds occupied with other tasks. They may work constantly or escape by using excessive electronic entertainment like video games, online activities, or internet.

3) Feeling emotionally or physically numb or unable to express feelings.

Feeling emotionally non-invested in people or things you used to care about. Just going through the motions without any investment in life.

Zoe (23 years old): "I know I should be content now that I am away from my toxic parents and on my own. I have been doing what people might consider fun activities, like gaming and knitting, but I don't feel happy; just feel numb. ...I have three states of emotion: irrational rage at everyone, high anxiety and panic attacks, and extreme numbness where I just feel nothing."

4) Showing hyper-arousal or jittery behavior. Being constantly alert and looking out for danger. You may feel like you have to be constantly on guard. This can lead to insomnia, angry outbursts, difficulty sleeping and/or nightmares.

This tendency towards over reaction may cause you to get upset at events or people that remind you of what happened. Reacting with angry outbursts or extreme irritability. You may be paranoid or have a hard time communicating with other people.

Over reaction may mean that you can be easily startled by noises or events. This can cause inappropriate or violent reactions to mild stimulus (someone wakes you, a firework goes off etc).

Other reactions to PTSD

★Escalating alcohol or drug use

★Thinking about harming yourself or others

★Isolating yourself from others

★ See the warning signs of suicide here.

Edwin Henry Landseer (1802-1873) - A Dog on Alert oil on canvas.

Veterans have a higher incidence of PTSD

How many veterans have PTSD?

PTSD is one of the most frequently diagnosed disorders in the military (Blais et al. 2021). This is not a surprise since most humans are not equipped to deal with the horrors of warfare. Since the incidence of PTSD changes over time it is hard to pin down an accurate estimation of how many veterans have PTSD but current estimations from the US Department of Veteran Affairs range from 14-20%.

Vietnam veterans: In 1988 the National Vietnam Veterans Readjustment Study found that 30% of Vietnam veterans have had PTSD in their lifetime, while 15% currently had PTSD. Over twenty-five years later, the 2014 National Vietnam Veterans Longitudinal Study estimated the current prevalence of PTSD in combat Vietnam veterans at 11%. Male veterans with PTSD were twice as likely to die in those 25 intervening years as male veterans without PTSD (Marmar et al. 2015).

Gulf War veterans: About 12% of Gulf War veterans have PTSD. The National Academy of Science's Institute of Medicine also found an association between serving in the Gulf War and multisymptom illness (Gulf War Illness).

Operation Iraqi Freedom (OIF) and Enduring Freedom (EF) veterans: Around 14-20% of OIF and EF veterans have PTSD. Military councilors believe this percentage is actually higher.

Vietnam Vet Throwing Medal at US Capital c1971.

Sarah Purser The sad girl 1923 Oil on buff board painting.

Military Sexual Trauma (MST)

One common cause of PTSD is military sexual trauma (MST). This is sexual harassment or sexual assault that occurs when the person is serving in the military. Both men and women are affected by MST. People reporting MST often also report depression, anxiety, alcohol abuse and PTSD.

Among veterans in the VA, 23% of women reported sexual assault and 55% of women reported sexual harassment. In addition, 38% of men reported sexual harassment. If you have MST do not be afraid to get help. Cognitive processing therapy (CPT) has been shown to help (Boehler 2019).

Women veterans with MST (131 women) received one of two treatments; CPT or Trauma Center Trauma-Sensitive Yoga (TCTSY) intervention. TCTSY is a Hatha-style yoga which focuses on interoception (perceiving body signals) and empowerment. Both treatment groups improved considerably and reduced their PTSD symptoms. TCTSY was equal to CPT in reducing the severity of PTSD symptoms but less people dropped out of TCTSY (Zaccari et al. 2023).

For veteran's stories on MST see the VA's page on: Military Sexual Trauma.

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