More than 12 million adults in the U.S. have post-traumatic stress disorder (PTSD) annually, according to the National Center for PTSD. The condition can be difficult to identify for both the patient and their clinical team.
Patients with PTSD often dismiss their trauma, experience intense shame, and avoid the topic. As a result, many clinicians may not be aware of their patient's trauma history. The condition can also present with symptoms of emotional dysregulation that mimic other conditions, such as bipolar disorder, borderline personality disorder or obsessive-compulsive disorder.
Common myths about PTSD
Shame and avoidance contribute to public confusion and myths about PTSD. Clinicians can help by clarifying these common points with patients.
- Only military veterans have PTSD. Injury, abuse, accidents, complicated grief, natural disasters or assaults can also cause PTSD.
- If symptoms are not immediate, it cannot be PTSD. While symptoms commonly begin within three months, a delayed onset is also possible.
- PTSD will resolve on its own. Most studies show that if symptoms persist for more than a year, they are unlikely to subside without PTSD-specific treatment.
- PTSD symptoms are the same for everyone. Symptoms vary significantly between individuals. Some people do not experience flashbacks or nightmares.
- There are no effective treatments for PTSD. Cognitive processing therapy (CPT) and prolonged exposure (PE) therapy are strongly recommended by the American Psychological Association. Other modalities, such as EMDR, are also effective for some populations.
Misconceptions about PTSD treatment
Some professionals hold misconceptions about trauma-specific therapy and when it is appropriate to refer a patient. This can inadvertently reinforce a patient's own avoidance of care. Please consider the following points regarding readiness for trauma treatment.
- Trauma-focused treatments are unsuitable for complex trauma. Traumatic experiences often overlap. Working on one can help alleviate the painful impact of others.
- Stabilization is always required before memory work. The need for stabilization should be assessed case-by-case. For many outpatients, research suggests trauma-specific therapy is unlikely to cause destabilization.
- Talking about trauma is retraumatizing. Painful experiences are not the same as traumatic experiences. The patient should remain in control of the therapeutic process, which minimizes retraumatizing impact.
- Some traumas should not be relived. Trauma-specific treatment teaches a patient to remember their experiences, not relive them. This process helps a person move on from their worst moments.
- Dissociation interferes with memory work. For patients prone to dissociation, trauma-focused work is still effective, as long as the patient does not dissociate for prolonged periods.
- PTSD is primarily about fear. Evidence shows only about half of the negative emotions related to trauma involve fear. Treatment must also address guilt, shame, anger, betrayal and disgust.
Other considerations for readiness
In addition to the points above, consider the patient’s commitment level, coping skills and any thoughts of suicide. It is important for an individual to be personally committed to working on their PTSD. If a patient has attempted suicide within the last two months, they may need to engage in immediate treatment to manage acute safety stressors before starting PTSD-specific therapy.
