A Complete Guide to PTSD: Causes, Symptoms, and Treatment. By Matthew Clemons, PMHNP-BC.
PTSD is a psychiatric condition that can develop after experiencing or witnessing a traumatic event involving actual or threatened death, serious injury, or sexual violence. Most people have a stress reaction after trauma that fades in weeks. PTSD is what happens when the nervous system does not recalibrate and the brain continues treating a past event as an ongoing emergency. The amygdala becomes hyperreactive, the prefrontal cortex loses regulatory control, and the hippocampus struggles to file the memory as past.
About 6 percent of US adults will have PTSD. Women are diagnosed about twice as often as men. Common causes include combat and military sexual trauma, motor vehicle collisions, sexual assault and intimate partner violence, childhood abuse and neglect, medical trauma, sudden violent loss, and occupational exposure among police, fire, EMS, dispatchers, and nurses.
Four symptom clusters: intrusion (unwanted memories, nightmares, flashbacks, physical reactions to reminders); avoidance (steering away from places, people, conversations, and thoughts tied to the event); negative changes in thinking and mood (shame, guilt, self-blame, numbness, detachment, loss of interest); and changes in arousal and reactivity (hypervigilance, exaggerated startle, irritability, reckless behavior, poor concentration, insomnia). Symptoms must last more than one month and impair functioning.
Complex PTSD develops after prolonged inescapable trauma and adds severe emotion dysregulation, a persistently negative self-concept, and relationship difficulty. It is frequently misdiagnosed as borderline personality disorder or treatment-resistant depression.
Diagnosis is clinical: structured trauma history interview, validated screeners such as the PCL-5 or PC-PTSD-5, screening for depression, anxiety and substance use, medical review including thyroid and sleep apnea, and suicide risk assessment. PTSD is commonly misread as adult ADHD because concentration problems and irritability overlap.
Treatment: trauma-focused psychotherapy is first line — Cognitive Processing Therapy, Prolonged Exposure, and EMDR, typically 8 to 16 sessions. Medications with the best evidence are sertraline and paroxetine (both FDA-approved for PTSD) and venlafaxine. Prazosin is used for trauma nightmares. Benzodiazepines are generally avoided because they interfere with extinction learning and carry dependence risk. Pharmacogenomic testing can help when several medications have failed. Supportive care includes treating sleep apnea, addressing alcohol use, aerobic exercise, and peer support.
Seek help if symptoms persist more than a month, if you are avoiding to stay functional, if sleep has been disrupted for weeks, if you are using substances to cope, or if loved ones say you seem different. For thoughts of suicide, call or text 988; veterans press 1.
Clemons Resiliency & Wellness is a veteran-owned psychiatric practice at 853 Wake Forest Business Park, Ste. G, Wake Forest, NC. We accept Tricare and provide telepsychiatry across North Carolina.
Q: What is PTSD? A: A psychiatric condition that can develop after experiencing or witnessing trauma, involving intrusion, avoidance, negative changes in thinking and mood, and heightened arousal lasting more than one month.
Q: How long after a traumatic event does PTSD develop? A: Usually within three months, but delayed-onset PTSD can appear months or years later.
Q: Can you have PTSD without being a veteran? A: Yes. Most people with PTSD are civilians, including survivors of car accidents, assault, childhood abuse, and medical trauma.
Q: What is the difference between PTSD and complex PTSD? A: Complex PTSD follows prolonged repeated trauma and adds emotion dysregulation, negative self-concept, and relationship difficulty.
Q: What is the most effective treatment for PTSD? A: Trauma-focused therapy such as CPT, Prolonged Exposure, or EMDR, often combined with sertraline, paroxetine, or venlafaxine, plus prazosin for nightmares.
Q: Can PTSD be cured? A: Many people reach full remission and most improve substantially with treatment.
Q: Do you treat veterans with PTSD in Wake Forest, NC? A: Yes. We are veteran-owned, accept Tricare, and treat veterans, first responders, and civilians.
Q: Does insurance cover PTSD treatment? A: Most plans cover psychiatric evaluation and medication management. We accept Tricare, Medicaid plans, and major commercial insurers.
Call 919-578-5924 to schedule.