Post-Traumatic Stress Disorder (PTSD)

Frightening, painful or distressing experiences happen to everyone at some point. It’s when these experiences cause disruptions to our usual functioning that we refer to them as traumatic. Our responses to trauma vary; we might feel nervous, have a hard time sleeping well, or go over and over the details of a situation in our mind. Our responses also depend on whether the distressing experience happens again. For many, the symptoms of distress decrease over time and we can go back to our daily lives. Some experiences of trauma, however, stay with us and can seriously disrupt our usual functioning and well-being. Post-traumatic stress disorder (PTSD) is one example of this.

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a mental illness. It stems from exposure to an experience involving death or the threat of death, injury, abuse or sexual violence. PTSD affects approximately eight percent of the population in Canada.^[1]

Something is experienced as traumatic when it is very frightening, overwhelming, causes a lot of distress or disrupts our sense of self and security. Events that we may experience as traumatic include neglect and abuse during childhood, crimes, natural disasters, experiences of racism or gender-based violence, violence based on sexual orientation, accidents, war, conflict or genocide, colonialism, or other threats to life. Trauma, especially when it is experienced during childhood, can affect our ability to build trusting relationships with other people.^[2] It can also build up when we are exposed to many stressors that create a trauma response because it can make us more vulnerable and less able to bounce back.^[3] Trauma can be caused by an event or situation that you experienced or something that happens to others, including families and loved ones. Intergenerational trauma, for instance, means that the effects of trauma experienced by one generation are passed down, and are often accompanied by other traumas rooted in current social inequalities.^[4] Many Indigenous communities deal with the intergenerational traumas caused by colonial and genocidal policies at the same time that they are experiencing systemic violence that is the result of those policies.

Trauma happens in our bodies where stressors can cause neurochemical changes in the brain and alter not only our behaviours but also our immune system. Ongoing experiences of stress can even make us vulnerable to illness. A person suffering from trauma may experience chronic pain, heart disease, high blood pressure, stroke, diabetes, immune system-related illnesses and neurodegenerative disorders.^[5] PTSD causes symptoms such as re-experiencing the traumatic event. Many people have vivid nightmares, flashbacks, or thoughts of the event that seem to come from nowhere. They often avoid things that remind them of the event—for example, someone who was hurt in a car crash might avoid driving.

PTSD can make people feel very nervous or ‘on edge’ all the time. Many may be startled very easily, have a hard time concentrating, feel irritable, or have problems sleeping. They may often feel like something terrible is about to happen, even when they are safe. Some people feel very numb and detached. They may feel like things around them aren’t real, feel disconnected from their body, thoughts, or emotions. People also experience a change in their thoughts and mood related to the traumatic event. Some might experience symptoms of depression and/or anxiety, and they might use alcohol or drugs to cope with PTSD.^[6]

Who does it affect?

While most people experience trauma at some point in their lives, not all traumatic experiences lead to PTSD. It’s not clear why trauma causes PTSD in some people but not others, but it’s likely due to many different reasons. This includes the length of time the trauma lasted, the number of other traumatic experiences in a person’s life, their reaction to the event, and the kind of support they received after the event.

Social inequalities make some people more vulnerable to experiences that can result in trauma. Racism, socioeconomic disadvantage and poverty, sexism and gender-based inequality, discrimination based on dis/ability or sexual orientation, or experiences of stigma or mistreatment related to one’s mental health can all result in trauma. Children and adults who are dependent on others for care are also vulnerable, and youth who are homeless, living in poverty, identifying as 2SLGTBQ, or who have a disability are also at a higher risk of being victimized repeatedly.^[7]

Some jobs or occupations put people in dangerous situations. Military personnel, first responders (police, firefighters, and paramedics), doctors, and nurses experience higher rates of PTSD than people in other kinds of work. Trauma is not always a single event that happened in the past. Some trauma, particularly repeated trauma during wartime or ongoing abuse can impact a person’s life far beyond the symptoms of PTSD, making it difficult to form and nurture strong relationships and even bringing on other health problems. Some use other terms like ‘complex PTSD’ to describe this.

What can I do about it?

Many people feel a lot of guilt or shame about PTSD because we’re often told that we should just get over difficult experiences. Others may feel embarrassed talking with others. Some people even feel like it’s somehow their own fault. Trauma is painful. If you experience problems in your life related to trauma, it’s important to take your feelings seriously and talk to a healthcare professional.

Access to social supports

Experiences of trauma are often linked to the conditions we live in, and to any discrimination we experience, so it is important to address the root causes of social inequality. This is not your responsibility as an individual but rather is a collective one that must be addressed by governments and the health and social services sectors. When it comes to loved ones, we can help get them supports in the community, such as assistance for income, employment and housing, shelter services, crisis services, or access to cultural supports and support in different languages.

Counselling

A type of counselling called cognitive-behavioural therapy (or ‘CBT’) has been shown to be effective for PTSD. CBT teaches you how your thoughts, feelings, and behaviours work together and how to deal with problems and stress. You can learn and practice many CBT skills on your own. You can also learn skills like relaxation and techniques, such as meditation, to bring you back to the present moment. Exposure therapy, which can help you talk about your experience and reduce avoidance, may also help. It may be included in CBT or used on its own.

Medication

Medication, such as anti-anxiety medication or antidepressant medication, may help with anxiety itself, as well as related problems like depression or problems sleeping. Talk to your doctor if you’d like to learn more about medication options.

Support groups

Support groups can also help. They are a place to share your own experiences and learn from others, and help you connect with people who understand what you’re going through. You may also find support groups for loved ones of those affected by PTSD.

How can I help a loved one experiencing PTSD?

When someone is diagnosed with PTSD, loved ones can also experience difficulties. You may feel guilty or angry about the trauma itself—then, on top of those feelings, experience difficulties with helping your loved one cope with PTSD. You may feel like your loved one is a different person, worry that things will never be the same again, or wonder what will happen in the future. Here are some tips to help you cope:

• Start by learning more about PTSD. This can give you a better idea of your loved one’s experiences.
• People who experience PTSD may withdraw from family and friends. Even if your loved one doesn’t want to talk, you can still remind them that you are there to listen if they’re ready.
• Understand that behaviours related to PTSD—like avoiding certain situations or reacting angrily to a minor problem—are not about you. They are caused by the illness.
• While it’s usually not a good idea to support behaviours that create problems, it’s still important to support your loved one as they move toward wellness. This balance is not always easy, and you need to respect your own boundaries, too.
• Ask what you can do to help, but don’t push unwanted advice.
• Try to put your own feelings into words and encourage your loved one to do the same. It’s easier to solve problems or address conflicts when you know what’s really going on.
• Take care of your own wellness and seek support for yourself if you experience difficulties.
• If a loved one’s PTSD is affecting other family members, it may be helpful to seek family counselling.

With support, people can recover from PTSD and the effects of trauma. Recovery is helpful for everyone in a person’s circle, especially for young people who are still learning how to interact with the world. A loved one’s recovery is a chance for everyone to learn the skills that support wellness.

Do you need more help?

Contact a community organization like the Canadian Mental Health Association to learn more about support and resources in your area. Find your local CMHA.

Founded in 1918, the Canadian Mental Health Association (CMHA) is the most established, most extensive community mental health federation in Canada. Through a presence in more than 330 communities across every province and the Yukon, CMHA provides advocacy, programs and resources that help to prevent mental health problems and illnesses, support recovery and resilience, and enable all Canadians to flourish and thrive. For more information, please visit cmha.ca.

[1] Statistics Canada, Survey on Mental Health and Stressful Events, 2023, https://www150.statcan.gc.ca/n1/daily-quotidien/240527/dq240527b-eng.htm

[2] Karatzias, Thanos, Mark Shevlin, Julian D. Ford, Claire Fyvie, Graeme Grandison, Philip Hyland and Marylene Cloitre, “Childhood trauma, attachment orientation, and complex PTSD (CPTSD) symptoms in a clinical sample: Implications for treatment, Development and Psychopathology 34 (2022): 1192. https://www.cambridge.org/childhood-trauma-attachment-orientation-and-complex-ptsd-cptsd-symptoms-in-a-clinical-sample-implications-for-treatment.pdf

[3] Scaer, Robert, The Body Bears the Burden: Trauma, Dissociation and Disease. New York: Routledge, 2014.

[4] Bombay, Amy, Kim Matheson, and Hymie Anisman, “Intergenerational Trauma: Convergence of Multiple Processes among First Nations peoples in Canada” Journal of Aboriginal Health (2009): https://jps.library.utoronto.ca/index.php/ijih/article/view/28987

[5] Bombay, Amy, Kim Matheson, and Hymie Anisman, “Intergenerational Trauma: Convergence of Multiple Processes among First Nations peoples in Canada” Journal of Aboriginal Health (2009): https://jps.library.utoronto.ca/index.php/ijih/article/view/28987

[6] Hill, Jonathan, “Childhood Trauma and Depression,” Current Opinion in Psychiatry 16.1 (2003), 3-6. https://journals.lww.com/co-psychiatry/abstract/2003/01000/childhood_trauma_and_depression.2.aspx

[7] https://www.nctsn.org/what-is-child-trauma/populations-at-risk