Skip to Content
OpenStax Logo
Psychology 2e

15.6 Posttraumatic Stress Disorder

Psychology 2e15.6 Posttraumatic Stress Disorder
  1. Preface
  2. 1 Introduction to Psychology
    1. Introduction
    2. 1.1 What Is Psychology?
    3. 1.2 History of Psychology
    4. 1.3 Contemporary Psychology
    5. 1.4 Careers in Psychology
    6. Key Terms
    7. Summary
    8. Review Questions
    9. Critical Thinking Questions
    10. Personal Application Questions
  3. 2 Psychological Research
    1. Introduction
    2. 2.1 Why Is Research Important?
    3. 2.2 Approaches to Research
    4. 2.3 Analyzing Findings
    5. 2.4 Ethics
    6. Key Terms
    7. Summary
    8. Review Questions
    9. Critical Thinking Questions
    10. Personal Application Questions
  4. 3 Biopsychology
    1. Introduction
    2. 3.1 Human Genetics
    3. 3.2 Cells of the Nervous System
    4. 3.3 Parts of the Nervous System
    5. 3.4 The Brain and Spinal Cord
    6. 3.5 The Endocrine System
    7. Key Terms
    8. Summary
    9. Review Questions
    10. Critical Thinking Questions
    11. Personal Application Questions
  5. 4 States of Consciousness
    1. Introduction
    2. 4.1 What Is Consciousness?
    3. 4.2 Sleep and Why We Sleep
    4. 4.3 Stages of Sleep
    5. 4.4 Sleep Problems and Disorders
    6. 4.5 Substance Use and Abuse
    7. 4.6 Other States of Consciousness
    8. Key Terms
    9. Summary
    10. Review Questions
    11. Critical Thinking Questions
    12. Personal Application Questions
  6. 5 Sensation and Perception
    1. Introduction
    2. 5.1 Sensation versus Perception
    3. 5.2 Waves and Wavelengths
    4. 5.3 Vision
    5. 5.4 Hearing
    6. 5.5 The Other Senses
    7. 5.6 Gestalt Principles of Perception
    8. Key Terms
    9. Summary
    10. Review Questions
    11. Critical Thinking Questions
    12. Personal Application Questions
  7. 6 Learning
    1. Introduction
    2. 6.1 What Is Learning?
    3. 6.2 Classical Conditioning
    4. 6.3 Operant Conditioning
    5. 6.4 Observational Learning (Modeling)
    6. Key Terms
    7. Summary
    8. Review Questions
    9. Critical Thinking Questions
    10. Personal Application Questions
  8. 7 Thinking and Intelligence
    1. Introduction
    2. 7.1 What Is Cognition?
    3. 7.2 Language
    4. 7.3 Problem Solving
    5. 7.4 What Are Intelligence and Creativity?
    6. 7.5 Measures of Intelligence
    7. 7.6 The Source of Intelligence
    8. Key Terms
    9. Summary
    10. Review Questions
    11. Critical Thinking Questions
    12. Personal Application Questions
  9. 8 Memory
    1. Introduction
    2. 8.1 How Memory Functions
    3. 8.2 Parts of the Brain Involved with Memory
    4. 8.3 Problems with Memory
    5. 8.4 Ways to Enhance Memory
    6. Key Terms
    7. Summary
    8. Review Questions
    9. Critical Thinking Questions
    10. Personal Application Questions
  10. 9 Lifespan Development
    1. Introduction
    2. 9.1 What Is Lifespan Development?
    3. 9.2 Lifespan Theories
    4. 9.3 Stages of Development
    5. 9.4 Death and Dying
    6. Key Terms
    7. Summary
    8. Review Questions
    9. Critical Thinking Questions
    10. Personal Application Questions
  11. 10 Emotion and Motivation
    1. Introduction
    2. 10.1 Motivation
    3. 10.2 Hunger and Eating
    4. 10.3 Sexual Behavior
    5. 10.4 Emotion
    6. Key Terms
    7. Summary
    8. Review Questions
    9. Critical Thinking Questions
    10. Personal Application Questions
  12. 11 Personality
    1. Introduction
    2. 11.1 What Is Personality?
    3. 11.2 Freud and the Psychodynamic Perspective
    4. 11.3 Neo-Freudians: Adler, Erikson, Jung, and Horney
    5. 11.4 Learning Approaches
    6. 11.5 Humanistic Approaches
    7. 11.6 Biological Approaches
    8. 11.7 Trait Theorists
    9. 11.8 Cultural Understandings of Personality
    10. 11.9 Personality Assessment
    11. Key Terms
    12. Summary
    13. Review Questions
    14. Critical Thinking Questions
    15. Personal Application Questions
  13. 12 Social Psychology
    1. Introduction
    2. 12.1 What Is Social Psychology?
    3. 12.2 Self-presentation
    4. 12.3 Attitudes and Persuasion
    5. 12.4 Conformity, Compliance, and Obedience
    6. 12.5 Prejudice and Discrimination
    7. 12.6 Aggression
    8. 12.7 Prosocial Behavior
    9. Key Terms
    10. Summary
    11. Review Questions
    12. Critical Thinking Questions
    13. Personal Application Questions
  14. 13 Industrial-Organizational Psychology
    1. Introduction
    2. 13.1 What Is Industrial and Organizational Psychology?
    3. 13.2 Industrial Psychology: Selecting and Evaluating Employees
    4. 13.3 Organizational Psychology: The Social Dimension of Work
    5. 13.4 Human Factors Psychology and Workplace Design
    6. Key Terms
    7. Summary
    8. Review Questions
    9. Critical Thinking Questions
    10. Personal Application Questions
  15. 14 Stress, Lifestyle, and Health
    1. Introduction
    2. 14.1 What Is Stress?
    3. 14.2 Stressors
    4. 14.3 Stress and Illness
    5. 14.4 Regulation of Stress
    6. 14.5 The Pursuit of Happiness
    7. Key Terms
    8. Summary
    9. Review Questions
    10. Critical Thinking Questions
    11. Personal Application Questions
  16. 15 Psychological Disorders
    1. Introduction
    2. 15.1 What Are Psychological Disorders?
    3. 15.2 Diagnosing and Classifying Psychological Disorders
    4. 15.3 Perspectives on Psychological Disorders
    5. 15.4 Anxiety Disorders
    6. 15.5 Obsessive-Compulsive and Related Disorders
    7. 15.6 Posttraumatic Stress Disorder
    8. 15.7 Mood Disorders
    9. 15.8 Schizophrenia
    10. 15.9 Dissociative Disorders
    11. 15.10 Disorders in Childhood
    12. 15.11 Personality Disorders
    13. Key Terms
    14. Summary
    15. Review Questions
    16. Critical Thinking Questions
    17. Personal Application Questions
  17. 16 Therapy and Treatment
    1. Introduction
    2. 16.1 Mental Health Treatment: Past and Present
    3. 16.2 Types of Treatment
    4. 16.3 Treatment Modalities
    5. 16.4 Substance-Related and Addictive Disorders: A Special Case
    6. 16.5 The Sociocultural Model and Therapy Utilization
    7. Key Terms
    8. Summary
    9. Review Questions
    10. Critical Thinking Questions
    11. Personal Application Questions
  18. References
  19. Index

Learning Objectives

By the end of this section, you will be able to:
  • Describe the nature and symptoms of posttraumatic stress disorder
  • Identify the risk factors associated with this disorder
  • Understand the role of learning and cognitive factors in its development

Extremely stressful or traumatic events, such as combat, natural disasters, and terrorist attacks, place the people who experience them at an increased risk for developing psychological disorders such as posttraumatic stress disorder (PTSD). Throughout much of the 20th century, this disorder was called shell shock and combat neurosis because its symptoms were observed in soldiers who had engaged in wartime combat. By the late 1970s it had become clear that women who had experienced sexual traumas (e.g., rape, domestic battery, and incest) often experienced the same set of symptoms as did soldiers (Herman, 1997). The term posttraumatic stress disorder was developed given that these symptoms could happen to anyone who experienced psychological trauma.

A Broader Definition of PTSD

PTSD was listed among the anxiety disorders in previous DSM editions. In DSM-5, it is now listed among a group called Trauma-and-Stressor-Related Disorders. For a person to be diagnosed with PTSD, she must be exposed to, witness, or experience the details of a traumatic experience (e.g., a first responder), one that involves “actual or threatened death, serious injury, or sexual violence” (APA, 2013, p. 271). These experiences can include such events as combat, threatened or actual physical attack, sexual assault, natural disasters, terrorist attacks, and automobile accidents. This criterion makes PTSD the only disorder listed in the DSM in which a cause (extreme trauma) is explicitly specified.

Symptoms of PTSD include intrusive and distressing memories of the event, flashbacks (states that can last from a few seconds to several days, during which the individual relives the event and behaves as if the event were occurring at that moment [APA, 2013]), avoidance of stimuli connected to the event, persistently negative emotional states (e.g., fear, anger, guilt, and shame), feelings of detachment from others, irritability, proneness toward outbursts, and an exaggerated startle response (jumpiness). For PTSD to be diagnosed, these symptoms must occur for at least one month.

Roughly 7% of adults in the United States, including 9.7% of women and 3.6% of men, experience PTSD in their lifetime (National Comorbidity Survey, 2007), with higher rates among people exposed to mass trauma and people whose jobs involve duty-related trauma exposure (e.g., police officers, firefighters, and emergency medical personnel) (APA, 2013). Nearly 21% of residents of areas affected by Hurricane Katrina suffered from PTSD one year following the hurricane (Kessler et al., 2008), and 12.6% of Manhattan residents were observed as having PTSD 2–3 years after the 9/11 terrorist attacks (DiGrande et al., 2008).

Risk Factors For PTSD

Of course, not everyone who experiences a traumatic event will go on to develop PTSD; several factors strongly predict the development of PTSD: trauma experience, greater trauma severity, lack of immediate social support, and more subsequent life stress (Brewin, Andrews, & Valentine, 2000). Traumatic events that involve harm by others (e.g., combat, rape, and sexual molestation) carry greater risk than do other traumas (e.g., natural disasters) (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Women are more likely to have been traumatized because of sexual trauma, childhood neglect, and childhood physical abuse. Men are more likely to have been traumatized by natural disaster, life-threatening accident, and physical violence, either witnessed or directed at them. Adolescent boys are more likely to experience accident, physical assault, and witness death/injury; adolescent girls are more likely to experience rape/sexual assault, intimate partner violence, or unexpected death or injury of a loved one. Assaultive violence and witnessing trauma to others is more prevalent among non-whites when compared to whites. African American males are more likely to be exposed to and victims of violence than males of other races (Kilpatrick, Badour, & Resnick, 2017). A 2012 study found that 27% of corrections officers reported experiencing symptoms of PTSD in the past 30 days. Rates were higher for males (31%) than females (22%) (Spinaris, Denhof, & Kellaway, 2012). A study conducted by Jaegers et al (2019) found that 53.4% of jail correctional officers screened positively for PTSD. PTSD is more prevalent in prison populations than in the general public, with prevalence estimates of 6% in male prisoners and 21% in female prisoners (Facer-Irwin et al, 2019). Factors that increase the risk of PTSD include female gender, low socioeconomic status, low intelligence, personal history of mental disorders, history of childhood adversity (abuse or other trauma during childhood), and family history of mental disorders (Brewin et al., 2000). Personality characteristics such as neuroticism and somatization (the tendency to experience physical symptoms when one encounters stress) have been shown to elevate the risk of PTSD (Bramsen, Dirkzwager, & van der Ploeg, 2000). People who experience childhood adversity and/or traumatic experiences during adulthood are at significantly higher risk of developing PTSD if they possess one or two short versions of a gene that regulates the neurotransmitter serotonin (Xie et al., 2009). This suggests a possible diathesis-stress interpretation of PTSD: its development is influenced by the interaction of psychosocial and biological factors.

Support For Sufferers of PTSD

Research has shown that social support following a traumatic event can reduce the likelihood of PTSD (Ozer, Best, Lipsey, & Weiss, 2003). Social support is often defined as the comfort, advice, and assistance received from relatives, friends, and neighbors. Social support can help individuals cope during difficult times by allowing them to discuss feelings and experiences and providing a sense of being loved and appreciated. A 14-year study of 1,377 American Legionnaires who had served in the Vietnam War found that those who perceived less social support when they came home were more likely to develop PTSD than were those who perceived greater support (Figure 15.14). In addition, those who became involved in the community were less likely to develop PTSD, and they were more likely to experience a remission of PTSD than were those who were less involved (Koenen, Stellman, Stellman, & Sommer, 2003).

A photograph shows a person looking at the Vietnam Traveling Memorial Wall.
Figure 15.14 PTSD was first recognized in soldiers who had engaged in combat. Research has shown that strong social support decreases the risk of PTSD. This person stands at the Vietnam Traveling Memorial Wall. (credit: Kevin Stanchfield)

Learning and the Development of PTSD

PTSD learning models suggest that some symptoms are developed and maintained through classical conditioning. The traumatic event may act as an unconditioned stimulus that elicits an unconditioned response characterized by extreme fear and anxiety. Cognitive, emotional, physiological, and environmental cues accompanying or related to the event are conditioned stimuli. These traumatic reminders evoke conditioned responses (extreme fear and anxiety) similar to those caused by the event itself (Nader, 2001). A person who was in the vicinity of the Twin Towers during the 9/11 terrorist attacks and who developed PTSD may display excessive hypervigilance and distress when planes fly overhead; this behavior constitutes a conditioned response to the traumatic reminder (conditioned stimulus of the sight and sound of an airplane). Differences in how conditionable individuals are help to explain differences in the development and maintenance of PTSD symptoms (Pittman, 1988). Conditioning studies demonstrate facilitated acquisition of conditioned responses and delayed extinction of conditioned responses in people with PTSD (Orr et al., 2000).

Cognitive factors are important in the development and maintenance of PTSD. One model suggests that two key processes are crucial: disturbances in memory for the event, and negative appraisals of the trauma and its aftermath (Ehlers & Clark, 2000). According to this theory, some people who experience traumas do not form coherent memories of the trauma; memories of the traumatic event are poorly encoded and, thus, are fragmented, disorganized, and lacking in detail. Therefore, these individuals are unable remember the event in a way that gives it meaning and context. A rape victim who cannot coherently remember the event may remember only bits and pieces (e.g., the attacker repeating a word or insult); because the victim was unable to develop a fully integrated memory, the fragmentary memory tends to stand out. Although unable to retrieve a complete memory of the event, the victim may be haunted by intrusive fragments involuntarily triggered by stimuli associated with the event (e.g., memories of the attacker’s comments when encountering a person who resembles the attacker). This interpretation fits previously discussed material concerning PTSD and conditioning. The model also proposes that negative appraisals of the event (“I deserved to be raped because I’m stupid”) may lead to dysfunctional behavioral strategies (e.g., avoiding social activities where men are likely to be present) that maintain PTSD symptoms by preventing both a change in the nature of the memory and a change in the problematic appraisals.

Citation/Attribution

Want to cite, share, or modify this book? This book is Creative Commons Attribution License 4.0 and you must attribute OpenStax.

Attribution information
  • If you are redistributing all or part of this book in a print format, then you must include on every physical page the following attribution:
    Access for free at https://openstax.org/books/psychology-2e/pages/1-introduction
  • If you are redistributing all or part of this book in a digital format, then you must include on every digital page view the following attribution:
    Access for free at https://openstax.org/books/psychology-2e/pages/1-introduction
Citation information

© Sep 2, 2020 OpenStax. Textbook content produced by OpenStax is licensed under a Creative Commons Attribution License 4.0 license. The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, and OpenStax CNX logo are not subject to the Creative Commons license and may not be reproduced without the prior and express written consent of Rice University.