What Events Can Cause PTSD? Understanding Traumatic Events and PTSD
What Events Can Cause PTSD?
Trauma can happen in many different ways, and people can respond to traumatic experiences very differently. But not every distressing or difficult experience meets the clinical definition of a traumatic event for post-traumatic stress disorder (PTSD).
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) identifies specific types of exposure that can meet Criterion A for PTSD. These include:
Directly experiencing a traumatic event
Witnessing a traumatic event as it happens to someone else, in person
Learning that a close family member or close friend experienced a traumatic event involving actual or threatened death, with the death having been violent or accidental
Repeated or extreme exposure to aversive details of traumatic events as part of one's job, such as some experiences of first responders, military personnel, healthcare professionals, or others who work with trauma-related material
The DSM-5-TR also specifically excludes exposure through electronic media, television, movies, or photographs unless that exposure is work-related.
Importantly, this list does not mean that everyone exposed to one of these events will develop PTSD. Most people who experience trauma do not develop PTSD, and people can have very different reactions to the same event.
What Is the Difference Between Direct and Indirect Trauma Exposure?
Trauma exposure exists on a continuum. A person may experience a traumatic event directly, witness it happening to someone else, learn about a traumatic event involving someone close to them, or encounter traumatic material repeatedly through their work.
Research suggests that direct exposure generally carries a greater risk for PTSD than indirect exposure, although indirect exposure can also lead to PTSD. A systematic review by May and Wisco found that indirect exposure can result in PTSD, although the probability is generally lower than following direct exposure. The review also found that proximity to a traumatic event may increase PTSD risk, particularly among people who experience the trauma directly.
However, trauma exposure is not simply an "all-or-nothing" experience. Two people can experience the same traumatic event and have very different psychological responses.
For example, one person might experience intense fear, helplessness, or horror during or after an event, while another person might initially feel numb, detached, or unusually calm. These differences do not mean that one person's reaction is more legitimate than another's.
Other factors can also influence how someone responds to trauma, including:
How directly the person was exposed to the event
How close they were to the person who was injured or killed
The severity and duration of the traumatic event
Whether the event was intentional or accidental
Previous trauma exposure
Social support
A person's interpretation or understanding of what happened
This is one reason it is important not to compare one person's trauma response to another person's.
Can I Get PTSD If I Wasn't Present When the Trauma Happened?
Yes, in some circumstances.
The DSM-5-TR recognizes several forms of indirect trauma exposure that can meet Criterion A for PTSD.
For example, a person may develop PTSD after learning that a close family member or close friend experienced a traumatic event involving actual or threatened death, when the death was violent or accidental.
The DSM-5-TR also recognizes repeated or extreme occupational exposure to the details of traumatic events. This can apply to certain first responders, military personnel, healthcare professionals, forensic professionals, and others whose work repeatedly exposes them to traumatic material.
Research supports the idea that indirect exposure can be psychologically significant. However, the risk is generally lower than for direct exposure, and the degree of exposure and relationship to the people involved appear to matter.
Can a Life-Threatening Illness Cause PTSD?
A diagnosis of a life-threatening illness does not automatically qualify as a Criterion A traumatic event under DSM-5-TR.
However, some medical experiences can meet Criterion A. The DSM-5-TR notes that medical incidents that qualify as traumatic generally involve sudden, catastrophic events, such as experiencing a sudden life-threatening medical emergency.
This distinction can be particularly important for people who experience cancer, serious injuries, intensive medical procedures, or other major health conditions. A person can experience significant trauma-related symptoms in response to a medical diagnosis or treatment even when the experience does not meet Criterion A for PTSD.
In other words, having trauma-related symptoms does not necessarily mean that someone meets the full diagnostic criteria for PTSD.
What Are the Symptoms of PTSD?
PTSD symptoms are organized into four categories in DSM-5-TR:
1. Intrusion
These symptoms involve the traumatic event coming back into a person's mind or body in unwanted ways. Examples include:
Unwanted or distressing memories
Traumatic nightmares
Flashbacks or feeling as though the event is happening again
Intense emotional distress when reminded of the trauma
Physical reactions to reminders of the trauma
2. Avoidance
A person may try to avoid anything that reminds them of the traumatic event, including:
Thoughts or feelings about what happened
People, places, activities, conversations, or situations associated with the trauma
Avoidance can provide short-term relief but may contribute to PTSD symptoms continuing over time.
3. Negative Changes in Thoughts and Mood
After trauma, some people experience persistent changes in how they think about themselves, other people, or the world. Symptoms can include:
Negative beliefs about oneself or others
Blaming oneself or someone else for what happened
Persistent fear, anger, guilt, or shame
Loss of interest in previously enjoyable activities
Feeling detached or disconnected from other people
Difficulty experiencing positive emotions
Difficulty remembering important aspects of the traumatic event
4. Changes in Arousal and Reactivity
These symptoms reflect changes in the body's threat-response system. They can include:
Feeling constantly on guard or hypervigilant
Being easily startled
Irritability or anger
Difficulty concentrating
Sleep problems
Reckless or self-destructive behavior
To meet DSM-5-TR criteria for PTSD, a person must experience the required number of symptoms across these four categories, along with other diagnostic criteria such as symptoms lasting more than one month and causing significant distress or impairment.
Do Different Types of Trauma Cause Different PTSD Symptoms?
People with PTSD can experience symptoms from all four categories, regardless of the type of trauma they experienced. However, research suggests that some types of traumatic experiences may be associated with particular symptom patterns.
For example, one study found that combat trauma was associated with greater arousal and intrusion symptoms, while sexual trauma was associated with greater avoidance and negative changes in cognition and mood. Physical assault was particularly associated with symptoms involving blame.
These findings are general trends rather than rules. A person who experienced sexual assault may have significant hypervigilance and nightmares, while a combat veteran may struggle primarily with guilt, avoidance, or depression.
The type of trauma is only one factor that can influence someone's PTSD symptoms. The nature of the threat, whether the trauma was intentional, the person's relationship to other people involved, repeated exposure, previous trauma, and the meaning a person makes of the experience can all influence how PTSD develops and is experienced.
This is why two people can experience the same traumatic event and develop very different symptoms.
Is PTSD Treatable?
Yes. PTSD is treatable, and effective treatments are available.
Several evidence-based, trauma-focused psychotherapies have strong research support for PTSD, including:
Prolonged Exposure (PE)
Cognitive Processing Therapy (CPT)
Eye Movement Desensitization and Reprocessing (EMDR)
Treatment does not have to look exactly the same for everyone. A psychologist can help you understand your particular symptoms, how your trauma has affected you, and which treatment approach may be the best fit for your goals.
If you are experiencing symptoms after a traumatic event, you do not have to navigate them alone. Working with a psychologist who has experience treating PTSD and a variety of trauma-related concerns can help you determine whether your symptoms meet criteria for PTSD and identify appropriate treatment options.
If you would like to meet with a PTSD therapist in California, contact me to learn more about working together.
