What to Say: Post-Traumatic Stress Disorder
Support your loved one experiencing this disorder.
Support your loved one experiencing this disorder.
Nathaniel Glanzman
Reviewer URLSupport your loved one experiencing this disorder.
What we'll cover
Post-traumatic stress disorder (PTSD) was once only associated with the military. In the years since its identification, researchers now recognize it as a fairly common condition.
In this “What to Say” guide, we’ll examine the history of PTSD, the hallmarks of the disorder, its comorbid conditions and how it is treated. We’ll also help you figure out what to say and not to say to someone with PTSD.
What it is
According to the U.S. Department of Veterans Affairs, the medical community began researching the trauma associated with military duty as far back as the Civil War. But the existence of post-military trauma came to the forefront with World War I. Thousands of soldiers returning home were diagnosed with psychological issues labeled “shell shock” or “war neuroses.”
Disorders similar to PTSD were added (and removed) throughout multiple editions of the Diagnostic and Statistical Manual of Mental Disorders. In 1980, the American Psychological Association (APA) finally added PTSD to the DSM-III. PTSD can affect anyone who has experienced trauma, not just those who have been to war.
What it is
PTSD is a fairly common condition in the United States. The National Center for PTSD, part of the U.S. Department of Veterans Affairs, reports 6% of all Americans will develop PTSD at some point in their lives. In 2020, 13 million people experienced PTSD. Anyone can develop PTSD, including children, teens and adults. PTSD is more common in women than men, with 4% of American men reporting PTSD in their lifetimes and 8% of American women.
PTSD is easy to diagnose. The U.S. Department of Veterans Affairs provides a short self-evaluation. If the self-screen indicates you may have PTSD, they recommend you speak with a medical service provider.
The hallmarks of PTSD
The onset of PTSD usually occurs within three months of a trauma, but can occur years after the event. PTSD can occur due to a large series of stressful events, including sexual assault, physical harm (such as intimate partner violence or vehicular accidents), childhood trauma, natural disasters or mass violence. Those who witnessed a violent event can also experience PTSD.
Researchers are studying why some people who experience trauma develop PTSD, while others do not. Two people can live through the same trauma, and it is possible only one of them will develop PTSD.
According to the National Center for PTSD, there are four major symptoms of PTSD. These symptoms can manifest differently depending on the individual. They are:
Reliving
This is perhaps the most well-known aspect of PTSD. People may have flashbacks of the event or have repetitive and consistent nightmares of their experience.
Avoidance
Those with PTSD may try to avoid things that remind them of the traumatic event (for example, large crowds or fireworks). Additionally, those who develop PTSD often show symptoms of disassociation. Dissociation can cause one to feel disconnected from themselves (as if they are experiencing their own life at a distance). According to a World Health Organization study of more than 25,000 patients across the globe, all diagnosed with PTSD, 14% of those experienced dissociative symptoms.
Mood changes
Those with PTSD often develop other issues, such as depression and anxiety. Even those not diagnosed with comorbid conditions, however, may experience more negative thoughts than they had prior to their trauma. These mood shifts can present as cognition struggles, such as memory and concentration issues.
Hyperarousal
Hyperarousal is the state of being “on edge.” Those who experience PTSD may feel “keyed up” or unnecessarily alert. They may have insomnia and be easily startled.
Comorbid conditions
PTSD causes a period of prolonged stress. As a result, many patients with PTSD also experience a variety of physical and psychological comorbid conditions. These include:
— Anger: Those with PTSD may have a harder time controlling their actions due to anger.
— Depression: Those with PTSD may develop depression, taking less interest in activities that once brought them pleasure. Depression may also manifest in feelings of worthlessness, hopelessness or sadness.
— Substance use disorder: Due to the hyperarousal of PTSD, many people experiencing the disorder may engage in high-risk behaviors, including misuse of drugs and alcohol leading to substance use disorder.
— Chronic pain: Chronic pain, which often has no clearly defined explanation, occurs in a number of those suffering PTSD. According to the National Institute of PTSD, anywhere from 15% to 35% of patients with chronic pain also experience symptoms of PTSD.
— Increased risk of heart issues: According to one study, those with long-term PTSD were more likely to develop a range of heart issues, including angina pectoris and tachycardia.
Treating PTSD
It is possible to recover from the effects of PTSD. Most people, with the support of friends and family, recover in the weeks and months after a traumatic event. Some may recover without the aid of professional support. However, if the symptoms of PTSD are interfering with one’s daily life, seeking professional help is recommended.
There are several treatment options for PTSD. Talk therapy options, including cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE), are all recommended for PTSD. People who experience PTSD may also be prescribed medications, like selective serotonin reuptake inhibitors (SSRIs) to treat symptoms. Benzodiazepines are not recommended to treat PTSD.
For those trying to help their loved one with PTSD find an appropriate therapeutic modality, the Veterans Administration (VA) created a free online diagnostic tool to help you.
What not to say
PTSD is a complex disorder. It can present in a variety of ways. In this section, we’ll cover things not to say to your loved one with PTSD.
"I know you’re anxious around crowds, but it is important we all go to the amusement park. It’s our big family day."
Why it doesn't work: If your loved one has expressed a trigger of theirs, it is important to honor it. The way your loved one’s PTSD presents may seem inconvenient to you, but if it isn’t harmful to themselves or others, honor their needs. Let them build up their own tolerance, rather than forcing them into uncomfortable situations to meet your own expectations.
"It’s not real PTSD, though. It isn’t like you went to war."
Why it doesn't work: PTSD was first identified in soldiers, but the science is clear: many traumas can cause PTSD. Rather than judging the validity of your loved one’s diagnosis, focus on supporting them through this difficult time.
"You’re so touchy!"
Why it doesn't work: PTSD can cause an elevated startle response. The things causing one to startle may not make sense to you, but it makes sense to them. No one wants to feel afraid. Focus your feelings on sympathizing with that fear rather than disapproving of their reactions.
"That was forever ago. Shouldn’t you be over it by now?"
Why it doesn't work: PTSD usually occurs within three months of the event, but in the case of some traumas, specifically childhood trauma, the delay between the event and the onset of PTSD may be much larger. Exposure to verbal and physical abuse as a child can change one’s developing brain. Focus on your loved one and their feelings, rather than poking holes in their lived experience.
"You’re too young/too old to have PTSD."
Why it doesn't work: Anyone can be diagnosed with PTSD. Young children who are exposed to abuse, trauma or other large-scale tragedy can have PTSD. According to the National Center for PTSD, 70% to 90% of adults aged 65 or older report having seen one or more traumatic events during their lifetime. And 7% to 15% of older adults meet some, if not all, of the diagnostic criteria for PTSD. There is no one way to have PTSD. There is no one face for the disorder.
Nothing.
Why it doesn't work: Finding the right words can be difficult for anyone, but that doesn't mean you should neglect to say anything to your friend or loved one. During especially difficult situations, your loved one will appreciate any kind or reflective words you can offer during their time of need. Saying something—with intention and thoughtfulness—is better than saying nothing.
Instead of avoiding a conversation in a fraught moment, try a phrase like, "I can't begin to know what you are going through, but I am here for you." If the moment is more lighthearted or celebratory, a simple, "I am so happy for you right now!" goes a long way.
What to say
Now that we’ve covered what not to say, here are some conversation openers that can help you support your loved one.
Note: These conversation starters are just suggestions. Each individual’s experience will vary and users should measure their words based on what they know and do not know about their loved one.
"We’re having a party this weekend. It’ll be about 25 people, for Tony’s birthday. You are invited. I know you didn’t want to attend Kyle’s Superbowl party, which was the same size. So, if you aren’t up to attending this, I totally understand."
Why it works: This works because it shows you’re willing to accommodate the person with PTSD. You love them and want them to feel welcome, but you understand if the situation might be anxious for them. You aren’t insisting your loved one heal on your schedule.
"I love you and am here to listen."
Why it works: If a friend or loved one discloses a PTSD diagnosis, an open-ended place might be a good starting point. Depending on your friend’s own healing journey, they may just want you to have the information. Let them lead.
"I’ve noticed lately you seem to be struggling. Have you thought about talking to someone? They may be able to help with your PTSD symptoms."
Why it works: If you are worried your loved one with PTSD needs more assistance, it may be time to suggest they engage professional help. This conversation starter may help with that. An opener like this is neutral. It points out what you have noticed, rather than making a declarative statement on what you think is wrong. It also gives a suggestion, kindly. For those who need more in-depth information on how to help a friend through a mental health crisis, we have tips on what to do.
How to recover
Suffering from PTSD can be an isolating and frightening experience. For someone struggling, triggers can be hard to avoid. People experiencing PTSD may find new triggers at inconvenient times. If you’ve found yourself prioritizing your own convenience, rather than your loved ones’ struggles, an apology may be necessary.
On the other hand, caretaking when someone has PTSD can be complicated. If you are feeling burnt out or overwhelmed, take note of that. You are allowed to have reasonable boundaries, even at a bad time. Give yourself time to rest and recharge so you can go forth in your conversations with your loved one in a neutral and non-judgmental way.