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Running head: MOST COMMON SYMPTOMS OF PTSD
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What are the Most Common Symptoms of Post-Traumatic Stress Disorder?
Marivel Cisneros, Analicia Rangel-Garcia, Khae Saechao
University of California, Merced
Writing 101: Writing in the Discipline, Psychology
Author’s Note: Analicia Rangel-Garcia is a Psychology major and is minoring in Sociology. She
would like to attend graduate school to major in Social Psychology and minor in Chicano
Studies. Marivel Lopez-Cisneros is a Psychology major and is a junior transfer student. Khae
Saechao is a Psychology major and minoring in Sociology. All are students of the University of
California, Merced.
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Abstract
People who are victims of sexual, physical, mental, or emotional abuse, depending on the
duration and severity of the event, are discovered to develop symptoms of Post-Traumatic Stress
Disorder based on a wide range of different studies related to victims of abuse and the
development of Post-Traumatic Stress Disorder. Post-Traumatic Stress Disorder is defined as an
anxiety disorder triggered by a life-threatening traumatic event that has caused intense-fear
and/or helplessness. There are a number of different types of symptoms, which are categorized in
to a number of different categories. The articles and studies within the articles include
experiments and studies done on those who have fallen victim to abuse. Some topics discussed
within the studies consist of what symptoms are prevalent within the individual, how these
symptoms developed, and which symptoms seems to be most common within these abused
individuals. Based on the different articles that we have collected as a group, and the studies
within those articles, many symptoms of Post-Traumatic Stress disorder develop at different
times, depending on the type of abuse the individual has experienced. The articles found within
out group include, victims of a variety of types of abuse among a number of socio-economic
status backgrounds, different age-levels, different ethnic backgrounds, and different types of
relationships where the abuse took place and whether they were formal relationships or not.
Ultimately, the purpose of this literature review assignment is to research and discover the
symptoms most common in the different areas of abuse of individuals and how they develop.
Keywords: Post-Traumatic Stress Disorder, symptoms, victims, abuse, most common
Common Symptoms of PTSD
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What symptoms of PTSD are most common in people who experience traumatic events?
Post traumatic stress disorder (PTSD) is a common anxiety disorder that people develop
from extreme fear, helpless, intense horror, or a traumatic event. PTSD is classified into three
main types of syndromes: intrusive memories (re-experiencing), avoiding and numbing, and
hyperarousal. PTSD has been around since war has existed. PTSD was classified as a mental
disorder in Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 by the
American Psychiatric Association (APA). After the Vietnam War, many veterans developed
PTSD; that was when the public started to notice PTSD and it became the main focus. During
this time they had developed assessment techniques to diagnose for PTSD. PTSD is also known
as battle fatigue for soldiers who show signs of PTSD after World War II, combat fatigue for
soldiers who experience symptom of PTSD after World War I, and soldier’s heart for soldiers
who developed PTSD after the Civil War. Before PTSD was announced as a disorder, most
people including doctors believed that it was a personal weakness or cowardice of the person
who suffered from the disorder. Due to the Vietnam War, PTSD rose to the surface bringing a
large amount of public attention. It wasn’t until the war that doctors started to diagnose soldiers
with post-Vietnam syndrome. Prior to the Vietnam War, PTSD was not considered a disorder of
any type and did not attract a large amount of attention.
After being studied and understood, PTSD they had four primary categories of
symptoms. The first category is intrusive memories or re-experiencing the traumatic event. When
the person re-experiences the traumatic event they often feel intense distress, they are often
reminded of the traumatic event, including having flashbacks, nightmares and experience intense
physical reaction of the event. The second type of symptom is avoidance and emotional
numbing. The person who receives these types of symptoms avoids anything reminding them of
the traumatic event, has the inability of remembering detail of traumatic event, loss interest in
Common Symptoms of PTSD
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life in general, and feels detached from others and emotionally numb. The third type of symptom
is increased arousal which includes difficulty of falling asleep, irritability or anger, having
trouble concentrating in general, feeling jumpy and easily startled. The fourth types of symptoms
are the other most common symptoms of PTSD. These include guilt, self blame, or shame,
depression and hopelessness, drug abuse, feeling alienated, unable to trust and suicidal thoughts
and feelings.
For our paper, we are interested in finding out how most common symptoms of PTSD
had an affect or had an influence on a person. We find the three most common symptoms that a
person could develop for PTSD, and then we locate the articles related to our topic through the
CSA (Cambridge Scientific Abstracts): Social Sciences from UC Merced library searches. We
use following the keywords to find our articles: PTSD, PTSD avoidance, PTSD anxiety, PTSD
flashback, and PTSD intrusive. We also found articles from the references list with the authors
name in order to find articles related to our topics. For the present articles, we have identified
and reviewed eighteen articles that focus on the three main symptoms that people develop from
PTSD. Throughout the paper we are defining the three main categories of symptom and how
they had effects or had an influence in a person. Then we will provide relevant studies according
to each main category of the symptoms of PTSD.
Intrusive Memories Symptom
One of the other common symptoms of PTSD is Intrusive Memories. Intrusive Memories
consist of re-experiencing the traumatic event, often through intense flashbacks, nightmares,
feelings of extreme distress, and upsetting dreams. Additionally, the core symptoms of PTSD are
consistent with the avoidance of anything that is associated with the trauma experience and is in
relation to intrusive re-experiencing, flashbacks, nightmares, and distress, especially when placed
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in a similar situation or reminded in some way of the traumatic event that he/she has
experienced. Moreover, the reduced ability to resist past impact of an event is in connection with
a high frequency of intrusive memories related to the traumatic event in the past ( Verwoerd,
Wessel & Jong, 2009).
Within an article is a study done by Ulrike Zetsche,Thomas Ehring, and Anke Ehlers in
which they found that being both reminded of and remembering a traumatic event is in high
correlation with PTSD symptom severity and an individual’s overall mental health
( Zetsche,Ehring,&Ehlers, 2009).
According to Bea Vickers, intrusive memories is the most prevalent symptom both
adolescents and adults who suffer from PTSD. Though many of those who suffer from PTSD
experience a wide range of symptoms on a variety of levels, intrusive memories and nightmares
remain constantly present, and can be triggered at any moment when one relates something heard
or seen to the past traumatic event. When intrusive memories, flashbacks, or nightmares take
place, there is high emotional arousal due to the fact that is involuntarily triggered by outside
stimuli (Vickers, 2005). Ehlers and Clark point out that in the mind of those who suffer from
PTSD, the traumatic event that they have experienced has been processed, but with somewhat of
a distortion because of the intensity and trauma of the event. As a direct result, the threat remains
active within the mind producing intrusive memories, nightmares, and flashbacks that, depending
on the severity of the event, can be easily triggered. In addition, not only does the event remain
active in the mind, but those who have experienced the event connect it to a long-lasting
meaning, making the traumatic event ever-current. Such meanings can derive from being raped
at a young age, and thinking they will never be able to get married nor have children or due to
the event, falling behind in school work and thinking they will never be able to go to a university
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of their choosing and become successful. Changes within the trauma memory are prevented from
being positively changed because of both behavioral and cognitive strategies of those who suffer
from PTSD (Ehlers & Clark, 2000).
According to Rothbaum, Foa, Riggs, Murdock, & Walsh, intrusive memories, disturbing
dreams, and flashbacks highly occur among those who have been raped. Among all of the other
symptoms of PTSD, the symptoms of intrusive memories and nightmare show up the most in
people who have been rape victims. This has to do with the altered cognitive process after the
traumatic event has taken place, because of the fact that the event was a shocking, violating,
horrific, and unexpected experience (Rothbaum, Foa, Riggs, Murdock, & Walsh, 1992).
Among the different types of intrusive memories are flashbacks, nightmares, visual
intrusions, and thoughts of the event. According to a study done by Ehlers, Hackmann, Steil,
Clohessy, Wenninger, and Winter, visual intrusions are most common among individuals who
have experienced a traumatic event. Their study involved an interview of people with PTSD who
have experienced different types of trauma and asked them to describe the content of their
intrusive memories.Within their study it was found that the severity of the visual intrusion had
low correlation with the type of traumatic event. It is suggested that intrusive memories are
produced through stimuli, acquire the status of warning signals that indicated potential danger.
As a result, intrusive memories, or more specifically visual intrusions, are associated with a
sense of serious threat, following high emotional arousal (Ehlers, Hackmann, Steil, Clohessy,
Wenninger, & Winter, 2002).
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Avoidance and Emotional Numbing Symptom
One of the main symptoms of PTSD is avoidance and emotional numbing. Sometimes the
avoidance cluster of PTSD symptoms is divided into two separate groups, one reflects on
avoidance symptoms and the other one reflects on emotional numbing symptoms. Avoidance
symptoms are categorized into one specific group of PTSD symptoms, which include trying to
avoid thoughts, feelings, or conversations about the traumatic event; trying to avoid places or
people that remind them of the traumatic event; having a difficult time remembering important
parts of the traumatic event; losing an interest in activities that they once enjoy and feeling
distanced from other peoples. Emotional numbing symptoms are a part of the avoidance group of
PTSD symptoms and they are generally referred to those symptoms that show signs of
difficulties in showing positive emotions. Emotional numbing symptoms include a loss of
interest in important, once positive, activities; a feeling of distance from others and an experience
of having difficulties in maintaining positive feelings, such as happiness or love.
There are six articles that had the relevant studies that falls under the category of
avoidance and emotional numbing symptoms. The studies show that people who went through
traumatic event will develop avoidance and emotional numbing. Researchers are required to use
the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), which
consist of seventeen item self-report measures and diagnostic of PTSD. Researchers use DSMIV and Checklist-Civilian to test the avoidance symptom criterion and its relation to the
traumatic event (Asmudon, Stapleton, & Taylor, 2004; Elhai, Gray, Docherty, Kashdan, & Kose,
2009; Lauterbach, Bak, Reiland, Mason, Lute, & Earls, 2007; Norris & Aroian, 2008; Nye,
Katzman, Bell, Kilpatrick, Brainard, & Haaland, 2008; Simpson, Jacupcak, Luterek, 2006).
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Lauterbach, Bak, Reiland, Mason, Lute, and Earls (2007) discuss their studies on parentchild relationship quality and examined the connection between PTSD and other negative
psychological and behavioral outcomes that can influence relationships. The parent and child
bond is impaired because when there is avoidance between them, it results in emotional numbing
which has been shown to create strain on the bond. They suggested that individuals with high
levels of PTSD related symptoms who are going through emotional numbing and avoidance are
at risk of being less satisfied with their parenting and have a poorer parent-child relationship
quality. In other cases, people with high level of PTSD show more intimate partner aggression,
poorer martial quality, and lower social support; these factors will lead to poor child outcomes
and there then arises a necessity to be in control of these variables.
Nye, Katzman, Bell, Kilpatrick, Brainard, and Haaland (2008) explore their studies on
attachment organization in Vietnam combat veterans with PTSD. Attachment organization is the
development of PTSD by determining individual differences in processing and coping strategies
for managing intrusive symptoms and physiological arousal following exposure to trauma. It is
also possible that the level of numbing that emerges among male combat veterans is more severe
or pervasive than the levels among civilian trauma victims (Lauterbach, Bak, Reiland, Mason,
Lute, & Earls, 2007). Simpson, Jacupcak, and Luterek (2006) indicated in their studies that the
individuals who show signs of weaknesses are likely to use substance such as alcohol to selfmedicate and perhaps to augment avoidance of trauma-related internal and external cue. Nye also
examines an important role in adult behavior which determines the individual differences in the
regulation of affective arousal, and behavioral responses. They compared the attachment
organization in a sample of combat veterans with PTSD to published non-clinical and clinical
samples. Then they examined the relationship between secure and insecure attachment
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organizations and the probability of being classified as unresolved/disorganized (U/d) with
respect to loss or trauma. Finally they try to find the association between U/d attachment and
PTSD severity. They survey forty-eight participants who are in Vietnam combat Veterans that
are diagnosed with PTSD and in treatment. Researchers use the Clinician-Administered PTSD
Scale (CAPS) to assess PTSD symptoms, which produce subscale scores for avoidance and
numbing symptoms. The result shows and provides support for U/d attachment that it would be
associated to severity of avoidance symptoms, but not symptoms of re-experiencing or
hyperarousal. This mean that the person who went through the Vietnam combat Veterans are
most likely to develop avoidance symptoms and may face the different range of stress response
syndromes.
Hyperarousal and Anxiety Symptom
A psychiatry definition of long term anxiety is a relatively permanent state of worry and
nervousness occurring in a variety of mental disorders, usually accompanied by compulsive
behavior or attacks of panic. On the other hand, anxiety by itself is defined as a vague unpleasant
emotion that is experienced in anticipation of some misfortune. There are many things that cause
anxiety in people. There are three main causes of anxiety which includes genetics, brain
chemistry, and environmental factors. Some scientists believe that is that anxiety can inherited
from family members. If your parents suffer from any form of anxiety, there is a chance you may
inherit the disorder. Scientists have concluded that anxiety may be associated with uncommon
levels of neurotransmitters in the brain. These abnormal levels can lead to anxiety. Further
studies are being made to investigate the relationship between the neurotransmitters and anxiety.
There are also some environmental factors that can trigger anxiety. Traumatic and stressful
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events are examples of environmental factors that can lead to developing anxiety. Rape and
sexual assault are examples of traumatic and stressful events that can cause anxiety to develop.
According to a study done by Taylor, McKay, Abramowitz, and Taylor (2010), in order
to diagnose PTSD, a person usually has to have some type of anxiety disorder. This implies that
if you have PTSD, you have some kind of anxiety disorder that contributed to you developing
PTSD. There are many studies that suggest that anxiety has negative health consequences to your
overall health. There two studies that demonstrate this point. Kendall-Tackett (2010) did a study
that shows that negative emotions such as anxiety, pessimism, hopelessness, anger, and shame
have negative effects on people’s health. Odlaug, Mahmud, Goddard, and Grant (2009) did
another study that demonstrated that the negative effects of anxiety are seen not only in
emotional and physical health but also through impairments in educational, social, and
occupational functioning, as well as in overall quality of life. The article also stated that people
with anxiety disorders have a more likelihood of being suicidal. Anxiety is a negative emotion to
feel and it has its negative effects on your overall health and life and these three studies validate
that.
According to a study by Weaver, Chard, Mechanic, and Etzel (2004), women that have
been sexually abuse and develop PTSD and anxiety disorders have a higher rate of self-injurious
behaviors which have also be linked with having more negative health problems. In another
study by Choi, Klein, Shin, and Lee (2009), women that are prostitutes have higher rates of
having been sexually abuse in their childhood and of having higher PTSD and anxiety
symptoms. In the study by Ozbaran, Eremis, Bukusoglu, Bildik, Tamar, and Ercan (2009),
children who have been sexually abuse and receive psychological care within the first year of
being abused tend to develop less symptoms of PTSD than others who do not. They also have
Common Symptoms of PTSD
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less self-injurious behaviors than those children that so not get psychological help within a year
of being abused. These two studies demonstrate that the negative effects of PTSD and anxiety
symptoms can be minimized when people get psychological help.
Anxiety is a symptom of having PTSD and so is increased emotional arousal. Symptoms
of category include: irritability or anger, overwhelming guilt or shame, self-destructive behavior,
such as drinking too much, trouble sleeping, being easily startled or frightened, trouble
concentrating and hearing or seeing things that aren't there. These symptoms are common in
people that have PTSD. Some people need therapy to help him/her control these symptoms.
These symptoms can get worst if there not taken care of in time. Some of the anxiety and PTSD
symptoms can damage your relationships with other people including you family members.
Anxiety affects people in so many levels and this is why more research should be done on this
subject. By figuring out how to control anxiety, we may figure out how to control other disorders
that have anxiety as a symptom. The discovery of how to control anxiety would be a medical
break though. This would get us one step closer to solving many psychological disorders.
Conclusion
Above we defined the disorder, gave examples of the different types of disorders, and the
significance of the three major categories of symptoms of PTSD. The three main categories
stated are intrusive memories, avoidance and numbing, and hyper arousal. There are a number of
factors that are in relation with the symptom of avoidance and numbing. Some of these factors
include substance abuse, being an immigrant, victims of religious/ethnic prosecution, especially
among women, being a combat veteran, being a college student with traumatic history, and the
quality of parental relationships among people who have been diagnosed with PTSD.
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The history of this disorder was also stated, more specifically where it derived from and
how it became more recognized within the psychological field within mental health. We used
relevant studies to gives example of how these symptoms affect the people suffering from PTSD.
Due to the fact that PTSD rooted from the Vietnam War soldiers, there is a sufficient amount of
studies done about war veterans and soldiers in relation to PTSD because of the constant
exposure to violence and duties done within war that soldiers were under the extreme pressure to
do. In addition to being involved in the war, PTSD can increase depending on the way they are
treated when they go back home.Within our studies, we found that not all symptoms were
prevalent in people that suffer from PTSD. Some people may only experience certain symptoms
from one or two of the three main categories of PTSD, while others may experience all of the
three main categories within different severity levels.
However, a number of the studies are done with limitations. Consequently, the results
found in the study are limited as well. In regards to anxiety, anxiety is a highly common
symptom within in those who suffer from PTSD. This is prevalent within all of the studies found
on anxiety and hyperarousal of PTSD. Intrusive memories are almost unavoidable. Once the
victim has been exposed to the traumatic event, the memories of what occurred stay within the
mind. It is about being able to cope with the intrusive memories within everyday living. All of
the above symptoms are sometime easily identified, while others are not, depending on the
severity of the symptoms and how many of them occur in one person.
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References
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Choi, H., Klein, C., Shin, M., & Lee, H. (2009). Posttraumatic stress disorder (PTSD) and
disorders of extreme stress (DESNOS) symptoms following prostitution and childhood
abuse. Violence Against Women, 15(8), 933-951. doi:10.1177/1077801209335493
Ehlers, A., Hackmann, A., Steil, R., Clohessy, S., Wenninger, K., & Winter, H. (2002). The
Nature of Intrusive Memories After Trauma; The Warning Signal Hypothesis. Behaviour
Research and Therapy, 40, 995-1002.
Ehlers, A., & Clark, D. M. (2000). A Cognitive Model of Post Traumatic Stress Disorder.
Behaviour Research and Therapy, 38, 319-345.
Elhai, J. D., Gray, M. J., Docherty, A. R., Kashdan, T. B., & Kose, S. (2007). Structural validity
of the posttraumatic stress disorder checklist among college students with a trauma history.
Journal of Interpersonal Violence, 22(11), 1471-1478. Retrieved from
http://dx.doi.org/10.1177/0886260507305569
Kendall-Tackett, K. (2010). Depression, hostility, posttraumatic stress disorder, and
inflammation: The corrosive health effects of negative mental states. Washington, DC, US:
American Psychological Association. Retrieved from PsycINFO
Lauterbach, D., Bak, C., Reiland, S., Mason, S., Lute, M. R., & Earls, L. (2007). Quality of
parental relationships among persons with a lifetime history of posttraumatic stress disorder.
Journal of Traumatic Stress, 20(2), 161-172. Retrieved from
http://dx.doi.org/10.1002/jts.20194
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Norris, A. E., & Aroian, K. J. (2008). Avoidance symptoms and assessment of posttraumatic
stress disorder in arab immigrant women. Journal of Traumatic Stress, 21(5), 471-478.
Retrieved from http://dx.doi.org/10.1002/jts.20363
Nye, E. C., Katzman, J. W., Bell, J. B., Kilpatrick, J., Brainard, M., & Haaland, K. Y. (2008).
Attachment organization in vietnam combat veterans with posttraumatic stress disorder.
Attachment and Human Development, 10(1), 41-57. Retrieved from
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Odlaug, B. L., Mahmud, W., Goddard, A., & Grant, J. E. (2010). Anxiety disorders. In J. E.
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Ozbaran, B., Erermis, S., Bukusoglu, N., Bildik, T., Tamar, M., Ercan, E. S., et al. (2009). Social
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Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992). A Prospection of
Post-Traumatic Stress Disorder in Rape Victims. Journal of Traumatic Stress, 5(3), 455475.
Simpson, T. L., Jakupcak, M., & Luterek, J. A. (2006). Fear and avoidance of internal
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139-153). Washington, DC, US: American Psychological Association. Retrieved from
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Memories. J Behav Ther Exp Psychiatry. 2009 Jun;40(2):189-201. Epub 2008 Sep 9.
Vickers, B. (2005). Cognitive Model of the Maintenance and Treatment of Post-Traumatic Stress
Disorder Applied to Children and Adolescents. Clinical Child Psychology and Psychiatry,
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Weaver, T. L., Chard, K. M., Mechanic, M. B., & Etzel, J. C. (2004). Self-injurious behaviors,
PTSD arousal, and general health complaints within a treatment-seeking sample of sexually
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doi:10.1177/0886260504262965
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Marivel did research and wrote about one of the three PTSD symptoms. Her symptom
was anxiety and hyperarousal. She also found articles based on the symptom and mentioned
them within our literature Review.
Khae did research and wrote about one of the three PTSD symptoms. Her symptom that
she researched was avoidance and numbing. She also found articles in relation to the symptom.
Analicia did research and wrote about of the three PTSD symptoms. Her symptom was
intrusive memories. She also found articles in relation to intrusive memories. She put the paper
together and printed it out as well.