What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder (PTSD) is a psychological health disorder that some individuals develop after they experience or see a traumatic event. The traumatic event may be life-threatening, such as natural disaster, combat, a car accident, or sexual assault. But sometimes, the event is not necessarily a dangerous one. For example, the sudden, unexpected death of a loved one can also cause PTSD.
It’s normal to feel afraid during and after a traumatic event. The fear triggers a “fight-or-flight” response. This is the body’s way of helping to protect itself from possible harm. In addition, it causes changes in your body, such as releasing certain hormones and increases in alertness, blood pressure, heart rate, and breathing.
In time, most people recover from this naturally. But people with PTSD don’t feel better. Instead, they feel stressed and frightened long after the trauma is over. In some cases, the PTSD symptoms may start later on. They might also come and go over time.
According to the National Institute of Health (NIH) , researchers don’t know why some people get PTSD and others don’t. Genetics, neurobiology, risk factors, and personal factors may affect whether you get PTSD after a traumatic event.
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Risks of PTSD
People can develop PTSD at any age. However, many risk factors play a part in whether you will develop PTSD. They include:
- Having had trauma in childhood
- Your sex; women are more likely to develop PTSD
- Having a history of mental illness or substance use
- Feeling horror, helplessness, or extreme fear
- Going through a traumatic event that lasts a long time
- Having little or no social support after the event
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
Can You Develop PTSD from Emotional Abuse?
Post Traumatic Stress Disorder (PTSD) is a mental condition usually connected with war and very little else. The name itself suggests the image of a man in distress, coming home from war, and struggling to re-acclimate to civilian life. While this image may be actual, it is a limited view of PTSD and neglects to account for the countless events that can cause PTSD.
While war certainly qualifies as an unbelievably traumatic, stressful experience, the human body was not designed to withstand an extended period of abuse, intense fear, or intense stress and can develop the symptoms of PTSD in response to any one of these conditions.
PTSD can develop from emotional abuse. This is because emortional abuse is often not a single event, but a recurring cycle of behavior. PTSD from emotional abuse often does not follow the standard cycle, but instead falls into the category of “complex PTSD,” or PTSD that stems from multiple traumatic instances, rather than just one.
While a person with PTSD following a car accident might avoid cars altogether, or drive as recklessly and quickly as possible-or a back-and-forth of the two-people with complex PTSD are not working or reliving through a single event, but a compounding event that builds upon abuse, trauma, and neglect, again and again.
PTSD from emotional abuse often requires far more thorough treatment, as the person is not working to recover from a single event but from what can be a lifetime of emotional abuse. Each trauma a person has endured must be processed and healed from, so recovery can not only require an extensive period of therapy but can require you to create solid and firm boundaries regarding their relationships with family, as a family is often the source of emotional abuse.
Many individuals close to you and your partner will be unable to see the emotional abuse and may not understand your perspective. Compounding trauma is not impossible to recover from but does demand a lot of introspection, rewiring, and healing. For this reason, if it is possible, individuals are encouraged to remove themselves from the source of the emotional abuse during treatment, to make sure harmful thought patterns and experiences do not hinder the healing process.
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How Can Emotional Abuse Cause PTSD?
Emotional abuse involves someone emotionally manipulating another. It can include words and actions to control, insult, frighten, or isolate.
Examples of emotional abuse include:
- Taking away your freedom and privacy
- Expecting to know your whereabouts and activities at all times
- Frightening you with anger
- Separating you from loved ones, work, and activities
- Threatening you and those you love
- Humiliating and belittling you
Emotional abuse can be a form of mental trauma that can have a similar impact on the nervous system as physical trauma. The form of PTSD most commonly linked with emotional abuse is called “compounding” or “complex” PTSD, as it shows symptoms from a cycling series of traumatic events, rather than a single, stark event.
This makes the treatment for PTSD markedly more difficult, as clients are required to work through what could be a lifetime of abuse, trauma, and reactive behaviors that have come to be seen as expected and normal, often creating a vicious cycle of abuse, freedom, and abuse.
Effects of PTSD From Emotional Abuse
According to the U.S. Department of Health & Human Services , experiencing emotional abuse or other trauma puts people at risk of developing mental health conditions, such as:
- Anxiety disorders
- Post-traumatic stress disorder
- Misusing alcohol or drugs
- Borderline personality disorder
Emotional abuse may have happened during childhood or as an adult. Abuse can be verbal, emotional, physical, or sexual. Trauma can include dangerous, frightening, or extremely stressful situations or events, such as sexual assault, war, an accident or natural disaster, the sudden or violent death of a close loved one, or a serious physical health problem.
The long-term effects of PTSD from emotional abuse can include:
- Severe anxiety, stress, or fear
- Abuse of alcohol or drugs
- Eating disorders
The sooner the person can get professional help for PTSD from emotional abuse, the sooner they can start to get better. If the person is experiencing changes in how they think, feel, or behave that are interfering with their ability to work or live their life normally, reach out to a mental health professional.
A mental health professional can help make sense of any symptoms the individual may be having that are related to their PTSD from emotional abuse. The professional can help them find the best kinds of treatment to help manage symptoms of PTSD from emotional abuse.
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PTSD From Emotional Abuse Leading to Substance Abuse
Traumatic life experience, such as physical and sexual abuse and neglect, happen at alarmingly high rates and is considered a significant public health problem in the United States. Early trauma exposure is well known to significantly increase the risk for several psychiatric disorders in adulthood. Moreover, early traumatic experiences may increase the risk of substance use disorders (SUDs) because of attempts to self-medicate or dampen mood symptoms associated with a dysregulated biological stress response.
According to the National Center for Biotechnology Information (NCBI) , exposure to traumatic experiences, especially those occurring in childhood, has been associated with substance use disorders (SUDs), including dependence and abuse. Substance use disorders are also highly comorbid with Post-traumatic Stress Disorder (PTSD) and other mood-related psychopathology.
The level of substance use, particularly cocaine, strongly correlated with levels of physical, sexual, and emotional abuse and current PTSD symptoms. In particular, there was a significant additive effect of a number of types of trauma experienced with a history of cocaine dependence in predicting present PTSD symptoms.
It was found that drug and alcohol consumption was associated with more significant PTSD symptoms one year after the traumatic event. Additionally, women who used drugs were found to have significantly higher mean scores for total PTSD symptom severity and were more likely to meet the criteria for a diagnosis of PTSD compared to non-users .
The Role of Addiction in PTSD
Chemical dependency is often described as an attempt at self-regulation, not so different from self-injury other types of trauma-related impulsive behavior. From this perspective, we come to see that addiction is a result of an attempt to ward off intrusive memories, smooth out hypervigilance, and disconnect from anxiety.
When alcohol or drugs are used to manage PTSD symptoms, the disorder’s symptoms only become more severe. As a central nervous system (CNS) depressant, alcohol and opiates can worsen depression and anxiety and interfere with standard sleep patterns.
We might mistakenly believe that treating PTSD will stop alcohol and drug abuse. However, substance abuse may continue to persist. This is because the substance has hijacked the reward system, causing the person to develop enduring tolerance (need more of the drugs or alcohol to get the same effect) and withdrawal (physical discomfort and consequences when drugs or alcohol use stops) symptoms.
For these reasons, substance use disorder issues must always be addressed simultaneously in PTSD recovery because substance abuse will consistently threaten all other treatments by impairing memory, perception, and judgment.
Furthermore, PTSD from emotional abuse issues should always be addressed simultaneously in addiction recovery, given that the presence of PTSD from emotional abuse symptoms makes alcohol and drug abuse much more likely.
Successful recovery requires the individual to understand how the addictive substances have helped them survive: which trauma symptoms they have been attempting to treat through drinking and drugging. We need to know this because the trauma symptoms will increase when we enter sobriety, and we will need coping strategies to manage the triggers of PTSD from emotional abuse when they appear. Therefore, relapse prevention plans must create strategies to manage both addiction and PTSD from emotional abuse symptoms and triggers.
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PTSD From Emotional Abuse and Addiction Treatment
In the past, it was normal to treat comorbid PTSD and addiction separately. In fact, addiction or substance use disorder was usually treated first, and the treatment of PTSD will be delayed until the person was sober for a period of time.
Now, treatment programs have changed. The integrated model of treatment is used to address both substance abuse and PTSD at the same time. The individual may see the same clinician for both treatments rather than seeing two separate professionals.
This program serves to address the complexity of comorbid symptoms since some may overlap. Furthermore, the individual can address emotions and triggers linked with their addiction, which can help maintain and foster recovery.
What Is Dual Diagnosis?
The exact definition of dual diagnosis (also referred to as co-occurring disorders) can differ between institutions. However, it is generally defined as the specific treatment of someone who has been diagnosed with having a substance abuse disorder and a mental health disorder at the same time. There is no distinction of whether the mental condition led to substance abuse or vice versa.
Addiction treatment professionals understand that mental health and substance abuse have a complex relationship that is difficult to extricate from one another.
While there is no single best treatment for comorbid PTSD and addiction, research has shown that successful dual-diagnosis treatment uses an integrated approach. Standard therapeutic approaches include cognitive-behavioral therapy (CBT), cognitive processing therapy (CPT), and prolonged exposure therapy (PET) .
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 NIH – https://medlineplus.gov/posttraumaticstressdisorder.html
 U.S. Department of Health & Human Services – https://www.womenshealth.gov/mental-health/abuse-trauma-and-mental-health
 NCBI – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/
 NIMH – https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
 SAMHSA – https://www.ptsd.va.gov/understand_tx/tx_basics.asp