The symptoms of PTSD aren't necessarily as straightforward as we may think, and there may be additional complexity to it that needs to be recognized.

The first reference I ever saw to a mental health disorder, PTSD, was right after the Vietnam War, when a young military psychiatrist wrote a thin paperback intended for professionals. I had never heard of this disorder, and, I suspect, neither did many others, but wasn't there a disorder during World War II, Shell Shock?

Words like “soldier’s heart,” “shell shock,” and “war neurosis” originated in earlier battles. That second diagnosis was the same as the névrose de guerre and Kriegsneurose that were used in the scientific literature of Germany and France.

PTSD isn't a recent phenomenon; it has a history associated with it. Beginning in the American Civil War (1861–1865) and the Franco-Prussian War (1870–1871), there were official medical efforts to treat the issues faced by combat veterans. An additional contribution to our prior knowledge of trauma-related disorders came from European accounts of the mental effects of train accidents.

Today, it is not unusual for people in car, plane, or railroad accidents or natural disasters, such as floods, volcanic eruptions, or wildfires, to have PTSD. I once worked in a healthcare practice where many individuals with PTSD after car accidents came for therapy.

The first person I had ever known who received a diagnosis of Shell Shock after he returned from World War II was a friend’s relative. The man felt so overwhelmed with anxiety when they shipped him overseas to join the battle that he couldn't disembark from the landing craft and experienced absolute panic.

Instead of sending him to the front line, they sent him to a military hospital and then immediately shipped him home. Once he returned to his home, he never left the house for the rest of his life. He received no treatment and no medication because he and his family saw it as a horrific shame on all of them. When he required a haircut, the barber came to the house. Anxiety disorders ran in the family, and several of them experienced shy bladder syndrome, also known as paruresis.

The following person I would meet, who had PTSD, was a woman who narrowly escaped death during the attack on the Twin Towers on September 11, 2001, in New York City, where she worked. Her fear was so great that she could not enter Manhattan from the state nearby where she lived, and she said it was impossible to even think about visiting the memorial built there.

Typically, while walking in her neighborhood, something would trigger fear and panic, and she would try to hide in a store doorway or against a wall. She had atypical fits of anger and prejudice toward people of different ethnicities, something she had never experienced before. Even volunteering at a church food pantry became too much for her.

Imagine how this affected her; she never returned to work. Tragically, she contracted three different cancers from exposure at the site of the attack on that day, and she died because of them.

The usual symptoms of PTSD are well-known and documented in the literature, as well as in the DSM (Diagnostic and Statistical Manual of Mental Disorders). The National Institute of Mental Health delineates them as follows:

“To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognitive and mood symptoms

Re-experiencing symptoms

• Flashbacks — reliving the traumatic event, including physical symptoms, such as a racing heart or sweating
• Recurring memories or dreams related to the event
• Distressing thoughts
• Physical signs of stress

Thoughts and feelings can trigger these symptoms, as can words, objects, or situations that are reminders of the event.

Avoidance symptoms

• Staying away from places, events, or objects that are reminders of the experience
• Avoiding thoughts or feelings related to the traumatic event

Avoidance symptoms may cause people to change their routines. For example, some people may avoid driving or riding in a car after a serious car accident.

Arousal and reactivity symptoms

• Being easily startled
• Feeling tense, on guard, or on edge
• Having difficulty concentrating
• Having difficulty falling asleep or staying asleep
• Feeling irritable and having angry or aggressive outbursts
• Engaging in risky, reckless, or destructive behavior

Arousal symptoms are often constant. They can lead to feelings of stress and anger and may interfere with parts of daily life, such as sleeping, eating, or concentrating.

Cognition and mood symptoms

• Trouble remembering key features of the traumatic event
• Negative thoughts about oneself or the world
• Exaggerated feelings of blame directed toward oneself or others
• Ongoing negative emotions, such as fear, anger, guilt, or shame
• Loss of interest in previous activities
• Feelings of social isolation
• Difficulty feeling positive emotions, such as happiness or satisfaction

Cognition and mood symptoms can begin or worsen after the traumatic event. They can lead people to feel detached from friends or family members.”

However, we now realize that the symptoms of PTSD may not be as straightforward as we had thought. The disorder appears to be more complex and may affect more people who have not been diagnosed with it. The additional symptoms now being considered to be in this diagnosis include: “feelings of worthlessness, shame, and guilt, problems controlling your emotions, finding it hard to feel connected with other people, relationship problems, like having trouble keeping friends and partners.”

It goes without saying, that anyone who would be involved in a terrifying experience, such as a school shooting or being present in a war zone, being a victim of sexual or child abuse, domestic violence, or having been harmed in some way by someone you trusted might have the disorder. Each instance can implant that fear and anxiety response that we have seen in similar situations, however, usually in wartime. We might think of these episodes as a different type of war that battles in our brains.

Children are not exempt from this diagnosis, but it may not be accurately applied. It is easy to mistake the signs of traumatic stress for those of attention-deficit/hyperactivity disorder (ADHD) in youngsters because both conditions can make affected children seem clumsy and irritable. To avoid excluding experiences of trauma that might be distasteful, interviewers must take care during any health or mental health evaluation. There should be no age exclusion criteria in this regard.

Various treatments are available for those affected, and new therapies are also being explored to help relieve those with these symptoms since they can be life-changing. No one should suffer needlessly or feel ashamed because they are experiencing these symptoms. They've been in a battle for their sanity, and now it is time to heal, and the healers must be available for them.