How To Manage Severe PTSD In Everyday Life

Living through a traumatic event can be difficult, often leading to various challenges with mental health. For some, traumatic experiences may lead to post-traumatic stress disorder (PTSD), with the memory of the event continuing to affect everyday life long after it has passed. Symptoms can include flashbacks, nightmares, and severe anxiety, all of which can seem as real as the traumatic event itself. 

While some individuals may experience mild symptoms of PTSD that ebb and flow over time, others may experience more intense and persistent symptoms of PTSD. Those struggling with severe PTSD often find daily life more challenging, as their symptoms tend to be more frequent and debilitating. The condition can disrupt not only their sense of peace but also their abilities to connect with others and engage in their usual activities or responsibilities. However, severe PTSD can be addressed and managed with therapy, medication, self-care, and social support.

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What is severe PTSD?

Severe PTSD can develop when an individual undergoes extreme levels of stress following a traumatic event or series of events. While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not categorize PTSD into severity levels like mild or severe, clinicians often use the term “severe PTSD” to describe cases in which symptoms notably affect an individual's day-to-day activities.

Symptoms of severe PTSD may include the following:

• Persistent flashbacks or intrusive thoughts related to the traumatic event
• Intense and prolonged periods of distress or physical reactions, such as being easily startled or experiencing a racing heart
• A strong desire to avoid anything reminiscent of the trauma, including thoughts, feelings, or conversations about the event

The severity of PTSD can fluctuate

Types of post-traumatic stress disorder

Individuals can develop PTSD in various forms, each with potentially different symptoms and triggers. Recognizing various types of PTSD may help individuals find the right treatment and support. Some types of PTSD may be more severe than others.

Acute stress disorder

Acute stress disorder can be seen as a short-term condition that can develop after a person experiences a traumatic event, such as sexual assault or a car accident. Symptoms tend to be similar to PTSD but occur immediately after the event and last anywhere from three days to one month. The individual may experience flashbacks, nightmares, and a heightened startle response. If symptoms persist after one month, they may indicate the presence of PTSD.

Uncomplicated PTSD

Characterized by the presence of PTSD symptoms related to a single traumatic event, uncomplicated PTSD is usually more straightforward to diagnose and treat compared to other types. Individuals may experience persistent reliving of the trauma, avoidance of reminders, and mood changes. This type does not typically involve the severe dissociative symptoms seen in other forms.

Complex post-traumatic stress disorder

Complex PTSD often results from prolonged or repeated trauma, such as childhood abuse. This form may involve symptoms like trouble regulating emotions, mistrust in relationships, and a distorted self-perception. The complexities of these symptoms often require a comprehensive treatment approach. 

Comorbid PTSD

Comorbid PTSD can occur when an individual with PTSD also lives with other psychiatric disorders, such as anxiety or depression. This coexistence can amplify the struggle individuals face and complicate the treatment process. Individuals with comorbid PTSD often need a treatment plan that manages both PTSD and the accompanying mental health concerns.

Tools for measuring the severity of PTSD

Determining the severity of PTSD can often help in obtaining appropriate care. A range of standardized tools can help mental health professionals measure the impact of trauma and influence treatment approaches.

PTSD Checklist for DSM-5 (PCL-5)

The PCL-5 is a common 20-item questionnaire that can identify and measure PTSD symptoms. It generally follows the DSM-5 criteria for PTSD and is used by patients to report their symptoms. Practitioners may use this tool alongside others to diagnose PTSD and monitor treatment progress.

The PCL-5 can be used to:

• Measure symptoms over time
• Screen for PTSD
• Help make a provisional diagnosis
  

However, it should not be the only method used for diagnosis. Clinicians should also conduct interviews and use other structured tools, like the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), to confirm PTSD.

PTSD Symptom Scale Self-Report Version (PSS-SR)

The PSS-SR is a 17-item Likert-scale questionnaire that helps individuals self-report the severity of their PTSD symptoms based on DSM-5 criteria. The PSS-SR covers four subscales: re-experiencing, avoidance, arousal, and a total score. A score of 13 or higher usually suggests the presence of PTSD. Clinicians can use the PSS-SR to track changes in symptom severity over time. However, it can be crucial to consider other risk factors and assessments for a thorough evaluation.

National Stressful Events Survey PTSD Short Scale (NSESSS)

The NSESSS is a nine-item measure for adults aged 18 and above, assessing the severity of PTSD following highly stressful experiences. It's meant to be completed by individuals after a PTSD diagnosis or when significant PTSD symptoms are present before subsequent appointments with the clinician. Each item asks the individual to rate their PTSD severity in the past seven days on a five-point scale. Scores on the measure range from zero to 36, with higher scores indicating more severe PTSD symptoms. 

Clinician-Administered PTSD Scale (CAPS-5)

The CAPS-5 is a detailed 30-item interview widely recognized for PTSD assessment. It can help diagnose current and past PTSD, evaluate symptoms over the last week, and look at how these symptoms affect daily life. The interview usually covers various areas, like symptom onset, distress levels, impact on work and relationships, and overall severity. It's primarily designed for clinicians or researchers familiar with PTSD but can also be used by trained assistants. The interview typically takes 45 to 60 minutes and includes questions about traumatic events to guide symptom assessment.

A mental health professional may use more than one tool to assess the severity of PTSD in an individual. Although some tests may be self-administered, it can be important to seek guidance from a healthcare professional. Only a licensed mental health professional can provide an official diagnosis.

How to manage severe PTSD and improve mental health

Severe PTSD can deeply affect one's life, but there are effective strategies to manage the condition. Individuals often work through their symptoms with the guidance of mental health professionals, incorporating therapy, medication, and self-care practices to improve their mental health after a traumatic event.

Learn how to manage severe PTSD in therapy

Therapy can be seen as a cornerstone in treating PTSD. It usually involves working with a licensed therapist who helps individuals process the traumatic event and learn coping strategies to improve mental health. Different types of therapy that can be effective for treating PTSD include the following:

• Cognitive behavioral therapy (CBT): Usually focuses on changing unhelpful patterns of thinking and behavior
• Prolonged exposure therapy: Can help clients face their trauma-related memories and feelings
• Eye movement desensitization and reprocessing (EMDR): Typically uses guided eye movements to help individuals process and integrate traumatic memories

These therapies generally aim to reduce trauma avoidance symptoms and improve mood symptoms, along with addressing other common challenges in people with PTSD.

Talk to your doctor about treatment through medication

Medication may also play a role in managing severe PTSD. Psychiatrists and doctors can prescribe various medications to address certain symptoms. These medications can be particularly helpful when combined with therapy.

Practice self-care to support your mental health

Self-care can also be key for maintaining mental health and treating PTSD. Some self-care strategies include those listed below:

• Routine exercise can alleviate stress and improve mood.
• Regular sleep habits may help manage PTSD symptoms.
• Mindfulness and relaxation techniques, such as yoga or meditation, may reduce hyperarousal symptoms.

Engaging in hobbies and staying connected with loved ones can also promote positive emotions and reduce feelings of isolation.

Finding support for severe PTSD

Managing severe PTSD often involves finding appropriate support. Individuals may benefit from a range of therapy platforms, support groups, and online resources. Support groups can provide a space where those with PTSD can share experiences and coping strategies, often leading to validation and communal support.

How online therapy can help

Online therapy platforms may also be valuable resources. A 2020 study reported that online therapy could be an effective option to treat PTSD, and it could also increase accessibility to care. 

Online therapy typically offers flexibility, which may make it easier for individuals with severe symptoms to seek help. The convenience of accessing care from home can help those who might otherwise be overwhelmed or anxious about face-to-face appointments.