Updated: 5 days ago
Specific types of trauma, related stigma, and cultural influences may affect women in a specific way.
The overall symptoms of PTSD (post-traumatic stress disorder) include intrusive memories of a trauma, avoiding thoughts and memories about it, feeling on edge, and having strong negative thoughts about yourself and the world.
Women may suffer more with all of these. They are twice as likely to develop PTSD as compared to men, and are more likely to blame themselves and develop depression afterwards.
Here’s a closer look at what this disorder is, how professionals screen for it, how women may experience things differently, and the criteria used to ultimately make a diagnosis.
What is PTSD?
PTSD refers to a combination of experiences that some people experience following a trauma. The symptoms may start immediately after the trauma, several weeks later, or in some cases months or years later. They center around fears that the trauma, or a similar event, is likely to occur again.
Experts believe this disorder develops when an individual has difficulty making sense of a trauma, resulting in them having a hard time feeling safe again. They may have unrealistic fears that something similar will happen again (even against all evidence to the contrary), or that they won’t be able to handle any difficult event in the future.
Common examples of a trauma include surviving a car accident, a sexual assault, or active combat. However, any event that led to a fear of death or to one’s physical or emotional safety may be considered a trauma.
Women are more likely to experience a sexual assault, which more often leads to post-traumatic stress. This may be one reason women develop this disorder more often than men.
Because they feel unsafe, someone with the condition might react as if they’re constantly in a life-or-death situation, leading to the resulting symptoms.
Not every trauma causes PTSD, but every case of PTSD relates to a trauma.
Someone with the disorder may have defensive reactions that are out of proportion for a situation. For example, they may feel in extreme danger while at places or in situations that are unlikely to be harmful.
There are four broad categories of symptoms, and numerous possible experiences under each criteria. Mental health professionals commonly use a screen called the PTSD checklist (PCL-5) to measure these symptoms.
The screen, developed by the VA, breaks down the symptoms into 20 experiences someone might have following a trauma. The questions are listed on a one-page screen that’s given to patients to fill out. This form is then used within a broader assessment to diagnose, or rule out, the condition. The items in this screen are listed below.
17 or 20 Symptoms?
Many people are familiar with the idea that there are 17 symptoms that experts look for to make this diagnosis. The number comes from the original version of the PCL screen, then called the PCL-C. These 17 questions were based on a previous version of the DSM, the manual used to make mental health diagnoses.
In recent years, the screen has been updated, and is now referred to as the PCL-5. The “5” references the DSM-5, the newest version of the diagnosis manual.
The screen now includes 20 questions. Most of the original questions are included in the new screen, although a few have been updated or removed, and new questions have been added.
The more recent screens use are based on today’s understanding of the condition. The infographic above includes a list of the 20 symptoms screened for in the PCL-5, based on, and named after, the DSM-5.
These symptoms are paraphrased from the original source by the VA, available in the public domain. Remember that reviewing this screen doesn’t confirm that you do or don’t have a mental health diagnosis. It should be administered by a professional as part of a larger assessment. And if you do find you have this condition, there are fortunately treatments that can help.
While the PCL-5 and similar screens are a good start to identifying PTSD, they’re just the beginning. Let’s look further at how clinicians diagnose this condition, along with the treatment choices available.
Some therapists or doctors may use one screen, several screens, or may simply ask verbal questions about symptoms. This depends on the approach, training, and experience of the clinician.
Simply scoring high on any symptom screen doesn’t necessarily mean someone has a disorder. The therapist will also need to rule out other conditions, such as general anxiety disorder or depression, which have overlapping symptoms.
For example, someone with a past trauma may have high anxiety, and therefore believe they probably have PTSD. Their previous bias may affect how they respond to the questions. Or, the wording of the questions, distractions while completing the screen, or anxiety symptoms may influence the accuracy of their scores.
Because of these factors, the mental health professional will often probe further into what a patient is experiencing. They will likely ask more about thoughts relating to the trauma and how symptoms are experienced in everyday life.
At some point, they may also ask about details of the past trauma as part of the diagnosis, or to determine the best type of treatment.
Most professionals believe it’s important to get as accurate a diagnosis as possible, because this affects the type of treatment provided.
Stigma for Women
It's difficult for anyone with this condition to talk about their trauma. It may be even more difficult if the type of trauma carries a stigma, or a history of blaming the victim.
This is often the case for women who've experienced sexual assault. Such women may also be mistreated by authorities or accused of bringing the assault upon themselves. Due to this common occurrence, they may feel more uncomfortable reporting these crimes.
PTSD is diagnosed based on specific symptom criteria, or clusters. While symptom screens cover many possible symptoms, each of those questions fall within larger categories.
These clusters include having experienced a trauma, having intrusive symptoms, avoidance, depression-like symptoms, and heightened reactions (such as hypervigilance). A person must continue to experience the symptoms over time, and it must have a negative impact on their life.
Here’s a look at each of the broader criteria for post-traumatic stress disorder from the DSM-V:
Experiencing a Trauma
Many of these symptoms may be present with other conditions, such as general anxiety disorder. However, in the case of PTSD, the reactions are based on experiencing trauma.
Mental health professionals look for a connection between the symptoms and the trauma itself. For example, intrusive memories would be related to the event that’s causing the symptoms. Hypervigilance symptoms would have started following the trauma. In some cases, symptoms present immediately after, while in others they could come on years and months later.
Women are more likely to experience interpersonal traumas, such as sexual assault, rape, or domestic violence.
Intrusive symptoms are, as they sound, intrusive. A person may be going about their day, even feeling well, and suddenly thoughts of the trauma pop in. They might be triggered by a reminder, or may come up for no apparent reason.
Other intrusive symptoms might include disturbing dreams, or feeling a strong sense of panic or anxiety when reminded of the trauma. These symptoms are measured in questions 1 through 5 on the 20-item scale above.
One key difference between PTSD and other anxiety-related disorders relates to avoiding thoughts relating to a trauma. Sometimes people go out of their way to avoid conversations, reminders, memories, and any person, place, or thing that reminds them of what happened.
Women in particular may try to avoid thoughts of their trauma. This makes sense in the short term, but over time it becomes harder and harder to avoid reminders, and life begins to revolve around the trauma, even as you’re trying to avoid it. Questions 6 and 7 above relate to avoidance.
Symptoms similar to depression also present with a diagnosis. In fact, many people are also diagnosed with major depression disorder. However, these symptoms typically clear up as the underlying effects of the trauma better.
One factor that perpetuates PTSD seems to be negative thoughts about the trauma, especially relating to guilt and blame. Because people blame themselves for what happened, they may begin to feel doubt and shame in general. They may feel they are unworthy to be in the world, or that they’ll continue to put themselves or others in danger.
These constant thoughts may lead to isolation, negative beliefs about the world, and loss of interest in things that used to be important. These symptoms are measured in questions 8 through 14 above.
One of the most obvious signs is a heightened startle response, or near constant hypervigilance. Experts call these “arousal” symptoms, because they arouse the body’s defensive reactions.
Women might feel more jumpy, experience paranoia in public places, or feel easily irritated by others, especially if they feel close or intrusive. You may also feel ungrounded, or dissociate in the moment.
Often people describe needing to always see an exit, not being able to stand with people behind them, or feeling on edge even in previously safe places. These symptoms are measured in questions 15 through 20 above.
In the case of most mental health diagnoses, symptoms must have a negative impact on the person’s life. In most cases, someone with severe symptoms will report that it is interfering with at least some aspect, such as their personal, work, or social life. Women may be more likely to report that it interferes with dating or intimate relationships.
To make a diagnosis, symptoms must be present a month or more following the trauma. That’s because having such symptoms within days to a few weeks after a trauma may be a normal part of adjusting after the event and often clear up on their own. The symptoms may have started immediately and continued for over a month, or may start later.
Adding up the Criteria
A clinician will take these symptoms into account along with a patient’s personal history, medical conditions, and other mental health symptoms. Once it’s determined that all symptoms are present, and not caused by something else, they may make a diagnosis.
Missing or Misdiagnosing
As mentioned, sometimes PTSD is confused for other conditions, or may be missed by a professional. Even experienced therapists sometimes miss or confuse mental health signs and symptoms, and may change their diagnoses over time.
For example, if someone reports high anxiety, but not a trauma, a PTSD screen may not be used. They may be avoiding riding in cars, and may be diagnosed with a phobia.
Later, it may come to light that the person stopped riding in cars after they were in an accident. In this case, it may be wise to screen for post-traumatic stress. This clarification matters, because certain treatments work better for one condition versus another.
In a reverse situation, a doctor or therapist may assume that someone who avoids riding in cars must be doing so because of a previous accident. However, it may later be apparent that they don’t have intrusive memories of the trauma, and don’t avoid thinking about the accident.
In this case, they still have extreme anxiety when getting near a car. Following this realization, the person may then be diagnosed with another condition, such as a phobia of cars or driving. In that case, a more appropriate treatment can be recommended.
In other cases, medical conditions such as a head injury or dementia could have symptoms that look similar to post-traumatic stress. This is why it’s important to examine all areas of a person’s life to make a final determination.
Treatments that Relieve Symptoms
Once a woman is diagnosed with PTSD, there are few possible next steps. A professional might refer the patient for therapy, medication, or both. They might suggest that they wait it out, and see if things get better. They might also recommend ways to manage the symptoms, such as anxiety coping skills.
There are mental health professionals with advanced training who specialize in post-traumatic stress disorder. While any doctor or therapist may treat the condition, many believe these experts are the most appropriate to help with symptoms.
There is a misconception that PTSD is untreatable, and a lifelong condition. Even some mental health clinicians, along with medical professionals, are under this impression. While it’s true that some people do suffer for years, there are several treatments shown to help a majority of people get better. And, even those who’ve had the condition for decades may benefit from such targeted treatments.
Many mental health professionals are considered “generalists” or use what’s called an “eclectic” approach. Often these therapists believe that treatment should be more individualized, and modified for the current needs of the client.
They may believe that structured approaches, such as those outlined below, are too impersonal and not focused enough on the healing relationship with the therapist.
Others who specialize in this area may agree with these sentiments to a point, but their experience with treating the condition may give them a different perspective. The VA, arguably the organization that’s studied trauma the most, recommends these structured approaches, also called evidence-based treatments.
Often, individuals can be entirely free from symptoms, and would report low to zero scores on the 20-question screen included above. These effective treatments typically work within a few months or less.
Here’s a look at the most common, and most effective, treatments currently used.
Cognitive Processing Therapy
Cognitive processing therapy (CPT) is one of the most common and successful treatments for this condition. It involves identifying “stuck points,” or negative beliefs relating to the trauma, and challenging these.
Over time, the client begins to understand that they were not the cause of the trauma, and that they are able to function safely in the world. In some cases, this treatment also involves writing a narrative of what happened, to help them further process and stop avoidance techniques that interfere with recovery.
Prolonged exposure (PE) therapy is also based on countering avoidance patterns. Clients are asked to retell the story of the trauma repeatedly, and listen to recordings of their story. The therapist then helps them understand their experiences and beliefs that come up during this exposure. Meanwhile, they are desensitized to their memories. Over time, PE clients are also able to work through negative thoughts and guilt relating to the trauma.
Once again, this therapy involves remembering the events of the trauma. EMDR stands for Eye Movement Desensitization and Reprocessing. During this treatment, clients think about the trauma while stimulating both sides of the brain, thought to help them process the memories more easily. EMDR therapists also help clients come to new beliefs and realizations about what happened.
All three of these therapies are focused on desensitizing the individual to the memories of the trauma, and to thinking differently about what happened. Rather than blaming themselves, or believing they will never be safe again, survivors of trauma reintegrate back to a calmer, more accurate and neutral view of themselves and the world.
This in turn relieves symptoms such as avoidance, intrusive memories, hypervigilance, and depression.
How to Find Relief
If possible, look for a therapist who specializes in one of these evidence-based treatments, and who has specific experience with this disorder. Ask about their treatment approach, and if their clients typically feel better within a few months.
If you’re unable to find a local therapist who uses these techniques, consider a therapist in other parts of your state or region who provides such an approach via telehealth. In recent months there has been a shortage of qualified clinicians available. If this is a case, consider getting on a waiting list for a future appointment, especially if you think a certain therapist is the best fit.
If after a 2 to 4 months, your PTSD symptoms are not improving, or are feeling worse, talk to your therapist about a different approach, or consider looking for someone who specializes in other treatment types.
Jennie Lannette, LCSW, is a licensed, practicing therapist in Missouri, specializing in trauma, anxiety, and related mental health issues.