How to Write About: PTSD

This is the third post in my “How to Write About Medicine Series”. This series is, hopefully, going to make it easier for writers to include medically accurate information in their books.

Disclaimer: This post is not to be used to diagnose or treat anyone. I am not allowed to diagnose people over the internet, nor am I fully board certified to practice on my own. The sole purpose of this post is to help writers write medically accurate books. I am also not a writer so this information is coming from a doctors’ standpoint rather than a writers; regardless I hope you find this information helpful!

I’m keeping this brief, you guys… I really mean it this time.

What is PTSD?

PTSD stands for Post Traumatic Stress Disorder. It is a psychiatric condition characterized by nightmares, intrusive thoughts, flashbacks to traumatic events, and avoidance of reminders of trauma.

PTSD vs. Acute Stress Disorder

Patients with PTSD symptoms after a significant trauma are said to have “Acute Stress Disorder” for the first 30 days. After 30 days if the symptoms are still present then it is diagnosed as PTSD.

Translation: basically PTSD is considered a chronic condition, so the patient has to have symptoms for at least 30 days; before that it’s considered “Acute Stress Disorder”

The symptoms and treatment listed below, are the same for both of these disorders. For simplicity sake, I’m going to use the term PTSD- but remember if it’s less than 30 days call it Acute Stress Disorder.

DSM V Criteria for diagnosing PTSD

The DSM V are the current guidelines for diagnosing psych illnesses. I am going to paraphrase and remove jargon but if you want the original words you can look up the official “DSM V criteria for PTSD”

A diagnosis of PTSD is made when a patient older than 6 years old meets all of the following criteria:

• Exposure to actual or threatened death, injury or sexual violence:
  • direct trauma- happened to the person
  • witnessing in person the events that happened to someone else
  • learning that the traumatic events occurred to a close family member or friend
• Experiencing one or more of the following symptoms:
  • Recurrent, involuntary and intrusive distressing memories of the traumatic event
  • Recurrent distressing dreams about the traumatic event
  • Flashbacks- in which the individual feels and acts as if the traumatic event is recurring
  • Things that remind the person of the event can trigger intense distress- can be anything that the person associated with the event
  • Things that remind the person of the event can trigger physiological reactions- “fight or flight” type reactions so increased heart rate, adrenaline rush etc.
• Avoidance of things that remind the person of the event:
  • Avoidance of memories related to the traumatic event
  • Avoidance of people, places, conversations, activities, objects, situations that remind the person of the event
• Negative alteration in cognition and mood after the traumatic event:
  • Loss of memory of the traumatic event
  • Persistent negative thoughts about oneself, others, or the world
    • “I am bad”
    • “the world is dangerous”
    • “no one can be trusted”
  • Blaming oneself or others for causing the traumatic event to occur
  • Persistent fear, horror, anger, guilt, or shame surrounding the traumatic event
  • No longer doing the things they used to enjoy
  • Feeling isolated from loved ones
  • Person is unable to feel happiness, satisfaction or love
• Changes in behavior, such as
  • Increased irritability and angry outbursts
  • Reckless or self destructive behavior
  • Hypervigilance- enhanced state of sensory sensitivity to monitor surroundings for danger
  • Exaggerated startle response
  • Problems with concentration
  • Difficulty falling asleep or staying asleep
• Duration of symptoms is more than a month (if it’s less than a month its considered to be “Acute Stress Disorder”)
• The symptoms cause significant distress or impair the person’s ability to have normal relationships, or keep a steady job

Wow okay so that was a lot of criteria, so hopefully it wasn’t information overload

Situations that cause PTSD:

The most commonly discussed causes are war, sexual abuse, physical abuse etc. These are things you probably think about when thinking about PTSD.

Research is now showing that there are medical causes of PTSD such as: Strokes, heart attacks, and even ICU stays. These aren’t as well discussed but I’ll give you a gold star if you mention them in your book! Spread the word writers! If people don’t know these events can cause PTSD then they might not get help for them. Just something to keep in mind

How to Treat PTSD

First line treatment (fancy doctor speak for the primary treatment or the thing we try first):

Trauma-focused psychotherapy– or in plan English- Therapy. This can be either exposure therapy for patients with extreme fear or avoidance, or cognitive therapy for patients with extreme guilt and trust issues. Any combination of those two seems to work very well at treating PTSD.

If you’re writing about a Fantasy world and your character has PTSD, the treatment is to have them talk about their trauma with others. This is done in the book A Court of Mist and Fury by Sarah J Maas, and is an incredibly great example of showing the symptoms of PTSD and the treatment without ever actually talking about PTSD.

Therapy can be used with a medication: most commonly and SSRI/SNRI

How to Write a Character with PTSD

When writing your character with PTSD consider:

What traumatic event lead to the character having PTSD? Was it something that happened to them or to someone else? Did they witness it or did they hear about the traumatic event that happened to a loved one? Are they medical personnel or first responders who saw a grisly crime scene?

What symptoms do they have? Do they have flashbacks? Do they get panic attacks? Do they have nightmares reliving the event? Do they have panic attacks that are triggered by things that remind them of the trauma?

Do they avoid thinking about the event or talking about the event? Do they avoid people places, situations that remind them of the event?

Answering all these questions and then going through the criteria listed above will help you create realistic characters with PTSD. Also read stories written by people who have PTSD. Talk to people who have PTSD in order to fully flesh out your character and make them more realistic.

Summary

I’ve given all of the diagnosis criteria so work your way back from there.

Really think about how a traumatic experience might cause your character to think and feel. Keep in mind that triggers can be anything: smells, locations, situations.

Please don’t have characters that use harmful dialog that makes a mockery of PTSD. For example “OMG sitting in this traffic is going to give me post traumatic stress”. There are real people out there dealing with this debilitating disease so please be respectful in your writing!

As always I am happy to answer any questions you might have. Just leave me a comment below and I will get back to you!