PTSD & Trauma Treatment Specialists: In-Person and Online

What is PTSD?

Post-traumatic stress disorder (PTSD for short) is a complex mental health condition that affects the brain and the body after an extremely stressful event occurs. When it comes to a formal diagnosis of PTSD, there are specific types of trauma that must have occurred. The individual may experience the trauma, witness it happening to someone else, or they may learn about it happening to an individual with whom they are close. These types of traumas include:

• Exposure to actual or threatened death
• Exposure to actual or threatened serious injury
• Exposure to actual or threatened sexual violence

Some people experience different stressful events than those listed above, but still have problematic PTSD-like symptoms. A trauma counselor or trauma psychiatrist might diagnose adjustment disorder or other conditions instead.

Most people who experience these types of events will have a normal fight or flight reaction temporarily. This reaction may include dreams about the event, fear, feeling on edge, trouble sleeping, thinking a lot about the event, and avoiding things related to the event for a while. For example, if there was an intersection where someone rear ended your car, you may feel nervous about getting in the car, replay the scenario in your head a lot, and avoid the intersection for a little while. Typically these changes are temporary and improve within a month or so. The normal reaction to trauma is a way for our bodies and brains to be ready to protect us from more threats. The nervous system eventually calms down, and people move forward living pretty normally. In PTSD similar symptoms occur, but there are many more symptoms for a longer period of time, the symptoms are more severe, and they affect a person’s quality of life and/or functioning.

There is another form of PTSD that is currently recognized by the World Health Organization’s International Classification of Diseases, but not the Diagnostic and Statistical Manual of Mental Disorders. It is called complex post-traumatic stress disorder (or C-PTSD for short). In C-PTSD, there is not one discreet traumatic event, but rather prolonged threatening situations or repeated traumatic events that lead to a set of symptoms similar to those in PTSD. Examples of situations that can lead to C-PTSD include, but are not limited to: childhood abuse or neglect, repeated sexual abuse, domestic violence, being held captive, living in a warzone, human trafficking, and severe bullying.

If you have experienced trauma(s) and feel you are having a lot of difficulty coping with the effects, it is important to talk to a professional. Some signs that you might benefit from seeking psychiatric treatment for PTSD or trauma counseling include:

• Feeling like you are reliving traumatic event(s) in dreams or flashbacks
• Feeling always on guard
• Avoiding thoughts about, places, or activities that remind you of the event(s)
• Angry or aggressive behaviors, difficulty regulating emotions
• Your body feeling how it did while the traumatic event was happening
• Sleep difficulty and nightmares
• Blaming yourself for the event, or other guilty feelings
• Feeling detached or estranged from others
• Feeling easily distressed or triggered

At Rittenhouse Psychiatric Associates, we provide in person or online trauma counseling and psychiatric treatment (medication) for PTSD. You can reach out to us today to get started with assessment and treatment for concerns related to trauma.

What are the symptoms of PTSD?

There are three main categories of symptoms experienced by individuals who have PTSD. Below, the categories and examples of common symptoms are listed. Some symptoms from all of the categories must be present. The symptoms must last beyond a month for the diagnosis to be considered.

• Intrusion Symptoms
  • Distressing memories of the event(s) that are unwanted and recurrent.
  • Distressing dreams or nightmares with content related to the event(s)
  • Flashbacks – experiences in which the person feels or behaves as though the event is currently happening.
  • Intense or prolonged emotional or physiological distress when exposed to internal or external reminders about the event(s)
• Avoidance Symptoms or Negative Changes in Mood and Thoughts
  • Avoiding internal reminders of the event(s) such as memories, feelings, or thoughts
  • Avoiding external reminders of the event(s) such as people, places, things, activities, and situations
  • Inability to remember an important aspect of the event(s)
  • Ongoing and inflated negative beliefs about the self, others, or the world in general.
  • Blaming oneself or others for the event(s)
  • Persistently negative feelings (such as fear, horror, anger, guilt, or shame)
  • Significant decrease in doing or being interested in important activities
  • Feeling detached or estranged from others
  • Persistently feeling unable to experience positive emotions (such as love or joy)
• Arousal and Reactivity Symptoms
  • Irritability and angry outbursts
  • Reckless or self-destructive behavior
  • Being hyper-alert, watchful, or on guard
  • Being easily startled
  • Difficulty concentrating
  • Difficulty falling or staying asleep
• Other common experiences:
  • Depersonalization (frequent experiences of feeling detached from one’s thoughts or body, feeling as though one is in a dream, feeling oneself isn’t real)
  • Derealization (frequent experiences of feeling one’s surroundings are not real, are distant, dream-like, or distorted).

Complex PTSD is characterized by extremely threatening or horrific traumatic events from which escape is impossible or extremely difficult, and is typically prolonged or repetitive. The symptom groups are the same as above, but there is also additional and intense dysfunction in emotion regulation, self-identity and  interpersonal attachment/relationships.

What are the Causes and Risk Factors of PTSD?

The lifetime prevalence for PTSD in U.S. adults is estimated to be between 6.1% to 8.3%. Symptoms of PTSD typically manifest within 3 months after the event, but sometimes are delayed by months or years. About one half of people with PTSD recover within three months, but symptoms can persist for decades.

PTSD can affect individuals of any race, socioeconomic status, gender, orientation, age, and education level. Rates of PTSD are highest in survivors of sexual violence, survivors of military combat and captivity, and survivors of ethnically or politically motivated internment and genocide. In fact, one-third to over one-half of people exposed to these traumas will develop PTSD. PTSD rates are also quite high in veterans and first responders.

Other risk factors for developing PTSD include:

• Pre-existing mental health conditions
• Childhood adversity
• Inadequate social support prior to and after the event
• The severity of the trauma. threat to life, and/or physical injury
• Trauma being perpetrated by a caregiver
• Lack of agency and inability to escape during the trauma
• Genetic factors
• Being a woman
• History of traumatic brain injury
• And more

How Does Rittenhouse Psychiatric Associates Treat PTSD & Trauma?

Providers at Rittenhouse Psychiatric Associates use a variety of methods to help patients with PTSD. The approach is specific to each individual patient, as the symptoms can vary widely. General approaches include talk therapy and medication management.

Your First Visit for Trauma & PTSD

Your first appointment will be different depending on whether you see a prescribing provider (such as a psychiatrist or psychiatric nurse practitioner) or a therapist/counselor (such as a psychologist or professional counselor). Both types of professionals will gather information about your life, family, social supports, mental health, symptoms, strengths, risk factors, coping skills, and begin to build a trusting relationship with you. They will discuss your goals for getting better.

Once information is gathered, the provider will begin to form a treatment plan, including recommendations for the next steps. They will typically be able to provide you with information about your diagnosis, although at times several visits are needed to gather all necessary information, especially when there are multiple diagnoses.

A prescribing provider (a trauma psychiatrist or nurse practitioner) may recommend medication(s) for managing your symptoms and seeing a trauma counselor for in person or online trauma therapy. Many patients with PTSD need medication support for managing serious problems with mood, anxiety, irritability, and sleep.

A non-prescribing provider will formulate a therapy treatment plan, and may recommend that you see a prescribing provider for psychiatric treatment for PTSD while receiving trauma counseling.

An appropriate trauma treatment professional of any kind will NOT require you to divulge details of your traumatic experiences that you are not comfortable discussing in order to treat your condition.

Therapy for PTSD

RPA offers PTSD counseling or therapy both in person and via telehealth in most states. We have providers that use therapy methods such as trauma focused cognitive behavioral therapy (TF-CBT) and eye movement and desensitization reprocessing therapy (EMDR) to help clients heal from traumatic experiences and their effects.

Psychotherapy

Psychotherapy for trauma can help significantly with managing the effects of traumatic experiences. Patients should choose a therapist who is trauma-informed (that is, the provider understands the complexities of providing medical care to individuals who have experienced trauma). One of the most important benefits is understanding the impacts of trauma on the brain and body. Patients in psychotherapy for PTSD or trauma often feel less alone and relieved that there are reasons they feel how they do. Other benefits can include improving the symptoms of PTSD, improving relationships with others, improving ability to regulate emotions, improving self-esteem, improving insight about triggers, improved ability to manage the physiological and emotional effects of triggers, improving ability to trust, and more.

EMDR

Eye Movement Desensitization and Reprocessing (EMDR) is a type of psychotherapy that involves recalling traumatic experiences with guided eye movements or while focusing on a sound. This technique can help reprogram the brain and one’s response to specific triggers from a traumatic event. EMDR has strong evidence for effectiveness in alleviating trauma-related symptoms.

Cognitive Behavioral Therapy (CBT)

CBT also has strong evidence showing its effectiveness in alleviating trauma-related symptoms. This form of PTSD counseling aims to modify distorted or unhelpful thinking and negative reactions and behaviors related to the trauma. Main features of this form of therapy are: psychoeducation, coping skills, gradual exposure, behavioral activation, and cognitive processing.

Exposure Therapy

Exposure therapy is highly effective for PTSD, but is not always well-tolerated. The goal of exposure therapy is to re-train a patient’s brain to gradually approach trauma-related memories, feelings and situations. In doing so, avoidance of things that remind the patient of the trauma is reduced. This in turn reduces the fear and heightened responses to these triggers over time.

Medication Management for PTSD

RPA prescribers include psychiatrists (doctors) and psychiatric nurse practitioners. Medications work differently for everyone, so working closely with a prescriber who understands symptoms associated with trauma and PTSD is very important. Overall, PTSD and trauma treatment outcomes are best when medication management and therapy are utilized together.

Medications that may be considered by a PTSD psychiatrist or nurse practitioner include:

• SSRIs and SNRIs (medications that increase serotonin availability which helps depression and anxiety symptoms)
• Medications that can calm the nervous system and fight or flight response by other means
• Medications that can help with sleep
• Medications that can help with mood instability, irritability, impulsivity, and anger

PTSD Medication Management Available in these States:

• Delaware
• Florida
• New Jersey
• New York
• Pennsylvania

Please note: the prescription of controlled medications via online psychiatric appointments is dependent on state and federal regulations and provider licensing. Call our scheduling specialists for up-to-date information.

Rittenhouse Psychiatric Associates In-Person PTSD Treatment Locations

• Wilmington, DE
• Collingswood, NJ
• Manhattan, NY
• Paoli, PA
• Philadelphia, PA
• Pittsburgh, PA