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PTSD Questions & Answers
Joyce Boaz & Dr. Frank Ochberg, M.D.

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Symptoms: Emotional & Physical Reactions

Q: Dear Frank, We know that Posttraumatic Stress Disorder is an invisible injury. People can't see it like a broken leg so those affected are sometimes subjected to stigma which creates even more heartbreak. But what are the physical symptoms of PTSD? And what would be the difference in those with Chronic PTSD?

A: Dear Joyce, Physical and emotional symptoms are closely linked and overlap. The exaggerated startle response of PTSD is certainly physical: the combat veteran takes cover when a car backfires; an incest survivor recoils and retches in the presence of a man who looks like her predator; a victim of hurricane Sandy cries and trembles when the wind howls a year later. We are taught to document psychological and physiological effects that are triggered by trauma reminders.

The psychological effects include terror, disgust, confusion, despair, shame, guilt -- or an eerie absence of emotion, feeling hollow and dead inside. A close observer, skilled in reading feelings, can see signs in facial expression and body language.

There are physical signs of these psychological, internal, private sensations. But the physiological symptoms are a different category. They include a racing pulse, a pounding heart, rapid and audible breathing, sweating -often a cold sweat, trembling and turning white or red. "He looked like he saw a ghost." "She blushed scarlet." There are more extreme physical symptoms. A person can faint. They can scream and flee. They can run amok, harming others or bringing grave harm to themselves. This is very rare, but when it does occur, it generates attention and causes the mistaken conclusion that PTSD typically makes people dangerously crazy. That is a malicious myth, based on ignorance and rumor.

PTSD can precipitate or exacerbate medical syndromes. Usually these chronic diseases exist already, or are in the genetic code of the individual, waiting for a stressor to bring on an episode. Examples include irritable bowel, colitis and Crohn's disease -- the intestinal ailments; they include angina, arrhythmia and other heart conditions; they include psoriasis and other skin eruptions.

Stress does affect the immune system. So a host of infections and auto-immune problems can follow. Chronic PTSD means that symptoms have lasted at least three months. But many live with lifelong symptoms and learn to tolerate the burden, to anticipate anniversaries, to adjust expectations. Living with PTSD for a long time may actually diminish the physical effects, as the body accommodates to a new normal.

In general, PTSD improves with time. But we cannot ignore the fact that PTSD is a physical injury affecting several organs and systems of the body. It is as though the alarm reaction that helps us survive deadly threats is stuck in the "on" position. We do need to learn how to mitigate and manage that injury.

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Page created on 28 July 2014
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