What Are the Best Ways to Treat PTSD?

Post-traumatic stress disorder (PTSD) is a mental disorder that can occur in people who have witnessed or experienced terrifying events. Millions of people in the United States suffer from PTSD, and it can impact virtually every aspect of their lives.

While PTSD discussions often revolve around how it affects soldiers returning from war (it used to be known as "shell shock"), the disorder occurs more frequently than most people realize. Up to 8 percent of U.S. adults will be diagnosed with PTSD at some point.

Most people who experience a traumatic event can cope and get better over time, but PTSD symptoms sometimes worsen and may last a lifetime. Living with PTSD can put a strain on relationships and make life at work difficult.

PTSD and sexual health

PTSD can also affect a person's sexual health. The condition impairs sexual functioning, desire, arousal, orgasm, activity and satisfaction. A 2015 study published in The Journal of Sexual Medicine found that male military veterans with PTSD were more likely to report erectile dysfunction (ED), or the inability to maintain an erection firm enough for sex, and other sexual problems.

The research suggests women experience sexual complications as well. Female problems include vaginal pain and a disinterest in sex.

Sexual health is a significant predictor of physical and emotional health and overall quality of life. Because PTSD has a negative effect on physical and mental health, it comes as no surprise that people with PTSD experience increased rates of sexual dysfunction.

Treatment options, side effects and the cost of treating PTSD

Regarding PTSD treatments, there have traditionally been two primary options: medications and psychotherapy. Medication-focused treatments work by finding drugs to support each one of the symptoms individually rather than treating PTSD at its core.

"For example, the goal is to treat insomnia with the medication, or to treat depression with the medication," said Will Barone, Psy.D., a clinical psychologist with The Clinic in Berkeley, California. "While treating certain symptoms with medication can be beneficial for some people with PTSD, a major issue is that, if you're only using medication, it's not actually getting to the root cause of what's actually causing these symptoms."

Different types of psychotherapies are designed to treat PTSD in different ways. Some of them are more on the functioning side, including cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). These therapies focus more on developing coping skills to manage and live with the symptoms of PTSD.

"If someone is having panic attacks when they hear a loud noise, the treatment would focus on reducing the panic response and working on developing coping strategies to deal with anxiety and panic," Barone said. "That can be really beneficial for helping people live better lives. But again, these types of treatments are not really getting to the root cause of what is driving these symptoms."

Research generally finds that trauma-focused therapies have the best long-term outcomes.

"These therapy types are mostly focused on getting to the root cause, getting in there and understanding this terrible thing—or a long list of terrible things—that happened, exploring how they have affected your life and brain and body, and changing the stories that have developed as a result," Barone said.

Trauma-focused therapies work to address any issues that have developed and help the individual arrive at a place of understanding.

"[They should recognize] that these things might have happened, but now they can learn to remember and recognize that they are actually safe now—that they can rebuild their life after this happened," Barone said.

These therapies can also include coping with the symptoms that exist, but a core focus is on what is known as reprocessing the traumatic memory.

"Sometimes that can involve having to talk through or revisit the traumatic experience and go through that process of opening up that old wound that is underneath the surface that's causing all these issues," Barone said.

With PTSD, it is this deep-set wound that often has been covered up by sometimes years and years of psychological scabbing and scar tissue. The wound is still festering under the surface and causing problems.

"The best way to heal that, in the long run, is to actually open up all the scar tissue and go down there and clean the wound out completely so that it can heal from the inside," Barone said.

The issue with this is that it can be extremely challenging to go through. It's really difficult for people to go through that process of opening those wounds and facing the things that have been plaguing them for so long.

"We tend to see a lot of people dropping out of treatments because it's too much to handle," Barone said. "There might be an increased risk of things like self-harm, drinking and substance use behaviors to try to manage the symptoms. Things can sometimes get harder before they get better when you start to open up those wounds.

"On the path to deeply healing, it can get a little harder when you start to break down the old patterns of coping that may have helped in certain ways but likely contributed to the person staying stuck in a life that did not work for them."

New treatments are being developed to help make the process of trauma-focused therapies more successful and less daunting. Psychedelic-assisted therapies—primarily those that use the substances MDMA or ketamine—can aid in the therapy process and make it more manageable.

"These treatments use a substance that impacts the way that our brain deals with trauma and how it processes traumatic memories," Barone said. "The idea is that it allows for this traumatic reprocessing to happen in a way that is more manageable and more effective than trying to do that in a normal frame of mind.

"MDMA and ketamine work differently and have different considerations for working with trauma, but when they are paired with skilled clinicians and an intensive process of psychotherapy, both can be beneficial for treating PTSD."

Treating PTSD and sexual health

PTSD may affect an individual's sexual health in the following ways:

• Having sex less often. Individuals with PTSD tend to have sex less frequently than those without PTSD, according to research. Sexual activity requires vulnerability, which can be unappealing to a person who has experienced a traumatic event.
• Reduced sexual desire and libido (sex drive). People with PTSD experience a diminished desire for sex. Healthy sexual desire, arousal and functioning require the temporary suppression of fear, which is why individuals with PTSD may struggle in this area. Common medications to treat PTSD, such as antidepressants, are sometimes associated with sexual side effects such as reduced desire and arousal, even though they may be helpful for PTSD-specific symptoms.
• Struggles with trust and intimacy. Changes in a person's mood brought on by PTSD may make it more difficult for them to trust their partner. Because trust and intimacy are important components of sex, this could affect their level of sexual satisfaction.
• Increased sexual dysfunction. In men diagnosed with PTSD, erectile problems can be common. PTSD has the potential to negatively impact sexual functioning across desire, arousal and orgasm, according to Louis Pagano, Ph.D., a practicing psychologist in St. Cloud, Minnesota.

"In addition to ED, premature ejaculation can also cause problems some with PTSD struggle with," Pagano said. "Some of the hypothesized reasons why PTSD impacts sexual activity is that PTSD and sexual activity both come with physiological changes and the body can only do so much at once. In those with PTSD, sometimes a perceived threat or something reminiscent of an earlier trauma is responded to with a flight-or-fight reaction—they're angry, worried or afraid.

"When we're in this state, the last thing our body is programmed to do is to obtain and maintain an erection, and the last thing our mind will tell us to focus on in a heightened state of PTSD-driven arousal is sexual desire and gratification."

Another important aspect of PTSD for some people is changed beliefs about themselves and others (e.g., "I can't trust anyone" or "I can't protect myself") and negative alterations to mood, as well as hypervigilance.

"In order to have enjoyable sex, you need to not only perceive some relative degree of safety in the environment, you need to feel safe with the person you're wanting to have sex with," Pagano said. "You have to have the ability to open up and relax to some extent in order to experience a desire to initiate sex and enjoy the pleasure it offers."

Experiencing a traumatic event may predispose a person to compulsive sexual behavior. This may become a way for people with PTSD to cope with their negative emotions.

Complications and related conditions with PTSD

PTSD seems to occur frequently with other mental health conditions such as anxiety or depression. There seems to be a high prevalence of substance use among PTSD sufferers. The risk of suicide is higher in PTSD patients. Relationship issues with partners, friends and family may be a result of PTSD as well.

Problems with intimacy, communication and trust may arise for someone with PTSD. PTSD may occasionally develop into a chronic disorder that lasts for years. However, studies indicate that cognitive processing therapy (CPT) may be successful in treating even challenging instances that have lasted a long time. Memory issues and various physical health issues are frequently present in PTSD patients as well.

A future story will examine how to live and love while dealing with PTSD.