Post-Traumatic Stress Disorder
by Rachel Miller
Posttraumatic Stress Disorder (PTSD) is experienced by those who have witnessed in person or been the victim of an event that threatens death or serious injury. It is often exhibited by those who experience trauma on the level of a singular event, or acute trauma, such as natural disasters, terrorist attacks, shootings, or rape. It is also exhibited by those who undergo trauma as a life-style, or chronic trauma, such as domestic violence, war, or homelessness. It manifests itself in the person’s life through “re-experiencing symptoms, avoidance symptoms, and hyper-arousal symptoms.”
DSM-5: PTSD is expressed in a myriad of ways. The DSM-5 offers the following criteria in order to qualify for diagnosis.
“Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:” 
- Direct experience
- In-person witness of trauma experienced by others
- Learning of a traumatic event experienced by a family member or close friend
- Repeated exposure to the details of traumatic events, such as experienced by first-responders
“Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:” 
- Recurring intrusive memories of the event
- Recurring dreams related to the event
- Flashbacks to the related event in which the person feels or acts as if they are experiencing it again
- Intense stress triggered by cues that resemble aspects of the event
- Physiological reactions triggered by cues that resemble aspects of the event
“Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:”
- Avoidance of internal reminders of the event such as memories, thoughts, or feelings
- Avoidance of external reminders of the event such as people, places, conversations, activities, or objects
“Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:”
- Forgetfulness of significant aspects of the event
- Exaggerated negative beliefs about oneself, others, or the world
- Twisted memories of the event putting blame on the individual or others
- Constant negative emotional state
- Disinterest in significant activities
- Estrangement from others
- Inability to experience positive emotions
“Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:”
- Irritability and angry outbursts
- Reckless or self-destructive behavior
- Exaggerated startle response
- Lack of concentration
- Difficulty falling and staying asleep
“Duration of the symptoms is more than one month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.”
Recommended secular treatment and therapy includes:
- Cognitive Processing Therapy (CPT)- “CPT teaches you how to evaluate and change the upsetting thoughts you have had since your trauma. By changing your thoughts, you can change how you feel.” CPT involves organizing the thoughts of the counselee through writing and evaluating the conclusions they’ve drawn about their experience. The goal is to change distressing thoughts they may have about relational connection, power and control, and self-esteem by changing the way they view the world and their trauma.
- Prolonged Exposure Therapy (PE)- PE “teaches you to gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma. By confronting these challenges, you can decrease your PTSD symptoms.” PE involves exploring memories by verbalizing them in writing and in speech in order to begin to get used to them and control them rather than the memories controlling you.
- Eye Movement Desensitization and Reprocessing (EMDR)- EMDR “can help you process upsetting memories, thoughts, and feelings related to the trauma. By processing these experiences, you can get relief from PTSD symptoms.” The counselee is asked to reimagine their trauma while following the movement of the therapist’s finger or a laser with their eyes. It is unknown whether the effectiveness of this therapy comes from the eye movement or the exposure.
- Medication- “PTSD may be related to changes in the brain that are linked to our ability to manage stress. People with PTSD appear to have different amounts of certain chemicals (called neurotransmitters) in the brain than people without PTSD. SSRIs and SNRIs are believed to treat PTSD by putting these brain chemicals back in balance.”  Selective Serotonin Reuptake Inhibitors (SSRIs) act as antidepressants and are usually prescribed whether the counselee is depressed or not. Antipsychotic drugs and prazosin (which lowers blood pressure) are used to alleviate insomnia and nightmares.
In the late 19th century, the symptoms of PTSD were diagnosed as hysteria. Hysteria was used by men to describe all strange, mysterious, or unmanageable behavior in women. Eventually, a French neurologist named Jean-Martin Charcot identified the cause of such behavior to be psychological trauma. Sigmund Freud also contributed to its study and claimed hysteria originated from sexual abuse. However, he later disavowed this theory due to social pressure and the implications this had on the actions of many men of high class.
Observed symptoms of PTSD became an area of interest again after the first World War. As soldiers returned home, they experienced mental breakdowns due to the constant exposure to the horrors of war. It was initially attributed to what is known as “shell shock,” or the physical concussive effects of exploding shells. Eventually, it was also recognized to result from psychological trauma. Its main early contributors were two British psychiatrists, Lewis Yealland and William Halse Rivers. After the Vietnam War, veterans developed “rap groups” where they met together to provide support and talk therapy for their symptoms. The increased awareness in the aftermath of the wars led to the official recognition of PTSD as a real diagnosis and its insertion into the DSM-III in 1980.
Curtis Solomon provides a summary definition of PTSD as,
A whole personed response to traumatic events that encompasses the physical, mental, emotional, behavioral, and spiritual being of those affected. It results in significant disruption of life at home, work, school, and church, and it often draws on anger, fear, sadness, shame, and guilt to disrupt family relationships, friendships, careers, and Christian service. Those who are affected will often compensate the best way they can in ways that often compound the struggle they face.
PTSD is used to describe a variety of responses to traumatic suffering that affect every area of the counselee’s life.
PTSD is largely an interpretive disorder, “meaning that the way one perceives the threat determines their response to the threat.” The sufferer must contextualize their suffering in light of the truth of God’s Word in order to respond to it in a way that honors the Lord. Those suffering with symptoms of PTSD are responding to traumatic events in normal, not abnormal, ways.  Scripture demonstrates this by giving countless examples of people who experienced traumatic events and the subsequent symptoms, with some dishonoring and others honoring the Lord in their response.
A disobedient response to suffering from PTSD includes trying to either physical or mentally avoid and leave unpleasant situations to the point of sinning.  A few biblical examples of this are:
- Noah lived in a world of total wickedness, likely seeing and experiencing horrific events (Genesis 6:5)
- Whether he heard their screams over the storm or not, he knew that while he was in the ark the rest of mankind was drowning
- He responded by becoming drunk (Genesis 9:21)
Israel in the wilderness
- While they were not touched by the ten plagues, they viewed their effect on the Egyptians (Exodus 7-12)
- Nearly died by the hand of the Egyptians at the Red Sea (Exodus 14)
- Experienced extreme hunger and thirst in the wilderness (Exodus 16:1-3; 17:1-3)
- Faced nations of great might in battle (Numbers 13-14)
- Continually distrusted and disobeyed God in order to pursue comfort and security
- Killed many men in gruesome battle (1 Samuel 18:7)
- Was troubled in spirit (1 Samuel 16:14-23)
- Allowed feelings of fear and paranoia to rule, seeking to rid himself of the perceived problem (David) to the point of murder (1 Samuel 18:6-16)
An obedient response involves persevering through suffering, entrusting oneself to the Lord, and doing what is right before him even in difficult situations. A few biblical examples of this are:
- Nearly killed by his brothers (Genesis 37:18-24)
- Sold into slavery (Genesis 37:26-28)
- Nearly sexually assaulted (Genesis 39:6b-12)
- Unjustly thrown into prison (Genesis 39:13-20)
- Responded in obedience and faithfulness to the Lord in each situation
- Trusted in God’s purposes and faithfulness in the midst of trauma (Genesis 45:5-8)
- Faced, defeated, and mutilated a giant (1 Samuel 17)
- Killed many men in gruesome battle (1 Samuel 18:7)
- Betrayed and chased by close friends (1 Samuel 18:6-16; 2 Samuel 15:12; 16:23)
- Responded to sleepless nights by meditating on God’s greatness (Psalm 77)
- Responded to fear by trusting God (Psalms 27; 55; 56; 57; 121)
- Viewed the destruction of his city by Nebuchadnezzar (Daniel 1:1-2)
- Taken into Babylonian captivity (Daniel 1:3-7)
- Faced many near death experiences (Daniel 2:12-13; 6:16-18)
- Remained faithful to God even at personal risk (Daniel 1:8; 6:10)
- Numerous near-death experiences at the hands of man and of nature (2 Corinthians 11:24-27)
- Saw suffering as a source of rejoicing (Romans 5:3-5)
- Saw suffering as a means to encourage others (2 Corinthians 1:3-5)
- Found comfort in God’s presence (Philippians 4:5-7)
- Dwelt on God-honoring thoughts (Philippians 4:8-9)
- Relied on God’s strength for contentment in all circumstances (Philippians 4:11-13)
- Evidence of the Problem
The one struggling with PTSD must interpret and respond to their circumstances according to truth rather than according to their feelings. God’s Word is truth and the measure of truth, and it is authoritative over feelings and experiences. Feelings are created and experienced by God and are useful for indicating what may be going on in the heart, however they do not always reflect reality and are often difficult to interpret. Dr. Greg Gifford illustrates the roles of truth and feelings with the analogy of a chain. When truth, the first link in a chain, is allowed to lead, the rest of the links follow in an orderly fashion. When feelings are allowed to lead, they push the other links in a disorderly fashion and life gets messy.
Greater Christ-likeness 
Figure 1a. Truth vs. Feelings Led
Greater Christlikeness 
Figure 1b. Truth vs. Feelings Led
This is seen in several common emotions expressed by those struggling with PTSD:
|Led by Feelings||Led by Truth|
|Fear- directed toward circumstances, past experiences, and emotions resulting in a fight or flight response such as hyper-arousal or avoidance.  Anxiety- a selfish distrust in God seeking control over future problems and temporal matters. (Matt. 6:25-32) Guilt- a subjective emotion informed by man’s standards that leads to penance and attempts to minimize, mask, or deny the feeling. Anger- caused by sinful lusts and passions and displayed by outward bursts of ventilation and internalized moodiness and irritation, leading to evil and folly. (Jas. 4:1-2; Ps. 37:8)||Fear- directed toward God in obedience to his commands and leads to a response of faith. (Prov. 14:27; Heb. 11; 13:6; 1 Pt. 2:21-23) Anxiety- a selfless trust in God’s control while taking responsibility for the necessities of today and pursuit of eternal matters. (Heb. 13:5; Php. 4:6-7; Matt. 6:33) Guilt- an objective declaration by God of all men informed by God’s standards that leads to repentance and is resolved through trust in the work of Christ and confession. (Rom. 3:23; 2 Cor 7:9-10; Rom. 8:1; 1 Jn. 1:9) Anger- caused by righteous indignation or passion. The wise hold back from ventilation of sinful anger, leading to peace. (Mk. 11:15-18; Eph. 4:26; Prov. 29:11; 15:8)|
In allowing truth to lead rather than feelings, the thought life of the counselee must be submitted to truth of God’s Word. Rather than giving the mind free rein to dwell on that which it pleases, the counselee must learn to take their thoughts captive to obey Christ (2 Cor. 10:5), dwell on that which honors the Lord (Php. 4:8-9), remember God’s work in the past (Deut. 8:2; Isa. 46:9), and set his mind on “things above” (Col. 3:2; Ps. 1:2).
PTSD is often caused by a lack of trust in the sovereignty of God and a desire for personal control. The sinful pursuit of control may lead to attempts to control intrusive thoughts through sinful methods such as alcohol or drugs and to control circumstances through avoidance and escape methods. When control cannot be acquired, the response to uncontrollable circumstances often involves anger, fear, or anxiety.
PTSD is influenced by physical factors as well. Those who suffer from PTSD often have a damaged sympathetic nervous system, or “fight or flight” response system. It engages at the wrong time, such as attacking a loved one when woken in the night. It also engages for longer than it should, resulting in hypervigilance. PTSD leaves one prone to lack of sleep, migraines, stomach pain, back pain, and even heart disease. 
- Examining the Heart
Possible Heart Themes
Possible Heart Idols
- Biblical Solutions
Recommended books and articles
Babler, John. “PTSD, Memories, and Biblical Counseling.” Association of Certified Biblical Counselors. October 24, 2019. https://biblicalcounseling.com/ptsd-memories-and-biblical-counseling/.
Dunham, Dave. “Conceptual Issues in Counseling Those Who Fear Their Feelings.” Biblical Counseling Coalition. December 19, 2018. https://www.biblicalcounselingcoalition.org/2018/12/19/conceptual-issues-in-counseling-those-with-experiential-avoidance/.
Fain, Jim. “Facing Giants by Fixing Gaze: Eyes on the Covenantal King Rather than Self as the Means to Victory in Terrifying Circumstances.” ACBC Essays II (2019).
Gifford, Greg. Helping Your Family Through PTSD. Eugene OR: Resource Publications, 2017.
Jones, Robert. “Distinguishing Between Guilt and Guilt.” Biblical Counseling Coalition. July 18, 2017. https://www.biblicalcounselingcoalition.org/2017/07/18/distinguishing-between-guilt-and-guilt/.
Mehl, Scott, and Heath Lambert. “Christians and Cognitive Behavioral Therapy.” Association of Certified Biblical Counselors. April 5, 2017. https://biblicalcounseling.com/til-069-christians-cognitive-behavioral-therapy-feat-dr-scott-mehl/.
Scott, Stuart. Anger, Anxiety and Fear: A Biblical Perspective. Bemidji, MN: Focus Publishing Inc., 2009.
Solomon, Curtis W. “Counseling Post-Traumatic Stress Disorder: Plotting the Course.” ACBC Essays II (2019).
Viars, Stephen. Putting Your Past in Its Place. Eugene, OR: Harvest House Publishers, 2011.
Recommended homework resource
The following resource can be used to help the counselee understand their suffering and response according to the truth of God’s Word, aiding in the process of contextualizing their suffering. The passage shown in the example may be swapped out for any helpful passage of Scripture depending on the situation.
The Enemy’s Lies vs. God’s Truth: 1 Corinthians 10:13
|The Enemy’s Lies||God’s Truth|
|“Your problems are unique, bigger, and tougher than other peoples’.” (List problems in your life that you have thought about this way.)||“You are dealing with common temptations.” (List the daily temptations you face that are not unlike others’ temptations.)|
|“God has forgotten you.” (List the places where you have tended to feel forgotten.)||“I am faithful.” (List evidences of the faithfulness of God in your life.)|
|“Your problems are more than you can bear.” (Where have you felt overwhelmed or overburdened?)||“I will not let you be tempted beyond what you can bear.” (What are the resources for dealing with your problems that are already present in your life?)|
|“You are trapped and there is no way out.” (List the problems you are facing that seem unsolvable.)||“I will provide a way out so that you can stand up under it.” (Identify changes in you that would enable you to deal with the difficulties of your situation.)|
 Greg Gifford, Helping Your Family Through PTSD (Eugene OR: Resource Publications, 2017), 9.
 American Psychiatric Association, DSM-V Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Washington, DC: American Psychiatric Association, 2013), 271
 Ibid., 272.
 “Cognitive Processing Therapy for PTSD,” U.S. Department of Veterans Affairs, last modified August 10, 2018, https://www.ptsd.va.gov/understand_tx/cognitive_processing.asp.
 “Prolonged Exposure for PTSD,” U.S. Department of Veterans Affairs, last modified August 10, 2018, https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp.
 “Eye Movement Desensitization and Reprocessing (EMDR) for PTSD,” U.S. Department of Veterans Affairs, last modified August 10, 2018, https://www.ptsd.va.gov/understand_tx/emdr.asp.
 “Treatment Comparison Chart,” Decision Aid, last modified June 2017, https://www.ptsd.va.gov/apps/decisionaid/compare.aspx.
 Judith Herman, Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror (New York, NY: Basic Books, 1997), 10-28.
 Curtis W. Solomon, “Counseling Post-Traumatic Stress Disorder: Plotting the Course,” ACBC Essays II (2019): 47.
 Gifford, Helping Your Family through PTSD, 21.
 John Babler, “PTSD, Memories, and Biblical Counseling,” Association of Certified Biblical Counselors, October 24, 2019. https://biblicalcounseling.com/ptsd-memories-and-biblical-counseling/.
 Gifford, Helping Your Family through PTSD, 49.
 Curtis Solomon, “Demystifying PTSD: Part 2,” Biblical Counseling Coalition, August 11, 2018, https://www.biblicalcounselingcoalition.org/podcast-episode/1514-ep-068-demystifying-ptsd-part-2/.
 Gifford, Helping Your Family through PTSD, 49.
 Ibid., 31.
 Jim Fain, “Facing Giants by Fixing Gaze: Eyes on the Covenantal King Rather than Self as the Means to Victory in Terrifying Circumstances,” ACBC Essays II (2019), 20.
 Solomon, “Counseling Post-Traumatic Stress Disorder,” 46.
 “How PTSD can Cause Physical Pain Symptoms,” The Oaks Treatment, accessed April 1, 2020, https://theoakstreatment.com/ptsd/how-ptsd-can-cause-physical-pain-symptoms/.
 Paul David Tripp, Instruments in the Redeemer’s Hands (Phillipsburg, NJ; P&R Publishing, 2002), 349.