Post-traumatic stress disorder (PTSD) can affect anyone who has experienced or witnessed a shocking event, whether it’s a car accident, a death or injury on the battlefield, or a life-threatening fall while hiking.
While roughly half of American adults will experience a traumatic event at some point in their lives, not everyone who has lived through trauma will have?PTSD — mental health professionals may make this diagnosis if your symptoms persist for a month or more, affecting your ability to function well in normal everyday life. (1)
Often, PTSD coexists with other mental health conditions that you should be aware of. For instance, about 80 percent of people who have PTSD will experience a co-occurring psychiatric disorder over the course of their lifetime.
These conditions can include substance use disorders and depression, among other illnesses. Sometimes these conditions are diagnosed before?PTSD, sometimes after, with people unaware they are suffering from more than one condition, says Tara Emrani, MD, a clinical psychologist in New York City. (2)
“Say ‘Jane Grey’ gets into a really, really horrible car accident. She doesn’t know what PTSD is and what the symptoms are,” Dr.?Emrani explains. “Over the next three months, she’s sad and down and depressed. She goes to a psychologist or a psychiatrist and says, ‘Hey, I’m feeling really down and have no motivation — I go to work and I’m really suffering there.’ She tells the doctor: ‘Three months ago, I got into a car accident. I’ve been suffering from depression and?anxiety.’ She is then told that she has PTSD, and could be surprised that she had been dealing with depression and PTSD at the same time. A lot of times, these conditions can go together.”
For some people with a history of mental illness, like the hypothetical Jane Grey, receiving a PTSD diagnosis may come as a shock. But these comorbidities are actually common — and research suggests that a preexisting mental illness, such as major depressive disorder or bipolar disorder, may be a risk factor for PTSD. (3)
If you or a loved one is dealing with PTSD and another mental illness, here’s an overview of how to manage six conditions that commonly occur with PTSD.
Substance Use Disorders (SUD)
Addiction and PTSD are commonly linked. Indeed, they’re bidirectional, meaning there are high rates of substance use disorder (SUD) with PTSD because PTSD is a risk factor for developing SUD, and SUD is a risk factor for developing PTSD after a trauma.
Overall, research suggests about 46 percent of people with PTSD meet the criteria for a substance use disorder. (4) Substance use disorders stem from the recurrent use of alcohol or drugs that can cause clinical and functional impairment in a person’s life. This may be a disruption in school or work, and may also involve other health problems that result from this substance use. Examples of common SUDs are alcohol use disorder, tobacco use disorder, and opioid use disorder. (5)
“When people with PTSD [turn] to alcohol use or [drug] use, they might be trying to numb themselves from their problems and their trauma,” Emrani says.
This need to self-medicate with drugs or alcohol is a key sign of a substance use disorder. People with an addiction to substances often make their PTSD symptoms worse.
The U.S. Department of Veterans Affairs lays out the ways substance use can worsen your PTSD symptoms: (6)
- Interferes With Sleep People with PTSD may have sleep problems, and they may be led to self-medicate with drugs or alcohol to help them sleep. Unfortunately, self-medicating this way has the opposite effect: Drug and alcohol consumption can worsen your sleep quality and exacerbate symptoms of PTSD.
- Alters Your Mood PTSD can make people feel emotionally cut off from others, depressed, and irritable — all things that can get worse with alcohol and drugs.
- Affects Your Concentration People with PTSD have difficulty with concentration, something that drinking heavily, for example, can exacerbate.
- Perpetuates the Cycle of Avoidance?Substance use can be a way of avoiding your problems, which is a symptom of PTSD.
Elspeth Cameron Ritchie, MD, MPH, chair of psychiatry at MedStar Washington Hospital Center in Washington, DC, says that many of the military veterans with PTSD she has worked with over the years have resorted to marijuana and alcohol use, with the hope that the substances will help them better deal with their trauma.
“A lot of them don’t know where to turn … a lot of them are just looking for an escape from these [traumatic] experiences,” says Dr. Ritchie, who retired from the U.S. Army in 2010 as a colonel and has been working with veterans and members of the military for the past three decades.
Data suggests more than 2 out of 10 veterans with PTSD will also have an SUD of some kind, and nearly one out of every three veterans who seeks out treatment for SUD has PTSD. (6)
Where can you find help if you’re dealing with both PTSD and a substance use disorder? Ritchie says your primary care physician is a good person to start with. If they can’t assist you, they can at least point you in the direction of a specialist who can. You may also consider seeking guidance or advice from a religious figure, like a chaplain, rabbi, or priest, whom you may regularly turn to for advice.
People generally have improved symptoms of both SUD and PTSD when the conditions are treated together. A good treatment plan may involve individual therapy or couples therapy with a partner, support groups like Alcoholics Anonymous, or medications that can help you manage both conditions. (6)
Given how variable PTSD and substance use disorder symptoms can be, be sure to consult your doctor about the best way to move forward with treatment.
Depression or Major Depressive Disorder?
Depression and PTSD often occur simultaneously. While current statistics on the link between the two are lacking, the National Center for PTSD cites a study that depression is about 3 to 5 times more likely in people who have PTSD than in those who don’t. (7)
Depression is widespread and is more serious than just feeling down on one particular day. Annually this mental illness affects an estimated 16 million American adults, and about one in every six adults in the United States will experience depression at some point in their lifetime. (8)
Major depressive disorder, or clinical depression, seriously impedes your ability to function in everyday life. It’s a mood disorder that can show itself in the form of having feelings of sadness and hopelessness, trouble sleeping, anxiety, or recurring thoughts of death and suicide, among other symptoms. (9)
In many instances, depression can follow trauma. One example of a depression-inducing trauma is the Oklahoma City bombing in 1995 — a domestic terror attack that resulted in 168 deaths, including 19 children. (10) After the tragedy, 23 percent of survivors experienced depression. Before the bombing, just 13 percent of this same group of people reported having depression. (7)
This sequence of events isn’t unusual. Ritchie explains that veterans returning from war, for instance, may experience guilt over what they have seen or experienced, or feel remorse over losing fellow soldiers, which can contribute to the development of depression. (7)
If you are living with depression and PTSD, where do you turn? As with those dealing with substance use disorders, Ritchie says you need to be examined by your physician or other healthcare provider who can help identify the best treatment for you.
According to the National Center for PTSD, treatment for PTSD and depression may be one and the same because symptoms of these conditions overlap. The center cites cognitive behavioral therapy (CBT), which helps people reorient previously negative styles of thought and action, as a proven treatment for both conditions. When it comes to medication, the center cites selective serotonin reuptake inhibitors (SSRIs). (7)
Ritchie says PTSD used to be labeled an anxiety disorder, but the American Psychiatric Association reclassified the illness as a trauma and stressor-related disorder in 2013. (11)
Anxiety disorders involve persistent feelings of anxiousness that get worse over time. As with PTSD and substance use disorders, once this anxiety interferes with your daily life and ability to function, it’s time for you to start seeking medical attention.
You could be diagnosed with generalized anxiety disorder (GAD); panic disorder, which involves recurring and unexpected panic attacks with significant fear of them happening; or social anxiety disorder, which means you have a distinct fear of certain social situations or fear being rejected by or offending other people. (12)
GAD is the most common of the group. People who have this form of anxiety tend to feel worried and nervous about everyday activities and events that would not normally be worrisome. If you have this, you may have difficulty controlling your anxieties, feel restless, experience headaches, or go to the bathroom a lot. These concerns could be so consuming that they affect your ability to hold onto a job or manage your own health and well-being. (13)
One study looked at the link between GAD’s impact on the veteran community and found a link with PTSD. Out of 884 surveyed vets, 40 percent of people with?PTSD were also diagnosed with GAD. These people had more severe symptoms of the anxiety disorder than those who had only GAD without PTSD. (14)
“You’ll find a lot of people with PTSD will have some form of anxiety disorder. Many will experience panic attacks and have social anxieties, for sure. They might be withdrawn socially and avoid social gatherings,” Emrani says. “It’s important that these people discuss with their medical team to seek out the treatment they need.”
Treatment for anxiety disorders could include psychotherapy, or “talk therapy,” which aims to help individuals directly confront the specific anxieties that are plaguing them; CBT, which is also helpful for depression; support groups; and stress-management techniques, like exercise or meditation. Medications can’t cure anxiety disorders, but they could help alleviate symptoms. Antidepressants, selective serotonin reuptake inhibitors (SSRIs) and beta-blockers are some of the most commonly prescribed. (12)
There are several neurocognitive problems, or issues with cognitive function of the brain, that are comorbid with PTSD. This includes neurocognitive disorders (NCD), many of which are caused by traumatic brain injury (TBI).
If you look closely within the broad category of NCD alone, existing research examines PTSD’s potential impact on memory impairment and the role it can play in worsening dementia. Here’s a look at some of the ways PTSD and neurocognitive problems can go hand in hand.
Traumatic Brain Injury
A TBI occurs from a blow or jolt (usually to the head), and can be linked to a traumatic event, like a car accident or a fall. A TBI can be mild, moderate, or severe. If you have whiplash, your brain may have shaken inside your skull, leading to bruising or bleeding between your brain and your skull. This event may cause headaches, dizziness, issues with your vision, memory lapses, difficulty staying focused, depression, and bouts of anger and anxiety, among other symptoms. (15)
TBIs are a particular issue for military service members. The National Center for PTSD reports that 22 percent of all combat casualties from the Iraq and Afghanistan war zones in the past two decades are brain injuries, compared with 12 percent from the Vietnam War. Beyond this, 60 to 80 percent of soldiers who have experienced other kinds of blast injuries may also have TBIs. (15)
“Traumatic brain injury and PTSD often exist in the same person, especially veterans,” Ritchie says. “TBI and PTSD are two of the signature wounds of war. Say someone is in a bomb blast. He or she could be dealing with a brain injury, as well as developing PTSD from the trauma of being in the explosion. Many of the symptoms of TBI are some of the same symptoms that you see from trauma itself. There is a big overlap.” (15)
The link between the two conditions can be strong. One study found cognitive defects in veterans who had PTSD and comorbid TBI. The researchers found that those people with PTSD and comorbid TBI had weaker connectivity in the brain network that is responsible for storing and recalling memory. (17)
Neurocognitive Disorder (NCD)
This refers to a group of disorders that involve cognitive impairment. It should be noted that TBI is not an NCD, but a TBI can cause one. NCDs can range from “mild to major” cognitive impairment. If you are on the major end of that spectrum, it means you have experienced significant cognitive decline and high impairment in your ability to function in your day-to-day life. If you have mild NCD, you have moderate cognitive problems but they do not affect your ability to live your life normally. (18)
While it used to be a separate diagnosis, dementia was folded under NCD in 2013 by the American Psychiatric Association. The term “dementia” may still be used in?healthcare situations when a patient or a doctor are comfortable already using the term.
There unfortunately isn’t much research looking at the link between NCDs and PTSD and how one affects the other. Research conducted in VA health facilities between October 1997 and September 1999 looked at vets who had been diagnosed with PTSD or had received a Purple Heart, a status awarded to those who have been injured in combat. Outpatient reports on these people between October 1997 and September 2008, after they had been treated at these hospitals, looked for evidence of dementia, PTSD, and other physical conditions that are tied to dementia. Overall, dementia was diagnosed in 6.2 percent of these veterans, but it was higher in those who had PTSD. It was found in 6.8 percent of those who had PTSD and received a Purple Heart, and in 9.5 percent of those who had both PTSD and had been injured in combat.
The authors pointed out that while veterans with PTSD had a higher incidence of dementia, that doesn’t mean that PTSD causes dementia. Instead, the two conditions have common risk factors — like trauma and TBI. (19)
Borderline Personality Disorder (BPD)
Borderline personality disorder is a mental disorder that is defined by a pattern of shifts in behavior, mood, self-image, and emotional functioning, among other symptoms. If you have BPD, you may have moments when you are prone to doing impulsive things and may show intense anger and depression. You might also have anxiety that goes on for just a couple of hours or as much as days at a time. (20)
BPD and PTSD can come as a package. The two conditions certainly share some symptoms — from mood swings and depression to anxiety. One study found a wide variation in reports of how interrelated these two conditions are. Previous research has found rates of PTSD among people with BPD going from 25 to 58 percent. On the flip side, other research has found rates of BPD among people with PTSD ranging from as little as 10 to as high as 76 percent. (21)
The same review finds that, while these two conditions are distinct diagnoses, some researchers have observed that one condition may exacerbate the symptoms of the other. For instance, PTSD can intensify the affective instability of someone who has BPD. It may also serve as a trigger for self-injury among people who have BPD.
BPD is often found in people who have suffered from childhood abuse of any kind, and the authors of this paper cite that out of 547 people who had both conditions, 36 percent had experienced childhood sexual abuse. Broken down by gender, 43 percent of women who had both PTSD and BPD had childhood sexual abuse in their backgrounds compared with 19 percent of men in this same group. (21)
Physical Health Problems
People who experience childhood abuse, sexual assault, car accidents, combat trauma, and other forms of trauma that can lead to PTSD are more likely to self-report physical health problems than those without PTSD. (22)
For instance, in war, Ritchie says, the loss of a limb or another physical injury can lead to as many psychological effects as it does physical effects.
Often, injury leads to chronic pain. About one in three people in the U.S. experience chronic pain in their lifetime. (23) In one small study, out of 20 people who had experienced chronic pain after a car accident, 10 met the criteria for PTSD diagnosis, and another 3 had significant symptoms. (24)
Beyond chronic pain, PTSD can play a role in other physical conditions. A review published in 2010 looked at a range of conditions from psychological to physical that are comorbid with PTSD. The authors found that over the past decade or so, more research has been done to look at PTSD’s relationship to everything from hypertension to obesity.
The authors cited one example of people two months after they survived the 9/11 terror attacks. These people showed an increase between 1.7 millimeters (mm) and 3.3 mm of mercury of systolic blood pressure compared with the year before. For this specific population, trauma exposure appeared to greatly increase blood pressure levels. (25)
Editorial Sources and Fact-Checking
- Post-Traumatic Stress Disorder (PTSD). National Institute of Mental Health. November 2017.
- Foa EB. Effective Treatments for PTSD: Second Edition [PDF]. International Society for Traumatic Stress Studies. 2009.
- Chang JC, Yen AMF, Chen HH, et al. Comorbid Diseases as Risk Factors for Incident Posttraumatic Stress Disorder (PTSD) in a Large Community Cohort. Scientific Reports. January 2017.
- Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Prevalence and Axis I Comorbidity of Full and Partial Posttraumatic Stress Disorders in the United States: Results From Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions. Journal of Anxiety Disorders. April 2011.
- Mental Health and Substance Use Disorders. Substance Abuse and Mental Health Services Administration. April 27, 2022.
- PTSD and Problems With Alcohol Use. U.S. Department of Veterans Affairs. September 22, 2022.
- Depression, Trauma, and PTSD. U.S. Department of Veterans Affairs. September 22, 2022.
- Mental Health Conditions: Depression and Anxiety. Centers for Disease Control and Prevention. September 14, 2022.
- Depression (Major Depressive Disorder). Mayo Clinic. October 14, 2022.
- Oklahoma City Bombing. FBI.gov.
- PTSD and DSM-5. U.S. Department of Veterans Affairs. October 6, 2022.
- Anxiety Disorders. National Institute of Mental Health. April 2022.
- Generalized Anxiety Disorder: When Worry Gets Out of Control. National Institute of Mental Health.
- Milanak ME, Gros DF, Magruder KM, et al. Prevalence and Features of Generalized Anxiety Disorder in Department of Veteran Affairs Primary Care Settings. Psychiatry Research. September 30, 2013.
- Traumatic Brain Injury and PTSD. U.S. Department of Veterans Affairs. September 22, 2022.
- Deleted, October 13, 2022.
- Spielberg JM, McGlinchey RE, Milberg WP, Salat DH. Brain Network Disturbance Related to Posttraumatic Stress and Traumatic Brain Injury in Veterans. Biological Psychiatry. August 1, 2015.
- Assessment and Treatment for PTSD With Co-Occurring Neurocognitive Disorder (NCD). U.S. Department of Veterans Affairs.?October 6, 2022.
- Greenberg MS, Tanev K, Marin MF, Pitman RK. Stress, PTSD, and Dementia. Alzheimer’s & Dementia. June 2014.
- Personality Disorders.?National Institute of Mental Health.
- Scheiderer?EM, Wood PK, Trull?TJ. The Comorbidity of Borderline Personality Disorder and Posttraumatic Stress Disorder: Revisiting the Prevalence and Associations in a General Population Sample.?Borderline Personality Disorder and Emotion Dysregulation. July 24, 2015.
- PTSD and Physical Health. U.S. Department of Veterans Affairs. October 6, 2022.
- The Experience of Chronic Pain and PTSD: A Guide for Health Care Providers. U.S. Department of Veterans Affairs. October 6, 2022.
- Hickling EJ, Blanchard EB. Post-Traumatic Stress Disorder and Motor Vehicle Accidents. Journal of Anxiety Disorders. July–September 1992.
- McFarlane AC. The Long-Term Costs of Traumatic Stress: Intertwined Physical and Physiological Consequences. World Psychiatry. February 2010.
- Blazer D. Neurocognitive Disorders in DSM-5. The American Journal of Psychiatry. June 1, 2013.