Unexpected Symptoms Of PTSD: Psychosis, Withdrawal, And Substance Abuse

Reviewed by Melinda (Santa) Gladden, LCSW

Published 06/27/2022

While decades of research have been poured into the causes, symptoms, and most effective treatments for Post Traumatic Stress Disorder, the condition is multifaceted and complex. It seems that new information about PTSD arrives every year or so, giving an even more insightful peek into the minds of people who have experienced trauma. 

Standard Symptoms Of PTSD

The standard symptoms of PTSD include a set of three general symptoms and symptoms that fall under the umbrella of those generalized symptoms. The three overall symptoms include:

  • Avoidance
  • Recurring thoughts
  • Mood and thought pattern changes

Within each of these larger symptomatic categories are smaller, more concrete ways in which the symptoms listed above manifest. Avoidance symptoms can include some or all of the following:

  • Refusal to entertain or acknowledge certain thoughts or ideas. Avoidance is not always physical: some people with PTSD will avoid certain thoughts or feelings and may go to great lengths to do so.
  • The avoidance of places or people tied to trauma. PTSD brought on by a car accident may encourage avoidance of getting into a vehicle or passing the site of the accident. PTSD following an assault might involve the avoidance of home or the street or park where the assault occurred. Avoidance of places can also be extended to include any areas that remind victims of their trauma, even if it is not directly related.
  • A refusal to engage in activities that could remind the victim of trauma or create conditions similar to the trauma in question. If someone engaged in a beloved activity with an abuser, they might no longer be able to engage in that activity. If someone with PTSD was chased as a part of their traumatic experience and once used running as a means of exercise, running or even have a high heart rate can trigger feelings of terror or pain.

Recurring thoughts typically manifest in the form of:

  • Flashbacks or flashes of images. People with PTSD may experience intense and unwanted flashbacks of the traumatic event/s or may have flashes of imagery directly or indirectly tied to their trauma source.
  • Unwanted or intrusive thoughts. People may experience intrusive thoughts involving violence, danger, or fear and may struggle to get those thoughts under control.
  • Recurring dreams that involve pieces or all of the events leading to trauma. These dreams are typically disturbing and overwhelming and can contribute to insomnia.

Hyperactive arousal is often misunderstood, but it is an important component of PTSD symptoms and is often the source of physical reactions to PTSD. Hyperactive arousal symptoms include: 

  • Intense responses to unexpected stimuli. Because PTSD develops as a response to trauma, it can create a sense of hypervigilance or a heightened response to external stimuli. Even a small noise can inspire feelings of fear, dread or trigger a traumatic response.
  • Angry or aggressive behavior. Hypervigilance can also be described as being constantly “on” or perpetually on edge. Consequently, people may be more likely to respond in anger or aggression.
  • Difficulty falling or staying asleep. Hyperarousal can make people feel as though they are not safe, leading to fragmented sleep and difficulty falling asleep at all.
  • Difficulty concentrating. Hyperactive arousal can also make it difficult to concentrate on. Being on constant alert can mean it feels impossible to focus on any one single thing.

Mood and thought pattern changes are the final general piece of the PTSD puzzle and are the symptoms most commonly observed by the friends and family of people with PTSD. These symptoms often include:

  • Exaggerated negative beliefs. Following an assault, someone might conclude “all men or dangerous,” or “All drivers are unsafe.” These negative beliefs are likely to tie directly to the traumatic event.
  • Low self-esteem. The symptoms of PTSD overall are vast and overwhelming, and the constant barrage of feelings and experiences can lead to low self-esteem.
  • Feelings of shame and codependency. PTSD often brings with it a great deal of self-blame and disgust, which can lead to shame and feeling as though you are incapable of acting alone.
  • Withdrawal from relationships. People with PTSD often withdraw from close relationships and fail to make time for friends and family in favor of spending time alone.

A simple online PTSD quiz can help identify the presence of PTSD symptoms.

Unexpected Emotional Symptoms Of PTSD

The name “Post Traumatic Stress Disorder” suggests that the disorder involves stress, but the emotional toll that continued stress can have on someone with PTSD cannot be understated. People with PTSD often feel as though they are walking emotional wounds, open and perpetually in danger of being exposed further and injured. People may be far more sensitive to criticism, maybe easy to anger, and may even be overwhelmed by happiness, as these are all examples of aroused emotional states. Any emotional arousal that exceeds the baseline of PTSD can cause fear and uncertainty, regardless of whether the emotion is perceived as a happy one. 

Infrequently discussed emotional symptoms of PTSD can also include the opposite: a complete shutting-down of emotions. Parents may suddenly seem hard or callous to their children, close friends may seem distant and uninterested, and work colleagues may appear to be perpetually bored. Because hyperarousal can make any emotional experience feel too intense and overwhelming, some people with PTSD will avoid emotional experiences whenever possible and suppress any emotional responses.

Unexpected Physical Symptoms Of PTSD

The unexpected physical symptoms of PTSD are vast. While it may not be difficult to imagine the many implications of chronic stress and heightened anxiety, few people have a deep understanding of the many negative impacts high cortisol levels have on the body. Because high cortisol levels are to be expected in PTSD (and many other anxiety disorders), the body will have identifiable physical reactions to PTD, many of which can be additional sources of distress.

Skin issues are common among people with PTSD because the body may divert energy away from keeping skin healthy in the midst of high cortisol levels, as attention is devoted to keeping vital organs healthy to preserve life as effectively as possible. For this reason, people with PTSD might find that their skin is increasingly dry, prone to acne, itchy, and uncomfortable. Phantom pain is also known to arise in PTSD, and people with the disorder may report feeling general pain and malaise, despite not having a single, pinpointed physical ailment at the root of the pain.

Exhaustion is another common physical ailment associated with PTSD. Because PTSD can cause numerous abnormalities in sleeping habits and sleep needs, many people with PTSD feel as though they are constantly exhausted and unable to get good quality sleep. This can lead to increased weight gain and other physical ailments, including digestive issues and appetite changes.

Unexpected Mental Repercussions

Perhaps the most unexpected potential repercussion is psychosis or a break with reality. Although PTSD-related psychosis is not common, it is possible due to the intense nature of trauma and the many symptoms associated with PTSD. Psychosis (also known as a “psychotic break”) is characterized by a break from reality. It may involve feelings of paranoia and highly unusual behavior, including disturbed speaking patterns, seeing patterns and signs where there is none, and feeling as though you are “called” to a certain action. These can signal impending psychosis, or the presence of psychosis, as these are deviations from reality.

Substance abuse is also increasingly common among people with PTSD. Although medication is often used as a treatment method to ease Post Traumatic Stress symptoms, not everyone with PTSD seeks help or has immediate access to help, and substances can initially numb some of the pain and trigger points involved in Post Traumatic Stress Disorder. Substance abuse is an unfortunately common co-morbid condition with PTSD, likely due to the painful and overwhelming nature of PTSD. Substance abuse disorders are frequently seen as moral issues rather than mental health ailments. Still, it is not typically a healthy mind that turns to substance abuse to cope, and the presence of substance abuse often suggests that something more is at play. Fortunately, because substance abuse is recognized as a condition in its own right, many therapists can treat both conditions simultaneously to most effectively encourage recovery from both. 

The Fallout Of PTSD

While there is much to be said about the symptoms of PTSD and the importance of seeking treatment, it is also important to recognize the potential fallout of PTSD symptoms and the truly enormous impact they can have on an individual’s life and the lives of loved ones. To start, PTSD can create significant problems at work, at home, and in relationships, all of which can negatively affect a person’s ability to care for themselves, support themselves, and support a family. Because PTSD can have such a substantial and pervasive effect on general health, even seasoned professionals may not immediately link all of the different symptoms that PTSD can cause, including skin issues, phantom pain, psychosis, and even substance abuse. The scope of PTSD can initially seem overwhelming, but with careful treatment and a well-rounded and consistent treatment regimen, patients with PTSD may experience dramatic relief from symptoms.