This document discusses post-traumatic stress disorder (PTSD) from a Christian perspective. It defines PTSD and outlines its symptoms and effects. PTSD is caused by exposure to traumatic events and can impact brain regions like the hippocampus and amygdala. Common symptoms include re-experiencing trauma, avoidance, numbness, and hyperarousal. Treatment options discussed include medications, psychotherapy like cognitive behavioral therapy, and critical incident stress debriefing. Risk factors for developing PTSD and its impacts on relationships are also covered.

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Post Traumatic Stress Disorder: A Christian Perspective
Kristin Erdman
Liberty University

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Abstract
This paper outlines what Post Traumatic Stress Disorder is and how it effects those who
experience it. The definition of PTSD is given along with criteria needed in order for a diagnosis
to be considered PTSD. Causes as well as risk factors for PTSD are discussed along with
treatment options that are available to those diagnosed. Finally, treatment is looked at from a
Christian perspective in order to inform Christian counselors of the importance of educating
themselves on the beliefs of their clients as well as ways to properly help other Christians who
are suffering from PTSD.

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Many people are affected by various types of traumatic experiences every day. These
experiences can range from being a soldier in a war zone, to witnessing a traffic accident.
Though each traumatic experience have different rates of severity and create different side
effects, they all have the potential to create serious physical and mental impairments to those
involved. One example of this is Post Traumatic Stress Disorder.
Hoff, Hallisey & Hoff (2009) defines PTSD as,
"a chronic condition that my occur months or years after an original trauma that falls
outside the normal range of life events, such as during a war or in a concentration camp
or from terrorist bombings" (p. 482).
In order for PTSD to diagnosed as a psychiatric disorder, exposure to a traumatic event must be
present (Roberts, Gilman, Breslau, Breslau, & Koenen, 2011). These traumatic events can
include physical or sexual abuse, as well as interpersonal violence (Hoff, et al. 2009). Another
term used to describe experiences that lead to disorders like PTSD is complex traumas. Complex
traumas occur when a person has had a history of being exposed to extended periods of danger
and stress without a way to get away from the situations (Worthington & Langberg, 2012).
When an individual experiences PTSD, there are certain occurrences that happen within
their brain. A normal person's brain functions properly due to each hemisphere performing their
specific duties in the correct way. The right side of the brain is responsible for spontaneous,
intuitive, emotional, nonverbal, visual, artistic and spatial activities. The left side is responsible
for the thinking, whereas the right side is responsible for collecting and storing "pictures" or
memories (Wright, 2011). When a person has PTSD, the memories that are stored in the right
side of the brain are constant reminders of the traumatic event. The memories act like photos or
silent movies that haunt the individual and bring on frightening flash backs of their trauma

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(Wright, 2011). Research also suggests that the hippocampus shrinks in those who are
experiencing PTSD. This is because people who have PTSD excrete excessive amounts of
cortisol, due to overstimulation caused by the trauma. These high levels of cortisol cause the
nerve cells of the hippocampus to work in overdrive, leading to "death by exhaustion" (Wright,
2011). When the hippocampus does not work properly, an individual loses their ability to recall
memories that create positive emotions (Wright, 2011). The amygdala is also affected in
someone who has PTSD. The amygdala is in charge of detecting when a danger is occurring.
When danger is detected, the brain signals off the "fight or flight" signal, which then leads the
body to the proper reaction to the event. However, in a brain where PTSD has taken over these
normal reactions do not take place. Instead, when a traumatic event occurs, the amygdala
remains "stuck" in the alert state keeping the body from properly working through process
(Howard & Crandall). When the amygdala continues to remain in the alert phase, the body
believes that it is still in danger and sends out stress signals such as releasing adrenaline and
cortisol. This causes the person to continue to "live in the moment" of the traumatic event, even
when the event is no longer occurring, leading to developing PTSD. Sufferers of PTSD cannot
distinguish between what is now or what is in the past. Since their amygdala has lost the ability
to send the proper "fight or flight" responses, their bodies react to a memory as if it were a real
event happening in the now, rather than a memory of a trauma that happened in the past (Howard
& Crandall, 2007).
There are a variety of different symptoms, lifestyle changes and threats that a person
living with PTSD can experience. The four main symptom clusters that those suffering from
PTSD experience are: re-experiencing, hyper-arousal, avoidance, and numbness (Meisenhelder
& Marcum, 2009). Re-experiencing symptoms involve things that cause the affected person to

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relive the event of the trauma such as loud noises, recurring nightmares and flashbacks
(Meisenhelder & Marcum, 2009). Avoidance and numbing symptoms are brought on by the
person not wanting to relive the memories and feelings that they experienced during the trauma.
This results in the person avoiding situations that remind them of the trauma such as a place near
where the trauma occurred, watching television shows that remind them of the event or being
around similar scents and sounds that trigger memories of the event (Meisenhelder & Marcum,
2009). Hyper-arousal symptoms cause people to constantly be alert and on edge, feeling that the
trauma is going to happen again, causing them to always be on guard and easily startled
(Meisenhelder & Marcum, 2009).
There are several other types of PTSD symptoms that fall under the four main symptom
clusters. Some of these include suicidal ideation, secondary mental disorders, substance abuse,
unemployment, and marital problems (Roberts, et al. 2011). Other changes include disruptions
in a person's affect such as outbursts of anger, compulsive behavior, self-destructive behavior.
Damage to a person's consciousness can occur as well with symptoms of amnesia, dissociation,
and intrusive memories. Their self-perception can become affected as well with a lack of
initiative, helplessness, shame, guilt, a sense of damage, and feelings as if no one can understand
what they are going through. Post Traumatic Stress Disorder can also affect the way a person
relates with others within their life. For example people may have an inability to trust others,
may isolate themselves and withdraw from social activities that used to make them happy, and
relive the trauma causing them to victimize themselves and others (Worthington & Langberg,
2012).
The type of trauma experienced is another factor in determining what kind of PTSD
symptoms a person will display. Military personnel fighting in battle are a good example of this.

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Soldiers returning home from war are one of the most common groups effected by symptoms of
PTSD. After returning home from war, military personnel displayed symptoms of arousal,
irritability, excessive talking, and sometimes incorrect perception of things that are happening
within their environment (Rumyantseva & Stepanov, 2008). Upon the first two weeks of
returning home, combatants showed signs of sleep disorders such as sleep walking and night
terrors where innocent people were captured or shot, unable to protect themselves. They also
experienced physical symptoms such as high blood pressure, tension headaches and survivor
guilt (Rumyantseva & Stepanov, 2008). Many also experienced flashbacks, which are vivid
memories of trauma experienced during war, causing the person to believe that they are reliving
the traumatic event, even when they are not there (Rumyantseva & Stepanov, 2008).
People who have PTSD are not the only ones who are negatively affected by their
disorder. Spouses, children, parents and close friends also experience dramatic life changes due
to their loved one's disorder. PTSD often times leads to marital problems due to a lack of
communication, sleep disturbances, changes in interest and outbursts of anger displayed by the
partner experiencing PTSD lead to a disruption in the normal relationship, causing some to fall
apart. Children and friends of those with PTSD may feel as if their loved one does not have an
interest in them anymore or is angry with them and therefore pulls away from them, leading to a
break in the relationship (Rumyantseva & Stepanov, 2008). In order for relationships to remain
healthy and stable after someone is diagnosed with PTSD, it is important for both parties to
receive a form of counseling or therapy together in an effort to inform them of what is happening
within the individual experiencing the PTSD and to keep the relationship strong.
Not everyone who experiences a trauma will develop PTSD. The development of PTSD
depends on the risk factors that the individual has been pre-exposed to or experienced during the

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traumatic event. Some common factors in determining on whether or not an individual will
develop PTSD are being exposed to a traumatic event, consistently re-experiencing traumatic
events through dreams, memories and flashbacks, becoming numb in similar situations to the
trauma, and an increased state of arousal. When these symptoms last for longer than 30 days, the
risk for developing PTSD increases. However, if these symptoms last for less than 30 days,
acute stress disorder is diagnosed (Wright, 2011).
As stated above, predispositions are a risk-factor in the development of PTSD. These
predispositions include: major depressive disorder, generalized anxiety disorder, alcohol abuse, a
parental history of alcohol abuse, drug problems and incarceration (Breslau, Troost, Bohnert &
Luo, 2013). When such disorders and addictions are previously diagnosed and experienced by
someone who has been exposed to a trauma, their chances of developing PTSD becomes much
greater due to their already being vulnerable to dramatic changes to their normal functioning
(Breslau, et al., 2013).
Himle (2009) conducted a study to determine if there was a correlation between race and
the likelihood of developing PTSD. He found that people of the Black race had a higher lifetime
likelihood of developing PTSD than did Whites. However, the findings did suggest that Whites
had higher exposure rates to events that could lead to trauma or serious injury than did Blacks,
Asians or Hispanics (Roberts, et al., 2011). Hispanics and Blacks however had higher rates of
being exposed to child abuse, domestic violence and assault. The Asian population had the
highest rates of war-related exposure such as being a refugee due to war or a civilian in a war
zone. Though overall, he found that Asians have the lowest frequency of developing PTSD.
This is due to higher educational and income status, whereas people from with the Black
population are more likely to have lower education and income statuses, leaving them at the

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greatest risk for developing PTSD (Roberts, et al., 2011). He also determined that White people
are more likely to seek treatment than are other minorities. This is due to the different cultural
beliefs held by minorities. To some cultures, admitting that you have a mental disorder is a
disgrace to the family and would result in the individual being shunned or even killed. To other
cultures, seeking treatment outside of their own culture is not acceptable and is even believed to
be dangerous. Other cultures belief that when an individual experiences any form of mental
disturbance, it is due to them being possessed by a demon which can only be treated by spiritual
healers and witchcraft (Roberts, et al., 2011). With these different cultural beliefs and practices,
many minorities who are in desperate need of professional help regarding their PTSD are not
receiving the treatment that they need. This results in the White population seeking and
receiving treatment at a much higher rate than any other race (Roberts, et al., 2011). Kessler
(2007) conducted a study to determine if gender or age had any determination in the likelihood
on one developing PTSD. He found that developing PTSD is more common among women than
men and it is commonly onset in early adulthood (Chapman, Mills, Slade, McFfarlane, Bryant,
Creamer, Silove, & Teesson, 2012). It was found that the median age of developing PTSD was
26 years, with 25 percent of people reporting onset at age 15 and 75 percent by age 42
(Chapman, et al., 2012).
When a person is diagnosed with PTSD, it is important for them to receive the proper
help and treatment in order for them to make a full recovery and keep their relationships stable.
There are a variety of different treatment options ranging from medications, psychotherapy,
counseling, and support groups. An example of medications as treatment for PTSD are drugs
within the Selective Serotonin Reuptake Inhibitor group. This family of drugs is found to be at
the top of the list for treating individuals with PTSD. Such drugs include paroxetine and

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sertraline which have been approved by the Federal Drug Agency in the United States and
Europe for the treatment of PTSD (Ipser & Stein, 2012). Peroxetine is used for the short-term
treatment of PTSD. A study by Tucker (2001) showed improvements in the severity of
symptoms displayed by people experiencing PTSD, with one third of the patients going into
remission after 12 weeks (Ipser & Stein, 2012). Sertraline is used for both the short-term and
long-term treatment of PTSD. A study by Brady (2000) reported that after only two weeks of
treatment with sertraline, 70 percent of people showed a reduction in symptoms and began to
show improvement (Ipser & Stein, 2012). Though SSRIs have shown to provide improvement in
many individuals with PTSD, it does not help everyone. This results in other forms of treatments
needed in order to relieve the symptoms of PTSD.
Another form of treatment used with individuals who have PTSD is psychotherapy.
There are several different types of psychotherapy that can be used in order to help people
overcome PTSD. One form are exposure-based treatments. These treatments have the
individual relive the trauma repeatedly in an effort to help them work through the trauma and
realize that it is in the past (Rumyansteva & Stepanov, 2008). Another form of treatment is
cognitive behavioral therapy. CBT is a form of talk therapy that helps individuals understand
what has happened to them and change the way that they think about it. CBT teaches them how
to recognize and understand the way that their body feels when they experience thoughts or
occurrences that remind them of the trauma which allows them to be prepared for it and not
stress themselves out more. CBT also teaches patients how to cope with stressful thoughts and
feelings of anger, guilt and feel that often result from PTSD (Rumyansteva & Stepanov, 2008).
Another form of treatment that is used with victims of PTSD is the critical incident stress
debriefing approach. This approach was developed by Dr. Jeffrey Mitchell in an effort to help

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firefighters, EMTs, police personnel, soldiers and other people who have experienced some form
of trauma (Wright, 2011). Most CISD programs have a seven step model that can be used within
a group or on a one on one basis. The first step is the introductory phase. This phase allows
both the therapist as well as the patient to introduce themselves and make a plan for what will
happen in treatment. The next step is the fact phase. This stage allows the patient to describe the
traumatic event that they have experienced in their own words. The next stage is the thought
phase. This step allows the patient to describe their thoughts and feelings toward the traumatic
event, helping them to determine where their feelings come from and why they are experiencing
them. The fourth state is the reaction, or feeling phase. In this step, the therapist tries to help the
patient to determine what the most traumatic part of their experience was. This allows the
patient to see where their strongest emotions are directed towards as well as invites the therapist
to assure the client that the way they are feeling and reacting is normal to what they have
experienced. The next stage is the symptom phase. This stage invites the counselor to talk with
the patient about the reactions that they had experienced within 24 hours of the event in order to
determine which current reactions are from the event as well as reassures the client that their
reactions are normal. The sixth step is the teaching phase. During this step, the therapist offers
coping strategies that the client can use to help deal with their symptoms of PTSD. Some
examples of coping strategies used are exercise, make positive use of time, share feelings with
others, journal, not make major life decisions while feeling out of control, avoiding alcohol,
eating well, and praying and reading scripture if religious. The final stage is the reentry phase.
This stage summarizes everything that has happened within previous sessions and prepares the
client for termination of services. Before sessions end, the therapist offers the client community

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resources that he or she can use in order to maintain remission and seek help when needed
(Wright, 2011).
Each of these different forms of treatments work in their own way and have shown
positive results for people experiencing PTSD, however there are many people who have PTSD
that define themselves as Christians and may need their spiritual beliefs incorporated into their
treatments. This makes it very important for counselors and therapists to be aware of their
client's religious beliefs and incorporate them into practice. Unfortunately, many psychologists
and therapists are inadequately trained in regards to incorporating religious beliefs into their
practice (Allmon, 2013). However, even if mental health professionals are not taught how to
incorporate religious views into their practice, it is still their responsibility to educate themselves
on the matter, especially regarding the specific views of their clients. The American
Psychological Association code of ethics describes this within its standards in section 2.01b
Boundaries of Competence. This standard outlines the importance of being aware of diversity
factors such as religion, while delivering services, assessing, diagnosing and interpreting
symptoms (Allmon, 2013). When mental health professionals educate themselves on their
clients beliefs and try to incorporate them into their treatment, clients feel safer, better
understood and are more open to receiving treatment than if the therapist ignored their beliefs or
tried to push their own personal beliefs onto their client (Allmon, 2013).
Along with the general symptoms of PTSD, Christians may deal with another symptom
known as self-condemnation (Worthington & Langberg, 2012). Worthington & Langberg define
self-condemnation as,

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"criticism and condemnation of oneself, along with accompanying moral emotions from
among guilt, shame, remorse, regret, and self-blame due to perceived moral wrongdoing,
failure at living up to one's standards, or failure to live up to one's expectations" (p. 274).
Many Christians feel self-condemnation due to the traumatic experience causing them to do
something that has gone against their moral beliefs such as killing another human being within a
war zone. This type of experience causes the individual to feel unworthy of God's forgiveness
and unable to face him due to what they have experienced. They also feel shame and guilt and
feel as though their family members and fellow combatants judge them for what has happened
(Worthington & Langberg, 2012). Self-condemnation, if not treated is very bad for the health of
those experiencing it. For PTSD sufferers, along with the symptoms that they are already
experiencing due to the PTSD, they also may experience long-term physical health problems due
to the increased amount of stress that is being put on their bodies (Worthington & Langberg,
2012). Receiving the proper treatment is essential in overcoming self-condemnation. In order to
overcome this, one must be able to forgive themselves and understand that what has happened is
not their fault and that God loves them and forgives them (Worthington & Langberg, 2012).
This is known as self-forgiveness. Self-forgiveness occurs when one decides not to put malice,
self-blame and self-condemnation on themselves but to treat themselves as though they have just
as much worth as everyone else. It also encourages the individual to display positive emotions
towards oneself such as self-empathy, self-sympathy, self-compassion, and self-love
(Worthington & Langber, 2012). Self-forgiveness is a very important step towards healing for a
Christian as well as others who are experiencing self-condemnation.
Other ways in which Christian counselors can help individuals who are suffering from
PTSD or other reactions to severe traumas are through incorporating comforting scripture

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passages into therapy. One example of a comforting and uplifting passage comes from 2
Timothy 1:7 which states, "For God has not given us a spirit of fear, but of power and love and
of a sound mind" (New King James Version). This verse offers a reminder that though we may
experience things in this life that can cause fear and pain, through God we have received power
to overcome and an unconditional love to help guide us through. Another comforting verse that
can be used in treatment comes from Psalm 144:1-2 which states,
"Praise be to the Lord my Rock, who trains my hands for war, my fingers for battle. He
is my loving God and my fortress, my stronghold and my deliverer, my shield, in whom I
take refuge, who subdues peoples under me" (NKJV).
This verse reminds us that God has equipped us with everything that we need to fight life's
battles no matter how hard that they may seem. A person going through the course of PTSD
may find this encouraging, as they will find hope in knowing that God has given them the
strength to get through what they are dealing with. Other things that Christian therapists can do
within practice is incorporate prayer and ask for forgiveness, protection, strength, direction and
purpose for the client with PTSD. Encouraging their client to get involved with a church can
also be a good tool to use within practice as churches offer a lot of support to people who have
experienced traumas (Shoemaker, 2012).
Churches are a great resource for people suffering from PTSD. Churches and other
religious organizations offer several supportive tools for people to use in order to receive help
and relief from their suffering. These tools include social networks, informational and material
support, problem solving assistance for coping with stress, support groups, provide a sense of
belonging and offer and overall feeling of hope and acceptance (Shoemaker, 2012). They also
offer spiritual support through a community of believers who provide trauma victims with

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feelings of peace, purpose love which help victims of trauma overcome their past and move
towards a happy and healthy future (Shoemaker, 2012).
Although the symptoms and side-effects of PTSD are severe, there is still hope for those
living with it. The majority of people who experience PTSD will recover, and for those who do
not, there are several treatment options readily available to them in order to help them do so. As
a Christian counselor, it is important to be aware of the symptoms and negative side-effects that
go along with PTSD as well as what experiencing a traumatic event can do to a Christian in order
to be able to fully help a victim recover. Educating oneself on tools to use and incorporate
within Christian practice as well as learning about the unique beliefs and morals of every client is
essential in helping people fully overcome PTSD.

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