What is PTSD
Post-Traumatic Stress Disorder. DSM-5 criteria: ① trauma exposure (direct, witnessed, close other's tragedy, or repeated occupational exposure) ② 4 symptom clusters lasting 1+ month ③ social / occupational / daily functioning impairment. Korean lifetime prevalence 5.7% (women 7.5%, men 4.0%, NCS-K 2016).
Major Korean trauma sources
① Military service: men mandatory 18~21 months. Accident, violence, suicide witnessing. Vietnam War / Korean War PTSD in elderly cohort.
② Domestic violence: 1 in 4 Korean women experience lifetime. Childhood abuse = 5× adult PTSD risk.
③ Industrial accidents: construction, manufacturing. Witnessing colleague accident. Korea's industrial-accident deaths are highest in OECD.
④ Traffic accidents: Korean traffic-death rate 1.5× OECD average. Post-accident driving phobia = avoidance.
⑤ School violence: 7~10% adolescent victims. PTSD persists to adulthood in 30~40%.
⑥ Mass trauma: Sewol, Itaewon, COVID-19. Not just direct victims; witnesses and survivor families also at risk.
⑦ Sexual assault: highest PTSD risk (~50%). Rape trauma syndrome.
DSM-5 4 symptom clusters
Cluster 1 Re-experiencing: intrusive memories, nightmares, flashbacks (as if happening now), strong psychological/physiological reaction to trauma cues. ≥1 required.
Cluster 2 Avoidance: avoid trauma-related thoughts/feelings; avoid trauma-related places/people/activities. ≥1 required.
Cluster 3 Negative cognition / mood: partial trauma amnesia, negative beliefs ("world is dangerous", "no one is trustworthy"), self/other blame, persistent negative affect, diminished interest, isolation, inability to experience positive emotions. ≥2 required.
Cluster 4 Hyperarousal / reactivity: irritability, self-destructive behavior, hypervigilance, exaggerated startle, concentration difficulty, sleep disturbance. ≥2 required.
All 4 clusters + 1+ month + functional impairment → PTSD diagnosis.
Why avoidance worsens PTSD
Immediately post-trauma, avoidance is a natural protective response. But chronic avoidance reinforces the false learning "trauma = danger". The more trauma cues are avoided, the more the brain encodes "these cues are truly dangerous". All first-line treatments (PE, CPT, EMDR) center on gradual dismantling of avoidance.
3 first-line treatments
Prolonged Exposure (PE): 8~15 sessions, 12 weeks. Detailed trauma memory recall + graded exposure to avoided trauma cues. Strong efficacy (60~80% improvement). Downside: intense in-session emotion. Inappropriate if self-harm / suicide risk.
CPT (Cognitive Processing Therapy): 12 sessions, 12 weeks. Identify trauma-induced distorted beliefs ("my fault", "world is dangerous") + restructure. Efficacy equal to PE. Lower emotional intensity than PE.
EMDR (Eye Movement Desensitization & Reprocessing): 8~12 sessions, 12~16 weeks. Trauma recall + bilateral stimulation (eye movements, sounds, touch). Efficacy equal to PE/CPT. "Emotional charge" of trauma memory weakens.
All 3 available from Korean psychiatry / clinical psychology specialists. ₩80~150K per session, 12 sessions = ₩1.0~1.8M. Partial insurance.
Pharmacotherapy
1st-line SSRI: sertraline (Zoloft) FDA-approved. 12-week effect. 50% improvement. Insufficient alone; combine with therapy.
Nightmares — prazosin: α1 blocker. Nighttime nightmares cut 50%. First-week dizziness side effect.
Contraindicated: benzodiazepines (Xanax, Ativan) inappropriate for PTSD. Reinforce avoidance, addictive. Avoid beyond short-term (1~2 weeks).
6 self-protection strategies
- Secure safe environment: if trauma ongoing (domestic violence), safety first. 1366 (Korean women emergency line, 24h).
- Trigger journal: log what triggers intrusion, avoidance, startle. Pattern recognition = treatment start.
- Grounding 5-4-3-2-1: during flashback, name 5 things you see, 4 things you hear, 3 things you touch, 2 things you smell, 1 thing you taste → return to present.
- Find a therapist: psychiatrist / clinical psychologist credentialed in PE/CPT/EMDR. Mental Health Welfare Center free counseling.
- Tell 1 trusted person: trauma fact + diagnosis + treatment plan. External observer for avoidance / hypervigilance.
- Avoid alcohol / drugs: self-medication (alcohol, sleep meds) worsens PTSD + addiction risk. Very common PTSD-AUD comorbidity.
Warning signs — immediate help
- Suicidal ideation ("no point living like this")
- Self-harm (cutting, head-banging)
- Daily alcohol / drugs
- Anger outburst beyond trauma (violence toward spouse / child)
- Dissociation (body doesn't feel mine, memory gaps)
Mental Health Center 1577-0199 or emergency room immediately.
