PTSD: Understanding Post-Traumatic Stress Disorder

Visit post-traumatic stress disorder (PTSD) is a réaction prolongée to a traumatic event [1]. It does not affect pas que les vétérans : accidents, agressions, deuils brutaux, traumatismes médicaux, violence conjugale, témoin d’un événement choquant peuvent en déclencher. C’est aujourd’hui un trouble bien défini according to the DSM-5, and most importantly: it is treated. This article provides an overview of diagnostic criteria, risk factors, proven treatments, resources in Quebec, and helpful tips for yourself or a loved one.

On this page

• Les critères DSM-5
• Qui est touché et pourquoi
• Les différents types de traumatismes
• Les traitements éprouvés
• La place de la médication
• When to consult
• Quebec Resources
• Support for Family Members
• TSPT chez l’enfant et l’adolescent
• Myths and misconceptions
• Frequently asked questions
• Sources

Les critères DSM-5

Visit DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) defines PTSD as critères précis that must be present for a diagnosis to be made [2].

Les critères principaux

• Exposition à un événement traumatique (vécu directement, témoin direct, apprentissage qu’un proche y a été exposé, exposition répétée comme chez les premiers répondants)
• Revivals : flashbacks, nightmares, involuntary intrusions of memories
• Avoidance persistent exposure to stimuli that remind the person of the trauma (thoughts, places, people, conversations)
• Altérations cognitives et de l’humeur : croyances négatives, distortions, detachment, anhedonia, inability to recall certain aspects
• Hypervigilance : startle responses, irritability, sleep and concentration problems, nervous system hyperactivity
• Symptômes présents plus d’un mois
• Suffering significant or functional impact
• Non attribuable à une autre cause (substance, autre condition médicale)

Subforms

• PTSD with dissociation : marked derealization or depersonalization
• TSPT à expression retardée : critères pleinement remplis au moins 6 mois après l’événement
• Complex PTSD (recognized in the ICD-11 but not classified as a separate disorder in the DSM-5): chronic trauma, often interpersonal in nature and beginning in childhood
• TSPT chez l’enfant de moins de 6 ans : critères adaptés à l’âge

To remember

• Visit PTSD is a prolonged reaction to a traumatic event, defined by specific criteria in the DSM-5
• It touches 5 to 10 % des personnes exposées à un événement traumatique, davantage selon la nature et l’intensité
• Several proven treatments exist: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), EMDR, thérapie d’exposition prolongée, thérapie du traitement cognitif (CPT)
• Visit ISRS and IRSN (sertraline, paroxetine, venlafaxine) are the first-line adjunctive medications
• Visit cannabis and benzodiazepines long-term are généralement déconseillés on the front lines
• Visit resources There are many resources available in Quebec: Info-Social 811 (option 2), CAVAC, SOS Domestic Violence, programs for veterans and first responders
• From symptoms persistant plus d’un mois après un événement traumatique justifient une consultation
• In the event of a’suicidal thoughts, seek medical attention immediately (Info-Social 811, option 2, 1-866-APPELLE, emergency)

Qui est touché et pourquoi

Visit majority People who have been exposed to a traumatic event exhibit réactions aiguës (sleep disturbances, anxiety, intrusive thoughts) that resolve themselves in a few weeks. PTSD occurs in environ 5 à 10 % des personnes exposées, davantage selon la nature, l’intensité et les facteurs personnels [3].

Risk factors

• Nature of the Trauma : Interpersonal trauma (assault, rape, domestic violence) poses a greater risk than natural disasters
• Intensity et durée de l’exposition
• Trauma répété ou en childhood
• Background personal or family psychiatric issues
• Background from previous trauma
• Missing social support
• Poverty, marginalization, housing instability
• Substances psychoactive substances at the time of the trauma
• Gender : Women are at greater risk, in part because of the type of trauma they have experienced
• Présence d’autres conditions médicales or serious injuries

Protective Factors

• Social Support immediate and long-lasting
• Capacité à give meaning à l’événement
• Access to care fast and competent
• Resources past personal issues (mental health, finances, relationships)
• Recognition and validation of suffering
• Intervention précoce appropriate
• Absence of stigmatization

Common comorbidities

• Depression major
• Anxiety Disorders (generalized anxiety disorder, panic disorder)
• Troubles liés à l’usage de substances
• Disorders of the sleep
• Pain columns, headaches
• Troubles de personnalité in certain cases of complex trauma
• Risk suicidal increased
• Terms and Conditions medical related to chronic stress

Les différents types de traumatismes

Single Acute Traumas

• Accidents traffic accidents, workplace accidents
• Témoin d’un event violent
• Assault physical assault, robbery
• Disasters natural disasters (storms, floods)
• Trauma medical (surgery, serious diagnosis, intensive care)
• Death brutal ou violent d’un proche

Interpersonal Trauma

• Sexual Assault, rape
• Domestic Violence and coercion
• Abuse childhood (physical, sexual, psychological, neglect)
• Harcèlement severe and persistent
• Témoin domestic violence
• Souvent associés à un Complex PTSD

Traumas répétés et professionnels

• Premiers répondants : firefighters, police officers, EMTs, paramedics
• Staff healthcare providers (emergency room staff, nurses, doctors)
• Vétérans and active members of the Canadian Armed Forces
• Journalists in conflict zones
• Workers social workers and child welfare professionals
• Membres de communautés marginalisées
• People réfugiées and survivors of torture
• Vicarious trauma : indirect but repeated exposure to traumatic stories

Traumas spécifiques

• Traumatic Grief (complicated grief following a sudden or violent loss)
• Trauma médical : cancer diagnosis, stay in the intensive care unit, aggressive treatments
• Traumatic Childbirth
• Pandémie : prolonged exposure to fear, loss, and stress
• Collective Trauma : Notable community events

Les traitements éprouvés

Several psychothérapies trauma-specific interventions have demonstrated their effectiveness. They are recommended as first-line treatments by international guidelines [4].

Thérapie cognitive et comportementale centrée sur le trauma (TCC-T)

• Approche structurée, for a limited time (8 to 20 sessions)
• Work on the thoughts, behaviors and emotions related to trauma
• Psychoeducation About PTSD
• Cognitive Restructuring dysfunctional beliefs
• Techniques d’exhibition marked by memories and situations that have been avoided
• Strategies for management de l’anxiété et du sommeil
• Map of prevention relapses

EMDR (Eye Movement Desensitization and Reprocessing)

• Approach structured in 8 phases
• Uses stimulations bilatérales (eye movements, sounds, tapping)
• Allows the reprocessing traumatic memories
• Efficacité démontrée par plusieurs études
• Often fast: quelques séances may be sufficient for a single traumatic event
• Approach longer for complex trauma
• Practitioners certifiés au Québec (recherche via l’OPQ ou les associations professionnelles)

Prolonged Exposure Therapy

• Approach structured, usually 8 to 15 sessions
• Includes a imaginary exhibition a traumatic memory
• Includes a in vivo exposure situations that were avoided
• Psychoeducation and management techniques
• Démontrée efficient for many types of trauma
• Request a commitment on the part of the patient

Thérapie du traitement cognitif (CPT — Cognitive Processing Therapy)

• Approach in 12 séances structured
• Spotlight on the thoughts trauma-related issues and their impact
• Identification «stuck points»
• Particulièrement efficace pour les traumas avec fortes croyances négatives (guilt, shame)
• Validée pour les vétérans et les survivantes d’agression sexuelle

Other approaches

• Narrative Exposure Therapy (NET) : A Narrative Approach to Multiple and Complex Trauma
• Approaches somatic (Somatic Experiencing, sensorimotor psychotherapy)
• Approaches based on the mindfulness and compassion
• Trauma-Focused Yoga in addition
• Approaches group in some contexts
• Therapies support non-specific, useful but less effective on their own

Comparison Table of the Main Approaches

Approach	Duration	Principle
TCC-T	8-20 séances	Travail sur pensées, émotions, exposition
EMDR	Variable (often short)	Stimulations bilatérales pour retraiter le souvenir
Extended Exhibition	8-15 séances	An Imaginary and In Vivo Exhibition
CPT	12 séances	Restructuration des croyances liées au trauma
NET	Variable	Récit chronologique des traumas multiples

La place de la médication

Première ligne : ISRS et IRSN

• Sertraline and paroxetine : only SSRIs specifically approved for PTSD in Canada
• Venlafaxine (IRSN): a well-documented alternative
• Other SSRIS used off-label with supporting data (fluoxetine, escitalopram)
• Visible results are often seen after 4 to 8 weeks
• Treatment duration: at least 12 months after improvement
• Well tolerated by a majority
• Possible side effects: digestive problems, sleep, sexual function

Médicaments adjuvants

• Prazosin : for trauma-related nightmares (effectiveness varies according to recent studies)
• Mirtazapine : utile en cas d’insomnie marquée
• Antipsychotics at low doses in certain specific situations (risperidone, quetiapine), under strict supervision
• Beta-blockers (propranolol) en contexte d’anxiété physique aiguë
• Gabapentin or topiramate in some cases

Substances à éviter ou à utiliser avec prudence

• Cannabis : generally déconseillé en première ligne, peut aggraver l’anxiété et l’évitement
• Benzodiazepines in the long run: généralement déconseillées, can hinder recovery and lead to addiction
• Alcohol : Use should be limited; often used for self-medication
• Drugs recreational
• Les benzodiazépines peuvent être utilisées très ponctuellement in acute situations, under supervision

Emerging Approaches

• MDMA-assisted In psychotherapy: active research; access through clinical trials in the United States and Canada
• Psilocybin In psychotherapy: ongoing research
• Esketamine : approved for treatment-resistant depression; currently being evaluated for certain types of trauma
• Repetitive Transcranial Magnetic Stimulation (rTMS) : an alternative in cases of resistance to standard treatments
• These approaches are not not yet standard common practice in Quebec in 2026

When to consult

Signs That Indicate You Should See a Doctor

• Symptômes persistant plus d’un mois after a traumatic event
• Nightmares, flashbacks that disrupt daily life
• Évitement marqué that limits one's life (work, relationships, activities)
• Increased consumption of’alcohol ou de drogues pour gérer l’angoisse
• Sentiment d’être « sur ses gardes » at all times
• Disorders of the sleep adults
• Irritability or anger that affects relationships
• A feeling of’emotional numbness
• Difficulties with concentration at work or in school
• Suicidal thoughts — urgent consultation

Who to Contact

• Family doctor or IPS for initial assessment
• Psychologist specializing in trauma (OPQ)
• Psychiatrist in complex or difficult cases
• CAVAC (Centre d’aide aux victimes d’actes criminels) si trauma criminel
• SOS Domestic Violence if domestic violence
• Programmes spécialisés for veterans, first responders
• Info-Social 811, option 2 for orientation
• CLSC for psychosocial services

En cas d’urgence

• 911 in the event of immediate danger or a suicidal crisis with a plan
• 1 866 APPELLE (1 866 277-3553) en cas d’idées suicidaires
• Info-Social 811, option 2 in case of an emergency
• Emergency hospital care in the event of a major crisis
• Do not to be alone in cases of acute distress

Vous traversez un événement traumatique récent ou ancien et voulez en parler à un médecin ? Clinique Omicron offre l’évaluation médicale du TSPT, la prescription des traitements et l’orientation vers les psychothérapeutes spécialisés en trauma à nos points de service au Québec, avec téléconsultation possible. Make an appointment or opt for the teleconsultation.

Quebec Resources

Support Lines

• Info-Social 811, option 2 — 24/7 psychosocial support
• 1 866 APPELLE (1-866-277-3553) — Crisis and Suicide Prevention
• CAVAC (Centres d’aide aux victimes d’actes criminels) — 1 866 532-2822
• SOS Domestic Violence — 1 800 363-9010
• Ligne d’aide pour les agressions sexuelles — 1 888 933-9007
• Tel-aide (Montreal) — 514 935-1101
• Tel-jeunes — 1 800 263-2266
• Kids Help Phone — 1 800 668-6868

Specialized Organizations

• Centres d’aide aux victimes d’actes criminels (CAVAC) in each region
• CALACS (Centres d’aide et de lutte contre les agressions à caractère sexuel)
• Maisons d’hébergement for women who are victims of domestic violence
• Centres de prévention du suicide regional
• Ordre des psychologues du Québec (OPQ) — directory of psychologists specializing in trauma
• EMDR Canada and EMDR associations in Quebec
• Centre d’étude sur le trauma (University of Montreal, Sacré-Cœur Hospital)
• Tracom (Centre de prévention et d’intervention de crise) pour certains traumatismes

Pour les vétérans et les premiers répondants

• Veterans Affairs Canada : Programs and Compensation for Veterans
• Military Family Support Service of Quebec
• Programs specific training for firefighters, police officers, and paramedics in various departments
• OSI Canada (Organization for Support of Operational Stress Injuries)
• Programme d’aide aux employés (PAE) specific to each department
• Specialized clinics in military and operational trauma
• Compass / Wounded Warriors Canada

Accès à la psychothérapie

• PQPTM (Quebec Mental Health Program) — free access based on eligibility criteria
• Psychologists in private practice (partially covered by group insurance)
• Social workers and licensed psychotherapists
• Directory of the’OPQ : opq.org
• Crédit d’impôt pour frais médicaux applicable
• Téléthérapie en croissance, élargit l’accès

Support for Family Members

How to Support a Loved One

• Listen without judging, without downplaying
• Recognize suffering as legitimate
• Respect a person's rhythm
• Do not force talking about trauma
• Maintain a présence régulière without being intrusive
• Encourage consultation, without imposing
• Understanding that the healing takes time
• Recognize the triggers and help manage them
• Take care of oneself also

What to Avoid

• Say « il faut tourner la page » or «It’s been a long time»
• Minimize ou comparer le trauma à d’autres situations
• Push to recount the details of the trauma
• Make promises impossible to keep
• Overinvesting au point de s’épuiser
• Cut Making contact when you're overtaken without explaining why
• Try to treat instead of professionals

Resources for Family Members and Friends

• Support for Family Caregivers : 1 855 852-7784
• Support groups for spouses, parents and friends of people with PTSD
• Support psychological for loved ones
• Employee Assistance Program (EAP) if available
• Information about the vicarious trauma et l’épuisement de compassion

TSPT chez l’enfant et l’adolescent

Special Features

• Visit PTSD can occur in children of any age
• Symptoms often different from those of adults: regression, repetitive reenactment of the trauma, sleep disturbances, physical pain, withdrawal
• Visit young children may not have the words to express their suffering
• Diagnostic criteria adapted in the DSM-5 for children under 6 years of age
• The’family environment and education is essential
• Visit parental support has a significant impact on the prognosis

Traitements adaptés

• TF-CBT (Trauma-Focused CBT): a validated, structured approach for children and adolescents
• EMDR suitable for children
• Approaches through play among the youngest
• Involvement of the parents in treatment
• Support school-related et collaboration avec l’école
• Medication used more cautiously, generally as a supplement

Ressources spécifiques

• Tel-jeunes : 1 800 263-2266
• Kids Help Phone : 1 800 668-6868
• Open Area for ages 12–25
• CHU pédiatriques (Sainte-Justine, Québec University Hospital) — teams specializing in child and adolescent psychiatry
• CIUSSS and CLSCs for community-based services
• Programs in youth protection when appropriate

Myths and misconceptions

« Le TSPT, c’est seulement pour les vétérans »

False. Visit PTSD may occur after any exhibition à un événement traumatique : agression, accident, deuil brutal, agression sexuelle, violence conjugale, trauma médical, témoin d’un événement violent. Les survivantes d’agression sexuelle ont en fait l’un des taux de TSPT les plus élevés.

« Il faut être fort, ça va passer tout seul »

False. Visit acute symptoms often go away on their own, but when they persist plus d’un mois, they report a PTSD which rarely resolves itself without help. The proven treatments improve the quality of life for most people. Wait On the contrary, it may cause the disorder to become chronic.

« Parler du trauma, ça va aggraver les choses »

Faux dans un cadre thérapeutique. Visit thérapie structurée (CBT-T, EMDR, prolonged exposure), addressing trauma in a structured setting allows for reprocessing emotional well-being and healing. Hors d’un cadre thérapeutique, repeatedly recounting an experience can indeed perpetuate the suffering. The timing and context are crucial.

« Le cannabis aide pour le TSPT »

It's not that simple. Some people report a temporary relief, but studies show that the cannabis peut maintenir l’évitement, aggraver l’anxiété à long terme et compliquer la guérison. Il n’est pas recommandé on the front lines. The discussion Consulting a doctor is essential, especially when comorbidities are present.

« Le TSPT, ça veut dire qu’on est fou »

False. Visit PTSD is a réaction normale à un événement anormal. Le cerveau s’adapte au trauma de façon qui pouvait être protective in a traumatic context, but which becomes disabling later on. Understanding this helps put things into perspective and motivates you to commit to treatment.

Frequently asked questions

Combien de temps après un trauma le TSPT peut-il apparaître ?

Les symptômes apparaissent usually dans les semaines suivant l’événement. Le diagnostic de TSPT requiert que les symptômes persistent plus d’un mois. The TSPT à expression retardée occurs later (at least 6 months later). Some people develop PTSD des années after the trauma, sometimes triggered by an event that reminds the person of the initial trauma.

How long does the treatment last?

Variable. For a single trauma, les approches comme l’EMDR ou la TCC-T peuvent être relatively short (a few weeks to a few months). For a complex trauma or comorbidities, treatment may last plusieurs mois à années. If prescribed, medication is often continued for at least 12 months after improvement.

La RAMQ couvre-t-elle la psychothérapie pour le TSPT ?

Visit psychotherapy in the public health care system (CLSCs, hospitals, PQPTM) is free of charge. For the victimes d’actes criminels, les CAVAC offrent du soutien et certains services peuvent être couverts par l’IVAC (Indemnisation des victimes d’actes criminels). Pour les vétérans, Veterans Affairs Canada covers services. In private practice, the group insurance often partially overlap.

L’EMDR, est-ce vraiment efficace ?

Yes, the’EMDR is an approach recommandée par les guides internationaux (WHO, ISTSS, NICE) for the treatment of PTSD. The studies show effectiveness comparable to CBT-T. The exact mechanism remains a matter of debate, but the results are solids. To be performed by a therapist formé et certifié.

Que faire en cas de crise aiguë ou de flashback ?

Techniques d’anchor : se concentrer sur les sensations physiques actuelles (cinq choses qu’on voit, quatre qu’on touche, trois qu’on entend, etc.). Respiration slow and deep. Remember that c’est un souvenir, pas la réalité présente. Contact d’un nearby trusted. In the event of a prolonged crisis, contact Info-Social 811 (option 2) ou se rendre à l’urgence.

Le TSPT peut-il guérir complètement ?

Yes, in most cases. The proven treatments enable most people to regain a qualité de vie satisfaisante, often with the symptoms disappearing or being significantly reduced. Some people experience a « post-traumatic growth »": a shift in values, a new outlook on life. The prognosis is generally best with early intervention.

Sources

1. American Psychiatric Association. DSM-5 — Manuel diagnostique et statistique des troubles mentaux, 5^e edition.
2. International Society for Traumatic Stress Studies (ISTSS). Guidelines for the Treatment of PTSD.
3. Public Health Agency of Canada (PHAC). Données et information sur le TSPT au Canada.
4. Lignes directrices canadiennes sur le TSPT — CMAJ, programmes spécialisés.
5. INESSS — National Institute for Excellence in Health and Social Services. Guides et évaluations sur le TSPT.
6. Ordre des psychologues du Québec (OPQ). Information sur la psychothérapie en trauma.
7. Veterans Affairs Canada. Programmes et soutien pour les vétérans.

Medical consultation | Clinique Omicron