Post-Traumatic Stress Disorder

 

Suffering a trauma caused by a frightening, very stressful, or distressing event, or series of events, can lead to a particular type of anxiety disorder called Post-traumatic Stress Disorder (PTSD).

 

The type of events that can cause PTSD include:

• serious road accidents
• violent personal assaults, such as sexual assault, mugging or robbery
• prolonged sexual abuse, violence or severe neglect
• witnessing violent deaths
• military combat
• being held hostage
• terrorist attacks
• natural disasters, such as severe floods, earthquakes or tsunamis

 

PTSD can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later.

PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it’s not clear exactly why some people develop the condition and others don’t.

It is normal to experience upsetting and confusing thoughts after a traumatic event, but in most people these will improve naturally over a few weeks. You should seek help if you are still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome.

Symptoms of PTSD

 

The symptoms of post-traumatic stress disorder (PTSD) can have a significant impact on your day-to-day life. The specific symptoms of PTSD can vary widely between individuals, and the impact that they have can also vary. Some people have symptoms that come and go, or are only present in certain situations, whereas other people will have severe symptoms that are constant.

In most cases, the symptoms develop during the first month after a traumatic event. However on occasion there can be a delay of months or even years before symptoms start to appear.

Some people with PTSD experience long periods when their symptoms are less noticeable, followed by periods where they worsen. Other people have severe symptoms that are constant.

 

The symptoms associated with PTSD tend to fall into the following categories:

 

Re-experiencing

Re-experiencing is the most typical symptom of PTSD. This is when a person involuntarily and vividly re-lives the traumatic event in the form of flashbacks, nightmares or repetitive and distressing images or sensations. This can include seeing images of, or associated with the trauma, or hearing sounds from the trauma. It can also include re-experiencing smells, tastes or physical sensations such as pain, sweating and trembling.

 

Unhelpful Thoughts

Some people will have constant unhelpful or negative thoughts about their experience, repeatedly asking themselves questions that prevent them from coming to terms with the event. For example, they may wonder why the event happened to them, if they could have done anything to stop it or what have happened if the situation had been different. These thoughts can lead to feelings of anger, guilt or shame.

 

Avoidance and emotional numbing

Trying to avoid being reminded of the traumatic event is another key symptom of PTSD. This usually means avoiding the people or places that remind you of the trauma, or avoiding talking to anyone about your experience.

Many people with PTSD will try to push memories of the event out of their mind, often distracting themselves with work or hobbies.

Some people attempt to deal with their feelings by trying not to feel anything at all. This is known as emotional numbing. This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing the activities that they used to enjoy.

 

Hyper-arousal (feeling ‘on edge’)

Someone with PTSD may be very anxious and find it difficult to relax. They may be constantly aware of threats and easily startled. This state of mind is known as hyper-arousal.

Hyper-arousal can lead to irritability, angry outbursts, sleeping problems or difficulty concentrating.

 

Other problems

People with PTSD might also have other problems, including:

• depression, anxiety and phobias
• Work-related problems
• Breakdown in relationships
• drug misuse or alcohol misuse
• headaches, dizziness, chest pains and stomach aches

Causes of PTSD

 

Post-traumatic stress disorder (PTSD) can develop after a very stressful, frightening or distressing event, or after a prolonged traumatic experience.

 

Types of events that can lead to PTSD include:

• serious road accidents
• violent personal assaults, such as sexual assault, mugging or robbery
• prolonged sexual abuse, violence or severe neglect
• witnessing violent deaths
• military combat
• being held hostage
• terrorist attacks
• natural disasters, such as severe floods, earthquakes or tsunamis

 

PTSD is not usually related to situations that are simply upsetting, such as divorce, job loss or failing exams.

PTSD develops in about 1 in 3 people who experience severe trauma. It is not fully understood why some people develop the condition while others don’t, but there are factors that appear to make certain people more likely to develop PTSD.

If you’ve had depression or anxiety in the past, or you don’t receive much support from family or friends, you are more susceptible to developing PTSD after a traumatic event.

There may also be a genetic factor involved in PTSD. For example, having a parent with a mental health problem is thought to increase your chances of developing the condition.

 

Possible causes

Although it is not clear exactly why people develop PTSD, a number of possible reasons have been suggested. These are described below.

 

Survival mechanism

• One suggestion is that the symptoms of PTSD are the result of an instinctive mechanism intended to help you survive further traumatic experiences.
• For example, the flashbacks many people with PTSD experience may occur to force you to think about the event in detail so you are better prepared if it happens again, and the feeling of being “on edge” (hyper-arousal) may develop to help you react quickly in another crisis.
• However, while these responses may be intended to help you survive, they are actually very unhelpful in reality because they mean you can’t process and move on from the traumatic experience.

 

Adrenaline levels

• Studies have shown that people with PTSD have abnormal levels of stress hormones.
• When in danger, the body produces these hormones, such as adrenalin, to trigger a reaction in the body. This reaction, often known as the “fight or flight” reaction, helps to deaden the senses and dull pain.
• However, people with PTSD have been found to continue to produce high amounts of fight or flight hormones even when there is no danger. It is thought this may be responsible for the numbed emotions and hyper-arousal experienced by some people with PTSD.

 

Changes in the brain

• In people with PTSD, parts of the brain involved in emotional processing appear to be different in brain scans.
• One part of the brain responsible for memory and emotions is known as the hippocampus. In people with PTSD, the hippocampus appears smaller in size. It is thought that changes in this part of the brain may be related to fear and anxiety, memory problems and flashbacks.
• It is thought that the changes to the hippocampus may prevent flashbacks and nightmares from being processed normally, so the anxiety they generate does not reduce over time.
• Treatment of PTSD results in proper processing of the memories so, over time, the flashbacks and nightmares will gradually disappear.

Treatment

 

PTSD can be successfully treated, even when it develops many years after a traumatic event.

Any treatment depends on the severity of symptoms and how soon they occur after the traumatic event. Any of the following treatment options may be recommended:

• watchful waiting – waiting to see whether the symptoms improve without treatment
• psychological treatment – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR)
• antidepressant medication

 

Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.

Psychological Therapy

 

If you have PTSD that requires treatment, psychotherapy is usually recommended first. A combination of psychotherapy and medication may be recommended if you have severe or persistent PTSD.

Trauma-focused therapy helps you to manage your problems by changing how you think and act and helps you to come to terms with the traumatic event(s). Your therapist may ask you to confront your traumatic memories by thinking about or talking about your experience in detail. This can be difficult and distressing, but your therapist would help you cope with any distress that you feel.

You may also try to find ways that you can restart anything that you have avoided since your experience.