PTSD

Post Traumatic Stress Disorder

Understanding PTSD symptoms, causes and treatment

What is Post Traumatic Stress Disorder (PTSD)?

PTSD is a reaction to experiencing a traumatic event.  To gain a diagnosis of PTSD, the person will have had to have been exposed to a trauma which involved death, the threat of death or serious injury, or a threat to their physical safety.  EMDR and Trauma Focused CBT are evidence based therapies for PTSD.

Such events may include:

  • Physical or sexual assaults
  • Fires
  • Car Accidents
  • Military and combat experiences
  • Unexpected disasters – flooding, hurricanes
  • Being involved in a terror attack or bombing
  • Seeing someone else hurt or killed

About 60% of men and 50% of women will be exposed to at least one trauma in their life. 

It can be helpful to break down types of trauma into the following three categories:

  • Acute trauma:  this results from a single one off stressful or distressing event.  This could include a car accident, being involved in a natural disaster or being the victim of a serious attack. 
  • Chronic trauma:  this trauma is created from repeated or prolonged exposure to highly stressful events.  It can include bullying, domestic violence or childhood abuse.
  • Complex trauma:  This results from an individual being exposed to multiple different traumatic events. 

What are the symptoms of PTSD?

Symptoms of PTSD usually appear within three months of the event, although may not occur straight away.  Sometimes, people may suppress and internalise the trauma and so it takes longer to recognise this.

There are three categories of symptoms:

Re-experiencing. 

This is where the individual have experiences in their current life that take them back to the trauma.  It can include nightmares, or flashbacks.  Flashbacks can involve having distressing memories of the event which feel like they come from nowhere and a sense that the person is experiencing the trauma as if it were happening right now. 

Avoidance:

Often, following a trauma, different things may trigger memories of this.  These can be something directly linked to the experience – such as getting in a car after a car accident.  However, sometimes these triggers are much less obvious, and may leave the person confused as to why they are thinking about the event.  These are likely to be linked to the senses and could include smells, tastes, sounds and images that are linked to the trauma.

In these situations, when the individual realises that something may trigger the memory, a normal response is to avoid these.  The range of items someone may avoid is vast, however some things that are commonly avoided include:

  • Trying to avoid certain thoughts or feelings
  • Avoiding people or places that remind you of the event
  • Feeling less interested in things you enjoyed before
  • Feeling numb and as if they can’t experience the same emotions as previously.
  • Using alcohol or substances to try and avoid negative feelings or re-experiencing. 

 Hyper arousal

Some people will find that they feel constantly on edge, overly anxious or thinking too much.  They may also find themselves becoming more frustrated or snapping at others more easily.   Other ways that this may occur is that people may struggle to switch off and sleep, or may find it hard to concentrate. 

Other symptoms:

People may also have changes to their thinking and beliefs.  They may have stronger negative beliefs about themselves, others or the world that were not there before.   Examples could include ‘I am bad’; ‘no one can be trusted’ or ‘the world is dangerous’.    The person may also have strong feelings that they are to blame, or are guilty for the event even though it was not their fault. 

How common is it?

Not everyone who has a traumatic experience will get PTSD.  Research suggests that between 8% of men and 25% of women who are exposed to a trauma will end up with symptoms that lead to a diagnosis. 

People who have suffered a traumatic event will be asked to wait for a month following this before assessment of PTSD take place, as in the majority of cases people will naturally recover from the experience.  Sometimes, Doctors may suggest upto 3 months of ‘watchful waiting’ to see whether time is what is required to allow people to readjust. 

Are some people more susceptible to PTSD than others?

PTSD is not a weakness, and it is not possible to predict whether someone is more or less likely to suffer from it after a traumatic event. 

Research suggests that there may be some factors which make some people more susceptible.  These include having:

  • Suffered from anxiety or depression in the past
  • A lack of social support
  • Family members with a history of mental health problems

However, people who do not have these factors can also experience PTSD.

Why does PTSD occur?

There are a number of different theories as to why PTSD occurs. Some of these are discussed below:

Cognition

One theory is that a traumatic event can be hard to deal with because it goes against a persons beliefs about how the world works. For someone who generally believes the world around them is safe, or that life is predictable, a traumatic event will challenge these views.   Due to this, people may spend a lot of time replaying the event in their mind, trying to make sense of it and trying to fit it into their beliefs.  However, as it is unlikely to be possible to do this, it stays in the mind and may lead to feelings of distress, guilt, and a lack of control. 

Survival

Symptoms such as flashbacks and hyper arousal may be the brain’s way of helping someone to make sure they are safe following an event.  By re-experiencing the event, it may be that their brain is helping them to be better prepared were it to happen again.    Also, if they stay ‘on edge’ or hyper aroused, their body is likely to remain in fight or flight, which the brain may believe will help were another trauma to happen.  The problem with this is that in many cases the threat no longer exists after the trauma, meaning that when these symptoms occur they feel frightening and as if they come out of the blue.   

Adrenaline changes:

When an individual is in danger, and their body goes into fight or flight, it produces adrenaline, a stress hormone, to help energise them into action.

Research has found that sometimes when people suffer from a traumatic event their body continues to produce too much adrenaline, which can leave them in a constant hyper aroused state. 

Memory

It is believed that the mind’s reaction to trauma switches off the part of the memory system which helps to file experiences, meaning that trauma memories are not encoded correctly.

There is evidence that when a person experiences a traumatic event it can change the hippocampus area of the brain, which deals with the retention and retrieval of memories. This can mean that people may find it harder to concentrate or remember things following the trauma.

Other responses to Trauma 

Although not everyone suffers from PTSD, a traumatic event can significantly impact on an individual’s life in other ways.  A person may be left with physical wounds, brain injury or may have lost someone due to the event.  As such, other mental health needs, such as anxiety or depression, could occur.  

Treatment for PTSD

The NICE guidelines for PTSD state that two evidence based therapies for symptoms are Trauma Focused CBT and Eye Movement Desensitization and Reprocessing (EMDR)

Both of these therapies focus on supporting the individual to reprocess the traumatic memory, on the basis that it has become ‘stuck’ in their memory system.

EMDR uses eye movements to do this, and more information can be found here

TF-CBT focuses on replaying the trauma memory to allow the person to realise it is no longer a threat. It also includes behavioural work to challenge any avoidance that there is. 

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