Post-traumatic stress disorder (PTSD)
It is inevitable that throughout our lives we will all experience our fair share of stresses, strains and difficult situations. For most of us, recovery from these events will be a natural process which occurs over time, without the need for further help. For others however, certain traumatic and frightening events can trigger a reaction which can last for a period of months, or even years.
This reaction is known as post-traumatic stress disorder, or PTSD for short, a condition which manifests both physically and psychologically and is thought to occur in approximately 30% of individuals who experience traumatic events.
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The term PTSD is used to describe a range of symptoms which occur following on from involvement in a traumatic event. These events are considered to be both beyond our control, and outside of our normal human experiences. The event itself could be anything from witnessing a road traffic accident, natural disaster or terrorist attack, through to being the victim of a mugging, or witnessing harrowing scenes whilst serving in the armed forces.
Whether you are present during a traumatic event, a witness, or a direct victim, the intense distress and helplessness you felt in the midst of that situation can have a deep and long lasting psychological effect and can trigger a series of symptoms which can seriously impact your life.
In some individuals the symptoms will develop very shortly after the event, but for others the onset may be delayed by a number of months, or even years after the trauma first occurred.
Some sufferers are not comfortable with the use of the term ‘disorder’ as used in the term ‘post-traumatic stress disorder’, as they consider their reactions to be natural and understandable responses to events that are abnormal, and would thus prefer the use of the term ‘syndrome’. However, post-traumatic stress disorder (PTSD) is the official medical terminology which is used to describe the condition by organisations such as the National Institute for Health and Care Excellence (NICE), and for that reason we will continue to use the above terminology throughout.
History of PTSD
Awareness of PTSD has grown rapidly during the past few decades but up until the post Vietnam War period (after 1975) was largely disregarded. Even though as a species we have been experiencing traumatic and life-threatening situations for centuries, the condition went under the radar for years until it was officially recognised as a medical disorder.
During World Wars I and II, soldiers who had disturbing experiences whilst in the trenches and were suffering from what we now know to be PTSD, were said to be suffering from battle fatigue, shell shock, soldier’s heart or gross stress reaction. At the time, none of these conditions were recognised by the medical community as viable emotional disorders and were actually considered to be a mark of cowardice or personal weakness by many.
It was only after the Vietnam War ended and doctors began to diagnose veterans with post-Vietnam syndrome that the condition came to the attention of both the public and medical professionals. Vietnam War veterans pushed both the medical world and the military community to recognise the condition as legitimate, and in 1980 post-traumatic stress disorder became officially classified as a mental health condition and was introduced in the Diagnostic and Statistical Manual of Mental Disorders (established by the American Psychiatric Association).
Symptoms of PTSD
PTSD will usually occur after an individual has been involved in, or has witnessed a traumatic event such as a serious road traffic accident, a natural disaster, being held hostage, a violent death, military combat, a sexual assault, or another situation in which an individual feels extreme fear, and or helplessness.
After events such as these, PTSD will usually develop fairly quickly, though for some (below15%), the development of symptoms will be delayed by a period of weeks, months, or sometimes years.
Symptoms will vary from person to person, but often involve the sufferer ‘reliving’ the event to some extent through a combination of flashbacks and nightmares. Re-experiencing the trauma can lead to sleep problems, concentration difficulties, feelings of isolation and depression and a variety of additional symptoms.
The severity and persistence of these symptoms will vary greatly from person to person. For some sufferers, symptoms will be interspersed with periods of remission and for others they will be constant and acute enough to considerably impact quality of life.
Some of the key symptoms of PTSD are outlined below:
Re-experiencing parts of the trauma
It is quite common for individuals with PTSD to relive parts of the event through vivid flashbacks and nightmares. It may be that something in everyday life such as a sound or image has triggered this response, or this may occur for no identifiable reason. Flashbacks, intrusive images, thoughts and nightmares can be extremely distressing for sufferers as they can make them feel as though the event is happening all over again, even if only for a brief moment.
Often, sufferers find that after a traumatic event they remain constantly alert and vigilant to potentially threatening events, and are extremely anxious and easily startled.
This ‘hypervigilance’ can also come coupled with irritability, angry outbursts, aggressive behaviour, sleep problems and concentration difficulties.
Reliving a traumatic experience is extremely upsetting, so understandably some sufferers attempt to avoid anything and anyone which may trigger a response. Sufferers sometimes believe that feeling nothing at all is better than the negative and upsetting feelings they keep experiencing so will try to numb themselves emotionally.
Avoiding situations, people, conversation, activities and thoughts that directly relate to the trauma or are a reminder of the trauma is a common reaction.
Sufferers often try to keep themselves busy so that they don’t have time to think about the trauma and thus it becomes easier to repress those very difficult memories. Many sufferers will develop an extremely pessimistic outlook to life, losing interest in activates they once used to enjoy, disregarding the idea of making plans for the future, finding it difficult to keep or form close relationships and generally detaching themselves on both a physical and emotional level from others.
Other common symptoms and indicators of the condition include inexplicable physical symptoms such as severe headaches, dizzy spells, upset stomach, sweating, the shakes and chest pains, as well as mental health problems such as depression, phobias and anxiety. PTSD is a mental health condition in itself and the symptoms and side effects experienced can result in a breakdown of personal relationships and work relationships which can lead to further distress and upset.
Friends and family – what to look out for
As discussed in the above, a very common symptom of PTSD is avoiding memories and repressing emotions, so it is often friends, family members or colleagues who identify warning symptoms and signs of the condition before the actual sufferers themselves.
PTSD is a very sensitive issue and often sufferers may feel uncomfortable opening up about their experiences and may not be able to recognise that they require extra support. If you are concerned that one of your loved ones may be suffering from PTSD then below are some useful tips, formulated by the Royal College of Psychiatrists (RCPSYCH) which could help you broach the topic:
What to do
- Look out for any behavioral changes such as frequent lateness to work, poor productivity and concentration, numerous days off sick etc.
- Look out for changes to mood. Are they more irritable and angry than usual, do they seem depressed and withdrawn and are they isolating themselves?
- If they open up to you about their story, don’t rush them and give them plenty of time to tell it.
- If you ask questions make sure they are general and not too specific, as talking about certain moments in depth when they are not ready could trigger symptoms such as flashbacks.
- Don’t interrupt them when they are telling you about their trauma and don’t reply with your own experiences.
What not to do
- Really try to avoid generic phrases such as ‘I know how you feel’ as everyone’s situation is different and this may make them close up and stop talking.
- Don’t tell them they are lucky to have come out the other side of their situation as they are unlikely to see this as a positive and again it could result in them closing up.
- Don’t underplay their experience with phrases such as ‘It’s not all bad’.
- Telling them to ‘snap out of it’ or to ‘get over it’ will not help them to recover.
Who suffers from PTSD?
Anyone who has witnessed a severe trauma could be susceptible to PTSD and it is estimated that up to one in 10 individuals may be affected by the condition at some stage during their lives.
However, some individuals who work within certain professions, and some individuals who exhibit certain risk factors may be more prone to develop the condition than others.
According to some studies the condition is present in approximately one in two female rape victims, one in three teenagers who have survived a car accident, two in three prisoners of war and one in five fire-fighters.
Those who have previously suffered from a mental health condition or who have a family history of mental health concerns are also considered to be at a ‘high risk’ of developing PTSD after being exposed to a harrowing event. It is estimated that up to four in five PTSD sufferers are affected by other mental health problems.
PTSD diagnosis can be problematic for health care professionals because very often sufferers will not feel comfortable talking openly about how they are feeling, and in a large number of cases may not even seek treatment until weeks, months or even years after symptom onset.
Visiting a GP can be a very difficult ordeal for sufferers, as discussing how they feel is required in order for a diagnosis to be reached. However, confronting these emotions and asking for professional help is the first step towards overcoming the condition so that sufferers are able to move forward in their lives.
The Royal College of Psychiatrists (RCPSYCH) have developed several sets of criteria in order to help medical professionals reach an accurate diagnosis, including many of the symptoms mentioned above (in ‘What are the symptoms?’) such as flashbacks, nightmares, irritability, mood swings, exhaustion, depression and relationship difficulties.
If symptoms such as these began after a traumatic event but have started to ease off and improve in the six week post trauma period, then it may be that they were part of the body’s natural coping mechanism. However, if the symptoms persist for longer than six weeks and show no signs of improving then it is advisable to seek medical advice from your GP.
Because each sufferer will experience their own unique PTSD symptoms, your GP will usually wish to discuss your symptoms with you in depth. They may ask you whether you believe the trauma is a result of a recent event or as a result of something from a long time ago, what symptoms you are experiencing, your physical and psychological health background and your current overall health status.
After completing an in depth assessment, a GP will have collated enough information to diagnose PTSD and refer you for specialist help.
Help for PTSD
PTSD is a condition which manifests itself both a physically and psychologically, and therefor treatment is required for both aspects. Effective treatments for the condition are still being researched as different types of trauma can have different impacts, and treatment for single incident trauma will usually differ to treatment for long-term trauma.
Your GP will take into consideration your specific circumstances in order to ensure that they refer you to a treatment option which they believe will prove the most effective for you. The treatments which follow have all been found to be helpful in improving PTSD symptoms and are recommended by the National Institute for Health and Care Excellence (NICE).
In their treatment guidelines NICE recommend that individuals undergo talking treatments such as psychotherapy, before medication is prescribed.
This is a form of talk therapy that involves focussing on the traumatic experience in a bid to help you think differently about it and about your life. Though it is not possible to forget about the event entirely, psychotherapy helps individuals to reach a stage where they feel safer and more in control of their feelings so that they will no longer need to avoid these memories and are able to control when they think about them.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy, or CBT, is a branch of psychotherapy which is based on the premise that the way we think (cognitive) determines how we respond to those thoughts (behaviour). Over years these negative thinking and behaviour patterns become fixed, and cognitive behavioural therapy hopes to challenge those behaviours, bringing about positive feelings and behavioural changes.
CBT for PTSD is aimed at teaching sufferers ways to help them modify negative thought patterns so they are able to gain control of their fear. Though techniques will vary from practitioner to practitioner, often-mental imagery is used to help individuals through their trauma.
Please note: Some medical professionals argue that general counselling may actually be detrimental in some PTSD cases, as encouraging ‘feeling’ work during such a fragile stage could embed the trauma even further. The condition and its treatments are very complex and that is why if help is sought from a counsellor, psychotherapist or another talk therapy practitioner, it is advisable to ensure they specialise in PTSD.
Eye movement desensitisation and reprocessing (EMDR)
Eye movement desensitisation and reprocessing (EMDR) is a form of treatment which has been found to benefit a variety of behavioural and emotional issues in both adults and children. The treatment itself involves performing a series of right to left eye movements whilst simultaneously recalling a traumatic event.
Though it is not known exactly how the treatment works, it is thought that it may be linked to the left and right stimulation of the brain whilst we are in REM (rapid eye movement) sleep, during which our eyes rapidly move from one side to another.
The eye movements are designed to help the brain process unconscious material and flashbacks so that in due course, sufferers are able to come to terms with the harrowing event they experienced and are able to adopt a more positive thinking approach moving forward.
Antidepressant medication is prescribed in many PTSD cases because not only does they help to treat depression, but have also been found to reduce other symptoms of the condition. For this reason among others, NICE have suggested that a form of medication known as paroxetine (belonging to the serotonin reuptake inhibitors (SSRIs) group), or mirtazapine (another form of antidepressant), be considered as a treatment option for adults with PTSD.
However, NICE also state that these drugs should only be prescribed when all other treatment avenues have been explored and none are deemed as suitable. For example:
- If a sufferer has chosen not to undergo psychological treatment.
- If they have had psychological treatment but experienced very little to no benefit.
- If they are at further risk of trauma.
- If they have severe depression that would make it unlikely for psychological interventions alone to be of benefit.
In any of the above incidences it may be that antidepressants are the most suitable option.
It is important to note that the effects of antidepressants will not begin instantaneously and it can take between two and four weeks for the effects to start being felt and up to three months before the benefits really become clear. Of course, with every positive there is a negative, and antidepressants don’t come without their downsides. They come with a long list of possible side effects, can be addictive, and can also be difficult to come off. With this in mind they should be taken with caution, with full knowledge of their side effects, and with regular supervision and check-ups from your GP.
Sertraline and Paroxetine (SSRI) are medications which have both been licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) for the treatment of PTSD, but there are several other medications (both SSRI and Non-SSRI) which are also used, including the following:
- Benzodiazepines – Medications such as diazepam are sometimes prescribed with the intention of being a short-term solution for issues such as irritability, sleep problems and anxiety. They can be addictive and begin to reduce in effectiveness after just a few weeks so only a short course should be prescribed.
- Betablockers – These are being examined as a treatment option but further research is needed to prove their efficacy.
If you are prescribed medication to help treat your PTSD and you have found it to be effective then you can expect the course of treatment to continue for a period of around 12 months before your healthcare provider gradually begins the withdrawal process.
PTSD in children and young people
NICE have developed a set of guidelines which outline the recommended treatment procedure for children and young people affected by PTSD. According to the guidelines, older children exhibiting severe symptoms should undergo a course of cognitive behavioral therapy (CBT), preferably within a month after the traumatic incident.
For cases that occur three months or more after the event first occurred, NICE recommend the following:
- Regular and on-going psychological treatment conducted by the same medical professional each week.
- Families playing a role in the treatment programme if appropriate.
- A course of CBT which is age and circumstance appropriate.
- Parents are informed that no evidence has been found proving the efficacy of play therapy, family therapy or art therapy to treat PTSD.
The National Institute for Health and Care Excellence (NICE) have developed a set of guidelines which they hope will help to promote the proper care and treatment of those suffering from PTSD.
The clinical guidelines include the following:
- The standard of care a sufferer should expect from both their GP and other healthcare professionals.
- The level of information a sufferer should expect to receive about their condition and treatment options.
- Information about the services that are available to help them recover from their condition, such as specialist mental health services.
- Guidance and information about recommended treatments and medications.
View the full NICE guidelines on PTSD
Hypnotherapy for post-traumatic stress disorder
As well as undergoing the treatment recommended by their health care provider, some PTSD sufferers also find that hypnotherapy treatment is beneficial. Though there is no solid evidence to support the efficacy of hypnotherapy for post-traumatic stress disorder, many sufferers have experienced success with the treatment.
The aim of hypnotherapy is to unlock stored emotion so that the trauma can be revisited and explored from a different perspective.
There are various forms of hypnotherapy a practitioner may use and in order to determine which is the most suitable for you, a practitioner will usually begin by performing an assessment of your personal circumstances.
In most cases practitioners will tend to use cognitive hypnotherapy or analytical hypnotherapy, both of which function on a deeper level than suggestion hypnotherapy and are able to work with the unconscious mind so that negative beliefs which were built up during the trauma can be explored and alleviated.
A hypnotherapy practitioner will treat you and your problems with sensitivity and understanding and will discuss and explain any decisions regarding you treatment plan with you thoroughly before treatment begins or any changes are implemented.
If you would like to find out more about how hypnotherapy could help you to over come post-traumatic stress disorder, you can contact a qualified hypnotherapy practitioner in your local area by using the search tool located on the homepage of this site.
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