Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.
Symptoms of post-traumatic stress disorder (PTSD)
Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.
They may also have problems sleeping and find concentrating difficult.
These symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.
In most cases, the symptoms develop during the first month after a traumatic event.
But in a minority of cases, there may 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 get worse. Other people have constant severe symptoms.
The specific symptoms of PTSD can vary widely between individuals, but generally fall into the categories described below:
Re-experiencing is the most typical symptom of PTSD.
This is when a person involuntarily and vividly relives the traumatic event in the form of:
- repetitive and distressing images or sensations
- physical sensations, such as pain, sweating, feeling sick or trembling
Some people have constant negative thoughts about their experience, repeatedly asking themselves questions that prevent them coming to terms with the event. For example, they may wonder why the event happened to them and if they could have done anything to stop it, which can lead to feelings of 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 certain people or places that remind you of the trauma or avoiding talking to anyone about your experience.
Many people with PTSD 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This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing activities they used to enjoy.
Hyperarousal (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 hyperarousal.
Hyperarousal often leads to:
- angry outbursts
- sleeping problems
- dfficulty concentrating
Other problems with PTSD
Many people with PTSD also have a number of other problems, including:
- depression, anxiety or phobias.
- Self-harming or destructive behaviour, such as drug or alcohol misuse
- other physical symptoms, such as headaches, dizziness and stomach pains
- permanent personality changes
PTSD sometimes leads to work-related problems and the breakdown of relationships.
Who’s at risk
If you have had depression or anxiety in the past, or you do not receive much support from family or friends, you’re 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.
Causes of post-traumatic stress disorder (PTSD)
Any situation that a person finds traumatic can cause PTSD. These can include:
- serious road accidents
- violent personal assaults, such as sexual assault, mugging or robbery
- serious health problems e.g. admission to critical care
- childbirth experiences, losing a baby
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 do not.
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 force you to think about the event in detail so you’re better prepared if it happens again.
The feeling of being “on edge” (hyperarousal) may develop to help you react quickly in another crisis.
But while these responses may be intended to help you survive, they’re actually very unhelpful in reality because you cannot process and move on from the traumatic experience.
High adrenaline levels
Studies have shown that people with PTSD have abnormal levels of stress hormones.
Normally, when in danger, the body produces stress hormones like adrenaline 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.
People with PTSD have been found to continue to produce high amounts of fight or flight hormones even when there’s no danger.
It’s thought this may be responsible for the numbed emotions and hyperarousal experienced by some people with PTSD.
Changes in the brain
In people with PTSD, parts of the brain involved in emotional processing appear 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’s thought that changes in this part of the brain may be related to fear and anxiety, memory problems and flashbacks.
The malfunctioning hippocampus may prevent flashbacks and nightmares being properly processed, 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 gradually disappear.
When to seek medical advice
It’s normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks.
You should see a GP if you or your child are still having problems about 4 weeks after the traumatic experience, or if the symptoms are particularly troublesome.
If necessary, your GP can refer you to mental health specialists for further assessment and treatment.
How post-traumatic stress disorder (PTSD) is treated
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 – monitoring your symptoms to see whether they improve or get worse without treatment
- antidepressants – such as Sertraline or Mirtazapine
- psychological therapies – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). You can refer yourself directly to a psychological therapies service.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.
Trauma-focused CBT uses a range of psychological techniques to help you come to terms with the traumatic event.
For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail.
During this process, your therapist helps you cope with any distress you feel while identifying any unhelpful thoughts or misrepresentations you have about the experience.
Your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience (for example, feeling you’re to blame for what happened, or fear that it may happen again).
You may also be encouraged to gradually restart any activities you have avoided since your experience, such as driving a car if you had an accident.
You’ll usually have 8 to 12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60 to 90 minutes.
Eye movement desensitisation and reprocessing (EMDR)
Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment that’s been found to reduce the symptoms of PTSD.
It involves making side-to-side eye movements, usually by following the movement of your therapist’s finger, while recalling the traumatic incident.
Other methods may include the therapist tapping their finger or playing a tone.
It’s not clear exactly how EMDR works, but it may help you change the negative way you think about a traumatic experience. Negative memories can be replaced by more positive ones specific to you.
Some people find it helpful to speak about their experiences with other people who also have PTSD.
Group therapy can help you find ways to manage your symptoms and understand the condition.
There are also a number of charities that provide counselling and support groups for PTSD. For example:
- Combat Stress – a military charity specialising in helping ex-servicemen and women
- Rape Crisis – a UK charity providing a range of services for women and girls who have experienced abuse, domestic violence and sexual assault
- Victim Support – providing support and information to victims or witnesses of crime
- CRUSE – a UK charity providing support and information for people who have experienced bereavement
Antidepressants, such as paroxetine, sertraline, mirtazapine, amitriptyline or phenelzine, are sometimes used to treat PTSD in adults.
Of these medications, only paroxetine and sertraline are licensed specifically for the treatment of PTSD.
But mirtazapine, amitriptyline and phenelzine have also been found to be effective and may be recommended as well. Often a combination of psychological therapy and medication produces the best results.
Antidepressants can also be prescribed to reduce any associated symptoms of depression and anxiety and help with sleeping problems. They are not usually prescribed for people younger than 18 unless recommended by a specialist.
If medication for PTSD is effective, it’ll usually be continued for a minimum of 12 months before being gradually withdrawn over the course of 4 weeks or longer.
If a medication is not effective at reducing your symptoms, your dosage may be increased.
Before prescribing a medication, your doctor should inform you about possible side effects. You may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn.
For example, common side effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea.
Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability.
Withdrawal symptoms are less likely if the medication is reduced slowly.
Complex post-traumatic stress disorder (PTSD)
People who repeatedly experience traumatic situations, such as severe neglect, abuse or violence, may be diagnosed with complex PTSD.
Complex PTSD can cause similar symptoms to PTSD and may not develop until years after the event.
It’s often more severe if the trauma was experienced early in life, as this can affect a child’s development.
Complex PTSD may be diagnosed in adults or children who have repeatedly experienced traumatic events, such as violence, neglect or abuse.
Complex PTSD is thought to be more severe if:
- the traumatic events happened early in life
- the trauma was caused by a parent or carer
- the person experienced the trauma for a long time
- the person was alone during the trauma
- there’s still contact with the person responsible for the trauma
As it may take years for the symptoms of complex PTSD to be recognised, a child’s development, including their behaviour and self-confidence, can be altered as they get older.
Adults with complex PTSD may lose their trust in people and feel separated from others.
Symptoms of complex PTSD
The symptoms of complex PTSD are similar to symptoms of PTSD, but may include:
- feelings of shame or guilt
- difficulty controlling your emotions
- periods of losing attention and concentration (dissociation)
- physical symptoms, such as headaches, dizziness, chest pains and stomach aches
- cutting yourself off from friends and family
- relationship difficulties
- destructive or risky behaviour, such as self-harm, alcohol misuse or drug abuse
- suicidal thoughts
Treating complex PTSD
If you have complex PTSD, you may be offered therapies used to treat PTSD, such as trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing (EMDR).
People with complex PTSD often find it difficult to trust other people. You may be offered more therapy sessions than usual, so you have time to build a trusting relationship with your therapist.
You’ll also be offered treatment for other problems you may have, such as depression or alcohol addiction.
You should be offered ongoing support after your treatment ends.
The mental health charity Mind has more information about complex PTSD.
PTSD in children
PTSD can affect children as well as adults. Children with PTSD can have similar symptoms to adults, such as having trouble sleeping and upsetting nightmares. Like adults, children with PTSD may also lose interest in activities they used to enjoy, and may have physical symptoms such as headaches and stomach aches.
Other symptoms you may notice in children with PTSD include:
- difficult behaviour
- avoiding things related to the traumatic event
- re-enacting the traumatic event again and again through their play
Trauma-focused CBT is usually recommended for children and young people with PTSD.
This normally involves a course of 6 to 12 sessions that have been adapted to suit the child’s age, circumstances and level of development.
Where appropriate, treatment includes consulting with and involving the child’s family.
Children who do not respond to trauma-focused CBT may be offered EMDR.
PTSD and driving
Post-traumatic stress disorder (PTSD) may affect your ability to drive safely, so you should inform the Driver and Vehicle Licensing Agency (DVLA) about your condition.
Visit GOV.UK for more information.
Copyright April 2020 Janet Meehan, Janet Meehan & Partners