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PTSD

Up to 30% of people who witness a traumatic event then go on to experience some of the symptoms of post-traumatic stress disorder (PTSD). These symptoms can vary widely between individuals.

A person with PTSD will often relive the traumatic event through nightmares and flashbacks, and have feelings of isolation, irritability and guilt.

They may also have problems sleeping and may find concentrating difficult. The symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.

The symptoms of PTSD usually develop during the first month after a person witnesses a traumatic event. However, in a minority of cases (less than 15%), 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. This is known as symptom remission. These periods are often followed by an increase in symptoms. Other people with PTSD have severe symptoms that are constant.

Re-experiencing

Re-experiencing is the most typical symptom of PTSD.

A person will involuntarily and vividly relive the traumatic event in the form of flashbacks, nightmares or repetitive and distressing images or sensations. Being reminded of the traumatic event can evoke distressing memories and cause considerable anguish.

Avoidance

Trying to avoid being reminded of the traumatic event is another key symptom of PTSD.

Reminders can take the form of people, situations or circumstances that resemble or are associated with the event.

Many people with PTSD will try to push memories of the event out of their mind. They do not like thinking or talking about the event in detail.

Some people repeatedly ask themselves questions that prevent them from coming to terms with the event. For example, they may wonder why the event happened to them and whether it could have been prevented.

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.

Irritability, angry outbursts, sleeping problems and difficulty concentrating are also common.

Emotional numbing

Some people with PTSD deal with their feelings by trying not to feel anything at all. This is known as emotional numbing. They may feel detached or isolated from others, or guilty.

Someone with PTSD can often seem deep in thought and withdrawn. They may also give up pursuing the activities that they used to enjoy.

Other symptoms

Other possible symptoms of PTSD include:

PTSD sometimes leads to the breakdown of relationships and causes work-related problems.

The type of events that can lead to PTSD include:

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

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

Risk factors

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.

Being abused during childhood is also thought to be another risk factor for PTSD.

Post-traumatic stress disorder (PTSD) can be difficult to diagnose because people who experience traumatic events often don’t want to talk about their feelings.

Also, people with PTSD may not seek treatment for many months or years after their symptoms appear.

The typical signs of PTSD are:

  • having vivid memories, flashbacks or nightmares about the event
  • trying to avoid things that remind you of the event
  • sometimes feeling emotionally numb
  • often feeling irritable and anxious for no apparent reason
  • eating more than usual, or drinking alcohol or using drugs more than usual
  • an inability to control your mood
  • finding it increasingly difficult to get on with others
  • having to keep yourself very busy to cope
  • feeling depressed or exhausted

When should I seek professional help?

If you have tried doing things to combat your these symptoms and you are still cannot cope, then go see your GP and ask to be put in touch with a local psychologist, CBT therapist or counsellor.

It can be very difficult to talk about your trauma and how it is affecting you. It’s natural to want to push these things to the back of your mind, to blank them.  However, trying to avoid talking and thinking about it can actually delay the process of healing.

If it is less than six weeks since you experienced the traumatic event and your symptoms are starting to improve, you may be going through the natural coping process and may not need to have any treatment.

However, visit your GP to discuss your feelings if your symptoms haven’t improved more than six weeks after the traumatic event took place.

PTSD affects everyone differently, so your GP will want to discuss your symptoms with you in as much detail as possible.

Your GP will ask you whether you have experienced a traumatic event, either in the recent or distant past, and whether you have re-experienced the event through flashbacks or nightmares.

They may also ask you about your overall health and whether you are having any sleeping problems.

The National Institute for Health and Clinical Excellence (NICE) recommends psychotherapy as the first treatment to try for post-traumatic stress disorder (PTSD). In some cases, medication may also be used.

PTSD can develop days, weeks, months or even years after a person experiences a traumatic event.

Such 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.

It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help.

Treatment plan

Treatment for PTSD usually begins with a detailed assessment of your symptoms before drawing up a treatment plan that is tailored to your individual needs.

Your GP should discuss your treatment plan with you, and any decisions regarding your treatment should be clearly explained to you.

Your GP may feel that you would benefit from seeing a mental health specialist, such as a:

  • psychologist: an expert in how the mind works
  • community psychiatric nurse: a nurse who specialises in mental healthcare
  • psychiatrist: a mental health specialist who diagnoses and treats mental health conditions

If you are referred to a mental health specialist, they should always treat you with sensitivity and understanding.

Watchful waiting

Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse.

It may be recommended in cases of PTSD where the symptoms are mild or have been present for less than four weeks after the traumatic event.

If watchful waiting is recommended, you should have a follow-up appointment within one month.

Psychotherapy

Psychotherapy is a type of therapy that is often used to treat emotional problems and mental health conditions, such as PTSD, depressionanxiety and obsessive compulsive disorder (OCD).

A psychotherapist is a trained mental health professional. They will listen to you and help you come up with effective strategies to resolve your problems.

If you have severe or persistent PTSD, a combination of psychotherapy and medication may be recommended.

Read more about psychotherapy.

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 treatment techniques to help you come to terms with the traumatic event.

For example, replacing negative thoughts associated with the traumatic event with positive ones. The aim is to help you work through the trauma and gain control of your fear and distress. You may be offered trauma-focused CBT if:

  • Your symptoms of PTSD are severe and develop within one month of a traumatic event.
  • You still have PTSD symptoms within three months of a traumatic event.

You will have 8-12 weekly sessions of trauma-focused CBT, although fewer may be needed if the treatment starts within one month of the traumatic event. Sessions where the trauma is discussed will last for around 90 minutes.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment that has been found to reduce the symptoms of PTSD.

EMDR involves making side-to-side eye movements while recalling the traumatic incident. It works by helping the malfunctioning part of the brain (the hippocampus) to process distressing memories and flashbacks so that their influence over your mind is reduced.

Read more about EMDR.

Medication

Sometimes your GP will recommend a course of anti depressants.

However, medication will generally only be prescribed if you:

  • choose not to have trauma-focused psychological treatment
  • cannot start psychological treatment due to a high risk of further trauma
  • have gained little or no benefit from a course of trauma-focused psychological treatment
  • have severe depression or hypersensitivity that significantly affects your ability to benefit from psychological treatment

Before prescribing a medication, your doctor should inform you about possible side effects that you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn.

The NICE guidelines contain more detailed information about how post-traumatic stress disorder is treated.

Content on this page taken from NHS website with amendments and accreditation from Martin Seager CPsychol AFBPsS 12th April 2013

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