PTSD is a type of anxiety disorder believed to affect around one in three people after a traumatic experience. The term 'PTSD' was originally used to describe symptoms of trauma arising primarily from combat exposure. People in the military are particularly susceptible to this condition due the frequency of their traumatic experiences. However, this has since been extended to encompass any group of people exposed to traumatic events. This includes:
Symptoms of PTSD are both psychological and physical, and usually develop within first month of the traumatic event, although they can appear up to a year later. While the specific symptoms of PTSD vary from person-to-person, living with the condition can have a significant effect on your ability to function in everyday life, particularly when you have persistent and extreme symptoms.
The symptoms most commonly experienced by people with PTSD include:
The most widely reported symptom of PTSD, and arguably the most distressing, includes re-experiencing the initial source of trauma, which can appear in the form of flashbacks, nightmares, thoughts and physical sensations, causing sweating and trembling. Whichever form involuntarily reliving the traumatic event takes, it'll often feel intensely vivid and closely mimic the initial physical and emotional responses felt when your trauma initially took place. These experiences can be interspersed with more general negative thoughts about the event, where you may internally question why your life has been affected so dramatically and if you could have done anything to stop it.
While the initial cause of PTSD will often be clear after a particularly traumatic event, it's not yet known why some people go on to develop the disorder, while others experiencing similar circumstances don't.
It's unlikely you'll be diagnosed with PTSD if you go through upsetting situations such as a divorce, being made unemployed, or not passing an exam, although you may still experience some symptoms that are closely related to the condition.
Other factors that are believed to contribute to the development of PTSD include having a history of or existing mental health conditions such as anxiety and depression. Having a lack of social support after the event can also exacerbate feelings of confusion, frustration and isolation, which can increase your chances of experiencing symptoms of the condition.
Theories for why PTSD develops in some but not others experiencing the same or similar levels of trauma include:
If PTSD is left untreated, these symptoms can become severe and long-lasting which can affect your family, social and work life.
The difference between expected levels of stress and anxiety after trauma depends on how long initial symptoms last. If you have PTSD, they can last beyond a few weeks and may not improve until you get professional medical help and support.
The ICD10 classification for PTSD (F43.1) states:
CPTSD is said to arise where there has been repetitive, prolonged trauma involving sustained abuse or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic.
In response to acute stress, the body's sympathetic nervous system is activated due to the sudden release of hormones, triggering the release of catecholamine. This leads to a state of hyper-arousal, commonly known as the ‘fight or flight’ response. When people experience trauma, the world may then feel like a less secure place and the trauma may re-invoke earlier feelings of vulnerability.
Some people with PTSD are said to show organic and functional abnormalities of the brain. Areas implicated include the amygdala, hippocampus and pre-frontal cortex.
PTSD can be successfully treated, even if your symptoms appear some time after the initial trauma. The type of treatment offered depends on the severity of your symptoms and how soon they've appeared after the traumatic event.
You may experience symptoms of PTSD immediately after the distressing event has occurred, although many people have a delay in onset of symptoms for months or even years. When these symptoms do occur, they may happen constantly, and severely affect your ability to function most days, although some people with the condition can go extensive amounts of time without noticing any issues, before symptoms ultimately flare-up.
For many people, these symptoms lead to depression, panic attacks and generalised anxiety. People can also withdraw from work and social activities. If you think you may be struggling with the symptoms of PTSD, it’s important to seek help and manage the condition.
Systematic reviews suggest that cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) are both effective in the treatment of PTSD.
National Institute for Health and Care Excellence (NICE) guidance suggests that all PTSD sufferers should be offered a course of trauma-focused psychological treatment (either trauma-focused CBT or EMDR), regardless of the time lapse since the traumatic event/series of events.
Treatment of PTSD at Priory involves tried and tested therapy techniques, working towards reducing the symptoms of the condition. This enables you to process memories and emotions relating to the event that are stopping you from functioning in everyday life.
People with PTSD find it very difficult talk about the traumatic events that have caused it. Trauma focused CBT helps them to talk about the trauma which is the first step in treatment.
CBT helps you to understand your thought processes and how to change your feelings and reactions to your symptoms. One form of CBT is known as exposure therapy, which is unique to treating trauma seen in conditions such as PTSD.
This involves you imagining the trauma within a safe, controlled environment to help you to face up to your fears. This enables our specialists to examine your reactions to the event and help you to overcome your anger, shame or guilt. This will enable you to deal with traumatic memories and feelings, without becoming overwhelmed or emotionally numb.
EMDR aims to help sufferers reprocess their traumatic memory. EMDR involves inducing a series of rapid and rhythmic eye movements to facilitate cognitive change and decrease anxiety. Patients are instructed to focus on a trauma-related image and to bring the negative emotions, sensations and thoughts to the forefront of their minds, while visually tracking the therapist’s fingers as they move back and forth in front of the patient’s eyes.
By discussing your emotions and trauma with a group of other PTSD sufferers, you'll achieve greater understanding of your condition and emotions. Group therapy sessions will help you to become more confident and trusting, and enable you to focus on the present rather than the past.
This focuses on the emotional conflicts caused by the traumatic event, particularly experiences dating back to when you were young. By working with a calm and unbiased therapist, you'll achieve a greater sense of self-esteem and develop effective methods of thinking and coping with intense emotions.
If your symptoms of PTSD are diagnosed as mild during your initial assessment, or your symptoms of the disorder have lasted only a short amount of time, then it may be recommended that you embark on a period known as ‘watchful waiting’.
This is an approach which requires increased focus on whether your symptoms are getting better or worse, with a follow-up appointment allowing assessment of whether treatment to relieve your symptoms is required.
Medication can be prescribed to reduce the anxiety, depression and insomnia often experienced with PTSD. In some cases, medication may help to relieve the distress and emotional numbness caused by traumatic memories, and also helps you to participate in psychotherapy sessions.
NICE recommends psychological therapy as first line treatment but with drug treatment alongside this. This includes selective serotonin reuptake inhibitor (SSRI) antidepressants such as paroxetine, sertraline, tetracyclic antidepressants or mirtazapine. These can be recommended when someone is struggling with the symptoms of depression or severe hyper-arousal that significantly affects a sufferer’s ability to benefit from psychological treatment alone. There may also be a clear patient preference for medication over psychological therapy.
Mirtazapine may be quite sedating in some patients but is potentially useful if a person is aroused, irritable or sleeping poorly.
