What is PTSD?

PTSD stands for Post-Traumatic Stress Disorder and really came into the consciousness of the public in a major way via the armed forces.

It is not unusual for frontline troops in war zones to witness events which cause PTSD at a later stage in their lives. However, PTSD is not confined solely to the military; anyone can suffer from Post-Traumatic Stress Disorder as it is caused by frightening, stressful or very distressing situations, and, unfortunately, no-one is immune from these in life.

Common causes of PTSD include witnessing or being involved in a crime, experiencing a car accident or living through the trauma of serious health problems, but there are many other possible causes like bereavement or just witnessing a distressing event.

How many people are affected by PTSD?

PTSD is a recognised health condition and according to ptsduk, PTSD is estimated to affect around 1 in 20 people in the UK, although the severity of symptoms which people experience and the point in time at which they develop symptoms can vary hugely. This suggests that the meaning of PTSD can change considerably across the spectrum according to individual circumstances.

In the US, the National Institute of Mental Health reports an estimated 3.6% of adults with PTSD at any one time with around 6.8% of adults experiencing PTSD at some point during their lives.

What are the symptoms of PTSD?

PTSD symptoms are grouped into four types and a PTSD sufferer may not experience all of these, plus the intensity of the symptoms may vary from one person to another.

The four classifications are:

• Intrusive memories – Repeated and recurrent memories of the traumatic event and actual episodes of reliving the event all over again which are described as flashbacks. Dreaming about the event or having nightmares is also common, so sleep is disturbed. PTSD sufferers can also develop severe physical reactions or emotional distress to triggers which remind them of the traumatic event, for instance witnessing another car accident or a near miss if the original PTSD was caused by a road collision.
• Avoidance – Refusing to talk about the event to others and shutting the mind away from it when reminded. Avoidance symptoms also include actual avoidance of people or places that were involved in or remind that person of the original incident.
• Negative changes in thoughts and mood – This can include a bleak outlook on life or one that is always tinged with hopelessness and despair about the future plus a difficulty in experiencing positive emotions in general. Memory loss about the event or the immediate aftermath can also be a symptom of PTSD as it can be difficult maintaining close relationships and a feeling of detachment from family and friends.
• Changes in emotional reactions and physical responses – These are also referred to as arousal symptoms and include being easily frightened or startled, always being defensive and ready for danger, and difficulty concentrating or sleeping. Behaviour can become self-destructive with an apparent disregard for risk and sometimes constant irritability or aggressive outbursts. Some sufferers report a feeling of overwhelming guilt or shame.

Symptoms of PTSD can start quite quickly after the trigger event but, equally, can take months or years to develop. Some people suffer fewer symptoms than others or they may be less intense and easier to manage, but for some sufferers PTSD causes huge problems at work and at home and interferes with their daily lives on every level.

The difference between PTSD and complex PTSD

A diagnosis by a doctor or specialist healthcare professional is always important because PTSD does share some clinical symptoms and commanality with other mental health problems like Borderline Personality Disorder. It is important to receive an accurate diagnosis of PTSD and also to determine whether it is PTSD or complex PTSD in order to manage treatment options effectively.

What is complex PTSD?

Complex PTSD refers to a condition where the sufferer has been exposed to repeated traumatic events such as violence, neglect or abuse. Unsurprisingly, this is often a diagnosis given to adults or children who have suffered in violent or abusive homes or relationships.

Complex PTSD is generally viewed as a more severe condition and there are various elements that a trained medical professional will look for when making the distinction between PTSD and complex PTSD.

These include:

• Trauma caused by a trusted person like a parent or carer.
• Trauma caused by events which happened earlier in life when the sufferer was a child or young person.
• The trauma or abuse was ongoing over a long period of time.
• The trauma was suffered alone.
• There is still contact between the sufferer and the person or persons responsible for perpetrating the abuse or trauma, for instance a parent or other family member.

The symptoms for PTSD and complex PTSD are similar but treatment may vary.  Complex PTSD may often be accompanied by other problems for the sufferer such as relationship breakdowns or substance or alcohol abuse, and so there may be other supportive therapies and interventions required as well as treatment for the complex PTSD.

What is a PTSD episode?

A PTSD episode is a period of time when a person experiences vivid flashbacks, feelings of fear, anxiety and panic. PTSD episodes are usually relatively short-lived and distinct from a period of relapse which can occur to anyone who has suffered from PTSD but who then experiences a reversion to symptoms which may not have occurred for a long time.

Learning how to manage a Post-Traumatic Stress Disorder episode is part of the techniques which are developed during treatment pathways. Being with someone who understands the symptoms and the cause of them such as a friend or family member is very effective, as are breathing techniques and some of the protocols used to manage panic attacks and episodes of anxiety which many people can experience.

Which part of the brain is affected by PTSD?

It is clear that the symptoms in terms of their recurrence and severity can vary hugely on the PTSD spectrum so not all people with PTSD experience the same symptoms or have the exact same pattern of brain changes.

Complex neuroimaging techniques used by experts have been able to analyse the different areas of the brain that are involved in PTSD and certain structures within the brain are closely related to this condition. Some parts of the brain become hypoactive whereas others conversely become hyperactive.

These include:

• The amygdala and hippocampus, part of the limbic system used to regulate emotional response.
• Parts of the PFC, the prefrontal cortex, the mid-anterior cingulate cortex and the right inferior frontal gyrus.

The amygdala and mid-anterior cingulate cortex become overstimulated when a person suffers from PTSD.

Who is affected with PTSD?

Anyone can be affected with PTSD at any age, so this includes adults and children.  Untreated PTSD can remain with people for life and they can continue to experience symptoms for years, even decades, after the original trauma.

This was certainly the case with many veterans from both the World Wars during the 20^th century whose condition largely remained misunderstood and untreated.

Certain groupings within society are likely to have a higher incidence of PTSD such as people who experience traumatic events as part of their work e.g., soldiers, frontline ambulance crews, police officers and firemen.

Women in particular societal groupings who are more likely to be exposed to domestic violence and assault would show a higher incidence of PTSD as would children in those households.

What is the best medication for PTSD?

PTSD is a wide-ranging and complex illness with huge variants and so the most important place to start is with an actual diagnosis. Like many conditions and disorders on the mental health spectrum, PTSD can share some symptoms with other illnesses so to find appropriate treatment, an accurate diagnosis is essential.

Depending on the trigger for PTSD and the severity of the symptoms, a treatment plan will be devised which can include many options, one of which is medication. Usually, psychological therapies and medicine are combined, with therapy being recommended first unless the PTSD symptoms are very severe.

Two specific medicines are licensed in the UK for the treatment of PTSD, and these are Paroxetine and Sertraline which are antidepressants. Medical professionals only tend to use oral medication if the patient chooses not to explore psychological therapies or if there is a likelihood the trauma will recur such as in a domestic violence situation or for a frontline soldier.

Medicines can also be used if the patient has tried psychological therapies and found them to be ineffective, which can happen, or if the patient already has an underlying medical condition such as severe depression in addition to PTSD.

What help is available?

There is a whole gamut of options available for someone who is suffering from PTSD and much of this will depend upon the trigger point as well as the medical perspective. Psychological therapies are usually the first recourse when advising on treatment options and help for PTSD as they are generally less invasive than medicines which can also carry their own side effects.

There are two main types of psychological therapies suggested for PTSD patients and these are Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR).

Cognitive Behavioural Therapy, or CBT, is a popular treatment on the NHS and involves changing the way a person responds to past problems in their life. CBT is used for a number of different issues not just PTSD.

A therapist can guide a patient through a range of psychological techniques which involve facing the trauma and dealing with the distress as these memories are uncovered. CBT is about taking control of fear and distress and dealing with negative emotions like guilt and blame.

Eye Movement Desensitisation and Reprocessing (EMDR) is a psychological technique which also involves recalling past traumas and using rapid eye movement following a stimulus – usually the therapist’s finger tapping or playing a note. EMDR is a relatively new therapy but is popular because it can show quite rapid changes to the patient’s outlook and potentially relieve symptoms more quickly.

Counselling and individual and group support is available from specific sources which are connected to the original trigger for the PTSD. They can often provide help that is specialist and contextual, targeted to PTSD sufferers who have experienced a particular trauma like those encountered in war zones or PTSD after a rape.

Groups include:

• Rape Crisis – A UK charity for women and girls who have experienced rape and all forms of domestic violence and sexual assault.
• Victim Support – Which provides support to victims and witnesses of crime.
• Combat Stress – A military charity which offers help and support to ex-servicemen and women.
• CRUSE – A bereavement charity providing all sorts of help and support to those who have experience bereavement.

It is important to discuss an appropriate treatment programme for PTSD with a healthcare professional as the range of options can be quite overwhelming. People suffering with PTSD should never overlook or disregard the support of friends and family who can provide day-to-day encouragement and help alongside other treatment options.

PTSD does not have to be a defining lifelong diagnosis, and people who have encountered a traumatic event which happened decades earlier can still be helped and freed from the symptoms of that occurrence in their lives.