Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder, also known as PTSD, is an affect anyone who experiences a traumatic experience. Here is a look into PTSD in more detail, including symptoms, common causes and treatment options.

What is PTSD?

When you experience something traumatic, your body and mind might react in different ways. Some people develop post-traumatic stress disorder. This often involves the person re-experiencing the event through flashbacks and nightmares. These flashbacks can be triggered by everyday items and scenarios, making day-to-day living difficult.

After a traumatic event, some people will experience early symptoms that are associated with PTSD, such as difficulty sleeping or feeling numb. For many, these symptoms will naturally disappear after a few weeks. If the symptoms last longer than a month, however, someone may be diagnosed with PTSD.

Speaking to a family doctor is the best way to get started if you suspect you have PTSD. You may be given a diagnosis of mild, moderate or severe PTSD. This has nothing to do with how upsetting/frightening your experience was, but how strongly the symptoms are affecting you.

Some other terms that may be used by your doctor include delayed-onset PTSD (if you start experiencing symptoms more than six months after the event), complex PTSD (if the trauma happened at an early age or if you experienced it for a long time) and birth trauma.

Birth trauma

Birth trauma, a shorthand term for PTSD after birth, can occur if the experience of birth has been frightening or traumatic in some way. Perhaps the mother experienced a difficult labour with a long, painful delivery, or the baby’s heart rate dipped, leading to an emergency C-section. Maybe the mother or the baby suffered injuries during birth.

Birth trauma can also develop if the mother feels they were poorly looked after during the birth, or if they believe they were misinformed.

Birth trauma and the impact of the experience is often underestimated. While it is known that pregnancy and birth are often unexpected, nothing can prepare you for a traumatic birth. Birth trauma, as well as the recognised PTSD symptoms, can impair the relationship between mother and partner, mother and child. It can also prevent a woman from wanting another baby.

If you are experiencing some symptoms of PTSD, but the trauma happened to someone close to you, this may be referred to as ‘secondary trauma’.

PTSD symptoms

Everyone who develops PTSD will have a unique experience of the condition. These differences will be according to the person, not the traumatic event. For example, two people who are involved in the same traumatic event and go on to develop PTSD may experience the condition in different ways.

However, there are some common symptoms associated with PTSD, including:

Flashbacks

Flashbacks to the trauma can make you feel as if it is happening to you again, at this very moment. It may also feel like you’re watching a video of what happened, from another point of view. You may see images/partial images from the event, hear noises or feel sensations/emotions you felt at the time.

Sometimes these are triggered by something you come across in your day, sometimes they come from nowhere as intrusive thoughts or images. For many, sleep is affected and you may find you have distressing nightmares. Physical symptoms like nausea, shaking and even pain may also be experienced.

I suffered from bad dreams about the car accident and kept getting flashbacks of the accident every time I got in a car – even as a passenger.

Feeling on edge

Feeling constantly on edge is common for those with PTSD. This may make you easily startled and easily upset or angry. You might struggle to concentrate or even have panic attacks and anxiety symptoms.

You may become more aware of your surroundings, feeling incredibly alert. This is called hypervigilance. Studies have shown that those with PTSD produce higher levels of stress hormones than those without PTSD, which may explain this symptom.

Avoiding certain feelings/memories

If you have PTSD, you might try to keep yourself busy to stop yourself from thinking about the traumatic event. You may avoid anything that reminds you of the event and feel emotionally detached from your feelings. You may feel physically numb and as if you aren’t in your body.

Some people may struggle to show affection, finding it difficult to trust people. Alcohol and drugs may also be used as a way to avoid certain memories or feelings.

Guilt and isolation  

Some people experience guilt after a traumatic experience, blaming themselves for what happened. You may feel difficult emotions like shame and anger. If you struggle to trust people, you may believe it’s better to isolate yourself. If you feel unsafe in many situations, you may choose to stay where you feel safe, which can further isolate you.

If you have PTSD and you drive, you may need to tell the DVLA. If you’re unsure whether or not you need to tell the DVLA, speak to your doctor who can advise you further.

It’s quite common for people with PTSD to struggle with other mental health problems too. These can include anxiety disorders. If you feel you’re struggling with these, be sure to tell your doctor or counsellor so they can help.

Causes of PTSD

Post-traumatic stress disorder develops after an event or situation that has been very frightening or distressing, whether you were directly affected or a witness. It can also occur if you’ve experienced prolonged trauma.

Here are some examples of events/scenarios that can result in PTSD:

Not everyone who experiences something traumatic will develop PTSD. While it’s not fully understood why some people develop the condition and others don’t, there are certain factors that may make a person more likely to develop the condition.

If you’ve suffered from anxiety or depression, or if you don’t tend to get much support from those around you, you may be at a higher risk of developing PTSD. Genetics may also be a factor, if a parent has a mental health condition, you may be more likely to develop PTSD. In some cases, the condition will develop immediately after the event, in other cases, it will develop weeks, months or even years later.

While it’s not known exactly why PTSD develops, suggestions have been made by the medical community. These include:

Survival mechanism

One theory is that PTSD symptoms come from an instinctive mechanism designed to keep us safe from further traumas. The flashbacks and hyperarousal could have been to help us be better ‘prepared’ should something similar happen again.

Brain changes

Looking at brain scans, those with PTSD have a different looking hippocampus (appearing smaller). This part of the brain is related to anxiety, memory problems and flashbacks. If it isn’t processing the trauma properly it could explain why people experience anxiety long after the event. PTSD treatment allows these memories to be processed effectively, allowing this anxiety to reduce over time.

When you know what you’re working with, you can build on it and create a life around it rather than letting it limit your life. You can learn about how the condition affects you, so you can put together your own coping plan, learning and adjusting as you go along. You have the power then, not it.

PTSD treatment

If you recognise symptoms of PTSD, going to your GP in the first instance for diagnosis is recommended. If you’ve had symptoms for under four weeks since the event, or your symptoms are mild, they may suggest ‘watchful waiting’. This means keeping a close eye on your symptoms and seeing if things improve by themselves. You should be offered a follow-up appointment within a month to check-in and see how you’re doing.

If you are diagnosed with PTSD, you may be offered the following treatments:

Trauma-focused cognitive behavioural therapy (TF-CBT)

Cognitive behavioural therapy looks at the way our thoughts and behaviours interact, with the aim of helping you to change them to be more positive for your mental health. Trauma-focused cognitive behavioural therapy is a specially adapted form of therapy, designed to specifically help those with PTSD.

Children and young people will usually be recommended trauma-focused cognitive behavioural therapy. This will likely last eight to 12 sessions and may, where necessary, involve the child’s family.

Medication

Those with PTSD are not typically offered medication. Your doctor may recommend it however if you are struggling with depression, difficulty sleeping or are unable/unwilling to try talking therapies. The medication you may be offered will likely be antidepressants, your doctor will be able to talk this through with you.

Complex PTSD

Complex PTSD (sometimes shortened to CPTSD) can occur in children or adults who have experienced traumatic events repeatedly, such as abuse, neglect or violence. Someone is more likely to develop complex PTSD if:

Children’s development can get affected by this, especially if the condition isn’t diagnosed. This can affect behaviour, confidence and their ability to trust people.

If you have complex PTSD you may be more likely to experience ‘emotional flashbacks’. These are when you feel the intense feelings you felt at the time of the trauma. You may react as if it is happening again, not realising you are having a flashback. Treatment for complex PTSD often involves rebuilding feelings of trust, something that can be helped by developing a trusting relationship with a therapist.

Going through a trauma and then living with PTSD in any form is incredibly difficult. With support, you can learn how to manage your symptoms, take control and live a full life with PTSD.

Counselling

Many PTSD sufferers have had the symptoms for many months and sometimes years, but treatment can still be helpful. You should be offered treatment regardless of when the traumatic event happened. If you have developed symptoms recently you may get better with little or no treatment.

Depending on what your symptoms are and when you developed PTSD, you may be offered psychological treatments that are specific for PTSD sufferers.