Post-traumatic stress disorder (PTSD)

What is Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is an anxiety disorder which can develop following an extremely frightening or traumatic experience, such as witnessing violence or serious accidents. PTSD often makes people re-live the event, which causes distress and difficulty in their day-to-day life. Symptoms can be triggered by seeing, hearing or smelling something that reminds you of the trauma. Not everyone who experiences trauma will develop PTSD.

By World Health Organization, Post-traumatic stress disorder (PTSD) is a mental health condition triggered by a terrifying event — either experiencing or witnessing it. Symptoms may include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. Post-traumatic stress disorder disorders may develop following exposure to an extremely threatening or horrific event or series of events.   

The Diagnostic and Statistical Manual (DSM-5) describes PTSD as first, direct, or indirect exposure to a traumatic event, followed by symptoms in four categories: intrusion, avoidance, negative changes in thoughts and mood, and changes in arousal and reactivity.

UK NHS defines PTSD as an anxiety disorder caused by stressful, frightening or distressing events.

Symptoms of PTSD

Many people’s symptoms following a traumatic event become less severe as they face what’s happened. If the symptoms don’t go away, it’s possible you could have PTSD.

Post-traumatic stress disorder (PTSD) can develop in the hours or days after a traumatic event but can also be delayed by weeks or months. It will usually start within six months of the traumatic event.

Symptoms of PTSD include:

• Re-living what happened, having flashbacks, dreams or nightmares
• Not being able to feel emotions
• Not feeling connected to other people
• Feeling unable to enjoy activities you used to enjoy
• Staying away from situations which remind you of the event
• Feeling on edge, panicky, upset and startled easily
• Feeling like nowhere is safe, always on the lookout for threats
• Problems sleeping

Someone with PTSD often re-lives the traumatic event through nightmares and flashbacks and may experience isolation, irritability and guilt. These symptoms are often severe and persistent enough to impact the person’s day-to-day life significantly.

Types of post-traumatic stress disorder (PTSD)

PTSD usually develops within the first six months after a trauma. In some people, PTSD can take years to build. This is called delayed-onset PTSD, making up less than 1 in 5 cases. The symptoms are the same as PTSD.

Secondary trauma
It’s possible to develop symptoms of PTSD while supporting someone close to you who has experienced trauma. Although the event happened to someone else, the impact of the event is traumatic to you. It’s possible to develop this if you have to witness or hear about traumatic events as part of your job.

Complex post-traumatic stress disorder (CPTSD)
Complex PTSD is separate from PTSD. Complex PTSD often has some of the symptoms of PTSD but also describes some of the personality changes you experience after trauma, such as:

• Difficulty controlling emotions
• Feelings of worthlessness, hostility, and hopelessness
• Feeling like nobody can understand what happened to you
• Avoiding friendships and relationships
• Suicidal thoughts

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
• childbirth experiences

PTSD can develop immediately after someone experiences a disturbing event or occur weeks, months or even years later. PTSD is estimated to affect about 1 in every 3 people with a traumatic experience, but it’s unclear why some people develop the condition and others do not.

Post-traumatic stress disorder (PTSD) is caused by witnessing or being involved in a traumatic or frightening experience such as:

• Violence against you
• Rape or sexual assault
• A car accident
• War
• Natural disasters such as fire or earthquake
• Seeing someone die
• Traumatic childbirth

Not everybody who experiences something traumatic will develop PTSD. The risk of developing PTSD depends on how the experience affects you. PTSD is more likely if the event:

• Involves children
• Is unexpected
• It goes on for a long time
• Involved being trapped
• Causes many deaths
• Causes mutilation
• Is caused by people

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. 

Find out more about complex PTSD.

Treatments for PTSD

PTSD can be successfully treated, even when it develops many years after a traumatic event. 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 worsen without treatment,
• antidepressants – such as paroxetine or sertraline,
• Psychological therapies include trauma-focused cognitive behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR), or Talking therapy. 

The main treatments for PTSD are psychological therapies and medication.

Psychological therapies – Trauma-focused cognitive behavioural therapies (TF-CBT)

TF-CBT helps you deal with your symptoms by helping you change how you think and behave. You may have to remember things you find difficult to help you deal with your symptoms.

Eye movement desensitisation and reprocessing (EMDR)

This involves making eye movements while thinking about the traumatic event. It helps your brain to reprocess the event and deal with the painful memories in a new way until the event becomes less vivid.

Medication for PTSD

Medication is not typically offered to people with PTSD. However, your doctor may suggest it if you find it hard to sleep, live with another mental illness, or prefer to avoid therapy. Your doctor might provide you with venlafaxine or a selective serotonin reuptake inhibitor (SSRI) if you prefer drug treatment. The treatment will need to be reviewed regularly.

You may be offered antipsychotic medication, such as risperidone, at the same time as talking treatments. This may be provided if you have severe symptoms such as psychosis. The treatment will need to be reviewed regularly by a specialist.

Self-help for PTSD

There are things that you can do to manage your own PTSD, which is also known as self-care. When it comes to what helps people, everyone is different. You may need to try various lifestyle changes to find what works for you. This includes, but isn’t limited to:

• Learning relaxation methods, such as relaxing music, free meditation playlists, or videos online.
• Practising mindfulness and meditation. You can find out more at Mindful Communications: mindful.org/meditation/mindfulness-getting-started
• Eating healthy foods, having a balanced diet, having proper vitamins and microelements balance and drinking enough water. You can find nutritional advice here: nhs.uk/live-well/eat-well, and get necessary products here.
• Controlling your vital signs using Remote Patient Monitoring technologies and devices, such as Mawi Vital Monitor and many others.
• Keep physically active. Exercise can help to reduce stress and anxiety. It can increase serotonin and endorphins, your body’s natural ‘happy’ chemicals. You can find out more from “We Are Undefeatable”: weareundefeatable.co.uk
• Keeping a daily routine. Routines can help you to keep your mind occupied and focused on healthy thoughts and activities.
• Having healthy relationships. You can find more tips on maintaining healthy relationships from Mental Health Foundation.
• Getting enough sleep. Without regular bedtime, your mental health can be affected. 
• Being aware of your alcohol intake. Unhealthy drinking habits can lead to poor mental health. Some people use alcohol to deal with their emotions. This is called ‘self-medication.’ If you recognise that you do this, you could avoid alcohol or cut down. Try a different coping technique to help you manage how you feel. You should also consider the effect of alcohol on any medication you take. You may need professional help and can ask your doctor for more information.
• Avoiding smoking or cutting down. Smoking can affect your medication and your health. If you are unsure how your medication support is affected, speak to your doctor.
• Keeping a mood diary. This can improve awareness of your symptoms and what makes you feel better and worse. You can use a notebook, or you may want to try online resources or smartphone apps.