Chippenham Hospital October 05, 2018

Post-traumatic stress disorder (PTSD) is an anxiety disorder that sometimes develops after exposure to a traumatic event or ordeal in which physical or emotional harm occurred or was threatened. Events that can trigger PTSD include violent personal assaults, such as a rape or mugging, natural or human-caused disasters, accidents, or military combat. PTSD can be extremely disabling. The National Center for PTSD cites that in the United States: 

  • About 7-8% of the population will have PTSD at some point in their lives. 
  • About 8 million adults have PTSD during a given year, only a small portion of those who have gone through a trauma. 
  • About 10% of women develop PTSD sometime in their lives compared with about 4% of men.
  • 11-20% of those who served in the military during Operations Iraqi Freedom (OIF) and/or Enduring Freedom (OEF) suffered from PTSD. 

Many people with PTSD repeatedly experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. Anniversaries of the event also can trigger symptoms. People with PTSD experience emotional numbness and sleep disturbances, depression, anxiety, and irritability or outbursts of anger. Feelings of intense guilt are common. Most people with PTSD try to avoid any reminders or thoughts of the ordeal. PTSD is diagnosed when symptoms last more than one month. 

Co-occurring depression, alcohol use disorder, substance abuse, or another anxiety disorder is not uncommon. The likelihood of treatment success is increased when these other conditions are appropriately identified and treated, as well.

 

What are the risk factors for developing PTSD?

A risk factor is something that increases your likelihood of getting a disease or condition. Not everyone who experiences a traumatic event will develop PTSD. Symptoms of PTSD are more likely to occur if a person has one or more of the following risk factors: 

  1. Previous Traumatic Experiences

People who experienced a previous trauma, such as a rape, car accident, disaster, or act of violence, are more susceptible to PTSD. The stress of the trauma can have a cumulative effect, and a new traumatic experience can exacerbate the negative effects of a previous trauma. This is especially true for those with early and longer-lasting childhood trauma. 

  1. History of Abuse

People with a history of physical, emotional, or sexual abuse tend to be more susceptible to PTSD. Such experiences contributed to previous trauma and their effects may be reinforced by any additional trauma. 

  1. Family History of PTSD or Depression

People with a family history of PTSD and/or depression tend to be more susceptible to PTSD. Family history of other mental health problems also may increase the risk. 

  1. History of Substance Abuse

People with a history of substance abuse tend to be more susceptible to PTSD. It may be that drug use and alcohol use disorder interfere with a person's ability to cope with the added stress of a traumatic event. 

  1. Poor Coping Skills

Coping skills and the level of psychological functioning can play a role in a person’s susceptibility to PTSD. People are more susceptible to PTSD if they have poor coping skills or lower levels of psychological functioning. They may have little sense of control over their circumstances or blame themselves for the trauma. 

  1. Lack of Social Support

Research suggests that positive social and family relationships help moderate the effects of stress and trauma. Conversely, people who lack supportive relationships and environments tend to be more vulnerable to stress and, therefore, more at risk for PTSD after experiencing trauma. A social environment that produces shame, guilt, stigmatization, or self-hatred also increase the risk. 

  1. Ongoing Stress

The effects of extreme or ongoing stress on a person can result in extensive physical and psychological problems. This can reduce the ability to cope with trauma, thus increasing the risk of PTSD.

 

What are the symptoms of PTSD?

PTSD is categorized by when symptoms occur and how long they last. There are 3 types of PTSD: 

  1. Acute—symptoms last 1-3 months after the event
  2. Chronic—symptoms last more than 3 months after the event
  3. Delayed onset—symptoms do not appear until at least 6 months after the event 

For most people, PTSD starts within about 3 months of the traumatic event. For some, signs of PTSD do not show up until years later. PTSD can happen to anyone at any age, including children. Some people get better within 6 months, while others may have the disorder for much longer. Symptoms of PTSD vary in frequency and intensity over time, and may include: 

  1. Re-experiencing the event:
    1. Dreams or nightmares
    2. Intrusive memories
    3. Flashbacks
    4. Anxious reactions to reminders of the event 
  1. Avoidance:
    1. Avoidance of external reminders of the event, such as places, situations, or people that can trigger memories
    2. Efforts to avoid feelings, thoughts, memories related to the event 
  1. Changes in Mood and Thinking
    1. Negative changes in mood and cognition related to trauma, including detachment, numbness, and difficulty remembering relevant details of the trauma 
  1. Arousal:
    1. Difficulty falling or staying asleep
    2. Anger and irritability
    3. Difficulty concentrating or maintaining attention
    4. Being easily startled
    5. Hypervigilance 
  1. Physical symptoms may also occur such as:
           
    1. Impaired memory
           2. Stomach and digestive problems
           3. Rapid breathing or heart rate
           4. Being easily startled
           5. Hypervigilance

 

  1. Alcohol and/or Drug Abuse:
    1. People with PTSD are also more prone to abusing alcohol or drugs.

 

How is PTSD diagnosed?

Diagnosis of PTSD is usually based on the following:

  1. Initial Assessment

Your doctor will ask you about your symptoms and medical history. You will be given a psychological assessment and asked about past trauma. PTSD will be diagnosed if you have the specified symptoms, they last for more than one month, and they result in both emotional distress and disturbed functioning (problems at school, work, and/or in family and peer relationships). 

Diagnosis is often based on the criteria outlined by the American Psychiatric Association, which include: 

  • Exposure to a traumatic event
  • Recurrent and intrusive distressing memories of the event
  • Repeated vivid and uncontrollable memories
  • Emotional numbness
  • Physical symptoms of fear triggered by cues in the environment or other physical sensations that dredge up the traumatic event
  • Interference with work, school, and/or relationships 
  1. Evaluation for Substance Abuse

Using and withdrawing from addictive substances can cause anxiety and other symptoms that resemble PTSD. Your doctor may ask about your use of alcohol and other drugs. 

  1. Evaluation of Other Psychiatric Disorders

Other psychiatric disorders often occur with or can be mistaken as PTSD. You may be tested for other psychiatric disorders, such as: 

  • Alcohol or drug abuse and dependence
  • Depression
  • Other anxiety disorders
  • Phobias
  • Borderline personality disorder
  • Schizophrenia
     

How is PTSD treated?

Treatment for PTSD involves counseling, psychological intervention, medication, and some lifestyle changes. Because PTSD is usually a delayed responses to events over which you had no control, it is nearly impossible to reduce your risk. You can, however, reduce your risk for negative psychological consequences after experiencing trauma with a variety of lifestyle and psychiatric techniques. 

You and your family will be educated about PTSD and its effects and complications. You may need to re-experience the event via imagery, as well as your reactions to and beliefs about the event, in a therapeutic situation. Therapy will help you focus on resolving strong feelings that accompany PTSD. You need new coping skills to deal effectively with memories, reminders, reactions, and feelings associated with the trauma. 

PTSD treatment may include: 

  1. Seeking Mental Health Counseling

When you are dealing with the aftermath of a traumatic experience, counseling can help you to understand and deal with these feelings. Dealing with these feelings may help reduce the chances that you will develop PTSD. There is a variety of styles of counseling available. Talk with your doctor about the best one for you. 

  1. Joining a Support Group

Many communities have support groups for survivors of trauma. Groups can provide emotional support and understanding to help you cope with your feelings. It may feel awkward to meet new people and talk about yourself, but with regular attendance, most people eventually feel more trusting and open. 

  1. Keeping in Touch With Family and Friends

Work at improving your relationships with your partner or spouse, family, and friends. The mutual support will aid in your healing. You will feel more “normal” as you increase your social support. 

  1. Relocating to a Safer Neighborhood

After surviving a trauma, you are likely to feel that the world is a dangerous place and that your chances of being harmed are high. If you live in a high-crime area, your beliefs and fears will be even worse. If possible, move to a quieter and safer neighborhood. 

  1. Joining an Alcohol or Drug Treatment Program

Many survivors of trauma use alcohol or drugs to help them deal with or forget their feelings about the trauma. While this may have some benefits in the short-term, it always makes things worse in the long-term. If you are using alcohol or drugs to cope with trauma, get help so that you can stop. A treatment program or group program is often the most effective way to stop using alcohol or drugs. Ask your doctor for referrals for treatment. 

  1. Starting a Regular Exercise Program

Exercise can provide a healthy outlet for your emotions, distract you from worries and disturbing memories, and help increase your self-esteem and feelings of control. Walking, jogging, swimming, weight lifting and other forms of exercise can help reduce physical tension. Talk to your doctor before you start an exercise program. 

  1. Getting Involved With Your Community

Get involved in a community activity such as volunteering, especially if you are not working. Whether you choose to work with youth programs, the elderly, literacy programs, or hospital services, or to take part in community sports, it is important to feel that you are making a contribution.

 

The National Center for PTSD has other resources available to help you find treatment for PTSD: www.ptsd.va.gov/public/where-to-get-help.

 

If you are in a crisis, there are ways to get help: 

  • Call 911.
  • Go to the nearest Emergency Room.
  • Call the Suicide Prevention Lifeline 1-800-273-8255.
  • Contact the Veterans Crisis Line: 1-800-273-8255, press 1 (text 838255) or Confidential Veterans Chat with a counselor.

 

Source:

National Center for PTSD: www.ptsd.va.gov