Post-traumatic stress disorder, commonly referred to as PTSD, is an anxiety-based condition that is characterised by a traumatised reaction to being involved in or seeing a distressing or frightening event.
An individual with PTSD will often relive traumatic events through nightmares and flashbacks, and can experience intense feelings of isolation. While PTSD is normally associated with soldiers, in actual fact anyone can suffer from the condition.
Although PTSD is the most renowned trauma-related condition, Acute Stress Reaction and Adjustment Disorder are two other conditions within this category.
All of these conditions can have a marked impact on an individual’s day-to-day life. The good news is that with the right treatment, support and lifestyle, a full recovery is possible for any trauma-related condition.
Types of PTSD & Trauma
While PTSD is the most well-known trauma-based condition, other disorders exist too. Moreover, there are actually two different types of PTSD.
Post-Traumatic Stress Disorder (PTSD): This is an anxiety-based condition that can develop after a person either witnesses or experiences a traumatic event. The person will often relive the trauma through disturbing thoughts or feelings, flashbacks or nightmares. The individual may withdraw from others and avoid visiting certain places. Due to the symptoms, PTSD is a very difficult condition to cope with.
Complex Post-Traumatic Stress Disorder (Complex PTSD): This form of PTSD is linked to people who have experienced ongoing trauma, as opposed to one singular traumatic event. Their trauma has lasted for an extended time period. Symptoms are similar, with disturbed thoughts or feelings common, as are flashbacks and nightmares. Losing trust in others is a normal reaction for someone with Complex PTSD – which is very difficult to live with.
Acute Stress Disorder: Acute Stress Disorder is an anxiety-based condition that can develop after an individual either witnesses or experiences a traumatic event. The condition shares many similarities with PTSD, with symptoms like flashbacks, withdrawal and nightmares common. However, Acute Stress Disorder is time-bound, and only relates to the first month after a traumatic event. If feelings persist for over a month, then an individual will normally be diagnosed with PTSD.
Adjustment Disorder: Adjustment Disorder is an anxiety-based condition that occurs when an individual is unable to adjust to or cope with a specific, identifiable stressor. The way someone reacts to this stressor is seen as abnormal, and more severe than what would normally be expected. However, this disruption will not exceed six months, for Adjustment Disorder to be diagnosed. The condition can cause significant distress in the aftermath of the stressor.
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Symptoms of PTSD & Trauma
In general, symptoms across the various trauma-related conditions tend to be the same. These symptoms normally appear within the first few weeks of a traumatic event.
However, sometimes it can take months or even years for symptoms to appear – especially in cases of PTSD. Symptoms can range from being mild to long-lasting to constant. Generally, symptoms can be positioned into the following categories:
- Disturbed thoughts
- Physical feelings of pain or sickness
- Ruminating over what might have been
- Avoiding certain people that remind an individual of the traumatic event
- Avoiding certain places that remind an individual of the traumatic event
- Changing the subject if a similar topic is discussed
- Isolating themselves from others, trouble trusting them
- Withdrawing from normal day-to-day activities
- Poor concentration
Such symptoms will often result in a person adopting coping strategies that have the potential to harm them, such as abusing drugs or alcohol. Self-harm and suicidal ideation are also relatively common.
PTSD often runs comorbidly with other mental health conditions such as Anxiety, Depression and substance abuse. Someone with Complex PTSD may also develop a Dissociative Disorder.
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Causes of PTSD & Trauma
Unlike many mental health conditions, the cause of PTSD and other trauma-based conditions is known. PTSD develops following a traumatic event – involving an individual either witnessing or experiencing it.
Examples of traumatic events include, but aren’t limited to:
- Witnessing warfare
- Military combat
- Being the victim of an assault
- Road accidents
- Rape or other sexual abuse
- Witnessing an act of extreme violence
- Terrorist attack or hostage situation
- Natural disaster such as a Tsunami
- Sudden death of a friend or family member
- Severe injury
Adjustment Disorder will normally be caused by an upsetting event, as opposed to a traumatic event. Possible events like this include:
- Losing a job
- End of relationship
- Financial problems
- Health problems
- Family conflict
As alluded to, there is a difference between a traumatic event and an upsetting event. An upsetting event like a job loss, relationship break up or being unable to pass the interview stage of a job application process – are not the same as a traumatic event. Sadness and low mood as a reaction of an upsetting event may develop into Depression or an Adjustment Disorder, but it is rare for it to become PTSD.
Around 1 in 3 people will go on to develop PTSD after a traumatic event. It isn’t known why some people develop PTSD after a traumatic event, while others don’t. Certain risk factors appear to be involved, such as a past mental health condition being diagnosed.
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Diagnosis of PTSD & Trauma
It is important to see a Doctor if an individual believes they are suffering from the symptoms associated with any trauma-based condition.
These conditions cannot be diagnosed through a laboratory test or other medical examination. Instead, an appointment with a Doctor will lead to a decision regarding the next steps.
Traumatic events are very difficult to relive, and ultimately come to terms with. But at an appointment, a GP will need to carry out an initial assessment regarding the feelings and behaviour of the individual – and whether or not the symptoms of a trauma-based condition are exhibited.
If they believe the individual is suffering from such a condition, they will be referred to a mental health specialist.
A mental health specialist will then undertake a detailed assessment. Symptoms of PTSD need to have been present for at least 1 month for a diagnosis to be made.
If symptoms last under than a month, Acute Stress Disorder is a more relevant diagnosis. If the condition is deemed to be due to an upsetting event, rather than traumatic, Adjustment Disorder is the most relevant diagnosis.
The specialist’s assessment will include questions regarding the traumatic/upsetting event. While it will be difficult to return to the event, it is a necessary part of diagnosis.
In order for PTSD or another relevant condition to be diagnosed, generally symptoms will include re-experiencing, avoidance, and negative impact on mood.
By getting a full picture of how a condition is affecting an individual, a doctor can tailor a treatment plan to fit the specific symptoms.
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Treatment of PTSD & Trauma
With the right treatment and support, most people with trauma-based conditions can make a full recovery. Treatment for the various trauma-based conditions differ slightly, but generally involve self-help, talking therapies, and on some occasions – medication.
The exact treatment plan depends on the severity of the presenting symptoms of the condition. Treatment is tailored to the severity of symptoms.
- Watchful waiting: If symptoms after a traumatic event are relatively mild, or symptoms have been present for less than 1 month, an approach called watchful waiting can be implemented. This is where the doctor suggests that the individual waits a short period of time and see if their symptoms clear up on their own. In some cases, trauma can be short-term – normally called Acute Stress Disorder. 2 in 3 people who experience a traumatic event will not go on to develop PTSD, so this approach is worthwhile. The individual will typically return within a month of their initial assessment, where their state will be analysed.
- Self-Help: Joining a self-help group for trauma can be therapeutic as it gives the individual an opportunity to talk through their thoughts and feelings with like-minded individuals. Also consider looking at the resources on our website.
- Talking Therapy: Trauma-based conditions are normally treated effectively through talking therapy. Therapy can help an individual come to terms with their traumatic event, or to understand their thoughts and behaviour. Some possible therapies include:
Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.
Eye Movement Desensitisation and Reprocessing (EMDR): While more of a newer treatment, EMDR is an exciting intervention that has helped many people cope with trauma-based conditions. This therapy involves an individual moving their eyes from side-to-side, with the therapist directing their eye movements. During this, the individual recalls their traumatic experience. EMDR is believed to help an individual change how they think about the traumatic event, with the therapist aiming to facilitate change.
Psychoanalytical Psychotherapy: Psychoanalytical Psychotherapy is a talking therapy that aims to help uncover and resolve unconscious beliefs that cause psychiatric conditions. Traumatic experiences that may or may not be buried in the unconscious mind can be highlighted and processed. Psychoanalytical psychotherapy involves talking to a trained therapist. The therapist can show the individual how early memories and past traumas have affected their thinking, behaviour and attitude in the modern day. Psychoanalytical psychotherapy is especially useful for any condition that involves past trauma. Renowned neurologist Sigmund Freud developed this therapy, which is typically completed over a long-term basis.
- Medication: Trauma-based conditions can often improve with medication. Medication is normally an antidepressant. Only two medicines are actually licensed for use in treatment of PTSD – Paroxetine and Sertraline. However, three other antidepressants have the potential to be effective in treating PTSD according to official guidelines. These are Mirtazapine, Amitriptyline and Phenelzine. If an antidepressant is successful in improving symptoms, the medication should be taken for at least a year, before being gradually withdrawn. Acute Stress Disorder is normally not treated by medication. Adjustment Disorder will often be treated by antidepressants.
Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.
There are a range of treatment options available for trauma-based conditions. Accessing treatment is crucial to maximise the chances of recovery.
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Living with PTSD & Trauma
Any trauma-based condition can be very difficult to live with. The distress caused by the symptoms can range in severity, but in general, these conditions can lead to several problems. Relationships and work can be difficult, among many more areas.
There are ways however of coping. Some people carry an object or possession that reminds them of the present day – this can help remind them that they are in the present.
Finally, everyone should remember that PTSD can develop years after a traumatic event – so it is important to keep an eye on those close to you. It is never too late to seek help. Offering someone the chance to open up to you can also prove helpful.
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Generally, the prognosis for PTSD and other trauma-related conditions is good. Treatment is available – and the combination of talking therapy and medication normally leads to recovery.
However, it isn’t all positive. There continue to be high suicide rates among those diagnosed with PTSD, while the fact that PTSD often runs comorbidly with other mental health conditions is another aggravating factor that worsens the prognosis.
Support from family members and those close to the individual affected is also an important area. Treatment can help, and accessing it early can be a crucial factor in recovery.
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