PTSD

WHAT IS PTSD?

Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.

Symptoms of post-traumatic stress disorder (PTSD)

Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.

They may also have problems sleeping, such as insomnia, and find concentrating difficult.

These symptoms are often severe and persistent enough to have a significant impact on the person's day-to-day life.

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 it can occur weeks, months or even years later.

PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it's not clear exactly why some people develop the condition and others do not.

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.

When to seek medical advice

It's normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks.

You should see a GP if you or your child are still having problems about 4 weeks after the traumatic experience, or if the symptoms are particularly troublesome.

If necessary, your GP can refer you to mental health specialists for further assessment and treatment.

How post-traumatic stress disorder (PTSD) is treated

PTSD can be successfully treated, even when it develops many years after a traumatic event.

Any 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 get worse without treatment
• antidepressants – such as paroxetine or mirtazapine
• psychological therapies – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR)

SYMPTOMS OF PTSD

Each person's experience of PTSD is unique to them. You might have experienced a similar type of trauma to someone else, yet be affected in different ways.

Common symptoms of PTSD

These are some common signs and symptoms that you might recognise.

Reliving aspects of what happened

This can include:

• vivid flashbacks (feeling like the trauma is happening right now)
• intrusive thoughts or images
• nightmares
• intense distress at real or symbolic reminders of the trauma
• physical sensations such as pain, sweating, nausea or trembling.

Alertness or feeling on edge

This can include:

• panicking when reminded of the trauma
• being easily upset or angry
• extreme alertness, also sometimes called 'hypervigilance'
• disturbed sleep or a lack of sleep
• irritability or aggressive behaviour
• finding it hard to concentrate – including on simple or everyday tasks
• being jumpy or easily startled
• self-destructive behaviour or recklessness
• other symptoms of anxiety.

Avoiding feelings or memories

This can include:

• feeling like you have to keep busy
• avoiding anything that reminds you of the trauma
• being unable to remember details of what happened
• feeling emotionally numb or cut off from your feelings
• feeling physically numb or detached from your body
• being unable to express affection
• using alcohol or drugs to avoid memories.

Difficult beliefs or feelings

This can include:

• feeling like you can't trust anyone
• feeling like nowhere is safe
• feeling like nobody understands
• blaming yourself for what happened
• overwhelming feelings of anger, sadness, guilt or shame.

CAUSES OF PTSD

The situations we find traumatic can vary from person to person. There are many different harmful or life-threatening events that might cause someone to develop PTSD. For example:

• being involved in a car crash
• being violently attacked
• being raped or sexually assaulted
• being abused, harassed or bullied
• being kidnapped or held hostage
• seeing other people hurt or killed, including in the course of your job
• doing a job where you repeatedly see distressing images or hear details of traumatic events
• traumatic childbirth, either as a mother or a partner witnessing a traumatic birth
• extreme violence or war, including military combat
• surviving a terrorist attack
• surviving a natural disaster, such as flooding or an earthquake
• being diagnosed with a life-threatening condition
• losing someone close to you in particularly upsetting circumstances
• learning that traumatic events have affected someone close to you (sometimes called secondary trauma)
• any event in which you fear for your life.

Secondary trauma

If you experience symptoms of PTSD while supporting someone close to you who has experienced trauma, this is sometimes known as ‘secondary trauma’ or ‘secondary traumatic stress’.

‘Secondary’ means that although the original (primary) trauma happened to someone else, the impact it’s having in your life is traumatic for you. It doesn’t mean it’s any less significant than any other kind of PTSD, or any easier to deal with. 

Repeatedly witnessing or hearing about traumatic events in the course of your job is also sometimes called 'secondary trauma', although this experience is increasingly thought of by professionals as an original (primary) trauma.

Are some people more at risk of PTSD?

Some factors may make you more vulnerable to developing PTSD, or may make the problems you experience more severe, including:

• experiencing repeated trauma
• getting physically hurt or feeling pain
• having little or no support from friends, family or professionals
• dealing with extra stress at the same time, such as bereavement or money worries
• previously experiencing anxiety or depression.

If you experienced trauma at an early age or you have experienced long-lasting or multiple traumas, you might be given a diagnosis of complex PTSD.

Anyone can experience traumatic events, but you may be particularly likely to have experienced trauma if you:

• work in a high-risk occupation, such as the emergency services or armed forces
• are a refugee or asylum seeker
• were taken into foster care.

COMPLEX PTSD

Complex post-traumatic stress disorder (complex PTSD, sometimes abbreviated to c-PTSD or CPTSD) is a condition where you experience some symptoms of PTSD along with some additional symptoms, such as:

• difficulty controlling your emotions
• feeling very hostile or distrustful towards the world
• constant feelings of emptiness or hopelessness
• feeling as if you are permanently damaged or worthless
• feeling as if you are completely different to other people
• feeling like nobody can understand what happened to you
• avoiding friendships and relationships, or finding them very difficult
• often experiencing dissociative symptoms such as depersonalisation or derealisation
• regular suicidal feelings.

Other terms for complex PTSD

Complex PTSD is a fairly new term. Professionals have recognised for a while that some types of trauma can have additional effects to PTSD, but have disagreed about whether this is a form of PTSD or an entirely separate condition, and what it should be called.

For example, you may find some doctors or therapists use one of the following terms:

• enduring personality change after catastrophic experience (EPCACE)
• disorders of extreme stress not otherwise specified (DESNOS) – this term is more common in America than the UK.

SELF HELP FOR PTSD

Tips on coping with flashbacks

Flashbacks can be very distressing, but there are things you can do that might help. You could:

• Focus on your breathing. When you are frightened, you might stop breathing normally. This increases feelings of fear and panic, so it can help to concentrate on breathing slowly in and out while counting to five.
• Carry an object that reminds you of the present. Some people find it helpful to touch or look at a particular object during a flashback. This might be something you decide to carry in your pocket or bag, or something that you have with you anyway, such as a keyring or a piece of jewellery.
• Tell yourself that you are safe. It may help to tell yourself that the trauma is over and you are safe now. It can be hard to think in this way during a flashback, so it could help to write down or record some useful phrases at a time when you're feeling better.
• Comfort yourself. For example, you could curl up in a blanket, cuddle a pet, listen to soothing music or watch a favourite film.
• Keep a diary. Making a note of what happens when you have a flashback could help you spot patterns in what triggers these experiences for you. You might also learn to notice early signs that they are beginning to happen.
• Try grounding techniques. Grounding techniques can keep you connected to the present and help you cope with flashbacks or intrusive thoughts. For example, you could describe your surroundings out loud or count objects of a particular type or colour.

Look after your physical health

Coping with PTSD can be exhausting. You might feel like you can't find the energy to take care of yourself, but looking after your physical health can make a difference to how you feel emotionally. For example, it can help to:

• Think about your diet. Eating regularly and keeping your blood sugar stable can help you cope when things feel difficult. 
• Try to exercise. Exercise can be really helpful for your mental wellbeing. (See our pages on physical activity for more information.)
• Spend time outside. The outside world might feel overwhelming, but spending time in green space can boost your wellbeing.
• Avoid drugs and alcohol. While you might want to use drugs or alcohol to cope with difficult feelings, memories or physical pain, they can make you feel worse in the long run. They can also make other problems worse, such as difficulty sleeping. 

PTSD and sleep problems

Lots of people who experience PTSD have problems sleeping. You might find it hard to fall or stay asleep, feel unsafe during the night, or feel anxious or afraid of having nightmares

Try peer support

TREATMENT FOR PTSD

The main treatments for post-traumatic stress disorder (PTSD) are psychological therapies and medication.

Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.

It's possible for PTSD to be successfully treated many years after the traumatic event or events occurred, which means it's never too late to seek help.

Assessment

Before having treatment for PTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs.

Your GP will often carry out an initial assessment, but you'll be referred to a mental health specialist for further assessment and treatment if you have had symptoms of PTSD for more than 4 weeks or your symptoms are severe.

There are a number of mental health specialists you may see if you have PTSD, such as a psychologist, community psychiatric nurse or psychiatrist.

Watchful waiting

If you have mild symptoms of PTSD, or you have had symptoms for less than 4 weeks, an approach called watchful waiting may be recommended.

Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse.

It's sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience get better within a few weeks without treatment.

If watchful waiting is recommended, you should have a follow-up appointment within 1 month.

Psychological therapies

If you have PTSD that requires treatment, psychological therapies are usually recommended first.

A combination of a psychological therapy and medication may be recommended if you have severe or persistent PTSD.

Your GP can refer you to a clinic that specialises in treating PTSD if there's one in your area.

Or you can refer yourself directly to a psychological therapies service.

There are 3 main types of psychological therapies used to treat people with PTSD.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act.

Trauma-focused CBT uses a range of psychological techniques to help you come to terms with the traumatic event.

For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail.

During this process, your therapist helps you cope with any distress you feel while identifying any unhelpful thoughts or misrepresentations you have about the experience.

Your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience (for example, feeling you're to blame for what happened, or fear that it may happen again).

You may also be encouraged to gradually restart any activities you have avoided since your experience, such as driving a car if you had an accident.

You'll usually have 8 to 12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60 to 90 minutes.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment that's been found to reduce the symptoms of PTSD.

It involves making side-to-side eye movements, usually by following the movement of your therapist's finger, while recalling the traumatic incident.

Other methods may include the therapist tapping their finger or playing a tone.

It's not clear exactly how EMDR works, but it may help you change the negative way you think about a traumatic experience.

Group therapy

Some people find it helpful to speak about their experiences with other people who also have PTSD.

Group therapy can help you find ways to manage your symptoms and understand the condition.

There are also a number of charities that provide counselling and support groups for PTSD.

For example:

• Combat Stress – a military charity specialising in helping ex-servicemen and women
• Rape Crisis – a UK charity providing a range of services for women and girls who have experienced abuse, domestic violence and sexual assault
• Victim Support – providing support and information to victims or witnesses of crime
• CRUSE – a UK charity providing support and information for people who have experienced bereavement

Medication

Antidepressants, such as paroxetine, sertraline, mirtazapine, amitriptyline or phenelzine, are sometimes used to treat PTSD in adults.

Of these medications, only paroxetine and sertraline are licensed specifically for the treatment of PTSD.

But mirtazapine, amitriptyline and phenelzine have also been found to be effective and may be recommended as well.

These medications will only be used if:

• you choose not to have trauma-focused psychological treatment
• psychological treatment would not be effective because there's an ongoing threat of further trauma (such as domestic violence)
• you have gained little or no benefit from a course of trauma-focused psychological treatment
• you have an underlying medical condition, such as severe depression, that significantly affects your ability to benefit from psychological treatment

Amitriptyline or phenelzine will usually only be used under the supervision of a mental health specialist.

Antidepressants can also be prescribed to reduce any associated symptoms of depression and anxiety, and help with sleeping problems.

But they're not usually prescribed for people younger than 18 unless recommended by a specialist.

If medication for PTSD is effective, it'll usually be continued for a minimum of 12 months before being gradually withdrawn over the course of 4 weeks or longer.

If a medication is not effective at reducing your symptoms, your dosage may be increased.

Before prescribing a medication, your doctor should inform you about possible side effects you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn.

For example, common side effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea.

Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability.

Withdrawal symptoms are less likely if the medication is reduced slowly.

Children and young people

Trauma-focused CBT is usually recommended for children and young people with PTSD.

This normally involves a course of 6 to 12 sessions that have been adapted to suit the child's age, circumstances and level of development.

Where appropriate, treatment includes consulting with and involving the child's family.

Children who do not respond to trauma-focused CBT may be offered EMDR.

PTSD and driving

Post-traumatic stress disorder (PTSD) may affect your ability to drive safely, so you should inform the Driver and Vehicle Licensing Agency (DVLA) about your condition.

If you feel like you are really struggling then always seek professional help as they are trained to help you with what you are going through.