Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is a type of anxiety disorder that happens after an extremely stressful or traumatic event. This could be a situation in which:

• There has been a serious threat to your life or the life of a loved one (e.g. violent personal assault, being held hostage, military combat)
• There has been a catastrophic event (e.g. airplane crash, earthquake, major fire, severe flood, terrorist attack, serious road accident, etc.)
• You have felt very frightened or helpless, or feared for your life

Around 25-30% of people experiencing such a traumatic event will develop PTSD. 

Symptoms of PTSD

The main symptom of PTSD is re-experiencing (or re-living) aspects of the traumatic event in a vivid and distressing way. This can include flashbacks, nightmares, and the intrusion of distressing images, sounds, or other sensations from the event into your thoughts.

Another key symptom of PTSD is avoiding reminders of the trauma. This can include people, situations, or circumstances that remind you of the traumatic event. Many people with PTSD try to avoid remembering, thinking about, or talking about the event, especially its worst moments.

On the other hand, some people with PTSD will think excessively about questions related to the event, such as why it happened to them, whether they could have stopped it, or how they could take revenge. This can prevent them from coming to terms with the event.

Other symptoms of PTSD include:

• Being on edge, constantly watching out for threats, feeling anxious, and being unable to relax.
• Being easily startled or irritated.
• Having difficulty concentrating, eating, or sleeping.
• Emotional numbing, such as being unable to experience feelings, giving up activities that used to interest you, or feeling detached from other people.
• Keeping excessively busy to avoid thinking about the traumatic event.
• Feeling angry or guilty.
• Difficulty in remembering stressful events when you are trying to remember them.

The symptoms of PTSD often develop straight after the traumatic event. However, for some people there is a delay of weeks, months, or even years between the event happening and the appearance of the symptoms.

People with PTSD are at increased risk of a number of other problems:

• Depression, feeling suicidal, and self-harm
• Alcohol abuse or drug abuse
• Heart disease and high blood pressure
• Impulsive behaviour and taking lots of risks
• Road accidents
• Eating disorders such as anorexia nervosa
• Diabetes
• Dementia

There is also complex PTSD, which can affect people who have repeatedly experienced severe neglect, abuse or violence as a child or adult. As well as the symptoms of PTSD, you may also:

• Feel shame,  guilt, or numbness
• Isolate yourself
• Have difficulties with relationships and trusting other people
• Unable to talk about your emotions
• Have difficulty controlling your emotions
• Lose your attention and concentration for periods of time (this is known as dissociation)
• Have physical symptoms such as headaches, dizziness, chest pains, and stomach aches
• Feel suicidal and want to kill yourself
• Feel impulsive and want to take risks (this can lead to self-harm, alcohol abuse, or drug abuse)

You may experience symptoms days, weeks, months or years after the traumatic event, although usually symptoms appear within 6 months.

If you would like more information about PTSD you can visit the YoungMinds website. 

Treating PTSD

If something traumatic happens to you and you notice a change in how you feel and behave, try and talk to someone you trust. This could be a parent, friend, teacher or your GP.

PTSD can be successfully treated, and it is never too late to seek help. It can be very hard to come to terms with a traumatic event, but you will need to confront your difficulties with the help of a professional in order to effectively treat PTSD.

Before being treated for PTSD, you will have a detailed assessment of your symptoms so that the right treatment can be selected for you. Your GP may do an initial assessment, but you will be referred to a mental health specialist if you have symptoms that are severe or have lasted for more than four weeks.

The main treatment that is recommended for PTSD is psychological therapy (‘talking therapy’) such as Cognitive Behavioural Therapy (CBT), which helps you to manage your problems by changing the way that you think and act. This will involve confronting the memories, thoughts, and feelings connected to the traumatic event and finding ways to cope with the distress.

Another treatment for PTSD is called eye movement desensitisation and reprocessing (EMDR). This is a technique which uses eye movement to help the brain process flashbacks and to make sense of what happened.

Medicines are not usually used for PTSD, but may be used if:

• You have chosen not to have trauma-focused psychological treatment
• There is an ongoing threat of further trauma (e.g. domestic violence)
• You have not had enough benefit from trauma-focused psychological treatment
• You have another condition that reduces your ability to benefit from the trauma-focused psychological treatment (e.g. depression)

Sometimes a medicine will be used in combination with psychological therapy to treat PTSD. If a medicine is suggested, then ask the doctor why he or she thinks it will help you.

Medicines that boost levels of serotonin (a naturally occurring messenger chemical) in your brain seem to be the most effective medicines for PTSD. This includes antidepressant medicines such as paroxetine or mirtazapine. You may need to take a high dose of an antidepressant for 6 to 12 months to get the full effect of the medicine on the PTSD symptoms.

The HeadMeds website will provide you with more information about the medication they are recommending, how it works, how you should take it and how you might feel. It should also be able to answer any questions you might have about going on medication.

You may also be able to access more information about PTSD and medicines used to treat it on the Choice and Medications website (www.choiceandmedication.org), which is usually free to access via your mental health trust. 

Related Conditions

• Anxiety
• Anger
• Depression 

References

• NICE CG26 Post-traumatic stress disorder: management. Mar 2005. Available online www.nice.org.uk
• Cowen P, Harrison P, Burns T. Shorter Oxford Textbook of Psychiatry, 6th edition. Oxford: Oxford University Press, 2012.
• NHS choices. Available online http://www.nhs.uk/pages/home.aspx

Choice and Medications website (www.choiceandmedication.org – usually free to access via your mental health trust)