The words trauma and post-traumatic stress are now part of most people’s vocabulary. Post-Traumatic Stress Disorder (PTSD) is now much more understood than it once was, often held in mind in the context of soldiers and war. However, there are many events that have the potential to be ‘traumatising’ to an individual, from significant life-altering events like terrorist incidents, to more frequent occurrences like car accidents. Not everyone who experiences a life-threatening or terror-inducing situation, will go on to develop PTSD symptoms. That is not to say that the event hasn’t had a significant impact on someone or that it has not been traumatic in some way. So, what’s the difference; what is different about a PTSD diagnosis, why do some people go on to develop these symptoms and what does it mean for treatment?
PTSD refers to a number of symptoms which persist and have an impact on your day to day life. A key one is the re-experiencing of the traumatic incident; flashbacks, nightmares, intrusive images, and physical symptoms. These might include trembling, sweating or nausea. Often, these seem so vivid, the threat or danger feels very real. With flashbacks, people will describe feeling they have lost touch with the current situation and are back in the moment. Memories from such experiences can be very ‘emotional’ in nature; they can be fragmented snapshots and associated with overwhelming emotions. These trauma memories are handled by the amygdala; a part of the brain associated with emotion. In contrast, normal memories are processed by the hippocampus and are held almost like a video track in order of what happened. These can deteriorate in detail over time while trauma memories can remain highly potent for years after the event.
Other symptoms associated with PTSD include emotional numbing; feeling empty or blank. Often, a high level of avoidance is described; avoidance of thinking, triggers, places or people who might remind them of the event. As with most anxiety disorders, this feels preferable in the short term, but maintains the difficulties over the long term. People often describe being highly preoccupied with thoughts of the incident; the ‘what-ifs’ and ‘should-ofs’. Finally, PTSD is associated with hyperarousal or being ‘on edge’. People can be quick to startle or find themselves constantly scanning for signs of danger. This begins to affect people’s ability to concentrate or possibly sleep. They can present as irritable or quick to anger. For children, somatic complaints such as tummy aches might be more likely. Anxiety over separating from parents is common, as are symptoms like bed-wetting. Young children might repetitively re-enact the trauma through their play.
Many of these symptoms are entirely normal after a traumatic experience and should improve naturally with time. Indeed, there is an argument to say that more formal treatments should not be implemented within the first month or so of the traumatic experience to allow your natural recovery processes to take place. However, if these symptoms are still apparent 4 weeks after the incident, it might be time to seek more support.
It is not fully understood why some people develop PTSD following a traumatic incident, and others don’t. The severity and length of time exposed to the trauma are key predictors. Beyond that, there is research to suggest that those who have experienced a level of early trauma or severe stress are more likely to experience PTSD in the event of a traumatic incident later in life. Early trauma can have a significant impact on a child’s developing nervous system and neurochemistry, effectively over-sensitising the body’s reaction to stress.
For people who experience prolonged and severe trauma, such as childhood abuse or domestic violence, symptoms of complex PTSD may be evident. In addition to that described, they might have trouble regulating their emotions, difficulty managing relationships or a distorted sense of themselves. Sadly, this is more challenging to overcome but with the right, longer-term support, these experiences can be processed.
PTSD can often occur alongside other mental health difficulties such as depression, alcohol dependency or personality disorder. In these circumstances, a thorough psychological assessment and treatment plan is key.
So what treatments are available for PTSD? There is a good evidence base for trauma-focused Cognitive Behaviour Therapy; a talking therapy that includes some exposure to trauma triggers. Medication can also help with the physical symptoms of PTSD. Meditation and mindfulness can help calm the sympathetic nervous system which is overly active within PTSD. In addition, this can improve symptoms of anxiety and depression. If you are struggling with PTSD, contact firstname.lastname@example.org for more information and support.
As touched on, many people can experience a traumatising event and not experience the cluster of symptoms seen within a PTSD diagnosis. That is not to say the experience hasn’t had a profound impact on you and your mental health. Frightening or overwhelming experiences can trigger low mood, anxiety and high levels of negative thinking. It can be very helpful to talk these through. Sometimes, talking to friends and family can be sufficient to help you process things and move forward. For others, speaking to someone neutral who can help work out your thinking patterns and emotional responses can be more beneficial.
Take a look at www.peterkinpsychology.com for more information.