A person may undergo or witness a horrific or horrifying event where there was substantial bodily pain or threat, and this can result in post-traumatic stress disorder (PTSD), sometimes known as shell shock or battle fatigue syndrome. Traumatic experiences that leave people feeling incredibly terrified, helpless, or horrified can lead to PTSD. Sexual or physical abuse, the unexpected loss of a loved one, an accident, a war, or a natural disaster are a few examples of events that might cause PTSD. Emergency responders and rescue workers, as well as victims’ families, are all susceptible to PTSD.
Most victims of traumatic events experience a range of emotions, including shock, rage, anxiety, dread, and sometimes guilt. These reactions are typical, and for the majority of people, they pass with time. But for someone with PTSD, these emotions persist and even worsen, becoming so intense that they prevent them from living their life normally. People with PTSD experience symptoms for more than a month and are less able to function than they did before the event that set it off. PTSD obstructs relationships, employment, and daily living.
In areas devastated by conflict, PTSD and other mental problems are very common. Following exposure to a terrifying or upsetting event or sequence of events, PTSD may manifest. It possesses every one of the traits listed below: Reliving the traumatic event or events in the present (intrusive memories, flashbacks, or nightmares); avoiding thoughts and memories of the event(s); or avoiding actions, people, or surroundings that bring back the event(s); and persistent perceptions of the increased present threat. These symptoms last for at least a couple of weeks and seriously hinder functioning. There are psychological treatments that work.
PTSD Causes and Risk Factors
Veterans of war were the ones who first brought PTSD to the attention of the medical profession, giving rise to the terms shell shock and battle fatigue syndrome. However, PTSD can appear in anyone who has experienced a terrible event. PTSD is more likely to occur in people who experienced abuse as children or who were frequently exposed to grave dangers. Those who have experienced physical or sexual assault are most at risk of developing PTSD.
If you have a history of other mental health issues, have blood relatives who have mental health issues, or have a history of alcohol or drug misuse, you may be more prone to experience PTSD following a traumatic event.
Most frequently, PTSD symptoms appear three months after the traumatic event. But occasionally they don’t start until years later. The sickness can range in severity and length. While some people get better within six months, others take considerably longer.
PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.
- Recurrent, unwanted distressing memories of the traumatic event
- Reliving the traumatic event as if it were happening again (flashbacks)
- Upsetting dreams or nightmares about the traumatic event
- Severe emotional distress or physical reactions to something that reminds you of the traumatic event
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities, or people that remind you of the traumatic event
Negative changes in thinking and mood
- Negative thoughts about yourself, other people, or the world
- Hopelessness about the future
- Memory problems, including not remembering important aspects of the traumatic event
- Difficulty maintaining close relationships
- Feeling detached from family and friends
- Lack of interest in activities you once enjoyed
- Difficulty experiencing positive emotions
- Feeling emotionally numb
- Changes in physical and emotional reactions
Changes in physical and emotional reactions (also called arousal):
- Being easily startled or frightened
- Always being on guard for danger
- Self-destructive behaviour, such as drinking too much or driving too fast
- Trouble sleeping
- Trouble concentrating
- Irritability, angry outbursts or aggressive behaviour
- Overwhelming guilt or shame
For children 6 years old and younger, signs and symptoms may also include:
- Re-enacting the traumatic event or aspects of the traumatic event through play
- Frightening dreams that may or may not include aspects of the traumatic event.
How is PTSD diagnosed?
If PTSD symptoms are evident, the doctor will conduct a thorough medical history and physical examination before beginning an evaluation. The doctor may use several tests to rule out physical sickness as the source of the symptoms, even though there are no lab tests that can be used to diagnose PTSD.
You might be directed to a psychiatrist, psychologist, or other mental health specialist who is uniquely qualified to diagnose and treat mental illnesses if no physical sickness is discovered. To screen a person for the presence of PTSD or other mental illnesses, psychiatrists and psychologists employ specifically created interview and evaluation instruments. The doctor bases their PTSD diagnosis on the patient’s reported symptoms, including any functional issues brought on by the symptoms. The doctor next decides if the severity of the malfunction and the symptoms point to PTSD. If a person experiences PTSD symptoms for more than a month, PTSD is diagnosed.
Management and treatment of PTSD
Reducing the mental and physical symptoms of PTSD, enhancing daily functioning, and assisting the patient in better coping with the stressful incident that led to the disease are the main objectives of treatment. Psychotherapy (a sort of counselling), medicine, or a combination of the two may be used to treat PTSD.
Doctors use certain antidepressant medications to treat PTSD — and to control the feelings of anxiety and its associated symptoms — including:
- Selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), fluvoxamine (Luvox), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)
- Tricyclic antidepressants such as amitriptyline (Elavil) and isocarboxazid (Doxepin)
- Mood stabilizers such as divalproex (Depakote) and lamotrigine (Lamictal)
- Atypical antipsychotics such as aripiprazole (Abilify) and quetiapine (Seroquel )
Certain blood pressure medicines are also sometimes used to control particular symptoms:
- Prazosin for nightmares
- Clonidine (Catapres) for sleep
- Propranolol (Inderal) to help minimize the formation of traumatic memories
Experts discourage the use of tranquilizers such as lorazepam (Ativan) or clonazepam (Klonopin) for PTSD because studies have not shown them to be helpful, plus they carry a risk for physical dependence or addiction.
Psychotherapy for PTSD involves helping the person learn skills to manage symptoms and develop ways of coping. Therapy also aims to teach the person and their family about the disorder and help the person work through the fears associated with the traumatic event. A variety of psychotherapy approaches are used to treat people with PTSD, including:
- Cognitive behavioural therapy, which involves learning to recognize and change thought patterns that lead to troublesome emotions, feelings, and behaviour.
- Prolonged exposure therapy, a type of behavioural therapy that involves having the person relive the traumatic event, or exposing the person to objects or situations that cause anxiety. This is done in a well-controlled and safe environment. Prolonged exposure therapy helps the person confront the fear and gradually become more comfortable with situations that are frightening and cause anxiety. This has been very successful at treating PTSD.
- Psychodynamic therapy focuses on helping the person examine personal values and the emotional conflicts caused by the traumatic event.
- Family therapy may be useful because the behaviour of the person with PTSD can influence other family members.
- Group therapy may be helpful by allowing the person to share thoughts, fears, and feelings with other people who have experienced traumatic events.
- Eye Desensitization and Reprocessing (EMDR) is a complex form of psychotherapy that was initially designed to alleviate the distress associated with traumatic memories and is now also used to treat phobias.