Post-traumatic stress disorder

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Post-traumatic stress disorder (PTSD) is a psychological reaction to experiencing or witnessing a significantly stressful, traumatic or shocking event.

This might be a car crash, a rape or other sexual abuse, an earthquake, or other natural disaster, or an attack.

Any situation where there was a risk of being killed or injured, seeing others killed or injured, or sometimes even hearing about such things, can result in PTSD. Some events are more likely than others to cause PTSD.

Reactions to trauma deliberately caused by other people, such as physical assault or rape, seem to be worse than those caused by accidents or natural disasters.

Living through PTSD can be an overwhelming, frightening, isolating and debilitating experience.

People with PTSD may feel intense fear. They may feel that their world has fallen apart, that everything is black and that nothing makes sense. Worse still, they can often lose hope or the belief that they can recover and lead a worthwhile life.

PTSD can affect people of any age, gender or culture. It’s more common among soldiers and refugees who have endured major traumas. Adults or teenagers who have experienced childhood sexual or physical abuse may also experience PTSD.

Children may be more vulnerable to PTSD than adults who have experienced the same stress or trauma. Their response to trauma may also be different. 

It’s normal to want to avoid painful memories or feelings, but it is important if you think you or a loved one has PTSD that you talk to your doctor.

If not recognised and treated, PTSD can lead to depression and suicidal thoughts. This is especially so for people with a history of depression. Sometimes long-term distress and anxiety can lead to panic attacks and some people may develop eating disorders. Sometimes people can use alcohol or drugs to make themselves feel better, but this just increases the chance of developing alcohol and drug abuse issues.

With timely recognition and treatment of PTSD you can get past the trauma and move on with your life.

Signs to look for (symptoms)

People with PTSD may be constantly watchful or jumpy. Their sleep is often disturbed and they may feel irritable and angry with themselves and others. Memory, concentration and decision-making are often affected.

You may try to avoid any situations, people or events that remind you of the trauma. You may be unable to feel emotions even for the people you love or care for. You may feel detached from others and may lose interest in things you once enjoyed.

The unpleasant feelings associated with the trauma keep coming back along with images, memories and intrusive thoughts about the event. There may be nightmares or bad dreams. In the daytime, you may feel that it’s all happening again or have brief but vivid memories or “flashbacks”.

Signs to look for in children include, disorganised or agitated behaviour. They may have nightmares, and they are likely to relive the trauma through repetitive play.
This may be seen through artwork or in changes of behaviour towards other children, bullying, hitting etc. Physical symptoms may include stomachaches, headaches and bedwetting.

How the doctor determines if someone has PTSD (diagnosis)

The symptoms outlined above are common in the first few weeks after a significant trauma. Some people may have PTSD symptoms that occur within a month of the traumatic event, and these lessen and disappear within around four weeks. This is called acute stress disorder.

If the symptoms persist beyond four weeks, and cause you intense distress and affect your everyday life, the diagnosis is changed to PTSD. Sometimes there is a delay of months or even years between the event and the onset of PTSD.

For these reasons it’s important that you take time to talk with your doctor and help them understand what you or your loved one has been going through. If PTSD has been going on for several weeks, or is very severe, specialist help is needed, and your doctor will refer you to an appropriate mental health professional.

Treatment options

Treatment of PTSD can involve a number of aspects, each of which can be tailored to your individual need. It is important you use a mental health professional with experience in treating PTSD. Treatment options include:

Medication

Your doctor may prescribe tranquillizers or other medications for anxiety or depression. Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective and tolerated (have fewer troublesome side effects) by any one person.

If you are prescribed medication you are entitled to know:
• the names of the medicines
• what symptoms they are supposed to treat
• how long it will be before they take effect
• how long you will have to take them for and what their side effects (short and long-term) are.

If you're breast feeding no medication is entirely safe. Before making any decisions about taking medication at this time you should talk with your doctor about the potential benefits and problems.

Talking therapies and counselling

Talking therapies are effective in the treatment of PTSD. Therapists or counsellors involved in the treatment of PTSD use two main strategies – one that deals with the memories and feelings about the trauma and the other that offers relaxation training to lessen anxiety and fear.

In traumatic situations, e.g. fire, earthquake, a violent incident, where PTSD could develop, it’s common for a specific type of post-traumatic counselling to be carried out. You will be helped through this by the team who assists you at the time of the incident.

Some people find group therapy helpful, particularly when there are a number of people who have endured a similar trauma, e.g. earthquake or rape. In some instances the leader may be someone who has recovered from a past trauma. Some groups may offer support and a number of social activities.

All types of therapy/counselling should be provided in a manner that is respectful to you and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

When considering taking any supplement, herbal or medicinal preparation you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking.

Physical health

It's also really important to look after your physical wellbeing. Make sure you get an annual check up with your doctor. Being in good physical health will also help your mental health.

Important strategies to support recovery

Family, whānau and close friends of someone with PTSD have found the following strategies important and useful:

  • In the early days after the trauma give the person time and space to be alone if needed. As time goes by encourage them to get back into life again, but never force them. Try to make sure they get the help they need. 
  • Learn what you can about PTSD, its treatment and what you can do to assist recovery. Sometimes the person with PTSD finds it difficult to explain to others how hard it is for them, or they may have trouble understanding what is happening to them and their behaviour. 
  • Do not blame the person for having PTSD. Understand the symptoms for what they are rather than taking them personally or seeing the person as being difficult. 
  • Help the person to recognise stress and find ways of coping with it. This may include helping to solve problems that are worrying them. 
  • Find ways of getting time out for you and feeling okay about this. It is critical to do what is needed to maintain your own wellbeing. 
  • Don’t overlook any situation or suggestion from the person experiencing PTSD that they are suicidal and wanting to end their life. Get support for this immediately, eg, by talking to their GP or counsellor.

 

Thanks to Janet Peters, registered psychologist, for reviewing this content. Date last reviewed: September 2014.