Understanding Post-Traumatic Stress Disorder (PTSD)

By Dr Usha Shri Kissoon, Psychiatrist at Pine Rivers Private Hospital

 

What is PTSD ?

Post-traumatic stress disorder (PTSD) is a common chronic psychological disorder that can develop after experiencing or witnessing a traumatic event. A person may be exposed to death, threatened death, actual or threatened serious injury or sexual violence either by direct exposure or even indirect exposure. For example, in the course of professional duties (such as first-responders, medics, police officers) or even learning that a relative or close friend was exposed to a trauma.

The lifetime prevalence of PTSD is estimated at 8.3% and the risk increases as the exposure to the number of traumatic events increases. PTSD is also more likely to occur after more severe types of trauma such as rape, childhood sexual abuse or military combat.

What are the symptoms of PTSD?

Generally the symptoms can be divided into four clusters:

• Re-experiencing - recurrent intrusive memories of the terrifying event, nightmares and flashbacks (feelings that the traumatic event is happening again)
• Avoidance - a tendency to avoid objects, people or places or thoughts and feelings associated with the trauma
• Negative changes in cognitions and mood - perceptions about oneself and the world can become distorted, shame and guilt, feeling emotionally numb, feeling alone, inability to recall important details of the trauma, becoming depressed and anxious
• Hyperarousal and reactivity - increase scanning of the environment, irritability, nausea, sweating, pounding heart, difficulty concentrating, feeling on edge, panic attacks, feeling disconnected from oneself, self-destructive or reckless behaviours like substance abuse or self-harm

To get a diagnosis of PTSD, the symptoms must be present for more than one month and must cause significant distress and functional impairment, and it must not be due to substance misuse or an underlying medical condition.

In essence, PTSD feels like you are in constant fear and flight, with a feeling of being on edge with tense muscles, feelings of being disconnected from yourself, with trouble sleeping or fear of falling asleep due to nightmares. You easily startle or become irritable with angry outbursts.

The intense stress can cause some personality changes and people around you may feel that they are treading on eggshells for fear of upsetting you.

What does PTSD do to the brain?

Your brain goes into fear, flight or freeze response when confronted with a terrifying event. There is an outpouring of neurochemicals like adrenaline, noradrenaline and corticosteroids and your body continues to send out stress signals so that it stays on high alert even though you are out of danger. Parts of the brain responsible for thinking and memory (hippocampus) gets affected by this excessive adrenaline. The part of the brain that handles fear and emotion (amygdala) becomes overly sensitive and triggers easily. The part of the brain called the prefrontal cortex gets affected in that it becomes hard to separate the events that are happening now from dangerous events that happened in the past.

How can I help someone with PTSD?

Be supportive and allow the person who has been traumatised to talk about their feelings or fears. Do not pressure them if they do not want to talk. Reduce the shame and guilt and do not blame all the relationship and family problems on their PTSD. Encourage them to participate in exercise, eat healthily and pursue their hobbies. If you are calm and relaxed and focused you will be better able to help them as recovery is a process that takes time and often has setbacks.

Take cues from them as to how you can provide support and companionship rather than telling them what to do. It is important to educate yourself about PTSD so that you can understand and be prepared to accept and expect the rollercoaster of emotions that you may have to deal with. Do not judge or disapprove but be patient and a good listener. Validate their experiences.

Try and rebuild trust and safety by keeping your promises and expressing to them that you are there for the long haul and committed to helping them. Minimise stress at home. Create routines and structure and try and get them involved in daily activities. Build confidence by giving them more choices and control and be future focused.

It can be challenging to deal with volatile tempers-watch for signs of anger such as agitation, jaw or fist clenching or raised voices. Try to remain calm and give the person space and ask how you can help. Put safety first if the situation escalates by leaving the home or calling the police.

Remember to take care of yourself by making time for yourself, spreading the responsibility and setting the boundaries by being realistic of what you can achieve as carer burden can lead to burnout and decompensate your own mental health.

How is PTSD treated?

First, we need to identify if someone has been exposed to a traumatic event and is experiencing the symptoms of PTSD. Assessment procedures may involve many steps. Initial screening can be done at primary care - such as a family practitioner, nurse practitioner and community clinics. A lengthy diagnostic interview and a self-report symptom questionnaire will be done to arrive at a diagnosis and then information will be provided on treatment planning and progress.

There is evidence to suggest that both pharmacological and psychological interventions have been shown to significantly reduce PTSD symptoms. Medications may be used to treat depression and anxiety and assist with sleep and reduce nightmares.

There are also other forms of technologically advanced treatments like transcranial magnetic stimulation (TMS) which is a non-invasive, non-drug treatment often used to alleviate symptoms of depression. Patients who receive TMS therapy to treat their depression have noticed significant improvement with their PTSD experiencing less flashbacks and nightmares. 

Psychological interventions include behavioural therapies involving relaxation breathing exercises and exposure-based interventions to help desensitise one to the trauma. Additionally, cognitive processing therapies are done which target inaccurate interpretations of situations that maintain PTSD symptoms. Another form of therapy is EMDR (eye-movement desensitisation and reprocessing) therapy which helps process the traumatic memory helping to reduce misperceptions or distorted thinking patterns that occurred at the time of the trauma.

What happens if PTSD is left untreated?

If untreated it can contribute to chronic mental health issues such as depression, anxiety, personality changes, chronic pain, drug and alcohol misuse, chronic disability due to social and occupational impairments and increased risk of suicide.

Can a person with PTSD be cured?

While there is no definite cure for PTSD there are many treatment options for PTSD that can help reduce symptoms and distress and allow a person to return to normal functioning. Statistics show that 50% of cases recover within two years and over three quarters recover within 10 years. The prognosis is influenced by the type of trauma experienced and other factors such as social support, community engagement and resilience building.

Recovery may mean different things to different people. For some it may mean being free from reliving or experiencing the traumatic event was for others it may mean equipping themselves with skills and strategies to manage memories that they still experience.
Treatment for PTSD has come a long way and research is ongoing looking for new ways to improve symptoms and shortened recovery times.

 

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This article deals with suicide and mental health. If you are contemplating suicide or having suicidal thoughts, please call Lifeline on 13 11 14, or the Suicide Call Back Service on 1300 659 467. If you are in immediate danger, call 000.