What PTSD is: symptoms and treatment
Post-traumatic stress disorder (PTSD) is a mental health condition that may occur in people who have experienced or witnessed a traumatic event such as a war or combat, natural disaster, a serious accident, a terrorist act or rape.
Nature and basis of PTSD
PTSD is a normal response to abnormal events. After traumatic events it is absolutely normal to lose faith or avoid other people, have unpleasant memories or trouble sleeping. If the symptoms last for a few months and interfere with your daily life — it may be PTSD.
How may people suffer from the post-traumatic stress disorder?
It is considered that 50% of people experience a traumatic event at some point in their lives. The defining characteristic of a traumatic event is its capacity to provoke fear, helplessness or horror. The prevalence of the post-traumatic stress disorder in the countries where military operations occurred is 11% to 50% of population. If to distribute this statistics by gender, then 6 of 10 men and every other woman experience at least one trauma in their lives. Men are more likely to experience accidents, physical assault, disaster, or to witness death or injury. Women are more likely to experience sexual assault and child sexual abuse.
However, women are twice as likely as men to have the post-traumatic stress disorder.
What can trigger PTSD?
Risk factors of PTSD include:
- war or armed conflict exposure;
- observation of violent death;
- serious accidents (such as a car accident);
- physical or sexual abuse;
- serious disorders or being in intensive care unit;
- complicated labor;
- diagnosis of a life-threatening illness;
- terrorist attack;
- natural or man-made disasters (e.g., tsunami or fire).
Many other events also can lead to the post-traumatic stress disorder. If your experience is not described here, it does not mean that you should not seek help and support from a specialist. It is very important to do it as early as possible to return to normal life as soon as possible.
Why traumatic events are so shocking?
The traumatic events are shocking because we cannot understand them. They differ from our perception of the world. They often seem to be “accidental” and their cause is unclear. Such events do not fit into our views of the world, making it difficult for us to understand their significance. This dissonance can lead to the PTSD.
Possible symptoms of PTSD: how to suspect the disorder?
Symptoms of PTSD usually begin within 3 months of the traumatic incident, but they sometimes emerge later.To meet the criteria for the post-traumatic stress disorder, the symptoms must last longer than 1 month, and they must be severe enough to interfere with the aspects of daily life, such as relationships or work. The symptoms also must be unrelated to medication, substance use, or other illness.
Each person’s experience of PTSD is unique to them and people react to traumatic experiences in a variety of ways: you might have experienced a similar type of trauma to someone else, yet be affected in a different way. Many people experience some symptoms following the trauma which resolve within a few weeks. However, if the symptoms continue for longer than a month, and are affecting your day-to-day life, they may be the signs of the post-traumatic stress disorder.
PTSD symptoms can vary in intensity over time.Some people with the post-traumatic stress disorder learn to ‘manage’ their symptoms and so have long periods when their symptoms are less noticeable. Other people have constant severe symptoms, or you may only have symptoms when you are stressed or when you run into reminders of what you went through.
PTSD symptoms vary from person to person, but some of them have common signs. See the detailed description of each group below.
Re-experiencing is the most typical symptom of PTSD. This is when a person involuntarily and vividly relives the traumatic event, e.g.:
- flashbacks — reliving the traumatic event, and feeling like it happening right now including racing heart or sweating;
- re-occurring memories or nightmares related to or reminding the event;
- distressing and intrusive thoughts or images;
- physical sensations like sweating, trembling.
Thoughts and feelings can trigger these symptoms, as well as words, objects or events that are reminders of the stress situation.
Trying to avoid being reminded of the traumatic event is another key symptom of PTSD. It is manifested in the following way:
- dissociative amnesia — the inability to remember fragments of a traumatic event;
- feeling detached or estranged from people who were close earlier;
- avoiding talks and thoughts related to the traumatic event;
- avoiding associations: thoughts, feelings, things, people and places related to the traumatic event;
- feeling that you need to keep yourself busy all the time;
- using alcohol or drugs to avoid memories;
- feeling emotionally numb or cut off from your feelings.
Avoidance symptoms may cause people to change their routines.
Alertness (hypervigilance) and hyperarousal symptoms
Feeling nervous or always alert and on the lookout for potential danger are other symptoms of PTSD:
- easily startled,
- having difficulty concentrating,
- having difficulty falling asleep or staying asleep,
- panic attacks,
- feeling irritable,
- engaging in reckless behavior.
Feeling and mood symptoms
The way you think about yourself and others may change because of the trauma. It also indicates that you have PTSD. Signs of this group of symptoms are:
- negative feelings and expectations: toxic thoughts about oneself. others or the world;
- blaming oneself or others for the causes of the traumatic event or its consequences;
- feeling like you can’t trust anyone;
- negative emotions, such as ongoing fear, horror, anger, guilt, or shame;
- loss of interest in previous activities;
- unable to experience positive emotions, even minor joy.
Such changes in mood, feelings, self-perception should be taken seriously and if they persist for a long time, you should consult a doctor to prevent the chronic PTSD.
When does PTSD start?
Symptoms of the post-traumatic stress disorder may develop immediately after the traumatic event happened or within weeks or even months after it. Usually PTSD symptoms develop within 6 months after the event. However, there are cases when symptoms appear after 6 months. Unfortunately, many people do not seek help when they develop the first symptoms. PTSD is impossible to diagnose within the first month after the event. If you immediately experience symptoms of trauma that are marked and interfere with your functioning, possibly it is the acute stress disorder.
In general, there are 3 main types of PTSD course: acute, chronic and delayed.
Acute PTSD — symptoms last for 1 to 3 months.
Chronic PTSD — symptoms persist for more than 3 months.
Delayed PTSD may be manifested after 6 months. During this period, the clinical picture of the disease will be most pronounced. That is, before the onset of characteristic symptoms, the patient feels normal and may not even suspect that PTSD is already developing.
PTSD treatment approaches
There are two main approaches to the treatment of post-traumatic stress disorder: psychological therapies and medications.
Psychotherapy as a treatment method for PTSD
PTSD psychotherapy will be focused on the traumatic experience but not on your past life. Any psychotherapy should be conducted by a person who has the appropriate training and certification. In PTSD, the sessions are usually conducted at least once per week with the same therapist and often last for 8-12 weeks. The duration of each session is 1-1.5 hours. Psychotherapy will allow you to properly accept, remember events, share your experiences and feel safe.
PTSD treatment involves the following psychotherapeutic approaches:
Trauma focused cognitive behavioral therapy (TF-CBT) is a talking therapy which may help changing your way of thinking in PTSD: feel better and behave differently. Usually this PTSD therapy is taken place in one-to-one meetings sometimes in group meetings.
Eye movement desensitization and reprocessing (EMDR) involves eye movements to help the brain reprocessing the traumatic memories and gradually relieve the PTSD. You will be asked to recall the traumatic event including the thoughts and feelings that come up while doing so. You should make eye movements or receive any bilateral stimulation, i.e. hand taps. It reduces vividness and emotion associated with the traumatic memories helping to relieve the trauma.
Medications for PTSD treatment
If you have tried different treatments for post-traumatic stress disorder, but found that they are not effective, your doctor may prescribe medications, including antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants that may help to relieve the PTSD symptoms. If you suffer from depression, the antidepressants may also be helpful in treatment. If selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are not effective to manage the post-traumatic stress disorder, you may be offered the alternative medicinal products – they should be generally taken on the recommendation of the mental health professional.
Possible prevention of PTSD
It should be understood that an acute reaction to a stressful event is normal. Remember that PTSD may be developed in any person within their life. Traumatic events can make us feel that life is out of control, we find it difficult to feel safe and trust other people, ourselves and our judgments. Our experience often seems unfair, groundless, inhuman and cruel, and can place in doubt our perceptions of the world and other people. As we cannot always prevent trauma, it is important to keep in mind certain protective factors that can be associated with a more favorable post-traumatic period:
- constant contact and support from important people in your life;
- sharing trauma to your close people;
- identifying yourself as a survivor, not as a victim;
- using positive emotions and laugh;
- finding positive sense in trauma;
- helping other people in the process of treatment;
- believing that you can control your feelings and cope with the situation.
It is important to remember that despite your experience, life goes on.
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- Cahill SP, Pontoski K. Post-traumatic stress disorder and acute stress disorder I: their nature and assessment considerations. Psychiatry (Edgmont). 2005;2(4):14-25.