Post-traumatic stress disorder (PTSD): causes & symptoms

Post-traumatic stress disorder (PTSD) can result from a single, highly distressing event such as a car crash or traumatic birth, or from recurring events. Events which expose people to the threat of injury or death provoke feelings of helplessness, horror and powerlessness. Some people are able to come to terms with these feelings after a short period of distress, but around 20 per cent of people develop PTSD. Symptoms must be present for at least a month, for people to be diagnosed with PTSD (American Psychiatric Association, 2013).
 

Here, one of our expert clinical psychologists Dr Sarah Barker, explains everything that you need to know about PTSD, including how the body physically responds to a distressing situation and how it feels to experience the condition.

Who is most likely to experience PTSD?

PTSD can also develop after recurring traumatic events. The cumulative impact is a first responder to trauma, for example, being in the police, military or fire service can have a significant impact on mental health. Complex PTSD (American Psychiatric Association, 2013; Korn, 2009) can develop from repeated abuse, neglect, witnessing violence, separation and adverse experiences, and can lead to distressing emotions such as shame, fear, sadness and despair.
 

What happens to the body during PTSD?

In a highly distressing situation, the body typically goes into fight, flight or freeze mode, which promotes survival (Van der Kolk, 2014). In this mode, the brain does not process the memory of the event, and it is only after the immediate danger has passed that the brain starts to process the memory for ‘filing’. Unfortunately, this can elicit unpleasant symptoms such as flashbacks to the event, nightmares and unwanted intrusive images.

All senses can be evoked in these images, which can involve smell, taste, vision, sound and touch (Ogden et al, 2006). This can be very distressing; people may experience symptoms of anxiety such as a tight chest and shortness of breath. They may become hypervigilant; constantly looking out for danger, and everyday places such as railway stations can be experienced in a heightened way and can lead to avoidance of triggers.

This avoidance makes sense in the short-term. In the long-term, the event or events are not processed and can result in emotions becoming blunted, people becoming irritable and tense, and relationships coming under strain.
 

What are the main types of PTSD?

DSM-5 (American Psychiatric Association, 2013) describes PTSD as encompassing four distinct clusters of symptoms. These include:

• Re-experiencing symptoms include spontaneous memories of the traumatic event, recurrent dreams related to it, flashbacks, or other intense or prolonged psychological distress.
• Avoidant symptoms include active avoidance of distressing memories, thoughts, feelings or external reminders of the event.
• Negative changes in cognitions and mood include a broad range of feelings, from a persistent and distorted sense of blame of self or others to estrangement from others or markedly diminished interest in activities, to an inability to remember key aspects of the event.
• Alterations in arousal and reactivity include aggressive, reckless or self-destructive behaviour, sleep disturbance, hypervigilance or related problems.

How is PTSD treated?

The good news is that PTSD and complex PTSD can be treated (Bisson and Andrew, 2009; Ehring et al, 2014). Some people choose to take medication, others to have psychological therapy or a combination of the two. Trauma focussed cognitive behavioural therapy (CBT) and eye-movement desensitisation and reprocessing (EMDR) are two NICE approved psychological therapies for PTSD (NICE, 2018).

Psychological therapies are delivered in a phased way, which can be cyclical:

1.  Stabilisation. This involves establishing safety, understanding and managing responses and addressing current stressors. Psychoeducation about reactions to trauma and the teaching of self-calming methods and techniques for managing arousal and flashbacks occurs.
2. Processing memories of traumatic events. After an initial stabilisation phase, identifying and treating target memories (often visual images); and processing trauma-related emotions, meanings and beliefs can occur.
3. Reintegration. The third phase involves reintegrating life issues and works on improving relationships, work, spiritual and recreational issues in life.

Many people I have worked with have returned to enjoying a good quality of life, with improved relationships and mood. I have regular supervision for my work with people who have PTSD or complex PTSD, and undergo regular CPD which maintains the quality of my work.

References
American Psychiatric Association. (2013). The diagnostic and statistical manual of mental disorders (5th ed). USA: American Psychiatric Association.

Bisson, J., Andrew, M. (2009). Psychological treatment of post-traumatic stress disorder (PTSD) (Review). The Cochrane Collaboration, John Wiley & Sons, Ltd.

Ehring, T., Welboren, R., Morina, N., Wicherts, J. M., Freitag, J., Emmelkamp, P. M. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review, 34(8), 645-657.

Gilbert, P. (2013). The compassionate mind: A new approach to life's challenges. UK: Constable & Robinson Ltd.

Korn, D. L. (2009). EMDR and the treatment of complex PTSD: A review. Journal of EMDR Practice and Research, 3(4), 264-278

National Institute for Clinical Excellence. (2018). Evidence update: The management of PTSD in adults and children in primary and secondary care. UK: Cromwell Press.

Ogden, P., Minton, K., Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy (Norton series on interpersonal neurobiology). USA: W. W Norton & Company.

Van der Kolk, B. (2014). The body keeps the score; mind brain and body in the transformation of trauma. UK: Penguin.

If you or a loved one are experiencing or displaying symptoms of PTSD, don't hesitate to book an appointment with Dr Barker via her Top Doctors profile.