Within this resource for GPs, Dr Pawan Rajpal, consultant psychiatrist at Priory Hospital Bristol explores the difference between post-traumatic stress disorder (PTSD) and trauma, looking at why PTSD might occur after a trauma and what the best treatment options for both are.
Trauma is an unexpected event or series of events that can have devastating effects physically and/or psychologically.
It could be caused by an accident, a one-off catastrophic event, or ongoing traumatic experiences. The two different types can be summarised as a:
- Single incident, unexpected trauma
- Complex, ongoing/repetitive trauma
People respond to trauma in different ways. For some, the issues settle; regretfully for a smaller percentage, the effects of this can be so severe that it interferes with an individual’s ability to live a normal life – their whole life is disrupted.
Those who experience trauma more than once, or repeatedly, sometimes experience behavioural, social and/or emotional issues afterwards, and this can sometimes be in the form of PTSD.
Some theories of psychology mention that for people who develop PTSD, traumatic experiences are stored in unhelpful ways that are not processed correctly – they are re-lived again and again.
Important things to consider about PTSD:
- PTSD is not a normal response to severe stress
- PTSD is not an inevitable response to stress
- Most trauma-exposed people do not develop PTSD
- Many individuals will recover quickly from PTSD
To support the above, it is important for GPs to spot the signs and symptoms of trauma early, in order to offer immediate and the most appropriate care and treatment.
Reactions to trauma can include:
- Anger and irritability
- Impaired sleep
- Cognitive and perceptual changes
- Hyper arousal/hyper vigilance
Those who have a history of early life trauma in particular, should absolutely be offered psychotherapy as well as pharmacotherapy as early as possible, to support their recovery journey.
Factors which can influence PTSD occurring
- Lack of a support network
- On-going life stresses
- Lack of economic resources
- Social or educational disadvantages
Approximately 80% of patients with PTSD will also have a co-morbid psychiatric condition, the most common being:
- Chronic depression
- Bipolar disorder
- Adjustment disorders
- Somatoform disorders
- Anxiety disorders
- Drug and alcohol abuse
How can a GP help?
It is important that a trauma victim is not just encouraged to ‘move on’ and are supported to resolve the PTSD as well. Initial distress and anxiety is in fact, very common.
Therefore, it is important to avoid phrases such as:
- Time is a great healer
- Wipe the slate clean
Instead, support to those involved should be along practical lines, which is evidenced to reduce avoidance and intrusive symptoms. This could include:
- Helping them gain access to Crisis Support Teams
- Access to a range of non-statutory services, for example CRUSE and Victim Support
- Psychological First Aid - technique designed to reduce the occurrence of PTSD
- Suggesting physical exercise
- Offering ideas for distraction techniques/activities
Those at increased risk of developing PTSD from experiencing a trauma may need more intensive support. Cognitive behavioural therapy (CBT) has been known to be extremely beneficial for more acute stress disorders.
This form of treatment helps correct mistaken beliefs such as ‘The world in entirely dangerous’ or ‘I am totally incompetent’ and the goal is to reduce anxiety or emotional distress by teaching patients to identify, evaluate and modify negative thoughts and dysfunctional beliefs.
Eye movement desensitisation and reprocessing (EMDR) is another effective treatment for PTSD recommended by NICE guidelines. This is considered to be a ‘third-wave’ cognitive behavioural technique which combines elements of CBT with exposure.
Priory has a nationwide network of hospitals and wellbeing centres which can provide support and treatment for those suffering after a trauma. Our expert consultants and therapists can provide comprehensive care, taking into account:
- Co-morbidities such as drug and alcohol misuse, along with co-morbid conditions such as depression
- Traumatic bereavement as this can complicate treatment
- What therapy should be offered in terms of individual signs, symptoms and risk management needed
Download our support leaflet to provide your patients with further information and advice that they can take away with them.