Page medically reviewed by Dr Leon Rozewicz (MBBS, FRCPsych, MRCGP, MRCPsych), Consultant Psychiatrist and Medical Director of Priory Hospital North London in September 2020.
What is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder is a type of anxiety disorder believed to affect around one in three people after a traumatic experience.
When the phrase PTSD was originally used to describe symptoms of trauma arising primarily from combat exposure but has since been extended to encompass any group of people exposed to traumatic events. This includes:
- Victims of violent crime (e.g. physical and sexual assaults, sexual abuse, bombings, riots)
- Emergency services personnel
- Victims of war, torture, state sanctioned violence, terrorism and refugees
- Survivors of industrial or road traffic accidents and disasters
- Women following traumatic childbirth
- Individuals diagnosed with a life-threatening illness
Those in the military are particularly susceptible to this condition due the frequency of their traumatic experiences.
What are the Symptoms of PTSD?
Symptoms of PTSD are both psychological and physical and usually developing within first month of the traumatic event, although they can appear up to a year later. While the specific symptoms of PTSD vary from person to person, living with the condition can have a significant effect on your ability to function in everyday life, particularly when you have persistent and extreme symptoms.
The symptoms most commonly experienced by those with PTSD include:
- Reliving the experience through nightmares and flashbacks
- Numbness and loss of deep feelings
- Difficulty in concentrating
- Suffering painful emotions such as guilt, anger and anxiety
- Avoidance of dealing with grief, anger and anxiety
- Experiencing anger issues
- Avoidance of activities that could trigger memories of the event
- Alcohol or drug use
- Headaches, dizziness and chest pains
- Irritability and difficulty sleeping
- Withdrawal from work and social interactions
- Weight loss or gain
The most widely reported symptom of PTSD and arguably the most distressing includes re-experiencing the initial source of trauma, which can appear in the form of flashbacks, nightmares, thoughts and physical sensations causing sweating and trembling. Whichever form involuntarily reliving the traumatic event takes, it will often feel intensely vivid and closely mimic the initial physical and emotional responses felt when your trauma initially took place.
These experiences can be interspersed with more general negative thoughts about the event, where you may internally question why your life has been affected so dramatically and if you could have done anything to stop it.
Sometimes referred to as CPTSD, complex PTSD refers to protracted trauma experienced when growing up, which means the symptoms are more ‘deep seated’ than other forms of PTSD.
Someone with complex PTSD and trauma will experience very similar symptoms to someone with PTSD, but will also experience feelings of distrust and disconnection. CPTSD is also associated with emotional instability.
PTSD and other Mental Health Conditions
Every stressful or traumatic life event will cause most people to experiencing heightened emotional reactions as the brain tries to process such a significant event. If you have PTSD, these feelings are heighted to the point where you may regularly feel anxious and ill at ease, making it difficult for you to settle, even during quieter moments of reflection.
This state of mind is also known as hyper arousal, and can cause symptoms such as:
- Difficulty concentrating
- Panic attacks
Panic Attacks and PTSD
A common symptom of PTSD is experiencing panic attacks, so keep an eye on how regularly these happen, particularly if they don’t seem to be reducing in severity or frequency. Flashbacks and nightmares of what you have experienced are also extremely common and can be disturbingly vivid, resulting from your body having difficulty processing the event in a healthy way. PTSD Symptoms such as this can be very distressing and mean that you may continue to relive the event repeatedly until you seek appropriate expert PTSD treatment.
Why does PTSD happen?
The ICD10 classification for PTSD (F43.1) states:
- The disorder arises as a delayed response to a stressful event or situation, (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive stress in almost anyone
- Upsetting situations that are described as ‘traumatic’ in everyday language, e.g. divorce, loss of a job or failing an examination are better classified as (F43.2) adjustment disorder
Complex PTSD is said to arise where there has been repetitive, prolonged trauma involving sustained abuse or abandonment by a caregiver or other interpersonal relationships with an uneven power dynamic.
In response to acute stress, the body's sympathetic nervous system is activated due to the sudden release of hormones, triggering the release of catecholamine. This leads to a state of hyper-arousal, commonly known as the ‘fight or flight’ response. When people experience trauma, the world may then feel like a less secure place and the trauma may re-invoke earlier feelings of vulnerability.
Some people with PTSD are said to show organic and functional abnormalities of the brain. Areas implicated include the amygdala, hippocampus and pre-frontal cortex.
What Causes PTSD?
While the initial cause of PTSD will often be clear after a particularly traumatic event, it is not yet known why some people go on to develop the disorder, while others experiencing similar circumstances will not.
It is unlikely you will be diagnosed with PTSD if you go through upsetting situations such as a divorce, being made unemployed, or not passing an exam, although you may still experience some symptoms that are closely related to the condition.
Other factors believed to contribute to the development of PTSD include having a history of or existing mental health conditions such as anxiety and depression. Having a lack of social support after the event can also exacerbate feelings of confusion, frustration and isolation, which can increase your chances of experiencing symptoms of the condition.
Reasons for development
Theories for why PTSD develops in some but not others experiencing the same or similar levels of trauma include:
Survival mechanism - While anybody who has experienced a traumatic or stressful event will develop natural stress reactions as the brain learns to cope and protect the body from extreme shock, people with PTSD may have an exaggerated version of this ‘survival mechanism’ response.
High adrenaline levels - Studies indicate that if you have been diagnosed with PTSD, you will have unusually high amounts of stress hormones in your body, which causes some of the extreme physical and emotional symptoms common in the disorder, such as feelings of numbness and the hyperarousal associated with the fight or flight reaction. Your body will continue to produce the hormone even when there is no obvious danger.
Changes in the brain - Brain scans of people with PTSD show that parts of your brain responsible for emotional processing are different than those with the condition. The hippocampus area of the brain is known to store memories and control emotional responses, with the reduction in size shown if you have PTSD possibly explaining the seemingly disrupted link between fear, anxiety, memories and reliving of the traumatic event which isn’t being correctly processed.
If PTSD is left untreated, these symptoms can become severe and long-lasting which can subsequently affect your family, social and work life.
The difference between expected levels of stress and anxiety after trauma depends on how long initial symptoms last, as if you have PTSD, they can last beyond a few weeks and may not improve until you seek professional medical help and support.
Priory’s nationwide network of hospitals and wellbeing centres provide specialist care involving evidence-based therapy techniques, focused on helping you process your trauma and reduce symptoms of PTSD. PTSD treatment at Priory is specifically tailored towards dealing with trauma, with techniques such as eye movement desensitisation and reprocessing (EMDR) being particularly effective in helping to process and neutralise traumatic experiences and memories.
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