What is PTSD?
Any of us can, without warning, go through a traumatic event that is overwhelming, frightening, life-threatening (to ourselves or others) and beyond our control. This could be:
- getting a diagnosis of a serious illness
- having (or seeing) a serious road accident
- the unexpected injury or violent death of someone close
- being taken hostage
- being a prisoner-of-war
After such an event, most people feel distressed and can have symptoms for up to 6 weeks. Many people get over it without needing help, but about 1 in 3 people go on with these symptoms for many months or years – this is Post-traumatic Stress Disorder, or PTSD.
Less dramatic, but longer-lasting traumas can have a similar impact. These include continuing physical or sexual abuse in the home, mistreatment in prisons and torture.
When does PTSD start?
The symptoms usually start within 6 months, and sometimes only a few weeks after the trauma.
What does PTSD feel like?
After the traumatic event you can feel grief-stricken, depressed, anxious, guilty and angry. In PTSD you may also:
- have flashbacks and nightmares – you relive the event in your mind, again and again;
- avoid thinking about it and feeling upset by keeping busy and avoiding anything or anyone that reminds you of it;
- be ‘on guard’ – you stay alert all the time, can’t relax, feel anxious and can’t sleep;
- get physical symptoms – aches and pains, diarrhoea, irregular heartbeats, headaches, feelings of panic and fear, depression
- start drinking too much alcohol or using drugs (including painkillers).
Why does PTSD happen?
There are several possible reasons:
- Remembering things clearly after a shock can help you to understand what happened and, perhaps, help you to survive.
- Flashbacks force you to think about what has happened. You can decide what to do if it happens again.
- Avoidance and numbing help you to stop becoming tired and distressed from remembering a trauma. It keeps the number of ‘replays’ down to a manageable level.
- Being ‘on guard’ means that you can react quickly if another crisis happens. It can give you the energy you need to carry on afterwards.
- Vivid memories of what happened keep your levels of adrenaline high. You will feel tense, irritable and unable to relax or sleep well.
- The hippocampus is the part of the brain that processes memories. In PTSD, high levels of stress hormones, like adrenaline, may stop it from processing the memories of the event, producing continuing flashbacks and nightmares.
Getting through PTSD
Try to get back to your usual routine. Talk about what happened to someone you trust and try relaxation exercises. Eat regularly, take exercise and spend time with family and friends. Try to go back to where the traumatic event happened. Take care with driving – you are more likely to have an accident while you feel like this. Speak to your doctor and keep hopeful.
Don’t be hard on yourself or expect too much of yourself. PTSD symptoms are not a sign of weakness. They are a normal reaction of normal people to terrifying experiences. Don’t avoid other people, drink or smoke a lot, miss sleep or meals.
- Trauma-Focussed Cognitive behavioural therapy (CBT) – helps you to think differently about your memories, so that they become less distressing and more manageable. It usually involves relaxation to help you tolerate the discomfort of recalling the traumatic events.
- Gradual Exposure Therapy / Psychotherapy – by remembering the event, going over it and making sense of it, your mind can do its normal job of storing the memories away and moving on to other things.
- Eye movement desensitisation & reprocessing (EMDR) – uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience.
- Talking with a group of people who have been through the same or similar traumatic events.
- Group therapy – this can help you to feel less alone and isolated.
- Medication – antidepressant tablets will both reduce the strength of PTSD symptoms and relieve any depression. If the antidepressants help, you should carry on taking them for around 12 months before slowly tailing them off. If you are so distressed that you can’t sleep or think clearly, you may need tranquillising medication, although not for more than 10 days or so.
- Body-focused therapies such as physiotherapy and osteopathy, massage, acupuncture, reflexology, yoga, meditation and Tai Chi. These can help to control distress and reduce the feeling of being ‘on guard’ all the time.
CBT, EMDR and antidepressants seem to be most helpful. The evidence for other forms of psychotherapy or counselling is much weaker. Trauma-focused psychological therapies (CBT or EMDR) and gradual exposure therapy should usually be offered before medication.
How do I know when I’ve got over a traumatic experience?
When you can:
- Think about it without becoming distressed
- Not feel constantly under threat
- Not think about it at inappropriate times
How can I help someone who has PTSD?
Remind yourself that they are irritable and jumpy because, in a way, part of them is, in a way, still in the traumatic situation. Give them time to tell you about what happened. Ask general questions, and don’t interrupt or talk about your own experiences.