Fear is a natural and healthy response to a life-threatening event. When people experience or witness danger, the body prepares to take action with the “fight-or-flight” response. The heart rate speeds up, breathing quickens and we feel anxious and ‘pumped’, enabling us to run or combat danger. These feelings of fear normally fade away after the traumatic event. When someone develops post-traumatic stress disorder (PTSD), fear, anxiety and memories of trauma persist for a long period of time and interfere with their ability to function in life. PTSD is a treatable anxiety disorder affecting around one million Australians each year.
Traumatic experiences that involve death, serious injury or sexual violence (actual or threatened) can potentially cause PTSD. Such events include physical or sexual assault, living in a war zone, torture, and natural disasters. Everyone responds to trauma differently and although people may experience extreme distress, most eventually recover on their own. It is only a minority of people who develop PTSD after a traumatic event.
Symptoms of PTSD
The main symptoms of PTSD are:
- re-experiencing the trauma (memories, nightmares or flashbacks)
- avoiding reminders of the trauma
- negative thoughts and mood
- increased alertness to the environment and physical response to sudden changes that could be a sign of danger.
PTSD can be a chronic and disabling condition that has a devastating impact on individuals, relationships and families. Other conditions may also develop, such as depression or substance abuse. However, with the right support and treatment, recovery is possible.
No two people will experience post-traumatic stress disorder (PTSD) in the same way. The way it affects individuals varies greatly: ranging from subtle changes in day- to-day life, withdrawal and numbness, to distressing flashbacks or physical anxiety. Symptoms may be evident after a month, but sometimes can stay dormant for years. There isn’t just one kind of PTSD because each of our experiences and coping mechanisms are unique.
According to the latest version of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM 5), there are four main categories of symptoms:
1. Re-experiencing the trauma
- Repetitive memories (or flashbacks) that are hard to control and intrude into everyday life.
- Extreme distress caused by reminders of the trauma.
- Memories or disturbing thoughts can be prompted by smells, sounds, words or other triggers.
- Staying away from places, people, objects that may trigger memories of the traumatic event.
- Changing a normal routine to avoid triggering memories.
- Not wanting to talk about or think about the event.
- Feeling numb.
3. Negative thoughts and mood
- Feeling a sense of hopelessness about the future.
- Negative beliefs about oneself or the world.
- Blaming oneself or others unreasonably.
- Intense worry, depression, anger or guilt.
- Loss of memory of the traumatic event.
- Losing enjoyment in favourite activities.
- Becoming emotionally detached from others.
- Inability to experience positive emotions.
4. Increased arousal
- Constant, excessive alertness.
- Scanning the environment for signs of danger.
- Being easily startled.
- Irritable or aggressive behaviour.
- Feeling ‘on edge’.
- Difficulty sleeping.
- Poor concentration.
PTSD is often accompanied by other anxiety disorders, depression or substance abuse. Up to 80 per cent of people with long-standing PTSD develop one or more of these other issues. Coping by trying to block out the memories with substance abuse can lead to addictions. PTSD can cause impairment at work and isolation from relatives and friends, and can cause great stress on families. This is why early support and treatment is essential.
Children or teenagers with PTSD may have similar symptoms, with some differences.
PTSD in children
- New onset of bedwetting when previously dry at night.
- Being unusually clingy with parents or carers.
- Acting out the event during play.
- Forgetting how to talk.
PTSD in teenagers
A teenager may experience any of the adult symptoms but may be more likely to:
- have a desire for revenge
- behave in a destructive, disrespectful or violent way
- increase risk-taking behaviour.
If someone appears to be experiencing these symptoms for longer than one month after a traumatic event, it’s important to seek medical support or psychological assistance.
Diagnosis of PTSD
The majority of people who experience a traumatic event will not develop post-traumatic stress disorder (PTSD). However, if someone experiences the above symptoms for longer than one month, or symptoms return after a long period of time, it’s important to talk to a doctor or mental health professional. The doctor will do a mental health assessment, asking about current symptoms, past history and family history. A physical examination may be carried out to check that there are no other reasons for the symptoms.
The doctor may refer to a psychiatrist or psychologist to carry out a more detailed psychological evaluation. They will ask how long, how often and how intense the symptoms are, and what happened during the triggering event. The diagnosis of PTSD is made according to recognised criteria, such as the DSM 5. For a diagnosis of PTSD, the symptoms need to be severe enough to interfere with the person’s ability to function at work, socially or at home. A full diagnosis cannot be made until at least 6 months after the trauma.
Often a diagnosis can come as a relief for someone who has been suffering debilitating symptoms, as it provides an explanation and a basis for beginning treatment.
Causes of PTSD
Although a relationship break-up or losing a job can feel devastating, these are not the kinds of events that can cause post-traumatic stress disorder (PTSD). Events that can cause PTSD are potentially life-threatening, or involve serious injury or sexual violence. Witnessing such a traumatic event can also lead to PTSD.
The kinds of experiences that can potentially cause PTSD are:
- serious accidents
- natural disasters such as bushfires, floods and earthquakes
- living in a war zone, as a victim of war or a soldier
- sexual assault
- serious physical assault
- seeing people hurt or killed.
The reasons some people develop PTSD while others can cope is not completely understood. PTSD risks may be a complex mixture of factors.
Risk factors for developing PTSD include:
- repeated trauma, such as living in a war zone for a long time
- a past history of mental disorder such as anxiety and depression
- a history of trauma or abuse in early childhood
- the severity of the trauma
- lack of social support
- extra life stresses after the trauma, such as the loss of loved ones, a home or a job
- the type of traumatic event, with rape or sexual assault being more likely to lead to PTSD than other events.
PTSD is not the only mental health disorder caused by experiencing potentially traumatic events, and depression and anxiety disorders may be just as common. A recent Australian study showed that 22% of people developed a new onset psychiatric disorder following a traumatic event. Depression, generalised anxiety, PTSD and agoraphobia were the most common disorders.
It is important to note that the majority of people who experience a traumatic event will not develop PTSD, or other mental disorder. Most people will experience a period of stress and distress, and may feel numb or have episodes of unwanted return of memories or lived experience of the event. Over several days and weeks, often with the support of family and friends, these experiences settle and the person essentially restores their previous level of function. In research this is called resilience, which can be defined as “the ability to adapt and cope successfully despite threatening or challenging situations”.
In the event that a person develops more enduring symptoms that affect their relationships and everyday life over a much longer period of time – that is to say, the features of PTSD emerge – the challenges of coping with the distressing symptoms are intense. PTSD is not the result of having poor resilience. Sufferers will need to draw on much of their psychological and emotional reserves to manage living with symptoms and working towards recovery. This too is a demonstration of extraordinary resilience. Therapy and other supports build on these reserves of resilience to help individuals adapt to the potentially disabling impact of PTSD and focus on the strengths that build a pathway to recovery. Each person’s range and style of resilience factors can vary, and so therapy and other treatments need to be tailored to their specific strengths.
Treatment for PTSD
There are several treatments with proven benefit for post-traumatic stress disorder (PTSD), including cognitive-behaviour therapy (CBT) and some types of antidepressants.The most effective treatment can vary according to the individual, so it may be necessary to try different approaches to find out what works best.
Psychotherapy is recommended as the first-line treatment for PTSD. According to Australian guidelines, the two types of therapy which have been proven to be the most effective are trauma-focussed cognitive behaviour therapy (TF-CBT) and eye movement desensitisation and reprocessing (EMDR). These types of therapy can be delivered by a psychologist or psychiatrist, through referral from a doctor. TF-CBT involves working through memories of the trauma in a safe and structured environment, modifying unhelpful beliefs and thoughts, and gradual exposure to triggers which are being avoided.
EMDR involves working through memories of the trauma while going through a series of eye movements. This also includes many of the features of CBT above. It may take between six and 12 weeks to begin to get relief from symptoms. For some people the condition may have become chronic and can take much longer to treat. The sooner treatment begins the better.
Antidepressant medication can be effective for PTSD, and may be recommended if symptoms do not completely resolve with psychotherapy, or the person is unable to have therapy for some reason. Antidepressants can reduce anxiety and fear, depression and anger. It’s important to be aware of the possible side effects and to maintain regular contact with a doctor or mental health practitioner regarding their use.
Research has shown that support from family and friends is an important element in helping overcome the debilitating effects of PTSD. Couple or family therapy can help to restore damaged relationships, and in some cases family members may need to seek support of their own. With support and the right treatment the symptoms of PTSD can diminish over time and it is possible to live life fully again.