Post traumatic Stress Disorder (PTSD)

This is the anxiety disorder that may develop after exposure to a major traumatic event such as a bad car accident, rape, experience of war or combat, natural disaster, terrorist attack, physical assault or sudden death of a loved one.

Not everyone who experiences these horrors develops post traumatic stress disorder (PTSD). It is not known why but seem seem to recover from these events without disabling symptoms. However, many others suffer considerably after their tragedy, sometimes for a lifetime.

The more severe the event the greater the chance that PTSD will develop. Psychologists have studied the relationship of severity of trauma to likelihood of PTSD developing. Sutker and Allain (1996) found that as traumatic events become universally brutal; more horrific, gruesome and prolonged; and more threatening to life, the greater the likelihood that PTSD will develop. As the severity of the traumatic event increases the less relevant becomes the role of individual susceptibility. PTSD can develop in the most emotionally stable individuals if the event is severe enough e.g. prolonged torture, death of a child.

PTSD is characterised by high levels of anxiety, panic and often depression. PTSD is distinguished from other anxiety disorders by the presence of re-living experiences. For example flashbacks, nightmares and preoccupation with the precipitating event.

Other symptoms include an emotionally numb state, avoidance of cues which remind of the event, and symptoms of elevated anxiety such as insomnia, impaired concentration, hyper vigilance for danger, irritability and heightened startle reaction.

Emotional numbing which is described by patients as an inability to feel any positive emotions such as love, contentment, satisfaction or happiness, is extremely disruptive to personal relationships.

Sufferers also experience insomnia, poor concentration, and difficulty controlling anger.

Patients with PTSD tend to live for the present, rarely planning for the future. This can have a profound effect on children, adolescents and young adults who are developing life plans and careers.

PTSD is the fourth commonest psychiatric condition in the United States, behind alcoholism, major depression and social phobia.

According to research by psychologists 17 PTSD symptoms have been identified.

These are listed in the DSM IV. These 17 symptoms are divided into three separate clusters: 

Re-experiencing symptoms

  1. Frequently having upsetting thoughts or memories about the event
  2. Having recurring nightmares
  3. Acting or feeling as though the traumatic event is happening again - a flashback
  4. Having strong feelings of distress when reminded of the traumatic event
  5. Being physically responsive, such as experiencing a surge in your heart rate or sweating, to reminders of the traumatic event 

Avoidance symptoms

  1. Making an effort to avoid thoughts, feelings or conversations about the traumatic event
  2. Making an effort to avoid places or people that remind you of the traumatic event
  3. Having a difficult time remembering important parts of the traumatic event
  4. A loss of interest in important, once positive, activities
  5. Feeling distant from others. about the traumatic event
  6. Experiencing difficulties having positive feelings, such as happiness or love
  7. Feeling as though your life may be cut short

Hyper-arousal symptoms

  1. Having difficulty falling or staying asleep
  2. Feeling more irritable or having outbursts of anger
  3. Having difficulty concentrating
  4. Feeling constantly “on guard” or as if danger is lurking around every corner 
  5. Being jumpy or easily startled

Many of these symptoms are an extreme version of our body's natural response to stress. Understanding our body's natural response to threat and danger (the fight or flight response ) can help us better understand the symptoms of PTSD.

The diagnosis of PTSD can be very complicated. You should seek professional advice if you feel that you have PTSD. On the other hand, you may have a few of these symptoms but not the full 17. If so, and if your problem seems mild and is not interfering with your life, you may want to try working on the difficulty for a while, on your own. If you don’t feel better soon then ask for help.

There are many psychological tools and questionnaires which help in making the diagnosis of PTSD.

Case example

John had been in a bad road traffic accident. He describes his symptoms: “Ever since my accident, I have nightmares and constant images racing through my mind about glass breaking, tyres screeching, and passengers screaming. I’m so jumpy and irritable that I can barely get through the day."

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