Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.

​

Symptoms of post-traumatic stress disorder (PTSD)

Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.

They may also have problems sleeping, such as insomnia, and find concentrating difficult.

These symptoms are often severe and persistent enough to have a significant impact on the person's day-to-day life.

​

Causes of post-traumatic stress disorder (PTSD)

Any situation that a person finds traumatic can cause PTSD.

These can include:

• serious road accidents

• violent personal assaults, such as sexual assault, mugging or robbery

• serious health problems

• childbirth experiences

PTSD can develop immediately after someone experiences a disturbing event, or it can occur weeks, months or even years later.

PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it's not clear exactly why some people develop the condition and others do not.

​

Complex post-traumatic stress disorder (PTSD)

People who repeatedly experience traumatic situations, such as severe neglect, abuse or violence, may be diagnosed with complex PTSD.

Complex PTSD can cause similar symptoms to PTSD and may not develop until years after the event.

It's often more severe if the trauma was experienced early in life, as this can affect a child's development.

​

When to get medical advice

It's normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks.

You should see a GP if you or your child are still having problems about 4 weeks after the traumatic experience, or if the symptoms are particularly troublesome.

If necessary, your GP can refer you to mental health specialists for further assessment and treatment.

​​

The symptoms of post-traumatic stress disorder (PTSD) can have a significant impact on your day-to-day life.

In most cases, the symptoms develop during the first month after a traumatic event.

But in a minority of cases, there may be a delay of months or even years before symptoms start to appear.

Some people with PTSD experience long periods when their symptoms are less noticeable, followed by periods where they get worse. Other people have constant severe symptoms.

The specific symptoms of PTSD can vary widely between individuals, but generally fall into the categories described below.

​

Re-experiencing

Re-experiencing is the most typical symptom of PTSD.

This is when a person involuntarily and vividly relives the traumatic event in the form of:

• flashbacks

• nightmares

• repetitive and distressing images or sensations

• physical sensations, such as pain, sweating, feeling sick or trembling

Some people have constant negative thoughts about their experience, repeatedly asking themselves questions that prevent them coming to terms with the event.

For example, they may wonder why the event happened to them and if they could have done anything to stop it, which can lead to feelings of guilt or shame.

​

Avoidance and emotional numbing

Trying to avoid being reminded of the traumatic event is another key symptom of PTSD.

This usually means avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience.

Many people with PTSD try to push memories of the event out of their mind, often distracting themselves with work or hobbies.

Some people attempt to deal with their feelings by trying not to feel anything at all. This is known as emotional numbing.

This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing activities they used to enjoy.

​

Hyperarousal (feeling "on edge")

Someone with PTSD may be very anxious and find it difficult to relax. They may be constantly aware of threats and easily startled. 

This state of mind is known as hyperarousal.

Hyperarousal often leads to:

• irritability

• angry outbursts

• sleeping problems (insomnia)

• difficulty concentrating

​

Other problems

Many people with PTSD also have a number of other problems, including:

• other mental health problems, such as depression, anxiety or phobias

• self-harming or destructive behaviour, such as drug misuse or alcohol misuse

• other physical symptoms, such as headaches, dizziness, chest pains and stomach aches

PTSD sometimes leads to work-related problems and the breakdown of relationships.

​

​

Why does it develop?

Although it's not clear exactly why people develop PTSD, a number of possible reasons have been suggested.

​

Survival mechanism

One suggestion is that the symptoms of PTSD are the result of an instinctive mechanism intended to help you survive further traumatic experiences.

For example, the flashbacks many people with PTSD experience may force you to think about the event in detail so you're better prepared if it happens again.

The feeling of being "on edge" (hyperarousal) may develop to help you react quickly in another crisis.

But while these responses may be intended to help you survive, they're actually very unhelpful in reality because you cannot process and move on from the traumatic experience.

​

High adrenaline levels

Studies have shown that people with PTSD have abnormal levels of stress hormones.

Normally, when in danger, the body produces stress hormones like adrenaline to trigger a reaction in the body.

This reaction, often known as the "fight or flight" reaction, helps to deaden the senses and dull pain.

People with PTSD have been found to continue to produce high amounts of fight or flight hormones even when there's no danger.

It's thought this may be responsible for the numbed emotions and hyperarousal experienced by some people with PTSD.

​

Changes in the brain

In people with PTSD, parts of the brain involved in emotional processing appear different in brain scans.

One part of the brain responsible for memory and emotions is known as the hippocampus.

In people with PTSD, the hippocampus appears smaller in size.

It's thought that changes in this part of the brain may be related to fear and anxiety, memory problems and flashbacks.

The malfunctioning hippocampus may prevent flashbacks and nightmares being properly processed, so the anxiety they generate does not reduce over time.

Treatment of PTSD results in proper processing of the memories so, over time, the flashbacks and nightmares gradually disappear.

​

Assessment

Before having treatment for PTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs. This may be carried out by a GP or specialist.

​

Active monitoring

If you have mild symptoms of PTSD, or you've had symptoms for less than 4 weeks, an approach called active monitoring may be recommended.

Active monitoring involves carefully monitoring your symptoms to see whether they improve or get worse.

It's sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience get better within a few weeks without treatment.

If active monitoring is recommended, you should have a follow-up appointment within 1 month.

​

How post-traumatic stress disorder (PTSD) is treated

The main treatments for post-traumatic stress disorder (PTSD) are psychological therapies and medicine.

Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.

It's possible for PTSD to be successfully treated many years after the traumatic event or events occurred, which means it's never too late to seek help.

Treatment depends on the severity of symptoms and how soon they occur after the traumatic event. 

Any of the following treatment options may be recommended:

• watchful waiting – monitoring your symptoms to see whether they improve or get worse without treatment

• antidepressants – such as paroxetine or sertraline

• psychological therapies – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). 

  • In CBT we do prolonged exposure/re-living to help process the traumatic incident so that it moves to the left hemisphere (stored memory). If a traumatic memory is processed, the individuals distress levels should be reduced when they think or are reminded of it. Work can also focus on discriminating between then and now when a trigger is there. Traumas also have the ability to create new ‘Core Beliefs’ and can impact how an individual feel about themselves now as a result of the incident e.g. “I am permanently damaged” or “I am weak”. Cognitive and behavioural work can help reduce the post trauma belief that an individual is experiencing.

  • EMDR - Problems arise when an experience is inadequately processed. A particularly distressing incident may become stored in a state-specific form, meaning frozen in time in its own neural networks, unable to connect with other memory networks that hold adaptive information. When a memory is encoded in state-specific form (distressing), the original perceptions can continue to be triggered by a variety of internal and external stimuli, resulting in inappropriate emotional, cognitive and behavioural reactions, as well as overt symptoms (high anxiety, nightmares, intrusive thoughts). Dysfunctionally stored memories are understood to lay the foundation for future maladaptive responses, because perceptions of current situations are automatically linked with associated networks. The Adaptive Information Processing (AIP) model views negative behaviours and personality characteristics as the result of dysfunctionally held information. From this perspective, a negative self-belief (I am a failure) is not as the cause of present dysfunction, it is understood to be a symptom of the unprocessed earlier life experiences that contain affect and perspective.

​