Understanding PTSD

A traumatic event can cause anyone to feel anxious, scared and distressed. These are normal reactions to what can be considered an abnormal event, and with time, people can move on and return to their previous state of wellbeing. Developing PTSD after a trauma is not a given, and in fact, the majority of people will be able to process the events within a couple of weeks and get back to their usual self.

However, it’s estimated that one in three people who have been exposed to a traumatic event will go on to develop post-traumatic stress disorder (PTSD) or complex-post traumatic stress disorder (c-PTSD).

What is PTSD?

You might have heard the term ‘shell shock’ which was used to describe the way in which soldiers were affected by their combat experiences during the first and second world wars. We now refer to this trauma reaction as PTSD and also understand that there are many causes of the disorder – not just those linked to combat.

In the aftermath of any kind of trauma, most people will experience reactions such as feeling numb, shaky, troubled, or have intrusive memories of the event. This is human, and these and other symptoms are known as an acute stress reaction. This is different from PTSD in that the symptoms will usually subside within a few days or weeks and there won’t be any long-term consequences.

PTSD can develop after exposure to an event that involved the actual or possible threat of death, violence or serious physical or psychological injury. You don’t have to have been directly involved in the event to develop PTSD. You may have:

  • Witnessed the traumatic event occurring to someone else
  • Heard that someone close to you experienced the event
  • Been repeatedly exposed to the details of traumatic events (for example, first responders such as paramedics and police officers).

PTSD is fundamentally an anxiety disorder which can develop in someone who has been involved in a traumatic situation – it can even occur in someone who was a witness to a traumatic event. For those suffering with PTSD, the effect can be significant and have a serious impact on day-to-day life. Unlike an acute stress reaction, PTSD can take weeks, months or even years to develop.

What is c-PTSD?

The majority of people suffering with PTSD were exposed to a one-time event such as a natural disaster, a single violent assault, or an accident. Those who develop c-PTSD have experienced trauma over a prolonged period of time, which leaves the sufferer feeling unable to escape. The trauma can take place over weeks, months, or years but is consistent and seemingly without end. It is not to say however that c-PTSD is more painful than PTSD; the causes and treatments are different but the damage is the same.

What kind of events can cause PTSD?

Anything that is outside of the normal range of human experience can be considered a traumatic event. It might be something that you’ve witnessed, or something that directly happened to you. The following list includes traumatic events which, without support, might cause someone to develop PTSD. Remember that we’re all different so what traumatises one person might not present a threat to another.

  • An accident at work or home
  • An assault such as a robbery, mugging or physical attack
  • Rape or threatened rape
  • Threat of death by another person
  • A natural disaster such as a fire or flood
  • The loss of a loved one through violence, suicide, or other sudden and/or unexpected cause
  • Trauma experienced during childbirth (more than 28,000 women in the UK are affected by maternal PTSD)
  • A deeply humiliating experience at any stage of life

What kind of trauma can cause c-PTSD?

  • Involvement in war or other conflict (both military personnel and civilians)
  • Intimate partner violence (it’s thought that approximately 68% of people experiencing, or who have experienced, this type of trauma suffer from c-PTSD)
  • Neglect and/or sexual, emotional and physical abuse in childhood
  • Witnessing trauma on a regular basis as part of your work police officer, paramedic, nurse, doctor)
  • Slavery and human trafficking
  • Chronic and sustained bullying in childhood or adulthood

What are the symptoms of PTSD and c-PTSD?

The following are common amongst people with PTSD and c-PTSD, although not every symptom will be present. There may also be other signs – the key here is to question whether day–to-day quality and enjoyment of life is impaired.

Reliving the event

  • Intrusive memories of the event (flashbacks)
  • A feeling that you’re back at the exact moment of the trauma
  • Intense physical and emotional distress when reminded of the event such as a certain song or phrase which evokes the memory

Physical, emotional, and cognitive reactions

  • Problems sleeping such as oversleeping, or waking often in the night
  • Night terrors or nightmares
  • Somatic reactions when reminded of the event including nausea, shakiness, sweating, aches and pains, feeling dizzy
  • A sense that you are outside of your physical body
  • An intense reaction to physical touch from other people
  • Feelings of extreme anger or frustration
  • Feeling emotionally numb, disconnected, or ‘dead inside’
  • Depression
  • Feeling hopeless and not able to see a future for yourself
  • Panic attacks when reminded of the traumatic event
  • Difficulties with focus, memory, and concentration
  • Being unable to recall the event (not as a result of alcohol/drug intoxication or head injury)
  • Being overly alert to your surroundings (also known as hypervigilance)
  • An intense startled response to external stimuli especially noises which remind you of the event

Avoidant behaviours

  • Self-medicating with alcohol, food, gambling, or drugs
  • Reckless behaviour such as driving under the influence, getting into physical fights, gambling
  • Overworking
  • Not socialising, not leaving the house, not answering the phone
  • Taking exceptional effort to avoid the scene of the event or anything that reminds you of it

Distorted beliefs

  • Thinking that the world is unsafe and everyone around you is untrustworthy
  • Feeling that no one understands what you’ve gone through
  • Blaming yourself for what happened, or experiencing ‘survivor’s guilt’
  • Feelings of shame, embarrassment, or being judged by other people
  • Rigid thinking (people are all good or all bad – there is no grey area)

How are PTSD and c-PTSD diagnosed?

As it can take months or even years for symptoms related to PTSD to become evident, it is less about the time which has lapsed since the event, and more about the duration of symptoms once they appear. It’s important to speak with your GP if after one month of developing symptoms you’re still feeling that your day-to-day life is impaired. He or she will likely perform a physical examination to ensure that your symptoms aren’t being caused by an underlying physical illness. Both PTSD and c-PTSD can also cause physical health problems over the long-term such as stomach ulcers, high blood pressure, and other issues. You will also be asked about the traumatic event, any symptoms you’re experiencing, and how long you’ve been affected.

How are PTSD and c-PTSD treated?

The type of treatment depends on the nature of the event along with other factors such as the severity of symptoms and the presence of any other existing mental health conditions. However, it’s important that any therapy offered is delivered by a specialist who is well experienced and qualified to support people in this situation.

Talking therapies

  • Trauma-focused cognitive behavioural therapy (TF-CBT). This is a form of cognitive behavioural therapy (CBT) specifically adapted for PTSD. Sessions usually last between 60 and 90 minutes (8 to 12 sessions) and take place at least once a week. TF-CBT aims to restructure that way that the person thinks about the trauma and remove any distorted thinking patterns associated with it.
  • Eye movement desensitisation and reprocessing (EMDR). Developed in 1989, this relatively new treatment involves making specific eye movements while recalling the traumatic event. Over time, the therapist will help the sufferer to replace traumatic memories.
  • Exposure therapy. This gradually and gently exposes the person to the trauma they experienced in a safe way through imagining, writing, drawing, or visiting the place where the event happened.
  • Psychotherapy. This is a long-term type of therapy which may be appropriate for people who have c-PTSD, especially for those who have experienced long-term trauma during childhood.

Medication

While not routinely prescribed for those suffering with PTSD or c-PTSD, your GP may decide that short-term medication would be helpful if you have existing depression, and/or are experiencing severe sleep impairment. It is likely that you would also be offered a talking therapy in addition to medication.

Self-care

PTSD and c-PTSD can take time to heal from but with the right treatment and support, you can return to your usual self and start to enjoy life again free of painful memories. Here are some suggestions which have helped people to deal with the symptoms of PTSD and c-PTSD and recover:

  • Stay physically active – it keeps you physically well but also boosts mood and promotes good sleep (link to articles)
  • Cut back on, or avoid, alcohol 
  • Avoid recreational drugs 
  • Eat as healthily as possible 
  • Get good quality sleep 
  • Reduce your caffeine and sugar intake
  • Talk to a friend or family member about your feelings
  • Let your manager know that you’re recovering from a trauma and might need additional support
  • Spend time on a hobby or other interest
  • Create a plan for dealing with any stressors that are making life more difficult such as debt, housing problems, stress at work, or interpersonal relationship problems
  • Take time out for yourself but try not to isolate yourself
  • Consider joining a support group for people who have experienced trauma – your Local Mind Association may have information on how best to access this kind of help.

Other useful resources

  • The Birth Trauma Association supports mums who have experienced a traumatic birth and their partners. Online information includes leaflets, guidance, films, and a directory of private therapists.
  • PTSD UK helps people with PTSD, as well as their loved ones with online information and advice on all aspects of the condition. It’s also an excellent resource on where to access help as well as things that you can do to help yourself.
  • Combat Stress offers former servicemen and women support with their mental health including PTSD, c-PTSD, depression, anxiety and other concerns.
  • Young Minds offers a specialist service for young people between the ages of 14 and 25 who have experienced trauma. Help is also available to parents and caregivers who are concerned about the impact that a traumatic event has had on a child.