Post-traumatic stress disorder (PTSD) is a mental condition that results from exposure to some sort of traumatic experience, and is believed to affect around eight out of every 100 people. Trauma (or a traumatic experience) is referred to as a deeply disturbing or distressing event that causes an overwhelming amount of stress to an individual.

Symptoms

In most cases, symptoms develop within a month of exposure to the trauma. However, there are occasions where symptoms may develop a few months, or even years, after the event. In some cases, symptoms may be progressive, initially being less apparent for a long period of time and then surfacing more prominently. Symptoms may vary from mild to severe, and may be broadly categorised as follows:

• Intrusive re-experiencing – the patient involuntarily re-lives the traumatic experience in the form of nightmares, flashbacks or sensations, giving rise to trembling, sweating, pain, feeling sick
• Emotional numbing – the patient avoids people, places, objects that remind them of the traumatic event by either distracting themselves with other activities or numbing themselves of any thought of the same
• Hyper-arousal – the patient is anxious and constantly on edge, often giving rise to insomnia, reckless and sometimes self-destructive behaviour, difficulty in concentrating, angry outbursts, irritability, being startled easily
• Negative thoughts and feelings – the patient may feel fear or phobias, hopelessness, guilt, shame, anger, detachment from family and friends, difficulty in maintaining relationships, a lack of interest in usual activities, and develop anxiety or depression

These symptoms may be accompanied by physical symptoms such as frequent headaches, stomach aches, chest tightness or dizziness, and may also give rise to erratic habits such as alcoholism and drug abuse.

Causes

Any event that is traumatic to an individual has an impact on their mental health, and PTSD has been found to develop in one out of three people who face such a trauma. In some cases, symptoms are thought to arise as a sort of survival mechanism, where the mind is constantly on edge and re-living an experience to be better prepared if it happens again. In such cases, it has been found that there are often consistently elevated levels of adrenaline in their circulation, which is likely what keeps them in their constant ‘fight or flight’ mode.

Trigger factors vary, and include:

• experiencing or witnessing a serious accident
• experiencing or witnessing war or conflict
• witnessing an injury or death
• repeated childhood or domestic abuse
• physical or sexual assault
• death or loss of a loved one
• traumatic experiences at work, such as grave injustice or shaming
• traumatic experiences in hospital, such as during surgery or intensive care
• painful childbirth experiences, such as a stillbirth
• mental health issues that have not been dealt with
• substance abuse

It is believed that those with a family history of mental health issues may be at a greater risk of developing PTSD.

Prevention

While we may not be able to prevent traumatic events that lead to PTSD, an effective method of preventing, or minimising the impact of, PTSD would be to seek help or support when such an event has occurred. This could be talking to a confidante, speaking to a doctor or approaching a therapist. The idea is to confront and deal with one’s thoughts and feelings following the traumatic event, without putting it away. This would subsequently help avert alternative distractions such as misuse of alcohol or drugs.

It is also greatly beneficial if those around the person who has been through the trauma are able to support them through the post-traumatic period. This could be by just listening to them, offering perspective or helping them to get treatment. Either way, whether it is the patient or their peers who seek or try to support, it is imperative that there is awareness of the issues and impacts of mental health, and how they could be dealt with. For this, governments and health services also potentially play a significant role.

Diagnosis

While behavioural and mood changes are the most obvious signs of PTSD, as mentioned earlier, there is evidence of constantly elevated levels of adrenaline in circulation in PTSD patients. A blood test may be able to show such an observation. Additionally, it is also believed that the hippocampus part of the brain appears smaller in PTSD patients. An MRI (magnetic resonance imaging) or CT (computerised tomography) scan may be able to show such an observation. However, these latter two detections are not necessarily practised frequently.

Treatment

Although medication such as anti-depressants may be subscribed to help people whose lives have been affected by PTSD, psychotherapy is the most commonly practised form of treatment. This may involve:

• Cognitive Behavioural Therapy (CBT) – The aim here is to help the patient to perceive and act on bad things, situations or memories differently, i.e. to help them make sense of their trauma more realistically. This in turn might help them feel better in terms of guilt, anger or shame toward the event and to subsequently gain more control over their thoughts and behaviour towards it.
• Eye Movement Desensitisation and Reprocessing (EMDR) / Exposure Therapy – The idea is to gradually expose the individual to the trauma in a safer way, helping them to deal with and take control over their fear. The patient makes side-to-side eye movement during the re-exposure, or the therapist repeatedly taps a finger or plays a tone. This is believed to change negative perceptions about the event to more positive feelings.

Therapy lasts 6-12 weeks, on average, and may be conducted one-on-one or in a group – depending on each person’s preference. In some cases, therapy may have to go on for longer – months or even years. Either way, it is important that the patient feels the support of their loved ones too as they work their way out of PTSD.

Cover illustration from National Alliance on Mental illness.