Saunders Clinic

What is PTSD?

An individual can be said to be suffering from PTSD if they develop characteristic symptoms following exposure to an extreme traumatic situation, involving direct personal experience of an event that involves actual or threatened death or serious injury. PTSD can occur after witnessing an event that involves a death, injury or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm or threat of a death or injury experienced by a family member or other close associate.

Extent of the problem

Approximately 5-10% of the general public experience PTSD. Studies have indicated that approximately 20-40% of individuals exposed to traumatic events experience problems lasting for more than one year, and 15-20% for more than two years. Approximately half go on to develop a chronic form of the disorder.

PTSD is characterised by three main groups:

• Re-experiencing the event in some way
  e.g. frequent intrusive thoughts, nightmares and flashbacks.
• Persistently avoiding situations associated with the trauma, or experiencing a number of their emotions
  e.g. avoidance of people or places that serve as reminders of the event.
• Persistent symptoms of increased arousal
  e.g. sleeplessness, irritability and impaired concentration.

Causes

PTSD can be caused by an exposure to a traumatic event. These events can be a serious assault, road traffic accident or accidental injury, fires, bomb explosions and natural disasters such as earthquakes. A variety of factors can contribute to why one individual develops the disorder, while others does not.

Mood

Changes in mood are common during PTSD; raging from anger, shame, guilt, feeling isolated and alone, feeling a sense that life is pointless with a negative outlook in their future.

Anxiety symptoms include feeling tense and on the edge, and often feeling irritable. The individual may also experience an inability to express their emotions. Depression is also common.

Cognitions

Cognitions are characterised either by a pre-occupation with the traumatic event or a strong urge to forget about the event. Intrusive thoughts and images may keep re-occurring. Nightmares and flashbacks may also occur and cause the individual to believe that they were re-living the event. Reminders of the event, such as on television, newspaper articles may also trigger these symptoms.

Biological

A person may experience a range of anxiety symptoms, e.g. sweating, palpitations and startling easy. A biological feature of depression, such as sleep and appetite disturbance may also occur.

Behaviour

A person may avoid situations, places and activities associated with the trauma. In addition, there may also be an adverse effect on family relationships and occupational functioning. Drug and alcohol abuse is a not uncommon as a way of trying to forget.

Treatment

Almost all treatment for PTSD is psychologically orientated. There is evidence that supportive counselling is only of general, not specific use, in PTSD sufferers and that many PTSD problems require specialized treatment.

Specific behavioural interventions include:

• Exposure in real life - this involves the individual gradually confronting previously avoided anxiety provoking situations until their anxiety subsides.
• Imaginal exposure - this is a technique that involves direct exposure to memories of the trauma, evidently resulting in a reduction in anxiety and other related symptoms.
• Cognitive therapy - many individuals find that their beliefs and assumptions are shattered about themselves, others and their world are "shattered" as a result of their trauma. Cognitive restructuring addresses this and helps the individual to come to terms with their experience.
• Eye Movement Desensitisation and Reprocessing (EMDR) - this technique has been shown to be effective in the treatment for PTSD. The technique involves pairing memories/disturbing thoughts and the resultant emotions with repeated rapid and rhythmic eye movements, resulting in the desensitisation of the memories.

Debriefing

The aim of debriefing is to reduce the likelihood of the development of PTSD, by providing an opportunity for the expression of feelings and a framework for individuals to make sense of the traumatic experience.