The term Post Traumatic Stress Disorder (PTSD) is now in common use. Unfortunately, many use the term in everyday conversation, without realising that PTSD is often a very serious condition that may require professional, specialist treatment. Thus, the other day I heard someone describing a problem at work with a colleague who was being ‘rather difficult,’ with the person saying: “He’s enough to give you PTSD”.
PTSD is a relatively new term that describes a condition that has been known for thousands of years. I have come across accounts of what mental health professionals would now call PTSD in writings about the Battle of Marathon in 490 BC. Similarly, PTSD has been called many things, including shell shock, battle fatigue, anxiety reaction, etc.
Fortunately, there is very good and reliable information about the condition on the internet. Indeed, Wikipedia has an extensive and well-regarded page. In the UK we are fortunate to have access to information provided by the National Institute for Health and Care Excellence (NICE) that provides considerable information about various conditions and sets out very helpful information about effective treatments. The link, below, to NICE Guidelines, may be of considerable assistance.
As you will see on the web page, the information provided is not just for health care professionals but also people at risk of, or who have, PTSD, their families, carers and the general public.
There are probably many members of No Panic who have one form or another of PTSD. They may have developed this as a result of a car accident, a physical or sexual assault, or a range of other frightening events including, major accidents and disasters.
Over the years I have seen many patients with this condition, including those involved in major accidents and disasters, those involved or witnessing terrorist atrocities and, from the time of the Falklands War nearly 40 years ago, I have assessed and treated numerous service personnel who have been traumatised in theatres of war. However, more commonly, I have assessed and treated those who have experienced, witnessed, or been confronted with events that have involved threatened death or serious injury or a threat to their physical integrity, that have been involved in accidents on roads or in their workplace.
My interest in this condition began by listening to the accounts of my father, Joe, who was wounded and captured in the period leading up to Dunkirk, thereafter spending two years in hospital and two years in a prisoner of war camp – all the time being posted as missing, presumed dead. Those who are interested in hearing more about case studies might follow the link to the book I wrote on PTSD in which I provide information and various case studies.
There are three core elements of PTSD, i.e:
Intrusion is most commonly experienced in vivid flashbacks that can occur during waking time or by nightmares, which may be directly or indirectly associated with the traumatic event. Sometimes, flashbacks and upsetting memories may be triggered by reading something in a newspaper, seeing something on television or simply taking part in a conversation.
With regard to avoidance, people with PTSD often have considerable avoidance behaviour, avoiding anything connected with the original trauma and going to extreme lengths to avoid places or people connected with that trauma. Sometimes, people ‘block out’ memories as a way of coping. Alternatively, sometimes people simply detach themselves from others and may appear very distant. Avoidance is often accompanied by blunting of emotions; this leads to an inability to enjoy life, to experience depression and, in the worst cases, maybe generally regarded as someone who has undergone a ‘personality change.’
With regard to hyperarousal, people with PTSD are often physically very tense, have problems sleeping and are uncharacteristically prone to irritability and outbursts of anger for no apparent reason. One sign that I have seen on many occasions is the so-called ‘startle response.’ This has occurred during an interview when a minor sound outside of my consulting room has made the person ‘jump.’ When this matter is explored, you will find that this sensitivity to light, sound and skin sensations occurs very frequently during ordinary, everyday life.
On a positive note, many people who experience even quite severe levels of PTSD will, over time, recover without any particular treatment. This is often a testimony to the person’s resilience and a supportive family and social network, who may listen to the person’s worries and engage them in enjoyable activities.
I have often been asked a question about vulnerability to PTSD. While it is true that some people who present with PTSD have an anxiety disorder, on many occasions, following interviews with people who have experienced traumatic events, I have found that a history of anxiety disorder does not necessarily mean that the person will develop PTSD. Most professionals agree that one of the central reasons for developing PTSD stems from those who feel helpless during the traumatic event and feel that they have no control over what is happening.
If PTSD continues, the good news is that there are available treatments (recommended by NICE) that can be very effective. There are two central methods. The first is a focus on helping the person to cope with memories and consequences of the traumatic event by a variation of Cognitive Behaviour Therapy; Trauma-Focused CBT. The second is Eye Movement Desensitisation Reprocessing (EMDR). This is a simple treatment that helps the patient process memories of the traumatic event; the theory being that PTSD arises when memories are only partially processed. During EMDR the therapist will ask the person to bring to mind memories of the event and, with a process that involves the person following sideways movements of the therapist’s finger, or moving their eyes to a rhythmic sound, the distress associated with memories gradually reduces. Sometimes, EMDR can be effective in just a small number of sessions. EMDR may be combined with more general CBT treatment.
Medications are only used as a ‘second line’ treatment; there is consensus that tranquillisers and sleeping drugs should be avoided. NICE makes recommendations about the medications that may be used. Medications are often very helpful when there is a poor or only partial response to EMDR or Trauma-Focused CBT.
In summary, therefore, PTSD is a relatively common condition. However, there is some confusion in the general public because the term has been used widely to describe upset or distress that does not conform to the definitions that I have set out above. The good news is that people with PTSD often recover without any professional treatment and those who have professional treatment are more likely than not, to experience considerable improvement in their condition.
I am often asked whether PTSD can be cured. In one sense, this question is meaningless as, by definition, traumatic events are of such significance that one can never forget. However, it is true to say that even those involved in the most horrific circumstances can, in the majority of cases, return to ‘normal life,’ enjoying their families, friends and activities and while, on occasion, they may be upset when thinking or talking about the event, they will tell you that they are now ‘feeling much better.’
Professor Kevin Gournay CBE. (President and co-founder of No Panic)
Professor Kevin Gournay is an Emeritus Professor at the Institute of Psychiatry. He has more than 40 years of experience and is the author of more than 130 articles and books.
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