What is Post Traumatic Stress Disorder?
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Post Traumatic Stress Disorder (or PTSD) is an emotional disorder that can start after a traumatic event. A traumatic event is something shocking or frightening that makes a person feel threatened.
Michael and Chloe were referred to the Traumatic Stress service in Cardiff and diagnosed with PTSD. We will share their stories with you and follow the progress they made through the programme:
Michael
Three years ago, Michael was involved in a car accident. He was driving home with his son from a Christmas party when a drunk driver sped around a corner, lost control of his vehicle and crashed into the passenger side of his car. His son was injured but luckily recovered in hospital in the weeks that followed. Michael had only minor injuries.
In the days following the accident Michael could not believe or accept what had happened. He started having vivid distressing nightmares which would wake him up screaming in the middle of the night. At work he found it difficult to concentrate or focus on what he was doing. He felt anxious, tense and easily startled. He worried constantly for the safety of his family and felt very angry that the drunk driver had put his son’s life in danger. He couldn’t keep thoughts of the accident from his mind and was troubled day and night by the sounds of screeching tyres and his son screaming. Michael, a once sociable man, no longer enjoyed spending time with friends or doing the activities he used to. He felt he had no real future.
Chloe
Chloe was only 25 when she was mugged on her way home from a shift at a local supermarket. It was daylight and she was walking along a route she had walked hundreds of times before. The mugger held a knife to her throat and demanded her bag and the mobile phone she held in her hand. Chloe handed over her belongings and the mugger ran away.
For the rest of the day Chloe felt shaken by the ordeal but tried to convince herself that it could have been worse; that she’d had a lucky escape. In the weeks that followed Chloe couldn’t stop thinking about what happened. She made excuses not to go to work to avoid walking through the area she was mugged. Gradually she became hesitant of leaving the house at all. She found it difficult to sleep and felt dazed and on edge all day. Chloe felt angry at the mugger for what he had put her through and guilty for the worry her family expressed.
PTSD is a distressing disorder that can affect work, daily activities and relationships. The good news is that with a bit of hard work, there is a good chance of recovering from PTSD.
A useful first step is to learn about PTSD and its symptoms.
How does PTSD start?
PTSD can start after any traumatic event. These events usually involve the person fearing for their life or safety, or for somebody else’s life or safety. People react differently to traumatic situations. It doesn't have to be a life threatening event, it just has to be seen as traumatic by the individual.
Examples of traumatic events which sometimes cause PTSD:
- Road traffic accidents
- Physical assault
- Physical injuries or accidents
- Rape
- Sexual assault
- Childhood sexual abuse
- Natural disasters
- Manmade disasters
- Terrorist attacks
- Combat or military exposure
- Fire
- Emotional abuse
- Kidnapping
- Torture
- Receiving a life threatening diagnosis
- Medical complications
- Traumatic child birth
- Mugging
Thousands of people around the world suffer from PTSD. You are not the first or last person to feel the way you do. But PTSD is a distressing illness which requires treatment.
What does PTSD feel like?
The following are some common symptoms you may be experiencing. These are not experienced by everyone. There is no reason to think that you will go on to suffer any of the symptoms listed which you have not experienced already.
PTSD symptoms fall into 3 groups:
- RE-EXPERIENCING WHAT HAPPENED – having distressing memories or feeling like the event is happening all over again when awake or asleep.
- AVOIDING REMINDERS OF WHAT HAPPENED – trying to avoid thinking about or talking about what happened. Avoiding people, places or activities which remind the person of the trauma. Feeling emotionally numb.
- HYPERAROUSAL – feeling constantly anxious and on edge. Feeling unable to relax, concentrate or sleep.
We will learn about each of these symptoms groups in turn:
1. Re-experiencing what happened
- People with PTSD suffer upsetting memories and frightening thoughts about what happened.
- Thoughts about the event can be easily brought up by sights, sounds or smells connected to the traumatic event. These are often called ‘triggers’.
- Simple every day things can be ‘triggers’ which cause bad memories. Here are some examples:
Sound – unexpected loud noises, songs, sirens
Smell - smoke, alcohol, a certain perfume
Movement – sudden movement, sudden stillness
Sights - crowded streets, sunsets, flames
TV – scenes similar to the trauma even if unreal
Touch – blood, water, rain, certain surfaces
- Most people with PTSD have strong feelings of distress when they are reminded of what happened. This can involve physical reactions such as increased heart rate and sweating.
- People with PTSD may also re-experience what happened when they are asleep as distressing nightmares about the event.
- Some people have episodes where they feel or act as though the event is happening again. This is called a ‘flashback’. During a ‘flashback’ the person may lose their connection with what is happening around them, being taken back partially or completely to the traumatic event.
Here’s what Michael had to say about his experiences of re-experiencing what happened:
“I just couldn’t stop thinking about the accident. The slightest thing would bring back these memories of what had happened. The sound of tyres screeching or a car horn particularly would bring back these memories of what had gone on. The nightmares started quite soon afterwards and I’d wake up feeling absolutely terrified.”
2. Avoiding reminders of the traumatic event
- People with PTSD often try to avoid thinking about what happened.
- They may also attempt to avoid people, places or activities which remind them of the trauma.
Feeling ‘emotionally numb’ is also common. They sometimes find it hard to feel emotions like love and happiness.
- People with PTSD often feel distant from loved ones.
- Often people with PTSD find they don’t enjoy the activities they used to.
Here’s what Chloe had to say about her experience of avoiding reminders of the traumatic event:
“After the attack I was avoiding a lot of things that reminded me of what had happened. I avoided thinking about what happened or talking about it. I even went out of my way to avoid the neighbourhood where I was attacked, I avoided programmes about crime on TV, and anything to do with knives. I stopped spending time with my friends and I sort of felt very, very distant from everyone.”
3. Hyperarousal
- People with PTSD often find it difficult to fall or stay asleep.
- They find it difficult to concentrate or focus on tasks.
- They may also feel jumpy or easily startled.
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They may feel as though they (and their families) are constantly in danger. They are ‘on-guard’ at all times.
- It is common for people with PTSD to feel irritable or angry.
Here’s what Michael had to say about his experiences of hyperarousal symptoms:
“I felt really restless and on edge. Before the accident I used to drift straight off to sleep straight away, my head used to hit the pillow and I'd be gone. But after the accident I just felt really on edge and I couldn't relax, I just couldn't get to sleep. I couldn't really concentrate. Concentrating on work was just about impossible! My mind would just wander off. And I felt that I had to be constantly on my guard as well, all the time. Things would startle me and make me jump. I just couldn’t relax at all.”
Other problems
- Physical Problems - often people with PTSD suffer ongoing physical problems as a result of the traumatic event. You should talk to your GP about these issues. Physical symptoms like headaches, dizziness or chest pain can also sometimes affect people with PTSD. We hope these will improve through the programme.
- Problems with alcohol or other substances – it is
common for people with PTSD to drink too much alcohol or use other
substances. Module 11 aims to help you cut down on alcohol, caffeine or
illegal drugs.
- Depression – often people feel depressed after a
trauma. Symptoms of depression include feeling hopeless, loss of appetite
and having no energy. Feel free to discuss these feelings with your
therapist.
- Feelings of guilt or shame – it is common for individuals to blame themselves for the traumatic event or their actions at the time of the trauma. This leads to feelings of guilt. Module 6 will help you deal with guilty feelings.
- Relationship problems – PTSD can seriously affect
relationships with others. We hope that any relationship problems will
improve through the programme as your symptoms lessen.
- Anger – problems with anger are common in PTSD. Uncontrolled anger can cause lots of problems. Module 10 aims to help you manage your angry feelings.
- Ongoing legal proceedings – many individuals with
PTSD will be involved in ongoing legal proceedings. This can be
distressing. It also has the potential to interfere with treatment.
What causes post traumatic stress disorder?
- Almost everyone who goes through a nasty trauma will suffer some of the reactions already described for the first few weeks. In most cases these will slowly fade. Unfortunately, some people find their symptoms carry on.
- Researchers are still trying to understand what causes some people to develop PTSD after a trauma when others don’t. As with most mental illnesses, it is probably caused by a mixture of:
Genetics
Life experiences and history
Changes in the chemicals in your brain
- We also know that some characteristics of the event itself make PTSD more likely. These include:
Fearing for your life
The event being sudden or unexpected
Remaining conscious throughout
If it goes on for a long time
If it’s man-made (e.g. a terrorist attack)
Not being able to get away
If it causes deaths
Certain things can maintain traumatic stress symptoms such as not having enough social support or a lack of help / treatment.
The psychological explanation
- We generally have a belief that nothing bad can happen to us; that traumatic events happen to other people. A trauma shakes these beliefs. Suddenly the world seems like a more dangerous place.
- A traumatic event is usually very sudden and unexpected. There is no time to mentally prepare for what is about to happen.
- During a trauma, the mind is unable to take in what is happening properly. As a result, thoughts and feelings can’t be processed in the normal way. These thoughts and feelings go on to cause problems.
At the time of the trauma, you may have believed that you were going to die or that others were going to die. The mind holds on to these vivid memories possibly to stop the same thing from happening again. These memories are very upsetting.
It is common for the trauma memory not to be updated properly to include the fact that you (or others) survived. Thinking back to the traumatic event is very painful as a result.
- The Tackling Traumatic Stress programme will help you process these thoughts properly so they stop causing problems.
Ten tips to help you learn about Post Traumatic Stress Disorder?’
1. It might be a comfort to realise that you are not the first or last person to feel the way you do - thousands of people around the world suffer from PTSD. It is however a distressing illness which requires treatment.
2. Learn as much as you can about the diagnosis of PTSD - its causes and how it feels - you will be better able to tackle or cope with PTSD and its symptoms when you understand more about it.
3. It is sometimes
useful to identify the PTSD symptoms you are experiencing - there is however no
reason to think that you will go on to suffer any of the symptoms listed which
you have not experienced already. Symptoms
fall into 3 groups:
· Re-experiencing what happened
· Avoiding reminders of what happened
· Hyperarousal
4. It is helpful to identify any associated issues you are having - this can include physical problems as a result of the traumatic event, problems with substance use, feelings of guilt and shame or anger. Some of these issues will be addressed in the programme. Tell your therapist if you are experiencing any of these difficulties.
5. Be aware that PTSD can impact on relationships and family life - help your loved ones learn about PTSD too. Offer them the ‘Information for Family and Friends’.
6. It might be helpful to read the module more than once - this will help you learn the information.
7. It might also be helpful to summarise the important points of the module in a note pad or on some cards - you can refer to these notes later.
8. Highlight any information you have difficulty understanding - it might be helpful to come back to it later or discuss with your therapist.
9. Ask your therapist any questions you have that weren’t answered by the ‘What is Post Traumatic Stress Disorder?’ module – he or she will be happy to help.
10. Keep the psychological explanation of PTSD in mind - as you go through the programme. This suggests that during the trauma your mind was unable to take in what was happening properly. As a result, thoughts and feelings you had at the time were not processed in the normal way. These thoughts and feelings are now causing problems. The Tackling Traumatic Stress programme will help you process these thoughts properly so they stop causing problems.
It is now time to try the ‘Quick Quiz’! Don’t worry if you can’t answer correctly first time, the aim is to help you understand more about PTSD. Feel free to come back and read this information again.
