What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a condition which develops after you have been involved in, or witnessed, a serious trauma such as a life-threatening assault. During the trauma you feel intense fear, helplessness or horror. In some people PTSD develops soon after the trauma. However, in some cases the symptoms first develop several months, or even years, after the trauma.

Who gets post-traumatic stress disorder?

The strict definition of PTSD is that the trauma you had or witnessed must be severe. For example: a severe accident, rape, a life-threatening assault, torture, seeing someone killed, etc. However, symptoms similar to PTSD develop in some people after less severe traumatic events.

It is estimated that up to 1 in 10 people may develop PTSD at some stage in life. One large survey of the general population in England found that 3 in 100 adults screened positive for PTSD.

It is much more common in certain groups of people. For example, some studies have found that PTSD develops in about:

• 1 in 5 firefighters.
• 1 in 3 teenage survivors of car crashes.
• 1 in 2 female rape victims.
• 2 in 3 prisoners of war.

Some people have risk factors which make them more prone to develop PTSD when they are exposed to a traumatic event. These include:

• Previous mental health problems.
• Being female.
• Coming from a poor background.
• Lack of education.
• Coming from an ethnic minority.
• Being exposed to trauma in the past.
• A family history of mental illness.

What are the symptoms of post-traumatic stress disorder?

• Recurring thoughts, memories, images, dreams, or flashbacks of the trauma which are distressing.
• You try to avoid thoughts, conversations, places, people, activities or anything which may trigger memories of the trauma, as these make you distressed or anxious.
• Feeling emotionally numb and feeling detached from others. You may find it difficult to have loving feelings.
• Your outlook for the future is often pessimistic. You may lose interest in activities which you used to enjoy and find it difficult to plan for the future.
• Increased arousal which you did not have before the trauma. This may include:
  • Difficulty in getting off to sleep or staying asleep.
  • Being irritable which may include outbursts of anger.
  • Difficulty concentrating.
  • Increased vigilance.
  • You may be startled more easily than before.

What is the treatment for post-traumatic stress disorder?

You may need no treatment if your symptoms are mild, particularly if the trauma happened less than a month ago. However, if your symptoms are prolonged and moderate or severe, treatment can help you to adjust. If you have severe symptoms 2-4 weeks after the incident, you are likely to need treatment.

You should be aware that no treatment will 'wipe the slate clean' and erase all memories of the event.

Note: some nondrug treatments mentioned below may not be available on the NHS in every area.

Talking treatments and other nondrug treatments

• Cognitive behavioural therapy (CBT) may be advised. Briefly, CBT is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as PTSD. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful, and false ideas or thoughts. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful. It may help especially to counter recurring distressing thoughts, and avoidance behaviour. Therapy is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part, and are given homework between sessions.
• Eye movement desensitisation and reprocessing (EMDR) is a treatment that seems to work quite well for PTSD. Briefly, during this treatment a therapist asks you to think of aspects of the traumatic event. Whilst you are thinking about this you follow the movement of the therapist's moving fingers with your eyes. It is not clear how this works. It seems to desensitise your thought patterns about the traumatic event. After a few sessions of therapy, you may find that the memories of the event do not upset you as much as before.
• Other forms of talking treatments such as anxiety management, counselling, group therapy, and learning to relax may be advised.
• Self-help. Joining a group where members have similar symptoms can be useful. This does not appeal to everyone, but books and leaflets on understanding PTSD and how to combat it may help. A longer separate leaflet in this series, called 'Post-traumatic Stress - a Self Help Guide', is a good start. See also the groups listed below.

• Antidepressant medicines are often prescribed. These are commonly used to treat depression, but have been found to help reduce the main symptoms of PTSD even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing symptoms.
  
  Antidepressants take 2-4 weeks before their effect builds up, and can take up to three months. A common problem is that some people stop the medicine after a week or so as they feel that it is doing no good. You need to give an antidepressant time to work. If one does help, it is usual to stay on the medication for 6-12 months, sometimes longer.
  
  There are several types of antidepressants. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for PTSD. There are various types and brands of SSRI. Paroxetine has been found particularly useful for general use. Non-SSRI drugs sometimes used by specialists include mirtazipine and phenelzine.
  
  
• Benzodiazepines such as diazepam are sometimes prescribed for a short time to ease symptoms of anxiety, poor sleep, and irritability. The problem is, they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Therefore, they are not used long-term. A short course of up to 2-3 weeks may be prescribed now and then if you have a particularly bad spell of anxiety symptoms.
  
  
• Other medicines such as betablockers, mood stabilisers, and anticonvulsants are being studied. These are normally used to treat other conditions but there is some evidence that they may help some people with PTSD. Further research is needed to clarify their role.

A combination of treatments such as cognitive behavioural therapy and an SSRI antidepressant may work better in some cases than either treatment alone.

How can family and friends help people with PTSD?

Family and friends can:

• Keep a look out for behavioural changes, such as taking time off from work.
• Look out for mood changes such as anger and irritability.
• Provide a sympathetic ear and ask general questions.
• Give the person time to talk, and not interrupt them.

Can post-traumatic stress disorder be prevented?

Debriefing used to be offered to people affected by natural disasters, etc. However, it is no longer considered effective. No other treatment or medication has yet been found to prevent people from developing PTSD should they be exposed to a traumatic event.

Screening is appropriate for people who have been subjected to major disasters and for asylum seekers and refugees.

What is the outlook (prognosis) for post-traumatic stress disorder?

Statistics show that about 2 in 3 people with PTSD eventually get better without treatment, although the improvement may take several months. In about 1 in 3 three people the symptoms last longer, sometimes for many years, and can be quite severe in some people. The response to treatment can vary from person to person.

Further help and information

Support Groups

Anxiety UK

Zion Community Resource Centre, 339 Stretford Road, Hulme, Manchester, M15 4ZY
Tel: 0870 122 2325 Web: www.anxietyuk.org.uk
A leading UK charity for anxiety disorders such as PTSD.

ASSIST (Assistance Support & Self-help In Surviving Trauma)

11 Albert Street, Rugby, Warwickshire, CV21 2RX
Tel (Helpline): 01788 560800 Web: www.assisttraumacare.org.uk
A support organisation for people suffering from PTSD.

Ex-Services Mental Welfare Society (Combat Stress)

Tyrwhitt House, Oaklawn Road, Leatherhead, Surrey, KT22 OBX
Tel: 01372 587 000 Web: www.combatstress.org.uk
Specialising in the welfare of ex-Service men and women from all ranks of HM Forces and the Merchant Navy who suffer from psychiatric disabilities, including PTSD.

Specialist Referral Centres

Traumatic Stress Clinic

Web: www.traumaclinic.org.uk

The Trauma Centre UK

Web: www.trauma999.co.uk

References

• Post-traumatic stress disorder, Clinical Knowledge Summaries (July 2010)
• Bisson J, Andrew M; Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2005 Apr 18;(2):CD003388. [abstract]
• Anxiety: Management of post-traumatic stress disorder in adults in primary, secondary and community care, NICE (2005)
• Phillips CJ, Leardmann CA, Gumbs GR, et al; Risk Factors for Posttraumatic Stress Disorder Among Deployed US Male Marines. BMC Psychiatry. 2010 Jun 25;10(1):52. [abstract]
• Boscarino JA, Adams RE; PTSD onset and course following the World Trade Center disaster: findings and Soc Psychiatry Psychiatr Epidemiol. 2009 Oct;44(10):887-98. Epub 2009 Mar 7. [abstract]