What is PTSD? Post-traumatic stress disorder is a psychiatric disorder triggered after a person is exposed to a traumatic event either by experiencing it or witnessing it. PTSD happens when some memory of a past traumatic event causes recurrent mental or physical distress.

 Traumatic events may include sexual assault, warfare, crimes, fires, traffic collisions, natural disasters, or other threats to a person’s life.

PTSD has perhaps existed as long as humanity has experienced trauma. PTSD first attained the medical community’s attention post-world war when many veterans started presenting with this disorder. PTSD was finally recognized as a diagnosable condition in 1980 by American Psychological Association when they published it in the Diagnostic and Statistical Manual (DSM-lll) for mental health practitioners.

Symptoms may include nightmares, flashbacks, anxiety, and uncontrollable thoughts about the event.

People with PTSD have a heightened sense of danger, causing them to feel stress or fear even in safe situations.

Most people who have experienced a traumatic event will not develop PTSD. They may have difficulty coping and adjusting initially, but with time and good self-care, they usually get better. If the symptoms get worst with time, lasting from months to years and affecting your day-to-day activities, you might have PTSD.

PTSD is more likely to occur in people who have experienced an assault-based trauma such as rape or child abuse than those who experienced non-assault-based traumas such as traffic accidents or natural disasters.

PTSD is thought to affect between 7-8% of the population that has experienced a traumatic event, with women generally being more affected.

A person with PTSD is at higher risk of committing suicide and inflicting self-harm. PTSD can disrupt your life, including your joy, relationships, health, and enjoyment of everyday activities.

Getting effective treatment after developing the symptoms is crucial as it helps get your life back on track.

Symptoms of Post traumatic stress disorder PTSD:

Symptoms may appear within a month of the traumatic event, but sometimes it takes years to develop the symptoms. PTSD symptoms can have a significant effect on your day-to-day activity. The main symptoms are psychological, but these can lead to behavioural changes as well.

Symptoms of PTSD can vary from person to person, but most of the time, these symptoms falls into the following categories:

Re-experiencing the traumatic event:

This is one of the most common symptoms of PTSD. In this, the person may have recurring memories of the event in the form of:

• Flashbacks (reliving the traumatic event as if it were happening again)
• Nightmares (upsetting dreams about the event)
• Hallucinations
• Recurring, involuntary, and unwanted memories of the traumatic event
• Emotional distress leading to a physical response such as pain, sweating, trembling or feeling sick when something reminds you of the traumatic event.

Sometimes people constantly ask themselves questions like, could I have done anything to stop that from happening?. This self-blame will eventually lead to guilt and shame and prevent them from coming to terms with that event.

Avoidance:

Avoidance is another key symptom of PTSD. Here a person will actively try to avoid being reminded of the traumatic event. A person will try to avoid thinking or talking to anyone about the traumatic event. He will stop going to places or meeting with people that remind him of that event. People suffering from PTSD may become emotionally numb. Some studies suggest that people suffering from PTSD are not emotionally numb, but rather PTSD is associated with hyperresponsivity to negatively valenced emotional stimuli. Consequently, patients with PTSD require more intense positive stimulation to access the full complement of appetitive or pleasant emotional behaviour.

Hyperarousal:

Hyperarousal is one of the primary symptoms of PTSD. People with PTSD have a heightened sense of danger. They find it difficult to relax. This occurs when a person’s body suddenly kicks into a state of high alertness just by thinking about the event. Hyperarousal can lead to:

• Irritability
• Sleeping problems
• Angry outbursts
• Panic
• Anxiety
• Self distributive behaviours (fast driving or excessive drinking)

In children, sleeping difficulties are one of the main manifestations of hyperarousal. A child may experience nightmares about the traumatic event. They may re-enact the traumatic event or parts of the event during their daily activities such as playing or drawing.

Negative cognitional and behavioural changes in PTSD:

People suffering from PTSD often blame themselves for the traumatic event. This leads to the development of negative behavioural changes. PTSD can also harm a person’s cognitional abilities. Most of the time, these negative behavioural and cognitional changes may manifest themselves as:

• Negative thoughts about yourself or other people in general
• Self-loathing behaviour
• Detaching oneself from one’s friends and family
• Difficulty in performing everyday tasks
• Difficulty experiencing positive emotions
• Difficulty to maintain relationships
• Hopelessness about the future
• Lossing interested in the activities you once used to enjoy
• Developing anxiety, depression, or other phobias
• Drug abuse

PTSD can cause headaches, GI upset, dizziness, or chest pain.

Types of Post-traumatic stress disorder :

Although PTSD is a single condition, some experts break it down into subtypes depending on a person’s symptoms, known as condition “specifiers,” to make the diagnosis and treatment easier.

• Dissociative PTSD occurs when one detaches oneself from the trauma. During this, a person feels like he is losing touch with the events around him. Memory loss about certain events, people, or periods can also occur.

• Uncomplicated PTSD: This type of PTSD is characterized by having symptoms such as re-experiencing the traumatic event and avoiding people and places related to the trauma without having any other mental health issues such as depression. People suffering from this subtype often respond well to treatment. This subtype of PTSD is usually the result of one major trauma as opposed to multiple smaller events.

• Comorbid PTSD: This term is applied when a person has more than one mental health concern involving the symptoms of PTSD, along with another mental health disorder like depression, panic disorder, or a substance abuse problem. Comorbid PTSD is quite common as people can suffer from more than one type of mental disorder at a given time. People with this subtype of PTSD get the best results when treating both PTSD and other coexisting mental health problems.

• Complicated PTSD results from multiple traumas. Situations involving violence such as domestic abuse or violence can cause this type of PTSD. Symptoms of this subtype and uncomplicated PTSD are pretty common; the major difference is that people suffering from complicated PTSD take longer to recover. Treatment is very effective for this subtype of PTSD.

Causes of PTSD:

The doctors are not sure about the exact cause of PTSD. Following are the few events that are thought to cause PTSD.

Survival mechanism:

According to some suggestions, PTSD results from the body’s own intrinsic defence mechanism that helps you cope with future traumatic events. For example, continuously thinking about the traumatic events and thinking about different possibilities and outcomes will help one be better prepared if one experiences that traumatic event in the future. The feeling of being on edge all the time will keep your body alert all the time.

Despite being the body’s defence mechanism intended to help you survive, these mechanisms, in reality, are extremely unhelpful because they prevent one from processing that trauma and moving on with their life.

High level of adrenaline:

Adrenaline is a hormone that your body release usually during stressful situations. Studies have shown that people suffering from PTSD have an abnormally high level of adrenaline. A high level of adrenaline increases alertness and prepares our body for a response called a “ fight or flight “ response. It is also suggested that this high level of adrenaline is responsible for the numbness of emotions and hyperarousal state in people suffering from PTSD.

Risk factors:

Different people have different types of reactions to a traumatic event.

You can develop PTSD when you go through an event that involves a life-threatening condition, sexual assault, or traffic accident. Following are the few risk factors that can predispose one to develop PTSD:

• Serious accidents
• Physical or sexual assault
• Domestic or child abuse
• Childbirth experiencing, such as losing your baby
• War and conflict
• Torture
• Family history of mental health disease

Anxiety, depression can also increase one’s risk of developing PTSD significantly.

When to see your doctor for Post-traumatic stress disorder :

It is normal to feel upset about a traumatic event, but most people can shake off the effects of a traumatic event with time. If you are experiencing symptoms related to PTSD that have lasted for more than a month now or the severity of the symptoms is not decreasing, seek medical help. You should also seek help if you are thinking about inflicting self-harm. Schedule an appointment with your physician if you have difficulty performing everyday tasks or feeling difficulty in taking control of your life. Remember getting help as soon as possible can help you get your life back on track and, at the same time, help prevent worsening of the symptoms.

What to do if you have suicidal thoughts:

If you or someone you know is experiencing suicidal thoughts, seek help immediately. You can take the following steps:

• Eliminate your access to lethal methods of suicide
• Call suicidal hotline
• Reach out to your friends, your loved ones
• If you are on medications, take them regularly
• Pay attention to warning signs
• Make an appointment with your doctor or psychiatrist.

Diagnosis of Post-traumatic stress disorder

To diagnose PTSD, your doctor will

• Perform a physical exam to check for any underlying medical issues that might be causing your symptoms.

• Psychological evaluation: this includes discussing your signs and symptoms in detail with your physician. You will also be asked about the event or events that have to lead you to your symptoms.

• DSM-5 criteria: This criterion is published by the American Psychiatric Association can help your physician diagnose PTSD.

Gold standard for diagnosing PTSD is a structured clinical interview such as the Clinician-Administered PTSD Scale (CAPS-5). When necessary, the DSM-5 (PCL-5) can be scored to provide a provisional PTSD diagnosis.

Treatment of Post-traumatic stress disorder

Treatment of PTSD can help one in regaining a sense of control in one’s life. The primary treatment of PTSD is psychological therapies and medications. Traumatic events are often challenging to cope with but seeking professional help might be the only way to treat PTSD effectively. It is never too late to seek professional help as people have recovered from this condition after years of suffering from this disease.

Psychotherapy for Post-traumatic stress disorder

Psychotherapies are often the first line of treatment for people suffering from PTSD. Some types of psychotherapies that are used to treat PTSD are:

• Cognitive therapy: The main aim of this type of therapy is to help you to change the way you think. This type of therapy will help you realize the thinking patterns that are not allowing you to move on with your life. Once you recognize the root cause of your disease, it becomes relatively easy to deal with it.

• Exposure therapy: In this type of therapy, you’ll be safely exposed to the situations and memories that you find frightening to help you cope with those situations more effectively.

• Eye movement desensitization and reprocessing (EMDR): This is another psychotherapy found effective in dealing with PTSD.

Medications for Post-traumatic stress disorder

Several types of medications can be used for the treatment of PTSD; these include:

• Antidepressants: Antidepressants, such as paroxetine(Paxil), sertraline (Zoloft), mirtazapine, amitriptyline, or phenelzine, are sometimes used to treat PTSD in adults, but among these drugs, only paroxetine and sertraline are FDA approved.

• Anti-anxiety medications(Prozac): These drugs are used to treat any associated symptoms related to anxiety.

Complications

PTSD affects every aspect of your life, including your job, relationships, health, and other everyday activities. PTSD can result in the following complications:

• Anxiety and depression
• Alcohol and drug abuse
• Eating disorders
• Suicidal thoughts and self-harm

Prevention

Having PTSD-like symptoms after surviving a traumatic event is expected. At first, many people have PTSD-like symptoms, such as recurring thoughts about the event. Fear, anxiety, anger, depression, guilt are the natural reactions to trauma. However, most people exposed to trauma can shake the effects of the events after a while.

The importance of getting timely help cannot be understated. Support from your friends and family can prove highly beneficial. Seek out a mental health professional. If you are a religious person turning back to your faith community can also prove helpful.