About post-traumatic stress disorder (PTSD)
I am not broken. This was something that happened to me – it was not caused by me. There is no fault on the person with PTSD.
PTSD can affect people of any age, gender or culture. It’s more common among soldiers and refugees who have endured major traumas. Adults or teenagers who have experienced childhood neglect and/or abuse, be it sexual, physical, mental or emotional, may also experience PTSD. Children and adolescents may be more vulnerable to PTSD than adults who have experienced the same stress or trauma. Their response to trauma may also be different.
It is important if you think you or a loved one has PTSD that you talk to your doctor. If not recognised and treated, PTSD can lead to depression, self-harm and suicidal thoughts. This is especially so for people with a history of depression. Long-term distress and anxiety can sometimes lead to panic attacks. Some people also develop eating disorders.
People experiencing PTSD may try to numb their pain by using alcohol or drugs, but this increases the chance of developing substance abuse issues.
With recognition and treatment of PTSD, you can heal from trauma and reclaim your life.
Signs to look for (symptoms)
People with PTSD may find that the unpleasant feelings associated with the trauma keep coming back, as can images, memories and intrusive thoughts. There may be nightmares or bad dreams. In the daytime, you may feel that it’s all happening again or have brief but vivid memories or “flashbacks”.
Flashbacks are not like they are in the movies! It’s not standing staring at a perfect replication of the events. Sometimes it’s just freaking out and you have no idea why.
You may try to avoid any situations, people or events that remind you of the trauma. You may also avoid trauma-related thoughts and feelings.
Negative changes in thinking and mood are also a sign of PTSD. You may have difficulty recalling key features of the traumatic event. You may have persisting negative and often distorted beliefs about yourself and the world – for example, “I am bad” or “the world is dangerous”. You may persistently blame yourself and others for what happened.
You may experience ongoing negative emotions, including fear, horror, anger, guilt, or shame, and find it difficult to regulate your emotions. Alternatively, you may be unable to feel emotions at all, even for the people you love or care for. You may feel detached from others and may lose interest in things you once enjoyed or be unable to experience pleasure and joy. You may experience dissociation, a sense of being disconnected from yourself or your thoughts and feelings.
People with PTSD may also be constantly watchful or jumpy. Your sleep may be disturbed, and you may feel irritable and angry with yourself and others. Your memory, concentration and decision-making may be affected. You may act in ways that cause you harm or take action without considering the consequences.
Other people with similar experiences may have different reactions and behaviour. This does not invalidate your experience or pain.
Signs to look for in children
Sign to look for include unusual or agitated behaviour. They may have nightmares (not specific to the trauma), and they are likely to relive the trauma through repetitive play or re-enact aspects of the traumatic event. This may be seen through artwork or in changes of behaviour towards other children, bullying, hitting etc. Physical symptoms may include stomach aches, headaches and bedwetting. Some children experiencing PTSD withdraw, while others act out.
How the doctor determines if someone has PTSD (diagnosis)
The symptoms outlined above are common in the first few weeks after a significant trauma. Some people may have PTSD symptoms that occur within a month of the traumatic event and lessen and disappear within around four weeks. This is called acute stress disorder.
If the symptoms persist beyond four weeks, cause you intense distress and affect your everyday life, the diagnosis will be changed to PTSD. Sometimes there is a delay of months or even years between the event and the onset of PTSD.
For these reasons, it’s important that you take time to talk with your doctor or another health professional and help them understand what you or your loved one has been going through.
If PTSD has been going on for several weeks, or is very severe, specialist help is needed. Your doctor can refer you to an appropriate mental health professional, or you can make contact yourself.
Tell people what happened. If they dismiss it or try to blame you, find someone else. Do not get discouraged; there is help out there.
Treatment of PTSD can involve a number of aspects, each of which can be tailored to your individual needs. It is important you see a mental health professional with experience in treating PTSD. Treatment options include:
Your doctor may prescribe medications for anxiety or depression.
Finding the right medication can be a matter of trial and error – there is no way to predict which medication will be effective for and tolerated (have fewer troublesome side effects) by any one person.
If you are prescribed medication, you are entitled to know:
- the names of the medicine
- what symptoms they are supposed to treat
- how long it will be before they take effect
- how long you will have to take them for, what their side effects (short- and long-term) are, and whether they may be addictive or habit-forming.
Even if you are breastfeeding or pregnant, medication might be an option. It is best to discuss with your health provider what might be on offer for you.
Talking therapy, and in particular individual trauma-focussed Cognitive Behaviour Therapy (CBT), is effective in the treatment of PTSD. EMDR (Eye Movement Desensitisation and Reprocessing) is another therapy that has good research-based evidence for helping those with PTSD symptoms lasting for more than three months for a non-combat-related trauma.
Therapists involved in the treatment of PTSD use two main strategies – one that deals with the memories and feelings about the trauma and the other that offers relaxation training to lessen anxiety and fear.
Some people find group therapy helpful, particularly when there are a number of people who have endured a similar trauma, e.g. an earthquake or a sexual assault. In particular, exposure-based group CBT has been shown to have good outcomes.
In some instances, the leader of the group may be someone who has recovered from a past trauma. Some groups may offer social activities in addition to support and therapy.
All types of therapy should be provided in a manner that is respectful to you and with which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.
Thanks to Natasha de Faria, clinical psychologist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.
Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.