About post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder (PTSD) is a psychological reaction to experiencing or witnessing a significantly traumatic or shocking event or series of events.
For example, this might be a car crash, a sexual assault or other abuse, an earthquake or other natural disaster, or an attack.
Any situation where there was a risk of being killed or seriously injured can result in PTSD. This includes situations of sexual violence, of seeing others killed, injured or sexually assaulted, or sometimes even hearing about such things.
Sometimes what causes PTSD is not one single event but instead a series of ongoing traumatic experiences, such as childhood abuse or neglect by a parent or caregiver, bullying, or being in an abusive relationship.
Some events are more likely than others to cause PTSD. Reactions to trauma deliberately caused by other people, such as physical assault or rape, seem to be more intense than those caused by accidents or natural disasters.
Living through PTSD can be an overwhelming, frightening, isolating and debilitating experience.
If you are experiencing PTSD, you may feel intensely fearful, jumpy and on edge. You may have trouble sleeping and experience bad dreams. Your appetite may increase or decrease. You may stop wanting to be around your friends, lose trust in people you previously trusted, and start labelling people either “good” or “bad” in your head.
You may feel that your world has fallen apart, that everything is black and that nothing makes sense. Worse still, you can often lose hope or the belief that you can recover and lead a worthwhile life.
Helplines
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.
Symptoms
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 options
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:
Medication
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 therapies
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.
Other strategies to support recovery
Complementary therapies
The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.
Although they are not treatments for PTSD, certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.
When considering taking any supplement, herbal or medicinal preparation, you should consult your doctor to make sure it is safe and will not harm your health, for example, by interacting with any other medications you are taking.
Physical health
It’s also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor, and do what you can to reduce stress, get enough sleep, eat a balanced diet and exercise. Being in good physical health will also help your mental health.
Peer support and education
Learning more about PTSD can be very helpful during your recovery. It can make you feel less alone, reassure you that recovery is possible, and help you communicate your experiences to others.
You might seek out books about PTSD, written by clinicians or other people who have experienced the condition, or you might find it easier to read bite-sized pieces of information and quick tips online.
Peer support groups, where you can meet people with similar experiences to your own, can be an important source of support. It can be a relief to spend time in an understanding group, where there are no expectations on you to act a certain way.
Strategies to support your own recovery
Treatment for PTSD can take a significant amount of time. Here are some things others have found useful for keeping themselves well as they recover.
- Join an online support group that can offer quick support after hours or when you are really struggling.
- Find a support person who can help with appointments and transport.
- Schedule therapy for a time when you have no commitments afterwards, as it can take a few hours to settle afterwards.
- Find a kind, understanding person at your workplace or school who can support you if you have to leave suddenly or need help.
- Learn and practise some physiotherapy breathing techniques.
- Listen to a calming playlist or album.
- Watch a calming TV show, such as a cartoon or other gentle programme.
- Use a night light, and hug a stuffed toy at night.
Strategies to support someone else’s recovery
- Family, whānau and close friends of someone with PTSD have found the following strategies important and useful:
- In the early days after the trauma, give the person time and space to be alone if needed, while making it clear that you are there for them and ready to offer any support they need. As time goes by, encourage them to get back into life again, but never force them.
- Try to make sure they get the help they need. As a support person, you can help them navigate the health system, advocate for them and support them to advocate for themselves.
- Learn what you can about PTSD, its treatment and what you can do to assist recovery. Sometimes the person with PTSD finds it difficult to explain to others how hard it is for them, or they may have trouble understanding what is happening to them and their behaviour.
- Do not blame the person for having PTSD. Understand the symptoms for what they are, rather than taking them personally or seeing the person as being difficult.
- Help the person to recognise stress and find ways of coping with it. This may include helping to solve problems that are worrying them.
- It can feel overwhelming when a loved one is experiencing PTSD, and this can take a toll on relationships and family life. Find ways of getting time out for yourself and feeling okay about this. It is critical to do what is needed to maintain your own wellbeing.
- Don’t overlook any situation or suggestion from the person experiencing PTSD that they are suicidal and wanting to end their life. Get support for this immediately, by talking to their GP or therapist.
Looking after yourself
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.