Defining Post-traumatic stress disorder (PTSD)
As the name suggests, post-traumatic stress disorder (PTSD) occurs as a result of an experienced or witnessed traumatic event, or a perceived threat of danger, injury or even death. Many instances of PTSD follow major life-threatening events, such as a natural disaster, war or combat, an accident causing physical harm, assault or physical abuse, and sexual abuse. Any trauma with a heightened sense of danger, which results in debilitating anxiety can lead to PTSD.
The condition spiked during periods of war in recent years, and became known as ‘battle fatigue’ or ‘shell shock’ syndrome. A high number of war veterans experience PTSD, but the disorder can be experienced by anyone who is exposed to a level of trauma that triggers such a reaction. PTSD is also not uncommon amongst rescue workers and emergency personnel who are continuously exposed to the results of traumatic events.
PTSD is not a condition which may be stereotyped to a specific type of character flaw or behavioural weakness but is rather a response to trauma that effectively triggers a chemical change in the brain. The result of the chemical change? A person experiencing this severe anxiety disorder is unable to respond in a normal ‘fight-or-flight’ mode and can become severely fearful, even at inappropriate times when they are not in any danger at all.
The effects of this severe fear bring about a sense of helplessness and even horror. Fear that is experienced is intense. Other normal emotional responses such as anger, apprehension, shock, and guilt do not generally subside for a person experiencing PTSD, they continue and often intensify. The intensity of fearful emotions (terror) can severely impact a person’s ability to lead a normal life. A PTSD sufferer will have great difficulty in comfortable day-to-day function, finding adjustment post event difficult due to frequent trauma flashbacks, severe anxiety, intense nightmares, sleeping problems and uncontrollable thoughts. A PTSD suffer often feels estranged from normality and detached from others and their surroundings.
Such adjustment difficulty and lack of effective coping responses can occur for at least four weeks to several months and even years. Not all PTSD symptoms begin shortly after a traumatic event. Some develop symptoms after a period of time, and for others intense stress reactions come and go over time. Symptoms do not ‘go away’ on their own and most often intensify over time.
It’s important for PTSD to be diagnosed in order for treatment to be implanted in a way that improves a person’s quality of life. Additional disorders are not uncommon in a person suffering PTSD, these include depression, and a variety of other problems which result in substance abuse and addiction.
Memory and cognitive ability can become severely compromised, adding to severe stress reactions.
Medical intervention can help a person to learn better coping skills and ultimately be able to function normally on a day-to-day basis. Treatment can also have positive effects on a person’s ability to engage with others and teach ways and means to help a person improve relations in the family and their social life. This extends into areas of occupation as well. The earlier intervention takes place, the better for the sufferer of PTSD as this can dramatically reduce the long-term effects of this mental disorder.
What happens to cause post-traumatic stress disorder?
Traumatic events affect people differently. To date, it is not fully understood why feelings of shock, anxiety, fear or guilt appear to subside in time for some, and for others intensify to a debilitating degree.
It is generally felt that the development of PTSD is likely a result of a complex mix of the following:
- Inherited factors: a family history or mental disorders such as anxiety or depression, and personality characteristics or features (temperament).
- Chemical changes in the brain: Hormones that are naturally released as a response to stress become impaired and do not regulate normally.
- Traumatic events and stressful experiences.
Signs and symptoms
There are three distinctive layers to how symptoms for PTSD are experienced. At first a person may re-live the trauma, especially when exposed to triggers that remind them of specific details. Triggers can be as simple as certain words, smells or sounds. Specific situations can also trigger reminders of the traumatic experience.
This then prompts a reaction in the way of avoidance behaviours. A person may begin to isolate themselves, initially by avoiding specific places or people which trigger reminders. Due to the intensity of emotions, a person may then become irritable, and constantly appear ‘on guard’.
Symptoms often occur within months of a traumatic event, and in some instances, many years later.
How severe symptoms are (acute or chronic) and how long they last varies from one person to the next. Treatment length also varies - many PTSD suffers recover within months, while others take a lot longer.
Signs and symptoms to look out for or be aware of include:
- Re-living the event: Memories of the event (flashbacks or hallucinations) are vivid, distressing, unwanted and intrusive of daily life and a person feels as though the experience is occurring over and over again. A person may also appear visibly uncomfortable (mentally and physically) whenever the traumatic event (or something similar) is mentioned. A person can also experience recurring nightmares about the event. Emotions which are intensely heightened during a flashback or nightmare can feel as real as they did during the actual event which took place.
- Avoidance behaviours (detachment and isolation): A person may avoid people, places or specific situations which may remind them of the event, become emotionally apathetic (incapable of expressing feelings), display a lack of interest in specific activities or a loss of interest in activities once enjoyed, and even experience some memory loss about the traumatic experience (forgetting important aspects of the event). Memory loss can be a choice that is made so as to ‘numb’ or detach from memories of the traumatic event.
- Reactive or arousal behaviours (hyperarousal): Irritability, concentration problems, bursts of anger, sleeping difficulties (either in falling asleep or remaining in a sleep state), feeling on constant guard (feeling a need to be ready for danger), and experiencing exaggerated responses to startling events or situations. A person with PTSD often experiences negative thoughts about themselves which occur due to intense guilt, blame or worry, as well as of others or the world as a whole. A person with PTSD will often have difficulty relating to others (affecting close relationships), feel hopeless about the future, lack the ability to show affection, or become emotionally apathetic (‘numb’) and often appear ‘jumpy’. Many may experience panic attacks as well. Associated symptoms of panic attacks include light-headedness, feeling faint or dizzy, headache, a rapid heartbeat, excitability or agitation. Many with PTSD develop self-destructive behaviours such as substance abuse (e.g. drinking excessive alcohol or taking drugs) or driving dangerously.
- Physical symptoms: A person with PTSD may notice physical symptoms due to emotional and mental strain. These include a rapid heart rate, rapid breathing, a higher than normal blood pressure, nausea, muscle tension, chronic pain or diarrhoea.
- Symptoms as related to children and teenagers: A young child with PTSD may experience signs of delayed development. This includes problems and delays with motor skills, speech or language and toilet training. Young children (under the age of 6) often wet the bed, become unable to talk and develop an unusual clinginess towards a parent or other adult. Children may also re-enact details about an event through play and experience frequently frightening nightmares. Older children and teenagers, typically display similar symptoms to adults. Children between the ages of 7 and 11 often ‘act out’ details of the event through play, or drawings and written stories. Behavioural problems which develop can include destructive, disruptive or disrespectful outbursts. Many may also have frequent thoughts of attaining revenge as well. Some children tend to ‘run away’ or become withdrawn from friends, family and the school environment.
Who is most at risk of developing post-traumatic stress disorder?
The reality is, we all are. Anyone, anywhere in the world is unfortunately at risk of being exposed to a traumatic event. Traumatic events can include physical abuse (during childhood or at any stage in adulthood), sexual violence, physical assault and being threatened with a weapon (robberies, hijackings and muggings), a horrific or life-threatening accident (such as a car or plane crash), combat exposure (war), terrorist attack, natural disasters (earthquakes, tsunamis, landslides, hurricanes etc.), fires, torture and kidnapping, or even receiving a life-threatening medical diagnosis.
Not every person who experiences such an event will develop symptoms of post-traumatic stress disorder. Some develop effective coping measures that do not fall into the extreme. Many have effective support structures soon after an event which better enable the ability to cope and move on.
Any event that threatens violence (physically or sexually), or raises the risk of death increases risk of PTSD for a person experiencing the trauma.
Some factors associated with this include:
- Experiencing a trauma early on in life (during childhood, such as abuse).
- Experiencing an incredibly intense traumatic event or one which lasts for an extended period of time (such as a kidnapping).
- Having an occupation which places a person ‘in the line of fire’ (constant exposure to traumatic events), such as emergency personnel (first responders) and the military.
- Those with a family history, or personal history of other mental health disorders, or substance abuse.
- Those with a lack of a sufficient support system (family, friends, colleagues and community) following an event.
- Those who witness another experience a traumatic event.
- Those who need to deal with additional stress following an event, such as a sudden, unexpected death of a loved one, losing a home or a job, or experiencing some other form of pain and injury.
Co-occurring problems and complications
Some signs of PTSD are more obviously seen in the destructive impact the disorder has on a person’s live. The impact goes hand-in-hand with other conditions such as anxiety, depression, conduct disorder, eating disorders, and substance abuse (alcohol and drugs). Some develop suicidal thoughts and physical self-harming actions too.
Social anxiety, difficulties with employment (remaining employed or becoming unemployed), and relationship troubles (divorce or separation, and domestic abuse) are common problems for those with PTSD. Increased incidents of violent outbursts have also been frequently seen in some with PTSD.
Is post-traumatic stress disorder common?
Finding accurate statistics regarding PTSD diagnosis is somewhat of a challenge. Much of the information available relates to those connected with combat and specific countries only. It is currently very difficult to gain an overall global perspective of this condition.
What is known is that millions experience symptoms of PTSD during the course of a year, meaning that as many (if not more) are likely to experience the condition in their lifetime. The National Centre for PTSD estimates that about 60% of men and 50% of women will be exposed to a traumatic event in their lifetime.
Despite men being exposed to a higher incidence of traumatic events in the form of accidents, injury, combat, physical assault and witnessing death, medical professionals have noted that women are more prone to PTSD than men. One idea is that women are more exposed to emotional, physical and sexual assault.
Studies have also found that the highest prevalence of PTSD occur in Canada, followed by the Netherlands, Australia, the USA and New Zealand. A group of scientists from the Netherlands, London and Australia have conducted research studies into why it also appears that more affluent countries, like Canada, appear to have higher rates of PTSD than do those of poorer nations. Their findings appeared to show that low incomes, poor sanitation and malnutrition did not cause as much distress to populations as the research team had anticipated. Instead higher prevalence rates have a lot more to do with events that completely violate a person’s expectations, such as a violent attack or frequent natural disasters. A way of living that is (even temporarily) turned upside down by something such as a terrorist attack (or the threat of) in a city appears to be a big contributing factor to many countries where PTSD is more prevalent.
For some societies, the world is already viewed as a dangerous place from a very young age and thus, it does not come across as too surprising when bad things happen. Prevalence of PTSD does not necessarily result from societies suffering economic, social or educational disadvantages (which the research group anticipated). Some of the lowest rates of PTSD appear to be in Nigeria, China and Romania.
How is a PTSD diagnosis made?
It is time to seek help if after a traumatic event:
- Upsetting (or disturbing) thoughts occur frequently and seem uncontrollable (for longer than one month)
- Upsetting and disturbing thoughts are severe
- A person is incapable of living a normal lifestyle
- A person is unable to control negative actions
- A person becomes fearful of harming themselves (may be suicidal) or others
What should a person experiencing these things do?
- Reach out to a trustworthy loved one or close friend for support
- Make an appointment with a mental healthcare professional (psychiatrist or psychologist)
Diagnosis and tests
Once at a mental healthcare professional’s office for a consultation, the doctor will assess a person’s condition based on a thorough evaluation of symptoms. There is no specific diagnostic test for diagnosing PTSD.
A diagnosis for PTSD symptoms will often be based on the following:
- A person experiences as least one ‘re-experience’ symptom for at least 1 month.
- A person experiences as least one ‘avoidance behaviour’ symptom for at least 1 month.
- A person experiences as least two (each) ‘reactive or arousal, and mood change behaviour’ symptoms for at least 1 month.
Using these factors, a psychologist or psychiatrist will be able to rule out other serious symptoms following a dangerous event that typically relate to acute stress disorder (ASD) and resolve within a few weeks. Other factors include a notable effect on a person ability to function normally, which is not as a result of another medical illness, substance abuse or anything unrelated to the event itself. If all other possible conditions and factors are ruled out, a doctor may be inclined to make a diagnosis of PTSD.
The effects of a traumatic event can be directly experienced, witnessed or learned about from an individual close to an affected person. Thus, a person with PTSD need not have experienced a trauma first-hand in order to display symptoms.
Generally, a diagnosis for PTSD will only be made around one month following a traumatic event and as mentioned, involves specially designed assessment tools to evaluate various anxiety-related disorders. If a person presents symptoms and consults a doctor sooner, he or she may offer treatment while assessing the severity of possible PTSD and depressive symptoms before a conclusive diagnosis is made.
At the initial consultation, following a complete medical history and symptoms discussion (and the events that led up to them), a physical exam may be recommended (either by the evaluating professional or the patient will be referred to a general practitioner / GP).
If necessary, during the physical check-up a doctor may request tests to ensure that no symptoms have arisen as a result of a physical condition or medication use. These tests will depend on the physical condition of the individual.
How is post-traumatic stress disorder measured?
Evaluations for PTSD can vary. Some may be done in as little as 15 minutes, and others up to an hour long. A thorough assessment will involve structured questions (Clinician-Administered PTSD Scale [CAPS] or Structured Clinical Interview for DSM [SCID]) and completed surveys regarding thoughts and emotions. A loved one, such as a family member or spouse may be asked to attend a consultation of their own to provide any other relevant information, and assist with an assessment. Other types of structured interviews and questions a mental health professional may make use of include:
- ADIS (anxiety disorders interview schedule-revised)
- SI-PTSD (structured interview for PTSD)
- PSS-I (PTSD symptom scale interview)
- PTSD interview
Each evaluation has a set structure of questions to assist a mental health professional with making the most appropriate diagnosis.
What type of questions will be asked to assess whether any further evaluation is necessary?
- What kinds of symptoms are being experienced or have been of some concern?
- How long have these symptoms been experienced?
- Have any traumatic events been witnessed or experienced recently?
- Since the event, have nightmares, disturbing thoughts and memories been disruptive to daily life?
- Since the event, have avoidance behaviours been adopted? (Isolating oneself, or avoiding certain people, places or specific situations)
- Since the event, have there been in obvious difficulties in personal relationships, at work or school?
- Have any other mental health problems been treated in the past? If yes, which therapies proved most beneficial?
- Since the event, have alcohol, medications or recreational drugs been used to try and dispel any symptoms or concerning feelings?
- Since the event, have there been days when self-harm, or harming others been thought about?
Surveys and questionnaires are usually a printed set of questions which a patient is given to answer. This usually serves as a PTSD checklist (PCL).
From there, a mental health professional will use all psychological evaluations and test results (where relevant) to determine symptom criteria for PTSD, as well as the degree of dysfunction in a person’s overall life.
Treatment for PTSD
Mental health professionals usually recommend a combination of treatment therapies once a diagnosis is made. Treatment is aimed at alleviating the debilitating and severe nature of physical and emotional symptoms. By doing so, treatment helps to improve a person’s ability to function normally, while working through the traumatic ordeal and learning to better cope.
If achieved, a person with PTSD can gain better control over their own lives and move on in a more productive way. Where relevant, treatment will also incorporate measures that help control co-occurring problems and complications, such as substance abuse and reckless behaviours.
1. ‘Talk therapy’ (Cognitive Behavioural Therapy)
The objective of ‘talk therapy’ is to encourage a person with PTSD to remember the event (through exposure therapy which confronts a person with things or situations that bring up memories, and associated symptoms of the event), which caused the trauma by expressing emotions and feelings.
The point is not to create more emotional turmoil but to help desensitise a person in a controlled and safe setting that helps to gradually alleviate debilitating symptoms. When exposed to specific things or situations (through re-imagining, writing or direct contact – visiting a place where the trauma occurred) that result in symptomatic reactions, such as anxiety, a person with PTSD is encouraged to confront their emotions and fears.
A therapist will guide the process carefully so that a person learns the means to cope whenever they may next find themselves in situations which cause distress and anxiety. A therapist will also help a person to better understand the events which caused anxiety in a more realistic way. Sometimes recollection of events is distorted by exaggerated emotions and cannot be understood in a rational or realistic way.
‘Talk therapy’ is done by helping a person to both recognise and change their thought patterns which lead to debilitating emotions and sometimes, behaviours too. Therapy provides a person with the means to learn how to better manage symptoms, enabling them to cope a little better. Therapy also addresses key areas of PTSD as a disorder and helps a person (and their loved ones) better understand the condition.
2. Other psychotherapy methods
A doctor may also recommend one of the following:
- Psychodynamic therapy: which works to assess a person’s personal value and the emotional challenges following the traumatic event.
- Family Therapy: Another method involves close relatives and loved one. Family therapy may also be recommended where it is found that those closest to a person with PTSD have also been adversely affected. This can help loved ones to better understand what a person with PTSD is experiencing and how not only to handle their behaviour, but work through their own emotions too.
- EMDR (eye movement desensitisation and reprocessing) may be recommended as part of therapy sessions as a way of treating distressing memories which result in phobias. This works by combining exposure therapy and a series of guided eye movements in a safe set up, using sounds or hand movements. The purpose is to help a person with PTSD to ‘re-live’ specific things about the traumatic event that was experienced while learning how to recognise ways they can actively change how they react in anxiety causing situations.
- Prolonged exposure: A similar method to EDMR is prolonged exposure (these are sessions where a person repeatedly talks through their trauma until symptoms are no longer as distressing).
Psychotherapy helps a person better understand the experienced trauma and how it has directly affected them, teaches the use of ‘control skills’ to gain a handle on anger and better relax, equips a person with advice and tips to better help take care of themselves (sleeping, eating and exercising), addresses feelings of guilt or shame, and provides a means to help a person counteract negative reactions to their symptoms with others that better control anxiety triggers.
A doctor may prescribe medications as part of the treatment process to help alleviate the frequency of symptoms a person will find most debilitating emotionally. Medications can include anti-depressants (selective serotonin reuptake inhibitors / SSRIs) and anti-anxiety drugs (some are prescribed over a short period due to the risk of dependency), as well as mood stabilisers or neuroleptics (antipsychotics / major tranquilisers). Sometimes a sleeping aid may be recommended as well.
Medications do carry side-effects, so it is advisable to discuss these with the prescribing doctor before filling prescriptions. Most medications will show improvement in symptoms and mood within a few weeks. Depending on the nature of side-effects, dosages can be adjusted or medications changed during the initial stages to provide more comfortable use.
4. Support groups
A group session is often recommended to help a person with talking through their emotions. Groups sessions consist of others with PTSD who can all share similar symptoms together in a safe space. This can help a person to realise that they are not alone in what they are going through, and can provide some level of support which may not be available elsewhere (i.e. a ‘talk therapy’ session or among loved ones at home).
Treatment is best guided by a mental health professional who is experienced in PTSD cases. Treatment combinations that work for one individual may not be as effective for another. An experienced doctor will be able to assess the needs of a person with PTSD, based on their personal trauma (and whether there are any other ongoing issues such as substance abuse, suicidal tendencies, abusive relationships or depression), and advise the most effective ways to get a handle on the disorder. Post-traumatic stress disorder is a treatable condition and a person can recover within a matter of months.
Is colour therapy (or art therapy) effective for post-traumatic stress disorder?
Adult colouring has become somewhat of a trend in recent years, and not just for amusement. Colouring can have healing effects too. For people learning to cope through trauma, colouring has been found to help engage a different part of the brain which allows a person to process their emotions associated with traumatic experiences in a more beneficial way.
Colour or art therapy done with a trained mental health professional can form part of a beneficial treatment programme. Traumatic memories are effectively emotional physiological, sensory and visual reminders of those experienced at the time of a traumatic ordeal. They remain in the mind and physical body of a person suffering from PTSD.
Treatment helps a person to work through every aspect and detail of these memories until such time as they no longer cause a person distress. This then enables a person to better handle the kinds of memories or reminders going forward in a way that does not render them incapable of functioning normally again. Memories may not ever be forgotten, with or without an emotional response, but they can be better understood and managed through tools provided in therapy.
In the process of learning these tools, re-living the ordeal is not an easy thing to do and not everyone is able to talk through their emotions effectively. For some, colouring, drawing, painting, or using other art form mediums such as sculpture, provide a way to process trauma in a beneficial way.
Where art is noted as effective, a doctor may incorporate art or colour therapy into treatment sessions, virtually every step of the way. Art therapy can help to address a person’s entire experience, and specifically trauma which affects a person a very visual way.
Where words fail a person with PTSD, they may be able to better express themselves during a therapy session by drawing, instead of describing an emotion, for instance. Sometimes, creating a collage that represents part of the experience can help a person to better understand themselves. Art which is used to ‘tell the story of trauma’ provides a person with a healing alternative for expression.
Incorporation of art, even at a very basic level, can help a person with PTSD to tap into other areas of their ordeal, that may be more difficult to access through talking.
How art or colour therapy can help
- Reclaims a sense of physical safety: A person with PTSD often feels a sense of disconnection from their bodies (dissociation) as a result of an intense physical reaction to feeling threatened. This reactive effect means that a person can have difficulty feeling connected to their physical self. A person with PTSD struggles to feel safe within their own body. Re-establishing a sense of safety is a critical part of recovery for a person with PTSD. Therapy addresses ways a person can regain physical self-awareness and the way their physical bodies can engage with the world (and sensations) around them again. Art can help by externalising particularly difficult portions of their traumatic experience (while still confronting elements of the trauma) and enable the person to regain a sense of safety in a physical sense. Art thus helps to bridge feelings with a physical sense of reality (helping the person feel safe ‘in their own skin’).
If a person feels that art therapy may benefit them in their recovery, it is best to raise this with the treating doctor. He or she may have or know of an art expert (a therapist with certified psychotherapy and art therapy qualifications) who has training in supporting trauma survivors that can be integrated into a treatment plan. For some talking through trauma is the centrepiece of treatment. For others, it may be more visual forms of creative expression which best taps into healing methods.
It is advisable to use art therapy under the guidance of a trained mental health professional. As much as talking can trigger distressing memories, so too can visual or sensory materials. A therapist will always ensure that sessions are conducted in a manner that provides a sense of safety for a person with PTSD. When used in sessions, either method can also be better controlled if a person experiences any distress.
Is pet therapy (or animal-assisted therapy) effective for PTSD sufferers?
Studies have shown that pet therapy, also known as animal-assisted therapy can have highly positive effects on depressive symptoms. The practice of pet therapy has gained popularity in recent years, using dogs and other domesticated animals to provide positive benefits for those undergoing treatment for certain health conditions. Those with heart disease, cancer and various mental health disorders are some where pet therapy has shown some benefit.
Pet therapy involves animal-assisted therapy techniques and / or animal-assisted activities. Activities are used for comforting and enjoyment purposes, and are most common around nursing homes.
Therapy involves a short visit (sometimes 10 to 15 minutes at a time) with an assistance animal, such as a dog and their handler. Some animals can also help to reinforce rehabilitative behaviours through walking or throwing a ball.
These types of visits have shown to significantly contribute to the alleviation of anxiety, depression, fatigue and sometimes pain. Many war veterans dealing with PTSD, and their families (sitting in on a visit), have found pet therapy to be a beneficial part of their healing process. A short visit can help to significantly reduce levels of stress and anxiety, which can be highly beneficial for a person suffering symptoms of PTSD.
Living with post-traumatic stress disorder
Treatment for PTSD will take a little time, but it’s important to work through treatment following the advised steps of a trained mental health professional in order to make a recovery.
A recovery is possible. Recovery won’t mean that the trauma will be erased from memory, or that physical and emotional reactions will never be experienced again when memories surface. What recovery does mean is that a person can regain a fully functioning life that is not debilitated by symptoms of PTSD, as well as find self-confidence and self-respect once more.
Treatment enables a person with PTSD to better take back control of themselves and their lives, providing positive steps and tools to improve life overall.
There is plenty a person with PTSD can do to ensure effective benefits of treatment:
- Treatment is not a ‘one size fits all’ recovery plan. It can be adapted. A person with PTSD does have options and should talk with their treating doctor at any stage about whether the chosen recovery path is working or not. A person with PTSD should also realise that treatment may take some time, and thus, symptoms may improve gradually. Recovery is possible, but in controlled steps. The intensity of trauma and associated emotions may not ‘be easily fixed’ in a handful of sessions. A person with PTSD must remain on their path to recovery and follow their treatment plan with the treating mental health professional. Working closely with the treating doctor, and maintaining open communication regarding treatment, is the best way to make a recovery.
- Post-traumatic stress disorder is a classified psychological condition, affecting many around the world. Many people who have experienced trauma exist and through diagnosis and treatment have helped to provide a wealth of information about the condition. A person with PTSD, and their loved ones, can learn much about the condition as part of the recovery process. By understanding the nature of triggers, emotions and other responses, it is easier to adopt the various coping mechanisms learned and grasp their benefits.
- A doctor is likely to encourage a person with PTSD to ‘get out a little more’ and not isolate themselves. One of the ways this can be achieved is by participating in moderate physical activity (or exercise) on a regular basis. The added benefit is that this can help to reduce stress levels too. Another way a person with PTSD can help themselves, using this advice, is to make an effort to spend time with other people. A good start is to engage with close friends and family who are aware of a person’s PTSD symptoms (and symptom triggers) and who are a willing support base in places that a person finds most comfortable (i.e. not in places or areas where potential situations may trigger distressing symptoms). Time with others can involve talking in confidence (about the traumatic experience) with trusted individuals outside of therapy. This will also help those who care to better understand the disorder and the nature of symptoms. It can also help to clarify any outbursts of anger and ensure that others are aware that they may not have provoked it, especially where children are concerned. Quality time sharing things in common (or activities) is also beneficial and can also be a critical part of healing.
- Part of positive growth in life is the setting of realistic goals for attainable achievements. Life doesn’t stop. A person with PTSD can benefit from pacing themselves by prioritising things that are beneficial to recovery, and their future, and taking things step-by-step, day-by-day. It can help to break up large goals or tasks into smaller ones, ‘step-by-step’ in order to achieve them.
- A doctor will also recommend making an effort to eat a balanced diet and get enough sleep or rest in between treatment sessions. Where necessary medications can be prescribed to aid in better quality sleep. A healthier physical body as a result of better lifestyle choices can greatly contribute to a person’s overall wellbeing. Taking the best care of oneself also involves avoiding aggravators such as the use of nicotine or caffeine, which stimulates anxiety symptoms. ‘Self-medication’ by means of substance abuse may provide temporary relief of symptoms but is not beneficial for the long run and can worsen PTSD symptoms. A doctor will advise against anything that will interfere with the effectiveness of treatment, and includes behaviours such as lashing out or becoming abusive. It is better to adopt healthier habits that break the cycle of negative reactions. Anxiety can be better relieved with a brisk walk or a hobby, such as sewing or painting that helps a person to re-focus instead of reaching for a drink. Negative emotions associated with negative memories can be channelled into an array of different activities involving creativity or even sports and meditation techniques. Selfcare is about healthier habits and cutting loose those that do not serve a healing purpose. What a person chooses is a personal one. What is helpful for one may not work for another, or even interest them.
How a loved one can help a person with PTSD
Post-traumatic stress disorder can be an emotional journey for those who are close to someone affected by the distressing condition. It can be difficult for a loved one to understand how to help a person with PTSD as well. For many, their loved one may seem like a completely different person. In some respects, loved ones may feel like they do not recognise the person they once thought they knew so well, and find it difficult to show them affection or the kind of care or patience the person may need.
As a condition, PTSD places a significant amount of emotional and mental strain on the person affected by the condition, as well as those closest to them. Loved ones can often themselves feel helpless and guilty or even fearful, finding it troubling to help the healing process along, without pushing or trying to ‘fix’ a person’s illness. As much as a person with PTSD undergoing treatment needs to understand that healing is not immediate and takes time themselves, so too must their loved ones. There is no set timeframe for effective recovery. It’s a personal journey for a person with PTSD.
Some of the best ways loved ones can help promote healing are:
- Learn about the condition from trusted medical sources – common symptoms, triggers, treatment procedures and what they involve. In learning about the condition, a loved one can better recognise behaviours such as withdrawal or avoidance as a reaction to symptoms. Loved ones can also provide needed space when it is required, while assuring a person with PTSD that they are available when a friend or relative is needed. This will provide a person with a sense of trust and security that they are not alone and serve as a reminder that ‘needing space’ (for a short period in order to re-focus and rest) is not the same as isolating themselves completely (an avoidance behaviour). In this way, loved ones can be there for a person with PTSD when they need support the most (either as company or as a confident) and not add to overwhelming stress triggers or anxiety. If a person feels it beneficial for recovery, loved ones can participate in therapy sessions.
- Respect the process – the journey to healing is likely to be along a tough road. Recovery is not going to be without challenges and many tough days. Loved ones can help alleviate worries and stress or anxiety for a person with PTSD by understanding that treatment will take time at a pace that works best for them. Healing happens on their clock, so to speak. Recovery may take months or even longer. Another part of learning about the condition and respecting the process is understanding when to encourage a person to participate in every day types of activities, celebrations and events with others (with the intent of helping to form a healthy social network), and when to back off a little and provide some necessary space or take a break following conversations about the trauma. A person with PTSD will be very sensitive to being pushed. Patience and understanding are crucial for a loved one to be very mindful of. Truly listening (and asking questions that help to better understand what happened) when a person with PTSD opens up about their experience can be far more supportive than offering advice or statements such as “I know how you feel”. Showing support in a manner that is not as understanding as a person needs will not help to maintain trust, and may result in loved ones being pushed away.
- Self-care – Loved ones should not forget to take care of themselves too, especially those who are closest to a person with PTSD (such as a spouse or parent). Maintaining overall health is just as important for a loved one as it is for someone going through a mental health disorder. A loved one must maintain healthy levels of exercise, eat a balanced diet, rest well, get plenty of sleep and make efforts to spend quality time with other friends and family. A loved one is of little supportive use to another if they themselves are not fit and healthy. It is a good idea to acknowledge that as human beings, every now and then, everyone takes a little strain and finds troublesome things or emotions a little overwhelming. When and if this happens, a person should seek support where it is needed (i.e. a support group, friends and family or even a therapist). In instances where a person with PTSD is unpredictably aggressive or even abusive, loved ones should be mindful to ensure the safety of themselves and those around them.
- Recognise critical signs – ‘Re-living’ a traumatic experience through therapy is an exceptionally emotional part of recovery, and may not happen just once. There may be days when therapy shows signs of progression in the right direction and there may be intensely overwhelming stages which leave a person with PTSD in a state of despair. If the latter happens, loved ones should be well aware of any distressing signs where they can proactively help. It can happen that a person becomes severely depressed or even suicidal. If the latter occurs, loved ones will likely be able to notice the signs and respond (with care) immediately. A person with PTSD that becomes suicidal must not be left alone, or with access to items which pose a danger to themselves or others, such as weapons or medications. A close loved one should calmly seek assistance from a trained emergency personnel immediately and advise the treating mental health professional.
How to deal with stigma
Mental illness is all too often negatively stereotyped, and a person with PTSD may be all too aware of how others may perceive their condition. Post-traumatic stress disorder may be viewed with a negative attitude (disadvantage) and if openly shared (sometimes unintentionally) may have an adverse effect on a person’s treatment progress. Almost always, stigma stems from a lack of understanding.
If it becomes obvious to a person with PTSD that others are avoiding them because they may be viewed as unstable or even dangerous, it can cause problems that do not promote recovery. Some of these may be a reluctance to bother continuing with treatment, adverse impacts on a person’s work life, social life or school environment, decline in self-confidence and all-round negative outlook of the world.
A person with PTSD can disallow stigma from affecting their recovery by:
- Maintaining treatment and using their therapy to work through any fears of being negatively labelled.
- Use counselling to dispel any self-doubt, self-judgement or any other signs of personal weakness as a result of PTSD. A person has post-traumatic stress disorder, and should never equate themselves with the illness (the person should not feel that they are defined by the disorder but rather see themselves as a person with it).
- Make an effort not to become isolated and work with the treating therapist to better handle conversations around PTSD with others in a community.
- Find beneficial support where it is needed within the community or in organised support groups (in the community or online). Wherever support is sought, a person with PTSD should ensure to advise their treating professional.
- Parents of children with PTSD should make an effort to advise relevant parties at school so that educators can better accommodate handling a child undergoing treatment, as well as be more aware of situations which may occur as a result of stigma or misunderstanding.
What is the outlook for those recovering from PTSD?
Treatment for PTSD does not offer any quick fixes, making recovery a step-by-step process. Most do recover from their symptoms and make use of the learned coping strategies for the remainder of their lives.
Therapy, medication and support groups provide a person with the opportunity to get onto the right road for recovery. Life after treatment can be comfortable and normal if the most effective strategies to get the better of intrusive memories and thoughts remain as a part of life.
In this way recovery is ongoing, meaning that symptoms may never disappear altogether. Symptoms just become less intense and more infrequent.
Is it possible to prevent PTSD?
Early intervention following a traumatic event may be the best means of alleviating severe symptoms of PTSD. It is normal to experience symptoms post-event for short period of time. Doctors use one month of continuous symptoms as a benchmark for PTSD diagnosis. Many may experience symptoms that begin to subside by then. If not, a person is at risk of long-term post-traumatic stress disorder and should seek treatment as soon as possible.
The sooner any symptom associated with trauma is tended to by a certified medical professional the better, and in some instances, may prevent PTSD. A person should also lean on a healthy support structure post traumatic event, so as to steer clear of adverse behaviours such as substance abuse.
Postpartum PTSD – is it possible?
In short, yes. It is possible. Some women can become severely affected by medical complications during pregnancy or delivery (severe morning sickness or hyperemesis gravidarum, perineal injury or haemorrhage), emergency deliveries (traumatic labour / birth), stillbirth and pregnancy loss, postpartum depression, NICU (neonatal intensive care unit) hospitalisations, illness of a baby (especially those as a result of birth defects), problems with breastfeeding or severe colic. These types of challenges coupled with feeling isolated and lonely, as well as being severely sleep deprived and having virtually no support system can become a recipe for severe negative stress reactions – in both new mothers and fathers.
Internal stress reactors to the sounds of uncontrollable screams and wailing from a baby for weeks or months can have just as much impact as sounds like gunfire that are associated with a traumatic event. If stress is severe enough, it can cause PTSD symptoms.
Symptoms of postpartum PTSD are much the same and include avoiding consultations with a paediatrician, difficulties with bonding with a new baby and even becoming obsessive over a child. It is important for a new parent to recognise symptoms as soon as possible and seek medical treatment.