An Introduction to Post Traumatic Stress Disorder

I have read many descriptions of what PTSD is and how it affects us. The simplest description I have found is from the Combat Stress UK website, a UK Registered Charity dedicated service for Veterans whose mental health condition is often complex and long term. So I will tackle it two ways, firstly what are the symptoms that you may recognise and secondly by three main symptom clusters that your medical professional should discuss with you. These are re-experiencing, avoidance, and hyper-arousal symptom clusters.

For Individuals and families

Symptoms of trauma

People react to traumatic experiences in different ways. Here are some symptoms you may recognise:

• Feeling isolated
• Frequent periods of withdrawal into oneself
• Nightmares/flashbacks/insomnia
• Anger or aggressive behaviour
• Feeling distrustful and suspicious/blaming others
• Misuse of alcohol/drugs/gambling and/or food
• Seeking out high-risk/dangerous pursuits
• Work-related or relationship problems
• Feeling numb and empty
• Feeling suicidal
• Self harm and self-destructive tendencies
• Being easily moved to tears
• Avoidance of people and places
• Panic attacks/anxiety/depression/mood swings.

If you (or someone you know) may be suffering from any of the above, seek medical attention or if you just want to talk to a professional contact your local or national mental health service.

For medical professionals

PTSD: Common symptoms

PTSD is characterised by three main symptom clusters. These are re-experiencing, avoidance, and hyper-arousal symptom clusters.

Re-experiencing symptoms

Individuals with PTSD repeatedly relive the event in at least one of the following ways:

• Intrusive unwanted memories of the traumatic event.
• Unpleasant nightmares which comprise of replays of what happened.
• Flashbacks where they may suddenly act or feel as if they are reliving the event.
• They become emotionally upset if something reminds them of the traumatic experience.
• Palpitations, sweating, feeling tense or shaky if they are reminded about their traumatic experience.

Avoidance symptoms

People with PTSD try to avoid thoughts and feelings related to the traumatic event. They find it extremely difficult at times, as the traumatic images and memories intrude spontaneously. Symptoms include:

• Avoidance of activities, places or people which remind them of their trauma.
• Difficulty remembering exactly what happened during exposure to their traumatic event (this reflects the intense fear at the time of exposure).
• Becoming less interested in hobbies and activities that they used to enjoy before the traumatic event.
• Feeling detached and estranged from people, and feeling that nobody understands them – a tendency to isolate themselves.
• Becoming emotionally numb, and having trouble experiencing their feelings.
• A sense of futility in relation to their future and feeling that somehow they will be struck down by yet another disaster or tragedy.

Hyper-arousal symptoms

Hyper-arousal symptoms cause problems with relationships, especially problems generated by irritability and anger. They include:

• Great difficulty falling or staying asleep.
• A tendency to being irritable and angry at the slightest provocation and for trivial reasons.
• A tendency to become aggressive, verbally or physically, or to become violent towards themselves or others.
• Great difficulty concentrating, and concentration usually requires effort.
• Remaining especially alert and watchful (hyper-vigilant).
• Looking for signs of danger in their environment and in an exaggerated way; they are tuned in to any sign that they might perceive as threatening.

Commonly associated symptoms

The other symptoms that are commonly associated with PTSD relate to feelings of guilt, and difficulty relating to authority figures.

Guilt can take two forms:

• Guilt in relation to what one should or should not have done during the traumatic exposure.
• Survivor guilt: while the individual survived relatively intact (physically, at least), others involved in the traumatic experience did not.

In many traumatic exposures, the individual may perceive that the system or hierarchy has let them down, and therefore anger and hostility can be a major factor in the presentation of PTSD.

It should be noted that the most common co-morbid presentations with PTSD are depression and alcohol abuse or dependence. Co-morbid illness needs to be addressed and treated alongside PTSD.