We have heard about soldiers who returned from combat with post-traumatic stress disorder (PTSD). People who have never been in a combat situation but have been exposed to stressful situations have experienced this disorder. These situations threaten their perception of personal safety such as rape, accidents, and kidnapping. Acts of terrorism, physical abuse, natural disasters and sudden death of a loved one can trigger PTSD.
Each person may manifest symptoms in a different way but there are some symptoms that are common to all:
1. Re-living the trauma in the form of nightmares, frightening thoughts, and experiencing the original event, with or without physical symptoms such as sweating and palpitations. The triggers can include dreams, thoughts, words, sounds or situations that remind the person of the event.
2. Avoiding reminders of the trauma, whether they be places, thoughts, activities or objects.
3. Being easily startled, anxious and/or experiencing depression may be constant features that steadily increase feelings of anger or stress, and these feelings may prevent the person from doing routine tasks or they may have difficulty concentrating or falling – and staying – asleep.
4. Changes in thinking and mood such as the inability to remember key points about the trauma, feeling guilt or blame, loss of interest in previously enjoyed activities, or negative feelings about self or others or society.
Other symptoms may include substance abuse, physical aches, and pains, suicidal thoughts and feelings of distrust or betrayal.
PTSD can affect anyone at any age and could take days, weeks or months to manifest. Children may show different symptoms such as loss of previous skills, irrational fear, separation anxiety, acting out the trauma during play or story-telling, or create drawings of the trauma.
Effects of PTSD on the Brain
Changes do occur within the brain matter as a result of post-traumatic stress disorder. The changes occur in the areas known as the hippocampus, amygdala, and ventromedial prefrontal cortex. The areas control different responses and are affected to a greater or lesser degree:
· The hippocampus – in the medial temporal lobe – is responsible for memory function, and reduces in size in people who have ongoing PTSD causing them to lose the ability to interpret situations objectively resulting in the triggering of extreme responses to situations that slightly resemble the traumatic event.
· The amygdala – located near the hippocampus – also plays a role in memory, as well as emotional reactions and decision-making. This part of the brain becomes hyperactive in PTSD sufferers, making them overreact to stimuli and experience recurring flashbacks.
· The ventromedial prefrontal cortex – in the brain’s frontal lobe – plays a role in decision-making and the inhibition of emotional responses. The decrease in size as a result of PTSD can also lead to overreaction to stimuli.
The changes need not be permanent so the sooner treatment is started, the better the prospects of reversing the damage. Why do some people get PTSD while others don’t? A number of factors have been considered as precursors, such as:
· Getting hurt or seeing others get hurt and/or die.
· Feeling helpless or experiencing extreme fear.
· Having a pre-existing mental illness.
· Having little or no support after the event.
Every person’s experience is unique and there is, therefore, no single successful treatment for everyone. There are many different types of therapy and one type may not be effective in treating people who experienced the same traumatic event, such as a terror attack or car accident. Some people will be able to recover from the event, but others won’t.
And, no, telling someone to “get over it” is not going to work. If it were that simple, PTSD would not exist. Treatment of post-traumatic stress disorder includes psychotherapy and medication.
This is a term for therapy that involves talking to a psychologist, psychiatrist or any other mental health practitioner. Various types of psychotherapy are used to treat PTSD, including:
· Cognitive Behavioral Therapy is used to help people to recognize and challenge their own negative feelings and emotions, in order to develop coping skills that will address and eliminate their unwanted behavioral patterns, emotional problems, and/or depression.
· Exposure Therapy enables PTSD sufferers to gradually face the thoughts or places they previously avoided that are related to a traumatizing event. This may either be voice-guided only or with the use of virtual reality computer programs. Gradual desensitization occurs and the PTSD symptoms decrease.
· Eye Movement Desensitization and Reprocessing (EMDR) therapy is an eight-phase treatment that combines cognitive behavioral therapy and specific eye movements to help the PTSD sufferer to regain their normal coping mechanisms.
Different types of drugs may be prescribed by a psychiatrist for PTSD, such as anti-depressant and/or anti-anxiety medication. These are not “magic bullets” in that they do not take effect after the first dose, but rather provide a gradual improvement in the level of depression and decreased anxiety and stress over time.
Side-effects must be reported to the doctor as soon as possible so that the medication can be reviewed and amended accordingly.
Coping with PTSD
Once you have seen your healthcare professional, you can include these steps to further your recovery:
· Follow and persevere with the treatment plan you have been given. Recovery takes time.
· Avoid alcohol, drugs, caffeine and nicotine as these will negate your treatment.
· Take care of yourself – rest when necessary, eat correctly, exercise, get a good night’s sleep and take up a hobby.
· Join a support group. Being with people who also have PTSD and understand how you feel can be reassuring.
Supporting someone with PTSD
Although you might not be able to imagine what the person is experiencing, there are steps you can take to support your friend or family member:
· Learn about PTSD.
· Be willing to listen when they want to talk, but also accept that the memories may be too painful to recall. Don’t force someone to speak if they’re not able to.
· Be prepared to attend doctors’ appointments and support groups if asked to. Join a Post traumatic stress disorder forum and get help from people who have experience with the disorder.
· Plan activities to provide distractions.
· Look after yourself and do speak to healthcare professionals if you need advice.
· If the person with PTSD lives with you and has abusive or violent outbursts, have a plan to withdraw to a safe place.
Prevention of PTSD
Is post-traumatic stress disorder preventable?
There are differing points of view amongst members of the medical health fraternity regarding this question. Some think it is, whilst others think it isn’t. What they do agree on is that early detection is vitally important.
Two types of preventive treatment have been identified:
1. Universal prevention: This would be aimed at people who, for example, are employed in stressful occupations – such as military personnel, policemen, firefighters, paramedics and other first responders – and all of them would receive early psychological debriefing after the event is recommended.
2. Targetted prevention: Although many people may be exposed to the same trauma only some people might be at high risk of developing PTSD, and both psychological and pharmacological treatment would only be used for those identified.
One of the biggest barriers to overcome in the prevention of PTSD is that of people not seeking help because they fear they will be stigmatized if anyone finds out. PTSD must never be ignored as it can have life-altering effects on the sufferer and his/her family, friends and work. The reality is, though, that the sooner treatment is started, the less intense the disorder will be and recovery will also be faster.