Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a set of reactions that can develop in people who have experienced or witnessed a traumatic event that threatens their life or safety, or the life or safety of others around them. Such events can include a car or other serious accident, physical or sexual assault, war-related events or torture, a natural disaster such as a fire or flood, or grief.

In the first days and weeks after a traumatic event, people often feel heightened arousal and alertness, looking for danger and staying on guard. These reactions often alternate with numbness and detachment. There may be constant memories of the event and a fear it could happen again, along with strong feelings of fear, sadness, guilt or anger.

Generally these reactions and feelings settle on their own over the following weeks. However, if the reactions and distress continue, it may mean the person is at risk of developing PTSD or another mental health condition.

Who is at risk?#

Anyone can develop PTSD after a traumatic event, but the risk is greater if:

• they have had PTSD in the past
• the event involved physical or sexual assault
• they experienced intense helplessness
• the event involved something they never thought would happen to them
• they have had other traumatic experiences involving helplessness or danger, including physical or sexual abuse, car accidents, criminal events, natural disasters or conflict.

Symptoms of PTSD#

A person with PTSD has four main types of difficulty.

• Re-living the traumatic event through unwanted and recurring memories, flashbacks or vivid nightmares. There may be intense emotional or physical reactions when reminded of the event, including sweating, heart palpitations, anxiety or panic.
• Avoiding reminders of the event, such as thoughts, feelings, people, places, activities or situations that bring back memories. The person may feel numb, empty or detached.
• Negative changes in feelings and thoughts, such as feeling angry, afraid, guilty, flat or numb, developing beliefs such as “I’m bad” or “the world’s unsafe”, and feeling cut off from others.
• Being overly alert or “wound up”, shown by sleeping difficulties, irritability, lack of concentration, becoming easily startled and constantly being on the lookout for danger.

A health practitioner may diagnose PTSD if a person has symptoms in each of these four areas for a month or more, and these symptoms cause significant distress or affect their ability to work and study, their relationships and their day-to-day life.

People with PTSD can also have “dissociative experiences”, which are often described in ways such as: “It was as though I wasn’t even there”, “Time was standing still”, or “I felt like I was watching things happen from above”.

PTSD in children and teenagers#

Older children and teenagers experience similar problems to adults when they develop PTSD. Younger children can express distress in a different way. For example, they may re-live the traumatic event through repetitive play rather than having unwanted memories during the day. Many children have frightening dreams without recognisable content rather than dreams that replay the event. Children may also lose interest in play, become socially withdrawn, or have extreme temper tantrums.

About one third of children who experience a traumatic event will develop PTSD. Other problems that can develop alongside PTSD include anxiety or depression, defiant behaviour and attention deficit hyperactivity disorder. In teenagers and young adults, suicidal thoughts and alcohol or drug use can also occur.

Impact of PTSD on relationships and daily life#

PTSD can affect a person’s ability to work, perform day-to-day activities or relate to their family and friends. A person with PTSD can often seem uninterested or distant as they try not to think or feel, in order to block out painful memories. They may stop taking part in family life or ignore offers of help, which can leave loved ones feeling shut out.

It is important to remember that these behaviours are part of the problem. People with PTSD need the support of family and friends, but may not understand what is happening to them or may not think they need help.

When PTSD continues for some time, it is not unusual for people to experience other mental health problems at the same time. In fact, up to 80 per cent of people with long-standing PTSD develop additional problems, most commonly depression and anxiety. These may develop directly in response to the traumatic event or as a result of living with PTSD.

Risky alcohol and drug use#

People commonly use alcohol or other drugs to blunt the emotional pain they are experiencing. Alcohol and drugs may help block out painful memories in the short term, but they can get in the way of recovery and cause other serious problems.

When to seek help for PTSD#

Seek professional help straight away if you are thinking of harming yourself or someone else.

Some of the signs that a problem may be developing include:

• severe sleeping difficulties
• being constantly on edge or irritable
• having difficulty performing tasks at home or at work
• being unable to respond emotionally to others
• being unusually busy to avoid issues
• taking risks or not caring what happens to oneself
• using alcohol, drugs or gambling to cope.

It is also worth seeking help if you don’t feel any better after two weeks, feel highly anxious or distressed, or have reactions to the event that are interfering with home, work or relationships.

Many people experience some of the symptoms of PTSD in the first two weeks after a traumatic event, but most recover with the help of family and friends. For this reason, a diagnosis of PTSD is not usually made until a month after the event, and treatment does not usually start for at least two or more weeks. However, if the event is very distressing and emotions and reactions are intense, it is wise to seek help as early as possible to understand what is happening and to help recovery begin.

In the first days and weeks it is important to get whatever help is needed. This may include accessing information, people and resources that can support recovery. Support from family and friends may be all that is needed. Otherwise, a doctor is the best place to start in order to get further help. If you are still experiencing problems after two weeks, a doctor or mental health professional may discuss starting treatment. General telephone counselling and crisis support services can also provide advice.

Support and treatment#

Support is important for recovery, and effective treatments are available. Most involve psychological treatment, such as counselling, to understand what is happening and develop ways of managing reactions. Medication can also be helpful. Generally it is best to start with psychological treatment rather than relying on medication as the first and only solution.

The cornerstone of treatment for PTSD involves confronting the traumatic memory and working through the thoughts and beliefs associated with the experience, as part of a safe relationship with a trained professional.

Treatment for PTSD can:

• reduce PTSD symptoms
• lessen anxiety and depression
• improve a person’s quality of life.

Trauma-focused treatments can also be effective for people who have experienced prolonged or repeated traumatic events, though treatment may be needed for a longer period.

Treatment for children and teenagers#

For children and teenagers who are struggling to recover after a traumatic event, the recommended treatment is trauma-focused cognitive behavioural therapy (CBT). This involves:

• learning about the type of traumatic event experienced (for example, how common it is) and common reactions to trauma
• helping to create a coherent story of the traumatic event and correct any unhelpful beliefs about it, such as self-blame
• teaching how to relax and manage anxiety
• gradual exposure to trauma-related objects or situations that are feared or avoided
• helping the child get back into everyday activities.

Key points#

• PTSD is a set of reactions that can develop after experiencing or witnessing a traumatic event that threatens life or safety.
• The main difficulties are re-living the event, avoiding reminders, negative changes in thoughts and feelings, and being constantly on edge.
• It is important to remember that these behaviours are part of the problem, and people commonly use alcohol or other drugs to blunt the emotional pain.
• Diagnosis is usually made a month after the event, and treatment does not usually start for at least two or more weeks, but seek help early if distress is intense.
• Effective treatments are available, and support from family and friends is important for recovery.

Where to get help#