Post-Traumatic Stress Disorder (PTSD)
What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder (which is commonly known as PTSD) is a type of anxiety disorder that is caused by exposure to an unpleasant, stressful or traumatic event. PTSD is different to other mental health problems such as depression, although people with PTSD may suffer with low mood and depression as well.
Although PTSD was first recognised in ancient texts, it has only been known by its current name since the 1980s. Before that, soldiers with PTSD who were returning home from battle had previously been described as “shell shocked” or “neurotic”.
Whilst many PTSD experiences and research have a military background, this condition can also affect civilians and can be triggered by events unrelated to war or conflict.
How does PTSD affect the Iraqi community?
In Iraq, years of war, conflict and political unrest mean that a large proportion of the population have witnessed, or been involved in, traumatic situations. The witnessing or involvement of these events can lead to the development of PTSD in some people. It is thought that approximately 1 in 30 people in Iraq will develop PTSD at some point in their life.3 Some recent research shows that this figure is even higher in Iraqi youth, with up to 55.8% of 12 to 23 year olds quoted as suffering with PTSD.4
What are the different types of PTSD?
In the same way that a traumatic event affects different people in different ways, PTSD also affects people differently. Although there are several types of PTSD, people with the same type of PTSD may still feel or react very differently.
There are many different types of PTSD. These include:
PTSD, which is also known as uncomplicated PTSD, is the most common form of the disorder and the type that most people are familiar with.
People with uncomplicated PTSD usually start to experience symptoms in the first 12 weeks after the traumatic event. The symptoms can range from mild to severe and they can include:
- Feeling on edge
- Avoidance of people, places and thoughts connected to the triggering event
Complex PTSD often affects those who have experienced repeated episodes of trauma, especially those who have been exposed to trauma or stressful events since their childhood.
The symptoms of complex PTSD can be similar to uncomplicated PTSD, but they are often more severe and can affect the sufferer’s life more intensely. It is also associated with a higher risk of:
- Suicidal thoughts
- Longer term problems with emotions and managing relationships
Delayed PTSD is a form of PTSD which develops a long time after the original trigger event has happened. This type of PTSD is most often found in adults who experienced trauma as children, and those who have done active military service in a conflict zone. One research study found that delayed PTSD may account for up to 24.5% of all cases of PTSD.6
Refractory PTSD describes PTSD which does not respond to, or comes back after, appropriate treatment.
This type of PTSD can be very distressing for the person suffering from it and can require more intensive treatment to help treat their symptoms. There is still research being done on refractory PTSD, to try to better understand why it occurs and what can be done to treat it.
Occupational PTSD refers to PTSD caused by events related to an individuals’ job or workplace. This type of PTSD may develop amongst:
- Emergency medical providers
- Those who have witnessed or been involved in a serious incident whilst at work such as a death or robbery
Occupational PTSD is treated in the same ways as other forms of PTSD, but it also requires additional support when returning to work and comprehensive employee training.
Who can get post-traumatic stress disorder (PTSD)?
Anybody of any age who experiences a traumatic event is at risk of developing PTSD. However, not all people who experience a traumatic event go on to develop PTSD.
People who haven’t experienced a traumatic event themselves, but have either witnessed it or have a loved one who has been through trauma are also at risk of developing symptoms. This is sometimes referred to as ‘secondary trauma’.
Who has a higher risk of developing PTSD?
The risk of developing PTSD is higher in people who experience trauma at a young age, or who have pre-existing mental health conditions or substance misuse problems.
People who have a supportive network of family and/or friends are more likely to recover from trauma without getting PTSD, but even these people can still be affected.
There are also some environmental risk factors that can increase someone’s chance of getting PTSD, for example:
- Inadequate food supplies
This risk is present especially amongst young people.
What causes post-traumatic stress disorder (PTSD)?
PTSD develops when a person has suffered from, or knows somebody who has suffered from, a traumatic trigger event. The traumatic events that can trigger PTSD include, but are not limited to, the following:
- Childhood abuse
- War and conflict – both in soldiers and civilians
- Pregnancy and childbirth
- Rape and sexual assault
- Physical abuse
- Emotional abuse
- Domestic violence
- Being imprisoned, enslaved or tortured
- Witnessing death or injury
- Serious illness or injury
Does everyone who experiences trauma go on to develop PTSD?
No, only a small number of people who experience trauma go on to develop PTSD, and the reasons behind why this happens are still not clear.
As mentioned above, there are some risk factors which make a person more likely to develop PTSD after a stressful event, but research is still being conducted to find the exact causes of this condition.
Some current theories as to what causes PTSD to develop in some people are:
- The survival response theory – This theory suggests that PTSD is an exaggerated response to trauma which the brain generates in order to be better prepared for new traumatic experiences that might happen in the future.
- Genetic predisposition – Ongoing research is beginning to suggest that genetics may play a role in the development of PTSD, but so far the exact gene behind this has still not been found.
- Abnormal hippocampus – The hippocampus is the area of the brain that processes memories. Research has found that this part of the brain is often smaller than average in PTSD sufferers, which may partially explain the symptoms of flashbacks and processing problems in people with PTSD.
- Abnormal stress hormone levels – Some people produce abnormally high or low levels of specific hormones such as adrenaline and cortisol. These two hormones help the body react to times of stress. If they are continually produced at an unusual level, they can cause the symptoms of PTSD to continue happening, leaving the body in a constant state of stress.
What are the symptoms of post-traumatic stress disorder (PTSD)?
There are a number of symptoms that make up PTSD, and they are broken down into different groups.
Some of these symptoms (if they are short-lived or if they do not cause a person significant distress) can become part of a normal stress reaction to experiencing trauma.
The symptoms of PTSD can be split into the following groups:
- Having recurrent and intrusive memories of the event
- Having recurrent, distressing dreams about the event
- Feeling physically or mentally distress when exposed to reminders of the event or other similar events
- Avoiding thinking or talking about the event
- Avoiding people, places, situations or things related to the event
- Not being able to remember some or all details of the event – including having memory loss
- Having persistent negative beliefs about yourself or others
- Having persistent negative or illogical thoughts about the cause and results of the event
- Having a persistent sense of guilt, anger or shame
- Lack of interest in usual activities and hobbies
- Feeling detached from others
- Losing the ability to feel positive emotions
- Feeling increasingly irritable and having mood swings
- Taking part in self-destructive behaviour
- Being hypervigilant i.e. always being ‘on the lookout’
- Becoming startled very easily
- Finding it difficult to concentrate
- Having difficulty sleeping
In order for a diagnosis of PTSD to be made, at least one symptom from each group must be:
- Present for more than one month
- Causing significant distress or difficulty
Can people with PTSD also have anxiety and depression?
- Low mood
- Not enjoying hobbies or other activities
- Feelings of panic and worry
- Poor appetite
- Feeling tired or sleeping badly
- Having tense muscles
- Becoming socially withdrawn
What are the complications of post-traumatic stress disorder (PTSD)?
PTSD is a complex but treatable condition. Although we do not fully understand how it is caused, the study of PTSD patients over the years has shown that some other physical and mental health conditions are frequently associated with PTSD.
There is also a higher rate of alcohol or drug misuse amongst people diagnosed with PTSD. This may be because some people use these substances as a coping mechanism to avoid thinking about their experiences and to numb themselves to unpleasant psychological symptoms.
There are physical as well as psychological problems associated with PTSD. These can be:
- Pre-existing issues
- Issues caused by the same event that led to the development of PTSD
- New medical problems
The reasons why these physical health issues develop are not yet clear.
The most frequently reported physical health issues fall into four main areas, which are:
- Musculoskeletal – health problems relating to the muscles and joints
- Cardiovascular – health problems relating to the heart and blood vessels
- Metabolic – health problems relating to production, storage or breakdown of chemicals in the body
- Pain issues – such as back pain, chronic pain and chronic fatigue (fibromyalgia)
These physical issues are often treated in the same way as they would be in somebody with no history of PTSD. However, if you have been diagnosed, or think you may have PTSD symptoms, you should tell your doctor so that they can assess you fully and get a better understanding of your situation.
How is post-traumatic stress disorder (PTSD) diagnosed?
PTSD can be diagnosed by a qualified healthcare professional such as a doctor or psychologist. The diagnosis is made by assessing somebody for the symptoms of PTSD.
In order to be diagnosed with PTSD, the person must be suffering from at least one symptom from each of the four groups for over one month after a stressful or traumatic event.
If your doctor or psychologist thinks you may have PTSD, they will assess you by asking you about each symptom and asking you how you are feeling. Alternatively, they may ask you to fill in a questionnaire which assesses your symptoms.
Diagnosing PTSD in children
The symptoms of PTSD are not always obvious and it can therefore be a difficult diagnosis to make. This is even more true in children, as a child may not want, or be able, to explain how they are feeling and what has happened to them.
Watching how children play can give an insight into what they are thinking. Asking those close to the child such as their parents or caregivers if there have been any significant changes in their behaviour can also help. The approach to diagnosis in children is therefore more observational than it is for adults.
Which other conditions have similar symptoms to post-traumatic stress disorder (PTSD)?
As we have already mentioned, the symptoms of PTSD are often interwoven with those of anxiety and depression. The key differences between the three conditions are:
- PTSD – often has a clear trigger event and has ‘hallmark’ symptoms including flashbacks, being jumpy and on edge and avoiding anything which reminds the sufferer of the traumatic event.
- Anxiety – can be either specific or generalised but it tends to be unrelated to an event and it can be associated with panic attacks (a sudden overwhelming feeling of anxiety).
- Depression – causes a low mood and changes in appetite, concentration, sleep and behaviour.
These disorders are somewhat similar and may be present in any combination, although the presence of one does not mean that you will necessarily go on to develop another.
PTSD is in fact, a type of anxiety disorder that is distinguished by the exposure to something traumatic.
The treatments for all three can be given by a doctor or psychologist, and although they are different, have some similar elements.
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
How do you treat post-traumatic stress disorder (PTSD)?
PTSD is a treatable problem but it can take a long time to resolve. There are several treatment options, and the best treatment option for someone will depend on:
- The individual
- The type of symptoms they have
- The intensity of their symptoms
- Local access to healthcare professionals and resources
For people with a mild form of PTSD, it is possible that no treatment is required and the symptoms may resolve by themself. It is, however, still important that the person who is suffering with PTSD still has someone they can talk to, and knows they must seek help if their symptoms start to get worse.
Overcoming PTSD can take a long time but it is a largely treatable condition, even if it is not treated for many years. To start with, there are a few things that you can do at home which may help improve your symptoms:
- Meditation or mindfulness – This involves taking some time out of your day to clear your mind and reflect. You can do alone, in a group, or as part of a structured programme.
- Yoga and exercise – Staying physically healthy is important, and it can help improve your mental wellbeing, particularly when it is combined with mindfulness (which is a technique used in yoga practise).
- Seeking treatment for other problems – We have explored the possible psychological and medical problems which can go alongside PTSD. By getting help with these, you increase the likelihood of your PTSD symptoms improving.
- Improving the quality of your sleep – Poor sleep is a common feature of PTSD and other psychological problems, and it can affect every aspect of daily life. Creating a routine and allowing yourself to wind down before you go to sleep can help to improve the quality of your sleep.
In general, the next treatment that can be tried if symptoms fail to resolve on their own is a form of psychological therapy.
There are several types of therapy which have different approaches, but aim to achieve similar outcomes.
Psychological therapy requires a considerable time commitment and it requires access to a trained professional which means that unfortunately it may not be as common in Iraq as it is in other parts of the world.
The psychological therapies used to treat PTSD are:
- Trauma Cognitive Behavioural Therapy (T-CBT) – This therapy aims to challenge and change behaviours that cause PTSD symptoms (such as feelings of guilt towards the triggering event) by talking and simple written exercises.
- Eye Movement Desensitisation and Reprocessing (EMDR) – This is a specific type of psychological therapy that helps you to accept, process, and recover from trauma by using eye movements to reinforce positive beliefs and process memories.
In addition to these therapies, some people find talking about their PTSD to be beneficial. This may be informally with a friend or relative, or as part of a larger support group for individuals who have had similar experiences.
It is more likely that you will be offered medication for your symptoms if you consult a doctor in Iraq as they may be more readily available than psychological therapy.
The medications used to treat PTSD are all antidepressant medications, but there are a variety of options available, which all act in slightly different ways and have different side effects.
The main medications usually used for PTSD are:
As well as helping improve PTSD symptoms, these medications can also treat coexisting depression.
How long do you need to take these medications for?
It is important to understand that these medications are usually taken for around a year, depending on how well they work for you, and whether or not you experience any significant side effects.
What are the side effects of these medications?
Common side effects include:
- Initial worsening of symptoms
- Constipation or diarrhoea
- Increased appetite and weight gain
- Changes in vision
If you have PTSD and are considering taking medication for it, ensure that your doctor is aware of your full medical history, allergies and any other medications that you take. You should also report any side effects to them straight away, as well as worsening low mood and especially any suicidal thoughts.
Is there a cure for PTSD?
As is the case for most psychological problems, there is no cure or ‘one size fits all’ treatment for PTSD. It affects people in many different ways and therefore the best treatment varies from one person to the next.
Can you prevent post-traumatic stress disorder (PTSD)?
As we do not know exactly why some people develop PTSD and some do not, it is not possible to prevent it at an individual level.
Ongoing work between governments to end widespread traumatic events such as war, violence and famine should lead to a reduction in the number of PTSD cases, but the risk of exposure to trauma in an individuals’ lifetime will always exist.
Things that can be done to help people manage their PTSD are:
- Educating themselves and those around them about PTSD
- Developing support networks between friends and family
Is there a test or quiz I can take for PTSD?
Please be aware however, that this test does not give you a formal diagnosis, and does not replace a full assessment by a qualified mental health professional.
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