Post-Traumatic Stress Disorder – The Patient Journey

Introduction

Post-traumatic stress disorder (PTSD) is classified as an anxiety disorder, the symptoms become evident and were not present before a violently traumatic event, and you may have found this event frightening, extremely stressful or completely overwhelming.

There are no hard and fast rules about how long after a traumatic event the symptoms will emerge, and not all people who experience the event will develop PTSD, the acute phase of PTSD is within 3 months of being exposed to the unexpected event. However it can occur days, months, years or decades after the initial trauma.

PTSD usually only occurs in extreme and unexpected situation such as:

• Combat situations

• Hold hostage

• Rape / sexual Assault

• Natural disaster

• Witness violent death or serious injury’s

• Violet personal assault

• Family violence

• Child abuse

• Motor / Transport accidents

Normal life stressors such as losing a job, relationship breakdowns, failing exams, getting tackled hard at a football match under normal circumstances does not lead to PTSD. PTSD normally follows extreme and unexpected Trauma.

While PTSD has only been named by the medical community, it important to know this is not a modern day problem, it was documented by the ancient Greek historian Herodotus about the emotional strain that combat can have on an individual’s wellbeing. This was around 490BC, so don’t feel alone it’s a human condition and there is hope.

PTSD Symptoms

Depending on what research is utilized anywhere up to 30% of people who are exposed to traumatic events will experience some symptoms of PTSD, it’s important to note while there is different degrees of severity in PTSD, each episode is that individuals own battle and a personal struggle, it’s a journey a long personal journey but with the right help and support a journey that come to a positive ending.

The main symptoms include:

• Avoiding things which remind you of the trauma

• Higher level of anxiety and emotional arousal

• Re-experience past traumatic events

During the journey of PTSD unpleasant feeling will be with you, some of the following are commonly reported, such as feeling of isolation, irritable and guilt. You may also suffer with reoccurring nightmares, flashbacks to the traumatic event which at times can feel worse than the actual event itself. You may feel intense distress and overwhelmed when reminded of your trauma, even physical reaction such as nausea, body cramps, perfuse sweating and headaches, while not limited to these physical reaction they are the most commonly reported.

Avoidance behaviours are also what you might be experiencing, these include not going to places or participating in activities that remind you of the event, as your presentation progresses you may begin to associate more and more activities of daily living with your trauma and through this become increasingly dysfunctional. You may avoid you own mind, such as certain thoughts or feelings of the event or even thoughts you associate with the event. Ultimately can lead to feeling of detachment form people who are important to you, thinking you future is bleak and limited, loss of interest in life’s activities.

Due to your increased emotional response and heightened anxiety you may experience, insomnia, frequent waking during the night, poor concentration, a high level of alert which is known as hypervigilance, easily startled and jumpy. The simplest thing that prior to your trauma was taken for granted can cause anxiety and decrease your quality of life. Some examples of this are following returning from combat you hit the deck at the sound of a can falling from the supermarket shelf, or at the small of a perfume you were wearing at the time of a car accident be back in the seat while the fireman cut you out the wreckage. This can be very distressing and diminish your quality of life, also create fear and ultimately leave to avoidance.

Depending on the severity of your symptoms and certain predisposing factors, PTSD can lead to:

• Depression

• Helplessness

• Suicidal ideation

• Feeling of being alone in a crowd

• Physical manifestations of discomfort

• Mistrusting and betrayed

• Alcohol and Drug abuse

In children PTSD can be seen through loss of previous acquired skills, sleeping difficulty, separation anxiety (from parent or guardian), playing or acting out scenes of the trauma, developing new phobias such as the dark places, complaints of pain without evidence of, aggression towards other children and irritability. Children are resilient and have strong coping mechanisms which can make diagnosis difficult, but knowing your child and being aware of behavioural changes that are detrimental to development can begin the journey towards recovery.

The symptoms of PTSD follow no set guidelines and they can manifest themselves in you as has been established even years later, however the majority of people who suffer with PTSD notice symptoms within the first 30 days, however it might be a considerable time longer until they seek help. Solder’s who are exposed to Trauma early in there deployment can often just carry on and do what is expected of them only when they return home to the safety and comfort and love of their family’s realise emotions have not been properly processed and their PTSD journey begins.

Your PTSD journey is not a clear path, you may experience long periods of wellness were the symptoms appear to have gone away, this is known as symptom remission, during these periods functionality improves and your quality of life improves, however if the underlying problem has not been resolved following these periods of wellness can be followed by a crash, which people often report an increase in symptoms, for others there journey constant and symptoms ever present.

Causes of PTSD

PTSD while a well-known and treatable condition is not fully understood why some people develop PTSD while other doesn’t even when witnessing the same event. As established earlier PTSD is a personal journey and each presentation demands a personal approach, understanding your own experience of PTSD with the right help is important on the road to recovery. However while it is not fully understood as to “why me” there are certain factors that are thought to play roles and increasing risk factors.

Firstly let’s look at the physical areas of the body affected, these areas are shown to have altered brain functions, the prefrontal cortex, amygdala and the hippocampus. The fundamental message here is your brain is not processing the memories properly and your fear response is elevated leading to a PTSD response. One factor contributing to this is due to the fear response an increased level of adrenalin is released by the body that causes the hippocampus to stop working properly contributing to the nightmares and flashbacks, once the fight or flight response and be managed thus reducing the levels of adrenaline in the body over time the nightmares and flashbacks will decrease.

The stress hormone and the fight or flight response, this dates back to when we were cavemen and being chanced by Sabor tooth tigers, the body produces a physiological reaction which primes us ready to make a stand or flee (fight or flight), more specifically the adrenal medulla creates a hormonal cascade the result being secretion of catecholamine’s which include adrenaline. We then are ready to do what is needed to get ourselves out of danger, however in the modern world we have less use for our millions of years of evolution and the response in a perpetual state does adversely affect your quality of life. Suffers of PTSD continue to produce high amounts of the hormones even when there is no danger of the perceived danger has diminished. This aspect is thought to be responsible for the feelings of numbness and detachment on the PTSD journey.

Certain other risk factors and increase the likely hood of a PTSD reaction:

• Lack of coping skills

• Proper debriefing after the trauma

• High levels of stress prior to incident

• History of substance abuse

• Family history of PTSD

• History of child abuse

• History of depression or anxiety

• History of mental illness

• Previous unexpected trauma

Statistically over 50% of the people on this beautiful world will experience a significant traumatic event during their lifetime, while men or more likely to see a traumatic event, women are more likely to witness an unexpected and high impact trauma that can lead to PTSD. Current evidence indicates the most high risk group are soldiers returning form Afghanistan with certain study’s estimating up to 20% will develop some degree of PTSD.

How PTSD is diagnosed

ICD Code F43.11

DSM 5 Code 309.81

Often people on the PTSD journey do not want to talk about their feeling, as this in itself can initially lead to feeling worse and bring on the symptoms of PTSD; however avoidance will not help anyone. Suffers have been known not to seek support for PTSD for months or even years after first noticing symptoms.

There is also times when you may have experience an event which has caused you some distress, this is perfectly normal, if its less than 6 weeks past the trauma and you feelings are starting to improve, and you feel you have debriefed fully with family, friends, police and other involved was just part of your natural coping process which time will heal.

However if you notice other moving on from the event while you seem to be stuck there time has passed its getting on for 6 to 8 weeks and you are not doing well then it’s time to seek professional help, the first port of call is usually your family Doctor. When engaging with the Doctor its important to include your behaviours and emotions along with any physical changes you are or have experiences, such as eating, drinking smoking more than usual, feeling or irritability and anxiety, avoidance of things that remind you of the event, overly tired, lack of sleep, insomnia. When you talk to your Dr remember they are only human and want to help, no matter how trivial you think they will view it, if it’s important to you and effecting you them discuss it and begin you recovery process.

Importance should be place at this early stage in your PTSD diagnosis that every person has an individual journey and while there are commonalties the health professionals will want to work with you to contribute positively your recovery, you also may want to consider family involvement as understanding other peoples understanding of your experience can and does contribute to recovery.

Below is a list of diagnosis criteria:

A. Exposure to a traumatic event

B. Persistent re-experiencing

C. Persistent avoidance and emotional numbing

D. Persistent symptoms of increase arousal not present before

E. Significant impairment.

The diagnostic criteria is in place to ensure accurate diagnosis and to help on the pathway to recovery while also ensuring the right medications and psychotherapies are put in place to ensure you have the best chance of recovery. Although your PTSD journey begins prior to diagnosis and you have taken the brave steps to get the support and acknowledge you are not doing so well, it is a vital step on the road to recovery and wellness.

Treatments for PTSD

Following accurate diagnosis of PTSD getting the help you need and sticking with it is the next step on your journey to recovery, there are a variety of different treatments all well documented and with proven results. The therapies can often overlap, also they can contribute each other well, the most important aspect of your recovery is not to lose hope, it’s not an easy path but it’s a path full with great guides and support to help you recovery the right way. Below will look at some available treatments while not enduring any in particular just by knowing what out there will empower you to get the right help at the right time.

Cognitive behavioural therapy (CBT) is something you may come across on your journey to recovery, CBT will aim at altering the way you think about the negative events, it will help change thinking and behavioural patterns which are responsible for your negative emotions. CBT is often the go to therapy and is used by a wide array of recovery centres around the world and at the heart of many psychologists approach to the recovery from PTSD. CBT aims to help you identify negative thoughts and feeling and replace them with more positive or at the very least less distressing thoughts. Ultimately CBT aims to help you understand how your thoughts related to the incident of trauma lead to the PTSD response. In young people a trauma focus CBT approach id also indicated, this needs to be regular and continuous and should be as with all therapy’s given by the same person, its important to include where applicable the family and re-enforce that evidence shows CBT to be the most effective path on the road to recovery, play, art and family therapy do not have supportive evidence for PTSD recovery.

Eye movement desensitization and reprocessing (EMDR) has and is being utilized by the British military as a one of their valued tools on the road to recovery for sufferers from PTSD and with positive results. EMDR has shown to reduce symptoms of PTSD, it is often used In conjunction with and incorporates aspect of other psychotherapies. There is 8 phases to the treatment which include assessment, ensuring stability of the client (making sure they are at the right part in there PTSD journey to undertake the treatment), Exposure to images, beliefs, emotions and body sensations that are related to the traumatic event the therapist after identification of these discusses them until they no longer become distressing this is with the finger moving back and forth in front of the eyes, following this you will be asked to write down things related to the stressful event and evaluation of previous EMDR treatment in the next treatment. EMDR is one option for your recovery, and can help reduce symptoms and increase functionality.

Your Dr might also consider medication to help your recovery and symptom management, while medications have shown to have a adjunctive benefit in PTSD symptom reduction there is no clear pharmacological treatment pathway. Medications such as selective serotonin reuptake inhibitors (SSRI) are first line treatment these are in the anti-depressant medication family. While medications such as mood stabilisers can help in reduction of your hyper arousal symptoms as well with mood and aggression. The pharmacological approach for symptom management can help in the short and medium term improve the quality of life, increase functionality and bring some relief from symptom’s, however a combination of psychotherapy and medication can often lead to a positive outcome.

The importance of loved ones, family and friends should not be forgotten and plays a huge role in recovery also support groups of people who have suffered similar life changing events can offer wonderful support and understanding and even help you understand your journey to recovery in a more deep and meaningful way.

Message of hope

While your PTSD journey may only be just beginning its important to remember you are not alone, things will get better with the right support and medications there is not reasons that you will not make a full recovery. While the dark clouds hang over your head and you do not see a way out, please never lose hope, your PTSD journey may only just be beginning, but you will get to the end and through positive engagement with your family and health services you will improve and ultimately recover. Nobody can change the past, time travel has not yet been invented. In the same note nobody can write your future so take charge and write your own future a bright future. Good look and stay safe.