Post-traumatic stress disorder (PTSD)

First published by ABC Health and Wellbeing 28/09/2014

Post-traumatic stress disorder (PTSD) is a set of mental health symptoms that can develop in someone who has experienced a traumatic event. While anyone can develop PTSD after a traumatic event, not everyone does.

Post-traumatic stress disorder (PTSD) is a set of mental health symptoms that occur after someone has experienced a traumatic event. Not all people who are exposed to a traumatic event will develop mental health problems, most will recover with few or no symptoms. For those that do PTSD will affect some, while others may develop other issues such as anxiety, depression, and substance abuse. Children may also develop separation anxiety, phobias, and other behavioural problems such as oppositional behaviour.

People often think about trauma as experiencing situations such as war and torture.

But trauma can also occur as a result of:

• someone close to you dying unexpectedly,
• seeing someone badly injured or killed,
• being in a life threatening car accident,
• being physically or sexually assaulted,
• being involved in a natural disaster.

People can get PTSD if they are directly involved in a traumatic event or if they witness a traumatic event happen to somebody else. Hearing about a traumatic event that has occurred to a close family member or friend can also cause PTSD. Trauma can also have an impact across generations particularly among children of veterans or Holocaust survivors.

PTSD can affect people of any age from toddlers and preschoolers, to school-aged children, adolescents and adults.

About 50 per cent of people in Australia will experience a potentially traumatic event during their lives, of these one in five people will go on to develop PTSD.

The nature of a traumatic event can affect how likely it is that a person will go on to develop PTSD. For example, as many as half of those who have experienced rape or child sexual abuse are likely to develop PTSD, whereas those who have experience a natural disaster are least likely at about 3 to 4 per cent. Military personnel have a relatively higher risk of developing PTSD than the general population. Around to one in five veterans will develop PTSD at some point in their lives, compared to one in 20 Australians in the general population. At any one time about 8 per cent of veterans will have PTSD compared to about 5 per cent of the general community.

About half the people who get PTSD will recover within 12 months regardless of what treatment they have. Treatment can be successful no matter how long a person has had PTSD.

Symptoms

The symptoms of PTSD can be quite varied. Common symptoms in adults can include:

• Re-experiencing the traumatic event: A common problem is reliving or re-experiencing the traumatic event in a vivid and distressing way. This can include having recurrent and intrusive memories and flashbacks and recurrent nightmares.
• Avoiding reminders: Symptoms can be so distressing that people with PTSD try to avoid situations they think might trigger the flashbacks and dreams. They might avoid certain people, places, conversations, or activities to try and avoid arousing distressing memories, thoughts and feelings.
• Being overly-alert: People with PTSD can become over-alert and be constantly on the lookout for signs of danger. They may be irritable and easily startled, have problems with concentration and difficulty sleeping.
• Having negative thoughts and emotions: People with PTSD often feel emotionally numb. They may lose interest in their normal activities and interests, feel detached from friends and family, and be unable to feel positive emotions such as happiness.

Children under six may express intrusive memories and trauma re-enactment through their play. And they may have distressing dreams that may or may not be are related to the traumatic event. Children under six can also express behaviours that are part of an earlier stage of development, such as bed-wetting.

In most people symptoms of PTSD start very soon after the traumatic event, but for some people whilst they may be experiencing symptoms of PTSD, the onset of full PTSD can be delayed months or years after the event. Even when the onset of symptoms is delayed, PTSD can be successfully treated.

Diagnosis

When doctors are concerned someone may have PTSD they may do a short screening test to look for it and other mental health problems.

Health professionals may also screen people at high risk for PTSD, such as those involved in a major event or incident, refugees and asylum seekers, as well as those in high-risk occupations.

To make a diagnosis a specialist mental health professional, such as a clinical psychologist or psychiatrist, will need to do a thorough assessment including the history of trauma event as well as considering any other mental health issues you may have, your overall physical health, your use of drugs and alcohol and how well you have responded to any previous treatments.

Treatment

PTSD is most commonly treated with psychological treatments with or without medications. The types of treatment best suited to you depend on a number of different factors including how long it is since the traumatic event, how long symptoms have been present for, and whether or not there are also other mental health conditions eg depression, anxiety and substance abuse. For children and adolescents treatment is tailored to their age.

Psychological treatments:

Psychological treatments with the most evidence of effectiveness for PTSD include:

• Trauma focused cognitive behaviour therapy (TF-CBT): This involves confronting the memory of the event and coming to terms with it. It may also involve exposure to situations that trigger symptoms.
• Eye movement desensitisation and reprocessing (EMDR): This involves moving the eyes rapidly back and forth while focusing on traumatic thoughts and images. It also includes elements of trauma focused cognitive behaviour therapy. It is not known if this technique is suitable for children.
• Non-trauma focused psychological interventions: Non-trauma focused psychological treatments such as stress innoculation training may be useful where trauma-focused therapy such as TF-CBT or EMDR do not seem to be working.
• Internet therapy: Self-help therapy delivered over the internet may be useful when no other options are available or suitable.

Medications

Medications are recommended when psychological interventions don’t appear to be working, when the person is unwilling or unable to commence a psychological treatment, when the person also has severe depression, or when there is ongoing and significant sleep disturbance that does not respond to psychological interventions.

When medication is required a selective serotonin reuptake inhibitors (SSRI) antidepressant is most conmonly used. Other types of antidepressants can also be helpful for some.

Medication is not useful for preventing development of PTSD in those exposed to trauma.

Other treatments

• There should be a focus on vocational, family and social rehabilitation from the outset to minimize disability and promote recovery.
• Acupuncture may be useful in people who have not responded to psychological treatments or medication.
• Regular exercise may be helpful in managing symptoms and sleep disturbance.

Where to get help?

Places to get help include your doctor or a mental health professional such as a psychiatrist, psychologist or social worker.

A listing of helplines for specific trauma related issues (including information for veterans) is available at the Australian Centre for Post Traumatic Mental Health

If you, or someone you know, needs help, you can call Lifeline 13 11 14, Suicide Callback Serviceon 1300 659 467, Kids Helpline on 1800 551 800, or MensLine Australia on 1300 789 978. For an extensive list of national and state-based counselling contacts go to our Emergency Contacts page.

This article was reviewed by Dr Andrea Phelps from the Australian Centre for Post-traumatic Mental Health, and Professor Justin Kenardy from the University of Queensland Schools of Medicine and Psychology.

By Dr Jocelyn Lowinger