Post-Traumatic Stress Disorder (PTSD) is a complex and debilitating condition that can affect every aspect of a person’s life.
It is a psychological response to the experience of an event (or events) of an intensely traumatic nature. These type of events often involve a risk to life – one’s own or that of one’s colleagues.
It is a condition that can affect anyone, regardless of age, gender or culture.
PTSD has been known to exist since ancient times, albeit under the guise of different names.
During the First World War it was referred to as “shell shock”; as “war neurosis” during WWII; and as “combat stress reaction” during the Vietnam War. In the 1980s the term Post Traumatic Stress Disorder (PTSD) was introduced – the term we still use today.
Although PTSD was first brought to public attention by War Veterans, it can result from any number of traumatic incidents. The common denominator is exposure to a threatening event that has provoked intense fear, horror or a sense of helplessness in the individual concerned.
The sort of traumatic events that might be experienced by members of the general public include physical assault, rape, accidents or witnessing the death or injury of others – as well as natural disasters, such as earthquakes, hurricanes, tsunamis and fires.
In the case of Serving personnel, traumatic events mostly relate to the direct experience of combat, to operating in a dangerous war-zone, or to taking part in difficult and distressing peace-keeping operations.
PTSD: Common symptoms
PTSD is characterised by three main symptom clusters. These are re-experiencing, avoidance, and hyper-arousal symptom clusters.
Individuals with PTSD repeatedly relive the event in at least one of the following ways:
- Intrusive unwanted memories of the traumatic event.
- Unpleasant nightmares which comprise replays of what happened.
- Flashbacks where they may suddenly act or feel as if they are reliving the event.
- They become emotionally upset if something reminds them of the traumatic experience.
- Palpitations, sweating, feeling tense or shaky if they are reminded about their traumatic experience.
People with PTSD try to avoid thoughts and feelings related to the traumatic event. They find it extremely difficult at times, as the traumatic images and memories intrude spontaneously. Symptoms include:
- Avoidance of activities, places or people which remind them of their trauma.
- Difficulty remembering exactly what happened during exposure to their traumatic event (this reflects the intense fear at the time of exposure).
- Becoming less interested in hobbies and activities that they used to enjoy before the traumatic event.
- Feeling detached and estranged from people, and feeling that nobody understands them – a tendency to isolate themselves.
- Becoming emotionally numb, and having trouble experiencing their feelings.
- A sense of futility in relation to their future and feeling that somehow they will be stuck down by yet another disaster or tragedy.
Hyper-arousal symptoms cause problems with relationships, especially problems generated by irritability and anger. They include:
- Great difficulty falling or staying asleep.
- A tendency to being irritable and angry at the slightest provocation and for trivial reasons.
- A tendency to become aggressive, verbally or physically, or to become violent towards themselves or others.
- Great difficulty concentrating, and concentration usually requires effort.
- Remaining especially alert and watchful (hyper-vigilant).
- Looking for signs of danger in their environment and in an exaggerated way; they are tuned in to any sign that they might perceive as threatening.
Commonly associated symptoms
The other symptoms that are commonly associated with PTSD relate to feelings of guilt, and difficulty relating to authority figures.
Guilt can take two forms:
- Guilt in relation to what one should or should not have done during the traumatic exposure.
- Survivor guilt: while the individual survived relatively intact (physically, at least), others involved in the traumatic experience did not.
In many traumatic exposures, the individual may perceive that the system or hierarchy has let them down, and therefore anger and hostility can be a major factor in the presentation of PTSD.
It should be noted that the most common co-morbid presentations with PTSD are depression and alcohol abuse or dependence. Co-morbid illness needs to be addressed and treated alongside PTSD.
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