Post-traumatic stress disorder (PTSD) is a relatively common mental disorder that develops in response to a traumatic experience, such as warfare, assault, and violence, including domestic and sexual violence and child abuse. While it is normal and appropriate to experience mental and physical distress in response to trauma, PTSD can be diagnosed when you continue to experience symptoms for a month or longer after the event. Not everyone who experiences trauma will develop PTSD; some people will experience distress, anxiety, and other symptoms in the immediate aftermath, but will feel better quite quickly. Some will experience several exposures to trauma, but will only respond with PTSD to one of them.

What Sort of Person Gets PTSD?

Anyone who experiences trauma can experience Post-traumatic stress disorder, and it is higher among groups that encounter greater than average levels of trauma, including members of the armed forces, firefighters, paramedics and other frontline workers, survivors of natural and other disasters (for example, a terrorist attack, a flood, the collapse of a building, or a traffic accident), those who have experienced living through war, those who have experienced domestic violence, and victims of child abuse, including sexual abuse. People who already have a psychiatric diagnosis, such as depression or Obsessive Compulsive Disorder (OCD), or who have close genetic relatives with such a diagnosis, are more likely than average to suffer from PTSD.

People also sometimes experience PTSD when something happens to someone else, such as when a member of the family dies suddenly or unexpectedly, or when they witness – perhaps over a sustained period of time – domestic violence against another person.

Women are considerably more likely than men to experience PTSD, perhaps because of the much higher levels of domestic and sexual violence they suffer; research suggests that people who have experienced interpersonal violence are more likely to develop PTSD than those who have experienced other types of trauma.

It is not clear why some people develop Post-traumatic stress disorder in response to trauma and not others – it is possible that there is a genetic component or that early childhood experiences have an impact – and it is never diagnosed in the absence of the prolonged presence of symptoms.

What are the symptoms of PTSD?

The symptoms of PTSD include:

• Intrusive thoughts or distressing feelings.
• Intrusive memories of the traumatic event playing “on repeat,” apparently endlessly.
• Recurring dreams or nightmares, “flashbacks” when you might feel as though you are relieving the traumatic experience.
• Physical symptoms including persistently elevated levels of stress hormones such as adrenaline and cortisol, which are normally produced in response to short-term threats in the environment, and which can become very dangerous for the health in the longer term.
• Avoiding people or situations that you fear may trigger feelings of distress, which can have a very negative impact on life and contribute to the isolation and self-limiting behaviours displayed by many people with PTSD.
• Experiencing persistent negative thoughts, including feelings of hopelessness for the future, concerns that things might never get better, and difficulty having positive thoughts and emotions, or enjoying rewarding relationships with family members and friends.
• Increased irritability and issues with anger management.
• Memory issues, which might include the inability to remember aspects of the traumatic episode that triggered the PTSD.
• Being hyper-alert to possible dangers in the environment and easily startled or frightened.
• In some cases, people with PTSD can experience suicidal ideation, often having never had any suicidal thoughts before.
• In the case of children with PTSD, they also may display a combination of physical and behavioural symptoms including regression, unlearning skills that they had mastered before, like speaking or being toilet-trained, or setbacks in their motor skills.

Many people with PTSD do not seek help in the initial stages of the condition. They might be unable to, which is common in the case of victims of domestic or child abuse, or victims of war, or they might be reluctant to, because of feelings of fear and anxiety, or even shame and guilt. Untreated, people with PTSD are at elevated risk of suffering comorbidities including depression and anxiety disorders and mood disorders, which might include dramatic mood swings, panic attacks, and problems with emotional regulation. Many people also self-medicate with legal and/or illegal substances including alcohol and other mood-altering drugs.

People who experience PTSD over a prolonged period face many threats to their physical health too, and are much more likely than others to experience a range of conditions including immunological, gastrointestinal, and cardiorespiratory diseases.

Can PTSD be Treated?

For most people, Post-traumatic stress disorder is eminently treatable. The earlier help is looked for and provided, the better, but almost everyone with PTSD will experience a significant reduction in their symptoms.

In the short term, and in a crisis situation, pharmaceutical treatments, usually anti-depressants, can sometimes help to relieve the symptoms of PTSD, but these are of very limited effectiveness beyond the short term, and clinical trials have failed to find compelling proof of their usefulness in general.

In the case of people who have experienced suicidal ideation, short term support focused on dealing with this issue may be called for. However, various modalities of talk therapy have been clinically proven to provide effective long term management and treatment of PTSD, with the vast majority of sufferers experiencing a dramatic improvement in their symptoms in a relatively brief period of time.

For those who have been diagnosed with PTSD, a range of treatments is available. They include:

• Cognitive Behavioural Therapy (CBT), which is focussed on helping sufferers to identify the triggers to their PTSD symptoms, understand them better, and to replace upsetting thoughts with less upsetting thoughts, in this way gradually learning how to respond differently to the thoughts and behaviours that tend to trigger episodes of distress or mental ill-health.
• Narrative Exposure Therapy (NET) is based on the concept that we all tell stories about our life experiences that effect how we view and interpret the things that happen to us, and on our general sense of well-being or lack thereof. If you have PTSD, you might self-narrate your life in a way that places the traumatic experience centre-stage, which makes it difficult to leave distress behind, or to manage it more effectively. In therapy, you can learn how to gain control of your own narrative, accept what has happened as part of your story, but cease seeing it as the central “most important” element. You will become enabled to maximise your skills and abilities so as to best seize control of your own life and, gradually, to let go of traumas that you have experienced in the past. NET is also used to treat conditions including panic disorder and others that may develop in response to, or be worsened by, PTSD.
• Prolonged Exposure Therapy (PET), in which the therapist helps their client to revisit distressing memories and triggers in a safe and supportive environment so that they gradually acquire a sense of being in control of their own thoughts and feelings.
• Psychodynamic Therapy (PT), in which the therapist helps you to explore your own personal values and the various sorts of emotional conflicts that you have experienced since the traumatic episode that triggered the PTSD.
• Cognitive Processing Therapy (CPT) is a specialised form of CBT that can be very effective in reducing symptoms of PTSD. Typically delivered over a relatively brief period of time, it teaches you to challenge and adapt beliefs that you have developed relating to the trauma you experienced. In the process, you can incrementally reduce the impact that the trauma has on your life and on your general sense of well-being.
• Interpersonal Psychotherapy (IPT) originally developed as a treatment modality for conditions such as depression, but has also been adapted to treat PTSD, among other conditions.. This approach emphasises helping you to understand your emotional responses and your relationships with others, and can be particularly useful for those with PTSD who have strong familial and social networks.
• Eye Movement Desensitisation and Reprocessing (EMDR) is a form of psychotherapy that helps to retrain the mind. When we are experiencing distress and deeply negative emotions, we typically also experience rapid eye movements. By focusing on the eye movements, and consciously and deliberately slowing them down and gaining control over them, we can also slow down our intrusive thoughts and gain a sense of mastery over them, too.
• Family Therapy can sometimes be indicated, because when one member of a family experiences PTSD it can affect the entire family dynamic, while recovery is greatly supported when family members have a better understanding of what you are going through.
• Group Therapy can be a very useful approach for some people with PTSD as they can experience therapy in the context of a group that has had similar experiences and knows what they are going through.

In cases where you have been self-medicating your PTSD symptoms with legal or illegal substances such as alcohol or other intoxicants, it may also be useful to engage with a therapist or a self-help group to tackle this behaviour too, in parallel with attending therapy for the PTSD per se.

Regardless of the psychotherapeutic modality used in treating your PTSD, your therapist may also suggest a number of measures to enhance lifestyle and wellness. This might include paying attention to physical well-being because exercise, exposure to the outdoors, and a healthy diet are all useful in helping healing, while the use of techniques including mindfulness, meditation, and positive psychology can all actively support recovery.

Long Term Outcomes for PTSD

While many people with Post-traumatic stress disorder are willing to seek a relationship with a therapist and to engage in therapy, those whose condition may be linked to circumstances that they might see as shameful or embarrassing – such as experiencing domestic violence – can be slow to reach out for help, or may find it difficult to do so for other reasons. However, precisely because PTSD is a condition that can and does respond quickly and well to treatment, it is important to seek this out as early as possible.

It is crucial for both the therapist and the person with PTSD to be mindful of cultural differences as they relate to experiencing and discussing trauma. While people from all cultural backgrounds experience trauma, and all can develop PTSD in response, sometimes the vocabularies used to discuss these issues are quite culture-specific. Where there are cultural differences between a therapist and their client, these issues should be discussed in a respectful, empathy-informed manner.

While PTSD is a serious mental health condition, most people who see a therapist for this reason will get better. In the initial stages of PTSD, the prospect of being well again can seem hopeless, but the vast majority of people with this condition can, and do, get much better quite quickly, by engaging with their therapist and working incrementally towards a positive future.