VOL: 102, ISSUE: 15, PAGE NO: 23
WHAT IS IT?
WHAT IS IT?
- Post-traumatic stress disorder (PTSD) is caused by exposure to a traumatic event that results in the person experiencing extreme fear, horror or a sense of helplessness. It can manifest itself both physically and mentally.
- The condition was first recognised in the First World War when soldiers experienced psychological difficulties as a result of battle. At the time it was known as ‘shell shock’.
- Recently it has been accepted that other experiences can precipitate PTSD, such as accidents, witnessing violent deaths, rape and other situations in which a person feels extreme emotions.
- PTSD is more common in women and can occur at any age.
- It is not fully understood why some people go on to develop PTSD after experiencing a traumatic event while others do not. However, there are certain predisposing factors:
- Previous experience of depression or anxiety;
- Family history of mental health problems;
- History of abuse as a child;
- MRI scans have shown that people with PTSD can have structural differences in their hippocampus, which is responsible for memory. This could contribute to symptoms such as flashbacks;
- Hormonal differences. Production of hormones such as adrenaline is a normal response to danger but people with PTSD may continue to produce these hormones after the event.
- PTSD is diagnosed through an assessment of the symptoms experienced by the patient.
- It is normal to experience symptoms of stress after a traumatic event but in PTSD the symptoms persist. They include:
- Intrusive thoughts;
- Avoidance of stimulus that may trigger memories of the event, such as war films;
- Outbursts of anger;
- Reluctance to discuss the event;
- Feelings of alienation and a numbing of emotion;
- Memory loss regarding elements of the event;
- Lack of interest in daily life;
- Difficulties with concentration;
- Sleeping difficulties;
- Excessive alertness to potential danger;
- Feelings of guilt;
- Alcohol and drug abuse;
- Relationship difficulties;
- Compromised immune system.
- In 2005 NICE issued guidance on the treatment of PTSD. Recommendations include:
- Trauma-focused cognitive behavioural therapy (CBT);
- Eye-movement desensitisation and reprocessing (EMDR);
- Psychological therapies are suggested as first-line treatment;
- Antidepressants, especially selective serotonin re-uptake inhibitors, can alleviate symptoms. Sleeping tablets can help with insomnia. Benzodiazepines can be used to treat anxiety but must be used with caution due to their addictive properties;
- Children should be offered trauma-focused CBT tailored to their age and experience.