Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Mental health Post-traumatic stress disorder (PTSD) Post-traumatic stress disorder (PTSD) Introduction Symptoms Causes Treatment Complex PTSD Self-help guide Introduction Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events. Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt. They may also have problems sleeping, such as insomnia, and find concentrating difficult. These symptoms are often severe andpersistent enough to have a significant impact on the persons day-to-day life. Read more about the symptoms of PTSD . Causes of PTSD The type of events that can cause PTSD include: serious road accidents violent personal assaults, such as sexual assault, mugging or robbery prolonged sexual abuse, violence or severe neglect witnessing violent deaths military combat being held hostage terrorist attacks natural disasters, such as severe floods, earthquakes or tsunamis PTSDcan develop immediatelyafter someone experiences adisturbing event or itcan occur weeks, months or even years later. PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but its not clear exactly why some people developthe conditionand others dont. Read more about the causes of PTSD . Complex PTSD People who repeatedly experience traumatic situations such as severe neglect, abuse or violence may be diagnosed with complex PTSD. Complex PTSD can cause similar symptoms to PTSD and may not develop until years after the event. Its often more severe if the trauma was experienced early in life as this can affect a childs development. Read more about complex PTSD . When to seek medical advice Its normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks. You should visit your GP if you or your child are still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome. If necessary, your GP can refer you to mental health specialists for further assessment and treatment. HowPTSD is treated PTSD can be successfully treated, even when itdevelops many years aftera traumatic event. Any treatment depends on the severity ofsymptoms and how soon theyoccur after the traumatic event.Any of the following treatment options may be recommended: Watchful waiting  monitoring yoursymptoms to see whether they improve or get worse without treatment. Psychotherapy  such as trauma-focusedcognitive behavioural therapy (CBT)or eye movement desensitisation and reprocessing (EMDR). Antidepressants  such asparoxetine ormirtazapine. Read more about treatingPTSD . Symptoms The symptoms of post-traumatic stress disorder (PTSD) can have a significant impact on your day-to-day life. In most cases, the symptoms develop during the first month after a traumatic event. However, in a minority of cases, there may be a delay of months or even years before symptoms start to appear. Some people with PTSD experience long periods when their symptoms are less noticeable, followed by periods where they get worse. Other people have constant, severe symptoms. The specific symptoms of PTSD can vary widely between individuals, but generally fall into the categories described below. Re-experiencing Re-experiencing is the mosttypical symptom of PTSD. This is when a person involuntarily and vividly re-lives the traumatic eventin the form of: flashbacks nightmares repetitive and distressing images or sensations physical sensations  such as pain, sweating, nausea or trembling Somepeople haveconstant negative thoughts about their experience, repeatedly asking themselves questions that prevent them from coming to terms with the event. For example, they may wonder why the event happened to them and if they could have done anything to stop it, which can lead to feelings of guilt or shame. Avoidance and emotional numbing Trying to avoid beingreminded of the traumatic eventis anotherkey symptom of PTSD. This usuallymeans avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience. Many people withPTSD try to push memories of the event out of their mind, often distracting themselves with work or hobbies. Some people attempt to deal with their feelings by trying not to feel anything at all. This is known as emotional numbing. This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing activities they used to enjoy. Hyperarousal (feeling on edge) Someone withPTSD may be veryanxious and find it difficult to relax. Theymay be constantly awareof threats and easily startled.This state of mindis known ashyperarousal. Hyperarousaloftenleads to: irritability angry outbursts sleeping problems ( insomnia ) difficulty concentrating Other problems Many people with PTSD also have a number of other problems, including: other mental health problems  such as depression , anxietyor phobias self-harming or destructive behaviour such as drug misuseor alcohol misuse other physical symptoms  such as headaches , dizziness,chest pains and stomach aches PTSD sometimes leads to work-related problems and the breakdown of relationships. PTSD in children PTSDcan affect children as well as adults. Children withPTSD can have similar symptoms to adults, such as having trouble sleeping and upsetting nightmares. Like adults, children with PTSD may also lose interest in activities they used to enjoy and may have physical symptoms such as headaches and stomach aches . However, there are some symptoms that are more specific to children with PTSD, such as: bedwetting beingunusually anxious about being separated froma parent or other adult re-enactingthe traumatic event(s) through their play When to seek medical advice Its normal to experience upsetting and confusing thoughts after a traumatic event, but in most people these improve naturallyover a few weeks. You should visit your GP if you or your child are still having problems about four weeks afterthe traumatic experience, or ifthe symptoms areparticularly troublesome. Your GP will want to discuss your symptoms with you in as much detail as possible. Theyll ask whether youve experienced a traumatic event in the recent or distant past and whether youve re-experienced the event through flashbacks or nightmares. Your GP can refer you to mental health specialists if they feel youd benefit from treatment. See treating PTSD for more information. Causes Post-traumatic stress disorder (PTSD) can develop after a very stressful, frightening or distressing event, or after a prolonged traumatic experience. Types of events that can lead to PTSD include: serious road accidents violent personal assaults, such as sexual assault, mugging or robbery prolonged sexual abuse, violence or severe neglect witnessing violent deaths military combat being held hostage terrorist attacks natural disasters, such as severe floods, earthquakes or tsunamis a diagnosis of a life-threatening condition an unexpected severe injury or death of a close family memberor friend PTSDisnt usually related tosituations that are simply upsetting, such as divorce, job loss or failing exams. PTSD develops in about 1 in 3 people who experience severe trauma. It isnt fully understood why some people develop the condition while others dont. However, certain factors appear to make some people more likely to develop PTSD. If youve had depression oranxiety in the past, or you dont receive much support from family or friends, youre more susceptible to developing PTSD after a traumatic event. There may also be a genetic factor involved in PTSD. For example, having a parent with a mental health problemis thought to increase your chances of developing the condition. Possible causes Although its not clear exactly why people develop PTSD, a number of possible reasons have been suggested. These are described below. Survival mechanism One suggestion is that the symptoms of PTSD are the result of an instinctivemechanismintended tohelp you survive further traumatic experiences. For example, the flashbacks many people with PTSD experience may force you to think about the event in detail so youre better prepared if it happens again. The feeling of being on edge (hyperarousal) may develop to help you react quickly in another crisis. However, whilethese responses may be intended to help you survive, theyre actually very unhelpful in reality because you cant process and move on fromthe traumatic experience. Adrenaline levels Studies have shown that people with PTSD have abnormal levels of stress hormones. Normally, when in danger,the body produces stress hormones such as adrenaline totrigger a reaction in the body. This reaction,often known as the fight or flight reaction, helps to deaden the senses and dull pain. People with PTSD have been found to continue to produce high amounts of fight or flight hormones even when theres no danger. Its thought this may be responsible for the numbed emotions and hyperarousal experienced by some people with PTSD. Changes in the brain In people with PTSD, parts of the brain involved in emotional processing appear different in brain scans. One part of the brain responsible for memory and emotions is known as the hippocampus. In people with PTSD, the hippocampus appears smaller in size. Its thought thatchanges in this part of the brain may be related to fear and anxiety, memory problems and flashbacks. The malfunctioning hippocampus may prevent flashbacks and nightmares from being properly processed, so the anxiety they generate doesnt reduce over time. Treatment of PTSD results in proper processing of the memories so, over time, the flashbacks and nightmares gradually disappear. Treatment The main treatments for post-traumatic stress disorder (PTSD) are psychotherapy and medication. Traumaticevents can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD. Its possible for PTSD to besuccessfully treated many years after the traumatic event occurred, which means its never too late to seek help. Assessment Before having treatment forPTSD, a detailed assessment of your symptoms will be carried out to ensure treatment is tailored to your individual needs. Your GP will often carry out an initial assessment, but youll be referred to a mental health specialist for further assessment and treatmentifyouve had symptoms of PTSD for more than four weeks or your symptoms are severe. There are a number of mental health specialists you may see if you have PTSD, such as: a psychologist  an expert in how the mind works a community psychiatric nurse  a nurse who specialises in mental healthcare a psychiatrist  a mental health specialist who diagnoses and treats mental health conditions Watchful waiting If you have mild symptoms of PTSD, or youve had symptoms for less than four weeks, an approach called watchful waiting may be recommended. Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse. Itssometimes recommended because 2 in every 3 people whodevelop problems after a traumatic experience get better within a few weeks without treatment. If watchful waiting is recommended, you should have a follow-up appointment within one month. Psychotherapy If you have PTSD that requires treatment, psychotherapy is usually recommended first. A combination ofpsychotherapy and medication may be recommendedif you have severe or persistent PTSD. Psychotherapyis a type of therapy oftenused totreat emotional problems and mental health conditions such as PTSD, depression , anxiety and obsessive compulsive disorder . The treatmentis carried out bytrained mental health professionals who listen to you and helpyou come upwith effective strategies to resolve your problems. The main types of psychotherapy used to treat people with PTSD are described below. Cognitive behavioural therapy (CBT) Cognitive behavioural therapy (CBT) is a type of therapy that aims to help you manage your problems by changing how you think and act. Trauma-focused CBT uses a range of psychological treatment techniques to help you come to terms with the traumatic event. For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. During this process your therapist helps you cope with any distress youfeel, whileidentifying any unhelpful thoughts or misrepresentations you have about the experience. Your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience. For example,feelingyoureto blame for what happened or fear that it may happen again. You may also be encouraged to gradually restart any activities youve avoided since your experience, such as driving a car if you had an accident. Youll usually have8-12 weekly sessions of trauma-focused CBT, although fewer may be needed. Sessions usually last for around 60-90 minutes. Eye movement desensitisation and reprocessing (EMDR) Eye movement desensitisation and reprocessing (EMDR) is a relatively new treatment which has been found to reduce the symptoms of PTSD. It involves making side-to-side eye movements, usually by following the movement of your therapists finger, while recalling the traumatic incident.Other methodsmay includethe therapist tapping their finger or playing a tone. Its not clear exactly how EMDR worksbut it may help you to change the negative way you think about a traumatic experience. Group therapy You may also be offered group therapy as some people find it helpfulto speak about their experiences with other peoplewho also have PTSD. Group therapy can be used to teach you ways to manage your symptoms and help you understand the condition. There are also a number of charitieswhich providecounselling and support groups for PTSD. For example: Combat Stress  a military charity specialising in helping ex-servicemen and women Rape Crisis  a charity providing a range of services for women and girls who have experienced abuse, domestic violence and sexual assault Victim Support  providing support and information to victims or witnesses of crime CRUSE  a UK charity providing support and information for people who have experienced bereavement Medication Antidepressants such asparoxetine, sertraline, mirtazapine, amitriptyline or phenelzineare sometimes used to treat PTSD in adults. Of these medications, paroxetine and sertraline are the only ones licensed specifically for the treatment of PTSD. However, mirtazapine, amitriptyline and phenelzine have also been found to be effective and may berecommended as well. However, thesemedications will only be used if: you choose not to have trauma-focused psychological treatment psychological treatment wouldnt be effective because theres an ongoing threat of further trauma (such as domestic violence) youve gained little or no benefit from a course of trauma-focused psychological treatment you have an underlying medical condition, such as severe depression, that significantly affects your ability to benefit from psychological treatment Amitriptyline or phenelzine will usually only be used under the supervision of a mental health specialist. Antidepressantscan also be prescribed to reduce any associated symptoms of depression and anxiety and to help with sleeping problems. However,theyre not usually prescribedfor people younger than18 unless recommended by a specialist. If medication for PTSD is effective, its usually be continued for a minimum of 12 months before being gradually withdrawn over the course of four weeks or longer. If a medicationisnt effective at reducing your symptoms,your dosage may be increased. Before prescribing a medication, your doctor should inform you about possible side effects you may have while taking it, along with any possible withdrawal symptoms when the medication is withdrawn. For example, commonside effects of paroxetine include feeling sick, blurred vision, constipation and diarrhoea. Possible withdrawal symptoms associated with paroxetine include sleep disturbances, intense dreams, anxiety and irritability. Withdrawal symptoms are less likely if the medication is reduced slowly. Children and young people Forchildren and young people with PTSD, trauma-focused CBT is usually recommended. This normally involvesa course of 8-12 sessions that have been adapted to suit the childs age, circumstances and level of development. Where appropriate, treatment includes consulting with and involving the childsfamily. Treatment with medication isnt usually recommended for children and young people with PTSD. Complex PTSD Complex PTSD may be diagnosed in adults or children who have repeatedly experienced traumatic events, such as violence, neglect or abuse. Complex PTSD is thought to be more severe if: the traumatic events happened early in life the trauma was caused by a parent or carer the person experienced the trauma for a long time the person was alone during the trauma there is still contact with the person responsible for the trauma Asitmay take years for the symptoms of complex PTSD to be recognised,a childsdevelopment, including their behaviour and self-confidence, can be altered as they get older. Adults with complex PTSD may lose their trust in people and feel separated from others. Symptoms of complex PTSD The symptoms of complex PTSD are similar to symptoms of PTSD but may include: feelings of shame or guilt difficulty controlling your emotions periods of losing attention and concentration  this is known as dissociation physical symptoms  such as headaches, dizziness, chest pains and stomach aches cutting yourself off from friends and family relationship difficulties destructive or risky behaviour  such as self-harm, alcohol misuse or drug abuse suicidal thoughts Treating complex PTSD One of the key symptoms of complex PTSD is losing trust in people. If possible, people with complex PTSD are recommended to slowly start doing regular activities such as: finding friends getting a job regular exercise taking on hobbies Its important to try and develop some feelings of trust.It may take some time, but atrusting relationship with a therapistwill helptreat complex PTSD. Treatment from a therapist may be given in three stages, described below. Stabilisation One of the first steps in treating complex PTSD may involve speaking with a therapist to learn how to control feelings of distrust and lose the feeling of being disconnected from friends and family. Certain techniques, known as grounding techniques, may be able to help you separate an abusive or traumatic past from the present. The aim is to make the past seem less frightening and reduce the amount of flashbacks you experience. With time, you can begin to experience less anxiety and learn to cope with daily life. Trauma-focused therapy Trauma-focused therapymay include: certain types of psychotherapy cognitive behavioural therapy (CBT) eye movement desensitisation and reprocessing (EMDR) These treatments may help you to control any distressing thoughts but must be approached carefully to avoid making the situation worse. Reintegration The final stage is to begin to use these skills and techniques todevelop better relationships with other people. Medication, such as antidepressants , may still be recommended if psychotherapy isnt possible or you feel unsafe. You can read more information about complex PTSD on the Royal College of Psychiatrists website . Self-help guide If you think youre experiencing post-traumatic stress disorder (PTSD) or complex post-traumatic stress disorder (CPTSD), its important for you to visit your GP and discuss your concerns. The PTSD and CPTSD self-help guide can help with managing symptoms while you wait for an assessment by your GP or a mental health professional. This guide aims to help you: consider whether youre experiencing symptoms of PTSD or CPTSD understand more about PTSD andCPTSD think about ways to manage or recover from PTSD or CPTSD The PTSD and CPTSD self-help guide is based on Trauma-Focused Cognitive Therapy (TF-CT). TF-CT aims to help people who have been through trauma and adversity to make sense of what theyve experienced, and become less distressed and affected by it. PTSD and CPTSD self-help guide Work through a self-help guide for PTSD and CPTSD based on Trauma-Focused Cognitive Therapy (TF-CT). PTSD and CPTSD self-help guide Source: NHS 24 - Opens in new browser window Last updated: 27 November 2023 How can we improve this page? Help us improve NHS inform Thank You Your feedback has been received Dont include personal information e.g. name, location or any personal health conditions. Email Address e.g. you@example.com Message Maximum of 500 characters Send feedback Add this page to\n            Info For Me Also on NHS inform Post-traumatic stress disorder (PTSD) (BSL) PTSD and CPTSD self-help guide Anxiety Depression Counselling and psychotherapy Other health sites BABCP - What is CBT? 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