Post-traumatic stress disorder (PTSD)

What is PTSD?

Post-traumatic stress disorder (PTSD) is a treatable anxiety disorder affecting around 3 million Australians at some time in their lives.

It happens when fear, anxiety and memories of a traumatic event don’t go away. The feelings last for a long time and interfere with how people cope with everyday life.

What are the symptoms of PTSD?

Everyone is affected differently by PTSD. Symptoms can range from subtle changes in day-to-day life, withdrawal and numbness, to distressing flashbacks or physical anxiety.

Symptoms of PTSD may appear in the month after the traumatic event, but sometimes they can stay dormant for years.

Some symptoms of PTSD include:

• re-experiencing the trauma
• repetitive memories (or flashbacks) that are hard to control and intrude into everyday life
• nightmares
• extreme distress caused by reminders of the trauma
• memories or disturbing thoughts that can be prompted by smells, sounds, words or other triggers

Avoidance

• staying away from places, people or objects that may trigger memories of the traumatic event
• changing a normal routine to avoid triggering memories
• not wanting to talk about or think about the event
• feeling numb

Negative thoughts and mood

• feeling a sense of hopelessness about the future
• negative beliefs about yourself or the world
• blaming yourself or others unreasonably
• intense worry, depression, anger or guilt
• not being able to remember the traumatic event
• no longer enjoying favourite activities
• becoming emotionally detached from others
• not being able to experience positive emotions

Increased arousal

• constant, excessive alertness
• scanning the environment for signs of danger
• being easily startled
• irritable or aggressive behaviour
• difficulty sleeping
• poor concentration

For a symptom checklist, visit Beyond Blue.

Children or teenagers with PTSD may have similar symptoms, but with some differences. Symptoms of PTSD in children include:

• new onset of bedwetting when previously dry at night
• being unusually clingy with parents or carers
• acting out the event during play
• forgetting how to talk
• distressing dreams
• being more irritable, angry or aggressive — such as having extreme temper tantrums
• having problems with concentration
• not being able to sleep

A teenager may experience any of the adult symptoms but may be more likely to:

• have a desire for revenge
• behave in a destructive, disrespectful or violent way
• increase risk-taking behaviour

What causes PTSD?

PTSD can be caused by experiencing or witnessing a traumatic event — an event that was potentially life-threatening, or involved serious injury or sexual violence. The kinds of experiences that can potentially cause PTSD are:

• serious accidents
• natural disasters such as bushfires, floods and earthquakes
• living in a war zone, as a victim of war or a soldier
• sexual assault or threatened sexual assault
• serious physical assault
• seeing people hurt or killed

Although a relationship break-up or losing a job can feel devastating, these are not the kinds of events that usually cause PTSD.

Anyone can develop PTSD, but some people are at greater risk. There is probably a mixture of reasons explaining why some people develop PTSD while others do not.

Risk factors for developing PTSD include:

• repeated trauma, such as living in a war zone for a long time
• having had a mental illness in the past, like anxiety or depression
• a history of trauma or abuse in early childhood
• experiencing very severe trauma
• not having enough support afterwards
• extra life stresses after the trauma, such as the loss of loved ones, a home or a job
• the type of traumatic event, with rape or sexual assault being more likely to lead to PTSD than other events

PTSD is not the only mental health disorder caused by experiencing traumatic events, and depression and anxiety disorders may be just as common. Depression, generalised anxiety, PTSD and agoraphobia are the most common disorders that can be caused by traumatic events.

When should I see my doctor?

If you or someone you know appears to be experiencing symptoms of PTSD for longer than one month after a traumatic event, it’s important to talk to a doctor or other health professional.

How is PTSD diagnosed?

The doctor will do a mental health assessment. This means they will ask about current symptoms, past history and family history. They may do a physical examination to check that there are no other reasons for the symptoms.

The doctor may refer to a psychiatrist or psychologist. They will ask how long, how often and how intense the symptoms are, and what happened during the triggering event.

For PTSD to be diagnosed, the symptoms need to be severe enough to interfere with someone’s ability to function at work, socially or at home. A full diagnosis cannot be made until at least 6 months after the trauma.

Often a diagnosis can come as a relief for someone who has been suffering debilitating symptoms because it provides an explanation and a basis for beginning treatment.

How is PTSD treated?

Many people have some symptoms of PTSD in the first couple of weeks after a traumatic event, but most recover on their own or with the help of family and friends.

For people whose symptoms last longer, PTSD is treated with psychotherapy or sometimes medicine, or both. Everyone’s PTSD is different, so if you have PTSD you might need to try a few different types of treatment before you find something that works for you.

Psychotherapy for PTSD

There are different types of therapy that can be given by a psychologist or psychiatrist. You will need a referral from a doctor.

Some treatments include:

• trauma-focused cognitive behaviour therapy (TF-CBT), which involves working through memories of the trauma in a safe and structured environment, trying to change unhelpful beliefs and thoughts, and gradual exposure to triggers that are being avoided
• eye movement desensitisation and reprocessing (EMDR), which involves working through memories of the trauma while going through a series of eye movements

It may take between 8 and 12 psychotherapy sessions to begin to get relief from symptoms. For some people, the condition may have become chronic and can take much longer to treat. The sooner treatment begins, the better.

Medicines for PTSD

Medicine for PTSD is usually not recommended unless symptoms last longer than 4 weeks, or unless the symptoms are so bad that psychological treatments aren’t working. Generally, it’s best to start with psychological treatment rather than use medicine as the first and only solution to the problem.

Antidepressant medication may be recommended if symptoms do not completely go away with psychotherapy, or the person is unable to have therapy for some reason. Antidepressants can reduce anxiety and fear, depression and anger.

It’s important to be aware of the possible side effects and to maintain regular contact with a doctor or mental health practitioner while you’re using the medications.

Supporting someone with PTSD

Research has shown that support from family and friends is important in helping someone overcome the debilitating effects of PTSD. Couples or family therapy can help to fix damaged relationships. In some cases, family members may need to seek support of their own.

For detailed information on the most effective treatments for PTSD, see The Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder.

Complications of PTSD

Up to 8 in 10 people with long-standing PTSD develop other anxiety disorders, depression and/or substance abuse. Coping by trying to block out the memories with substance abuse can lead to addictions.

PTSD can prevent people from performing properly at work and make them isolated from relatives and friends. It can put great stress on families. This is why early support and treatment is essential.