Post-Traumatic Stress Disorder (PTSD): Diagnosis and Treatment

Definition of PTSD

Post-Traumatic Stress Disorder (PTSD) refers to a condition where an individual experiences persistent feelings of anxiety and distress following exposure to a highly stressful event. These symptoms last for at least one month and disrupt daily life. Such events could involve personal experiences or being a witness to situations like natural disasters, abuse, or sexual assault. The trauma-related memories often lead to flashbacks, nightmares, or avoidance behaviours. Physiological responses may include heightened startle reflexes, restlessness, insomnia, and irritability.

Historically, terms like "shell shock" or "combat fatigue" were used during studies of war veterans to describe similar psychological states. The term PTSD was later coined to unify these conditions under one diagnosis. The severity of symptoms varies from person to person. While some may experience frequent flashbacks, others might exhibit more pronounced physical symptoms. These symptoms can fluctuate over time. Around one-third of patients require follow-up treatment for a year post-recovery, while another one-third may still experience symptoms a decade after the traumatic event.

Causes of PTSD

Being female
Experiencing past trauma or ongoing stressors
A history of mood or anxiety disorders
An inherent tendency towards anxiety-prone personality traits
Lack of a supportive social network
Genetic predisposition or a family history of mental health conditions

Symptoms of PTSD

PTSD symptoms typically emerge within weeks to six months after a traumatic incident via either one of the following:

Direct/personal involvement/exposure
As witness to the event
Upon learning that the event happened to a close relative or friend, or
Indirect exposure usually via professional work such as emergency responders

If these symptoms interfere with daily life, a diagnosis of acute stress disorder is often made within 30 days of the event by a doctor. According to the American Diagnostic and Statistical Manual of Mental Disorders (DSM-V), PTSD requires symptoms to persist for over a month, cause significant distress, and disrupt daily functioning. The intensity of symptoms may vary, often worsening during periods of additional stress or when reminded of the traumatic event. Key symptoms include:

Intrusive thoughts: Unwanted memories of the traumatic event, often accompanied by reliving the emotions of the moment, as though re-experiencing it. These can manifest as recurring nightmares at night.
Avoidance: Actively steering clear of places, objects, situations, or conversations that may trigger memories of the trauma.
Hypervigilance: Being "on edge" or easily startled by minor stimuli, often appearing anxious, irritable, or overly responsive. This can result in difficulty sleeping or concentrating.
Emotional instability and negative thoughts: Some individuals may feel emotionally numb, lose interest in previously enjoyable activities, or withdraw from friends and family. Feelings of hopelessness about the future or concurrent issues like depression, substance abuse, or other health problems may arise.

In 15-30% of PTSD cases, especially among children, dissociative symptoms may occur. This can involve temporary disruptions in sense of identity, and awareness of themselves and their surroundings, leading to a sense of detachment or unreality.

To diagnose PTSD, physicians typically collect a detailed medical history concerning the traumatic event and associated symptoms. For patients involved in legal proceedings, such inquiries may cause additional stress. Some doctors utilise self-reporting assessment tools, such as the PCL-5 scale, to evaluate and monitor symptom severity over time.

Triggers of PTSD

PTSD triggers are subjective and often involve events that leave the individual feeling deeply unsettled or threatened. Direct experience is not always necessary—being present at the scene or witnessing the event can also provoke similar responses. Common triggers include physical or sexual assault, accidents, war, natural disasters, abuse, or terrorist attacks.

Prevalence

The prevalence of PTSD varies across countries due to differences in measurement methods, making comparisons challenging. Cultural factors may also influence its development. In the United States, the lifetime prevalence of PTSD is reported at 6.8%, with a 12-month prevalence of 3.5%. Meanwhile, lifetime prevalence rates in other countries range from 0.3% (China) to 6.1% (New Zealand).

PTSD is frequently associated with other mental health issues, such as depression, insomnia, personality disorders, eating disorders, and suicidal tendencies. Some individuals may resort to substance or alcohol use to manage symptoms like nightmares or intrusive thoughts. This underscores the importance of seeking prompt treatment.

Medication

Doctors may prescribe medication for individuals who prefer it, lack access to psychotherapy, or have co-existing mental health conditions. Antidepressants, particularly Selective Serotonin Reuptake Inhibitors (SSRIs), are commonly used to alleviate PTSD symptoms. Studies have shown that patients may benefit from taking an antipsychotic medication alone or a combination of antipsychotics and antidepressants to treat PTSD. Doctors may sometimes prescribe Prazosin to individuals struggling with nightmares and difficulty sleeping. Sedatives like benzodiazepines can be used for short-term relief to aid sleep and reduce anxiety; however, research has not identified other significant benefits and may worsen symptoms over time. Also, there is a risk of misuse and dependency.

Treating PTSD

Various psychological therapies are available for PTSD, with Cognitive Behavioural Therapy (CBT) being the most common. CBT helps patients process trauma-related emotions in a safe and controlled environment, reducing distress. This can be done in real-life scenarios or through guided imagery, allowing individuals to confront and overcome their fears. Therapists also teach coping strategies to manage symptoms effectively.

Another specialised therapy is Eye Movement Desensitisation and Reprocessing (EMDR). This involves a therapist guiding the patient’s eye movements to reduce traumatic memories’ associated fear and hyperarousal. EMDR has been shown to significantly alleviate PTSD symptoms.

If you or someone close to you is experiencing symptoms of PTSD, consider reaching out to a psychiatrist or psychological therapist for professional support.