A Post Traumatic Stress Disorder (PTSD) can happen to any one exposed to a traumatic event that is sufficiently stressful to fill them with horror and dread. Exceptionally horrific events are more likely to precipitate a PTSD. It is estimated that nearly one third of those directly exposed to the violence on September 11 2001 went on to develop a PTSD. Nearly 5% of men and nearly 10% of women develop PTSD in their lifetime. PTSD is the fourth most common mental health problem in Ireland.
The features of PTSD include, persistent distressing re-experiencing of the original event (flashbacks, nightmares or intrusive thoughts); long term avoidance behaviours (persistent unwillingness to re-engage in activity that reminds someone of the event, emotional numbness or depression) and sustained hyper-arousal (agitation, uncharacteristic irritability, sleeplessness and difficulty concentrating). There is significant overlap with other mental health problems and patients may also present with features of panic, agoraphobia, depression and or substance misuse.
It is normal to respond with fear in situations of threat. A fear mechanism giving the preparedness for fight or flight is an essential part of human physiology. Unfortunately some people develop a severe problem when this physiological response continues long after the horror has passed. This prolonged anxiety may take the form of PTSD.
PTSD is distressing. While many people experience anxiety guilt or agitation after a traumatic event most of these acute stress reactions settle down within four weeks of a trauma. Most people with acute stress reactions make a full recovery, however the experience of an acute stress reaction does increase the risk of developing a longer term PTSD. People with PTSD suffer persistent distress long after the event (at least 4 weeks after), and although most PTSD is resolved within six months following the trauma, some go on to experience chronic distress.
Many people blame themselves for the circumstances of their trauma and so they respond with shame and guilt to the distress. It may be difficult to elicit the symptoms because people conceal their distress or because they themselves are bewildered by the powerful psychological challenges they are going through.
Typical events leading to PTSD include horrific violence of an interpersonal kind (rape, childhood sexual abuse, or torture) or life threatening accidents and natural disasters (road traffic accidents or terror events, fires and earthquakes). Interpersonal violence is far more likely to precipitate a PTSD than other kinds of horror. This probably explains why women are twice as likely to develop PTSD compared to men since the likelihood of being raped is 10 time greater for a woman than a man. “PTSD develops in 55 percent of persons who reported being raped, as compared with 7.5 percent of those involved in accidents and 2 percent of those who learned of traumatic events”.
Along with the scale of the trauma and the extent of the loss, certain other factors increase the likelihood of developing a PTSD, these include the predictability of the trauma, the sudden nature of its onset and the perception of loss of control. “If the patient is wounded or exposed to pain, heat, or cold, the biological and psychological experience can be intensified… PTSD can occur in persons who have witnessed a violent injury or the unnatural death of another person and those who have learned that a loved one was involved in such an event. One study reported that PTSD developed in approximately 14 percent of those who experienced the sudden, unexpected death of a loved one, making this event the single most frequent traumatic event to occur in both men and women, accounting for 39 percent of cases of PTSD in men and 27 percent of cases in women”.
The causes of PTSD are biological and psychological and social. This is a condition that illustrates supremely the interrelationship of these three mental forces. Modern scientific data suggest the genetic and brain basis for the condition in a compelling way. Brain regions involved in memory formation (amygdala, hippocampus and the prefrontal cortex) and specific proteins necessary for the maintenance of fear memories appear to be dysfunctional in people with PTSD; but as with many mental health problems there is no single gene involved in PTSD and the brain regions which appear to be dysfunctional form a basis for the development of PTSD rather than a specific cause for the clinical distress.
A similar picture also exists with the treatment of PTSD which relies on several “talking- therapies” such as trauma-based cognitive behavioural therapy (CBT) and eye movement desensitisation (EMDR). Medicines such as specific serotonin re-uptake inhibitors may also be useful. These techniques act in a holistic way to harness the capacity of the brain to re-learn new responses and new attitudes even when we are injured by horrific traumatic experiences.
The main focus of recovery should be on the uncovering of distress and the building of trust so that the burdens of shame and guilt which sustain the isolation of PTSD begins to break down. PTSD is a treatable psychological condition which left neglected can become a chronic and disabling problem. Treatment is effective. That is why it needs to be made more available and more accessible.
For more information about PTSD and other mental health problems call the Information and Support Line on 01 2493333
Trauma and PTSD rates in an irish psychiatric population
A comparison of native and immigrant samples, PMID: 28228990
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