PTSD: The Definitive Guide

Introduction

In this feature, we’ll give you an overview of PTSD (Post Traumatic Stress Disorder) with real testimonials and concise, easy-to-read information and advice about treatment options. Whether you are suffering with PTSD, know somebody who is, or just looking to learn, we sincerely hope it helps.

This account, from PTSD sufferer P.K Philips, was posted to the Anxiety and Depression Association of America’s (ADAA) website in 2018.

“For months after the attack, I couldn’t close my eyes without envisioning the face of my attacker. I suffered horrific flashbacks and nightmares. For four years after the attack I was unable to sleep alone in my house. I obsessively checked windows, doors, and locks. By age 17, I’d suffered my first panic attack. Soon I became unable to leave my apartment for weeks at a time”

Although specific cases of PTSD can be as unique as the people who experience them, at least some of P.K’s story will be familiar to people with experience of PTSD.

What's in the Article

  1. What is PTSD?
  2. History of PTSD
  3. What Causes PTSD?
  4. Symptoms of PTSD
  5. How to Tell if you Have PTSD
  6. PTSD Diagnosis
  7. What Does a PTSD Diagnosis Mean?
  8. What Does PTSD Feel Like?
  9. How Long Does PTSD Last?
  10. Treatment Options for PTSD
  11. Coping With PTSD
  12. How to Support Someone who has PTSD
  13. PTSD in Popular Culture
  14. Who Can Develop PTSD?
  15. What is Complex PTSD?
  16. Portsmouth University Study into PTSD and the Security Industry
  17. Where to Get Help

1. What is PTSD?

“My husband of all of three months had become a shell of his former self overnight. He had gone from a hardworking, compassionate, independent man to someone whose hands tremor so badly he can’t tie his own shoes and has night terrors so vivid he is often hoarse the next morning.”

(Source: Gawker.com)

PTSD stands for Post-Traumatic Stress Disorder. It is an anxiety disorder that occurs in cases where an individual has experienced (or been otherwise exposed to) stressful, frightening or distressing events.

Although it is best known for affecting veterans and military personnel exposed to combat situations, PTSD can actually occur from a varied and diverse array of circumstances, including:

  • Road accidents.
  • assault (including sexual assault).
  • Near death experience
  • Burglary/Home invasion.
  • Serious health problems.
  • Experiences during childbirth.
  • Torture.
  • Harassment/Bullying/Stalking.
  • Being kidnapped/Held
  • Hostage.
  • Surviving a natural disaster.
  • Bereavement.
  • Imprisonment.
  • Re watching incidents on CCTV or Home installed Cameras
  • Any event in which a person fears for their life.

In simple terms, PTSD occurs when a person’s mind is unable to integrate unwanted memories in the usual way.

These memories (which can include emotional reactions and sensory experiences) can then intrude upon that person’s life in a variety of different ways, including flashbacks, nightmares, emotional outbursts and physical symptoms such as shaking or panic attacks.

The condition is far more common than most people realise, as it develops in about 1 in 3 people who experience severe trauma.

2. History of PTSD

“He gave a clear description of nightmares, vivid dreams, visual flashbacks, and he can also smell burnt flesh and feel the smell of death… He also described (…) tensing up when he saw hazard-warning lights on a vehicle. He explained that in Iraq, vehicles loaded with explosive devices only had their hazard warning lights on.”

(Source: The Guardian)

PTSD has probably been around for almost as long as human beings have. Examples of what would now be viewed as PTSD occur throughout our historical records, though the chroniclers of their time often lack the terms to properly describe it.

In 480BC, for example, Spartan commander Leonidas is recorded as dismissing men from the battlefield if they were too psychologically affected by previous battles. In another instance from antiquity, the Greek Herodotus describes an Athenian soldier who went blind from fear during the battle of Marathon.

In 1678, Swiss military doctors recognised the symptoms of PTSD, then grouped them together under the term ‘nostalgia’. Later, troops fighting in the American Civil War were diagnosed with ‘soldier’s heart’ or ‘exhaustion’.

During the First World War, the condition was identified as ‘shell shock’ because it was believed that the explosions of bombs and shells caused nerve damage. By the conclusion of the Second World War, where more than 43% of all men discharged were sent home with psychological trauma, the terminology had been softened to ‘battle fatigue’.

In the 1950’s, as a better standard of medical science began to emerge, the condition became known as ‘stress response syndrome’.

Following the Vietnam War, as more and more veterans were diagnosed with ‘post-Vietnam syndrome’, there was intense pressure for both the medical community and military organisations to better categorise and treat this elusive ailment.

Since that time, PTSD is understood to impact the lives of a great many people, even if those people are not soldiers. In fact, female victims of rape develop PTSD in far greater numbers than male war veterans do.

Compare these excerpts to the testimonials shared throughout this article and you’ll see that PTSD has a long and sad history.

3. What Causes PTSD?

“Until you kill other human beings for survival, what could you possibly say about it? It assaults all your scenes, the smell of death and the machines that cause it. Noises so loud you feel like an ant under a lawnmower. It is incomprehensible”.

(Source: Gawker.com)

We now know that trauma, of any kind, changes both the brain and the body. Every trauma-related neuropathway, even if it has lain dormant for a considerable period of time, has the potential to reactivate. 

In the ‘Triune’ (or ‘three part’) brain model, the brain is separated into three parts, the reptilian (responsible for instinctive and autonomic behaviour), mammalian (which processes emotions and senses) and neomammalian (which controls cognitive learning, decision-making, learning and memory).

During a traumatic event, the reptilian brain takes over, mainly to facilitate a quick escape. You often hear survivors of natural disasters or terrorist attacks saying things like “I didn’t think, I just acted” this is because the reptilian brain forcibly shuts down all non-essential body and mind processes. The sympathetic nervous system then releases all the ‘fight or flight’ hormones necessary to survive. This is called ‘reactive mode’.

Once the person has survived, the parasympathetic nervous system begins to reassert control, reducing the stress hormones now that the threat has passed. This is called ‘responsive mode’.

In some cases where PTSD develops, the transition from reactive to responsive mode never actually occurs. Instead, the reptilian brain maintains its grip on the individual, giving them a constant feeling of being under threat.

Imagine that your brain never stopped feeling like it did when that car almost hit you, or when that gang of big kids cornered you in childhood, or when somebody you loved was about to die and you were powerless to help them. Now imagine those feelings lasting years, even decades. That, in effect, is PTSD.

4. Symptoms of PTSD

“Even after I moved to Germany, removing myself from the city and the country where the burglary occurred, the robbery stayed with me. It took weeks before I stopped having bad dreams or stopped eyeing strangers on the street near my house. The most valuable thing the burglars took was my sense of security”.

(Source: Pacific Standard)

Generally speaking, PTSD symptoms fall into four main groups. These are:

  • Intrusive thoughts (unwanted memories or flashbacks).
  • Mood alterations (becoming excessively negative or irritable).
  • Hypervigilance (being constantly ‘on edge’ and having an exaggerated startle response).
  • Avoidance (going to great lengths to avoid anything that reminds the sufferer of the traumatic events).

PTSD may present via nightmares, flashbacks, mood swings, violent fits of rage, increased heart rate, pain, chest pains, panic/anxiety attacks, sweating, nausea, shaking, memory loss, forgetfulness, insomnia, shortness of breath, crying, emotional numbness, isolating oneself from friends, family and colleagues, low self-esteem, self-harm, self-destructive behaviour and abuse of alcohol or drugs.

Some PTSD sufferers experience complex feelings of guilt or shame relating to their experiences. They can exhibit trust issues or feelings that nobody understands them. Some feel that they can never be safe. They may become suspicious, even paranoid. In some cases, PTSD sufferers have become completely unable to express affection for other people.

In children, PTSD can present through bedwetting (or other ‘accidents’), anxiety about being separated from a parent or trusted adult or re-enactment of the trauma through play.

5. How to Tell if you Have PTSD

“The depression totally immobilises me. I can’t even pick up a razor to shave, unable to look in the mirror; I question my existence. It becomes so intense that I have to go to bed for a couple of days and wait for it to pass.”

(Source: NCBI)

If you’ve experienced a traumatic event at any point (even during childhood), you may develop PTSD as a result. If you are experiencing any of the symptoms described above on any kind of a regular basis, you may already have PTSD.

Fortunately, there are a number of tests available online. Click the link below and see for yourself.

If you have doubts, you should consult your doctor.

A good idea would be to talk to a trusted friend, family member or partner. Ask them if you seem different or if your behaviour has changed.

Think back to a time before the traumatic event took place, Did you do anything differently? How has the event changed you? 

The answers may surprise you.

6. PTSD Diagnosis

“Triggers can come from anywhere at any time… a smell, a look/ glance, a vibe, a dream… how someone treats you. You are unable, as hard as you try, to turn it off.”

(Source: The Mighty)

After a traumatic event has taken place, it is normal to experience feelings of anxiety, sadness or stress. Sometimes the event will play on your mind or stop you from sleeping, but these effects should only be temporary.

It is also normal for some people who don’t have PTSD to exhibit some of the symptoms of PTSD. This does not necessarily mean that they have the disorder.

It is very common these days for people to look up their symptoms online and immediately assume the worst (headache = brain tumour) and this is as true for mental ailments as it is for physical ones. Many PTSD symptoms are also symptoms of stress, for example.

The criteria for diagnosing PTSD consists of 8 points, labelled A – H. Patients must fulfil said criteria in order to be formally diagnosed.

However, only a medical professional can do this. If you are concerned about yourself or somebody else, we recommend taking one of the quizzes we’ve linked in this piece and following that up with a visit to your doctor.

7. What Does a PTSD Diagnosis Mean?

“I was diagnosed by my GP with PTSD a few weeks after the death of my father who died very suddenly, following a family outing to the local pub for lunch. He collapsed in front of us and we had to administer CPR at the scene while waiting for the ambulance. He died on his way to hospital.”

 (Source: Mind.org)

If you have an unpleasant or frightening experience, it is normal for your emotional reaction (e.g. fear, panic, anger etc.) to outlast the event itself. Usually, these feelings will fade over time. However, if they do not, you could be experiencing PTSD.

Being diagnosed with PTSD (or any other psychiatric disorder, for that matter) does not make you ‘crazy’ – nor is it a sign of weakness.

PTSD does not describe cowardice or even an ‘inability’ to deal with unpleasant events. It is the natural consequence of a human mind that is trying to process a traumatic experience.

Additionally, you don’t have to directly experience trauma in order to develop PTSD. If a person close to you experiences trauma of any kind, it is possible for you to develop PTSD from this. In some instances, police officers have developed PTSD after repeated exposure to the unpleasant details of child abuse or murder cases, even though they were never physically present for any of the events described. This is called secondary trauma.

8. What Does PTSD Feel Like?

“I was still mentally and nervously organized for War. Shells used to come bursting on my bed at midnight, even though Nancy shared it with me; strangers in the daytime would assume the faces of friends who had been killed.”

From an account given by Robert Graves, British poet and veteran of the First World War (Source: Washington Post)

Living with PTSD can be a constant challenge. Some sufferers have described it as being similar to the feeling of anxiety or alertness after someone or something suddenly scares you, except that it never goes away. Others describe a feeling of being constantly on guard.

According to some descriptions, it is a feeling of being perpetually trapped in a terrible moment of time, for others, it is, quite literally, a waking nightmare.

A PTSD sufferer named ‘Nargis’ gave a particularly evocative description of the disorder to the health website ‘The Mighty’

“It’s like you’re tidying your house before a dinner party. But there’s this one item that’s just out of place. The doorbell rings. It’s your guests. You just shove that item into the closet and tell yourself you’ll deal with it later.

You start to do this every time. Filling the closest more and more. Saying to yourself that you’ll deal with it later. The closet becomes so full that it starts to creak.

That’s your bodies way of saying ‘Hey! You got a lot of stuff to deal with! It’s time!’ But you keep thinking it’s fine.

Out of sight, out of mind. You ignore the closet. Until one day it’s too much. The closet bursts. And everything comes flying out in weird and wacky ways. Panic attacks. Dissociative episodes. Depression. Anxiety. Flashbacks. Intrusive thoughts.

And then you’re left lying on the floor with all the items that were stuffed into the closet, splattered around you. Forced to finally accept what happened. And forced to finally deal with it.

Forced to clean up the items around you and find appropriate places for each thing. And then over time, slowly, you learn what to do with each item, and how to deal with each thing, uniquely.”

9. How Long Does PTSD Last?

“I found my therapist very easy to talk to, understanding, a good listener and very helpful. The treatment he provided definitely helped me get over this traumatic time in my life”.

 (Source: NCBI)

There is no set duration for PTSD, but the good news is that it rarely lasts forever. In some extreme cases, it can bother a person for the duration of their life, but modern therapy has a high success rate and can at least lessen PTSD symptoms in such cases.

Very often, PTSD can be completely overcome. It takes time and hard work, but the condition is actually very treatable.

Symptoms are unlikely to go away by themselves, however. Treatment of some kind is most likely essential (more on this later). 

Factors that influence the duration of PTSD include the amount of times the trauma was experienced, whether it was accidental or intentional, whether or not the initial trauma was sexual in nature, prior experience of other mental conditions such as anxiety or depression, the level of social support a person has and their willingness to engage others for said support.

As stated earlier, each case is different, so there is no viable timetable.

10. Treatment Options for PTSD

“The thing that has been most helpful on this journey has been counselling. Friends and family can’t always understand what and why I feel the way I do, but counsellors are always there to listen. I have been in therapy almost a year now, yet I do believe that you need to find a counsellor you can click with. I tried a couple before I found the right one, but just knowing you can share with someone, who is not going to judge you and be there for you through dark times, has really helped me”. 

(Source: Time-To-Change.org)

PTSD can be treated, and even defeated. Most cases of PTSD are not lifelong and, even in cases where the condition persists, therapy can greatly reduce the symptoms.

Therapists pursue three main goals when treating a PTSD patient. The first is to improve the symptoms, the second is to teach the patient some skills that can deal with the symptoms and the third is to restore the individual’s self-esteem.

The most common (and effective) treatment technique used by PTSD sufferers is Cognitive Behavioural Therapy (CBT). CBT teaches methods by which the patient can ‘take back their mind’ as it were. Often, negative thought patterns continue unchallenged in the sufferer’s mind, even as she or he yearns desperately for peace. CBT teaches the patient to break these patterns, using techniques that have a very high success rate with PTSD patients.

Stress Inoculation Training (SIT) is part of CBT, and teaches a number of stress reduction techniques (such as breathing to stimulate the vagus nerve). These are tried and tested techniques that are proven to reduce anxiety.

Other forms of treatment available include support groups (especially successful if the PTSD stems from an event that affected a lot of people besides the patient, e.g. an industrial accident, a war or a natural disaster).

Some group therapy (for example groups pertaining to sexual assault, incest or domestic violence) can also be very useful, as it helps patients to talk with people that have experienced the same thing. Sometimes, simply understanding that their feelings aren’t unique to their ‘crazy’ brain and are in fact a normal human response to a perceived threat can be a huge step on the road to recovery.

Cognitive Processing Therapy (CPT) is a 12-week program consisting of weekly 60 – 90 minute sessions. During these sessions, the patient is asked to talk through the traumatic event in detail and also to write their experiences down. This helps a therapist to highlight unhelpful ideas and thought patterns that are impeding the patient’s recovery.

Prolonged Exposure Therapy (PET) helps the patient to confront the event(s) and their feelings about it/them. This is mostly used in cases of avoidance. Patients are recorded describing their trauma and then listen to the recordings at home, this helps them face up to the past and put it behind them.