PTSD - Post-Traumatic Stress Disorder

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Post Traumatic Stress Disorder (PTSD)

One point four million Australians at any one time have Post Traumatic Stress Disorder (PTSD)

Post traumatic stress disorder develops after someone is exposed to an extremely traumatic event and they reacted to the event with intense fear, horror or helplessness.

Such traumatic events include:

War

Torture

Rape

Child sexual or physical assault

Physical assault / Domestic violence

Being kidnapped

Terrorism

A natural disaster (e.g. a bushfire, flood or cyclone)

A major car accident

Being diagnosed with a potentially fatal illness e.g. cancer

Finding the body of someone who has committed suicide or been murdered.


The Intrusive Symptoms include:

Distressing thoughts or images

Nightmares about the event

Feeling or acting as if the traumatic event were recurring

Intense psychological distress when exposed to something that triggers memories of the traumatic event.

Physical symptoms such as sweating, muscle tension and rapid heartbeat when exposed to things that trigger memories of the traumatic event.


The Avoidance Symptoms include:

Trying to avoid thinking or talking about the trauma, as well as any feelings associated with the trauma.

PTSD sufferers may resort to alcohol or illicit drugs to block out unwanted memories & feelings.
According to the Australian Centre for Post Traumatic Mental Health (1999), approximately 50% of men and 25% of women with chronic PTSD have drug and alcohol issues.

Avoiding people, places and activities that trigger memories of the traumatic event.

Not remembering an important part of the traumatic event

Losing interest in, and enjoyment of e.g. leisure activities, study, work or stop participating in such activities altogether.

Feeling detached from other people.

Being unable to feel joy or have loving feelings.

Not be able to see a future for themselves, they don't expect to get married, have a family, live a long time.


The Physical Symptoms include:

Sleep disturbance

Irritability or anger

Impaired concentration

Being always on the alert for signs of danger.
The PTSD sufferer may be constantly scanning their surroundings for possible threats, e.g. someone who has been in a major car accident may become a back seat driver. Someone who has been physically assaulted may always sit with their back to a wall so noone can sneak up behind them.

Being easily startled.
THE PTSD sufferer may overreact to something such as a noise. E.g. a war veteran may be shaken if they hear a car backfire because of their past experience of being threatened by gun fire)


TREATMENT OF PTSD

Psychological Treatment of PTSD in adults involves a number of phases, including:

Education and information

Learning how to manage anxiety, anger and depression

Exposure therapy where the sufferer confronts feared situations and memories

Cognitive therapy- where unhelpful, irrational thoughts and beliefs are replaced with more rational ones

Relapse prevention


Psychological Treatment of children with PTSD may include:

play therapy

information about PTSD

anxiety, anger and depression management techniques

cognitive therapy.



It is common for PTSD sufferers to have other psychological disorders as well.

The most common mental conditions accompanying PTSD include: drug & alcohol issues, depression, social anxiety, panic and/or agoraphobia, generalised anxiety, obsessive compulsive disorder and bipolar mood disorder.

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Help

Many people consider anxiety disorders are not 'real' health problems or that they are best dealt with by 'soldiering on'. Only about a third of people with anxiety disorders seek treatment. Fortunately, there are a range of effective treatments available. Some work well for some types of anxiety disorders and not for others. Sometimes more than one therapy is needed. The treatment is most successful if it's tailored to the individual.


Psychological treatments

For the majority of anxiety disorders, psychological techniques offer the most successful forms of treatment. These include techniques that help a person relax and cope with the issues causing their anxiety. Because they approach the underlying problem, they offer hope of a cure rather than temporary symptomatic relief as might be achieved by medications. They require a GP or psychologist to be trained in and familiar with them.

In some people they may be combined with drug treatment. However, they may be costly; on average a psychologist charges about $80 per hour and multiple sessions may be needed (these treatments aren't covered by Medicare but may be partially covered by private health funds). Another drawback is the lack of therapists in some areas, particularly rural areas. For more information about obtaining help from a psychologist, see Health Matters' Consumer Guide to Allied Health Professions.

The main types of psychological treatment are:

Relaxation techniques. These aim to induce the mind and body into a state of relaxation. Some use muscle-relaxing exercises, while others are based on meditation, which aims to 'still the mind' by focusing it on an image, word or activity (such as breathing slowly in and out), to eliminate anxious or stressful thoughts.

Structured problem solving. This is a technique that allows anxious people to deal with problem situations and worries. It teaches the person to identify what is troubling them, to formulate solutions to the problem, and put these solutions into effect.

Graded exposure. This technique involves gradually exposing a person to something they fear, with the degree of exposure increasing over repeated occasions. The aim is to desensitise the person to the point where the fear no longer poses a threat. It's used in the treatment of many phobias.

Cognitive behavioural therapy (CBT). This is a form of structured problem-solving. It's a behaviour-modification technique that aims to change the way a person thinks. By applying rational reasoning to evaluate a feared situation, the person comes to see that the feared situation isn't as fearful as he or she thinks. These strategies are often combined with behaviour modification techniques such as graded exposure (to feared situations) and relaxation techniques. It requires special training, is usually done by a psychologist or psychiatrist, and typically requires ten to 12 sessions to be effective. Of all psychological treatments, CBT gives the most consistent and long-lasting positive results.

Drugs

Drugs are not as effective as psychological treatments. They do reduce anxiety, but only while they are actually being taken. When the medication is stopped, the symptoms return. They tend to impair a person's performance, and they also cause dependence. They may be more useful for certain conditions – such as generalised anxiety disorder – than others, such as phobias. They can also be helpful in combination with psychological therapies.

Serotonin Reuptake Inhibitors (SRIs). SRIs, such as Prozac (fluoxetine), Cipramil (citalopram), Aropax (paroxetine), and Zoloft (sertraline), are best known for treating depression, but they're also used to treat anxiety disorders. Many doctors believe they may be the best choice, especially in people who are also suffering from depression.

Benzodiazepines. Benzodiazepines such as Euhypnos or Normison (Temazepam), Valium (Diazepam), Serepax (Oxazepam), and Xanax (Alprazolam) are often used for generalised anxiety disorder and sometimes for panic disorder and social phobia. They have the advantage of working quickly. But they shouldn't be continued in the long term because of the risk of dependence and withdrawal symptoms when they're stopped. Benzodiazepines are best used in short courses of two to four weeks. The main side effect is drowsiness.

Beta blockers. Beta blockers (such as propranolol, atenolol, nadolol, pindolol and labetolol) reduce blood pressure and slow the heartbeat. They are used mainly to reduce certain anxiety symptoms like palpitations, sweating and tremors, and to control anxiety in public situations. They often are prescribed for individuals with social phobia.

Tricyclics. Examples include Tofranil (imipramine), Pertofran (desipramine), and Deptran (doxepin). These drugs were first used for treating depression, but some are also effective in blocking panic attacks. Most tricyclics may also reduce symptoms of post-traumatic stress disorder (PTSD) and some are effective against obsessive-compulsive disorder (OCD) They generally take two or three weeks to take effect. Side effects include weight gain, drowsiness, dry mouth, dizziness and impaired sexual function.