Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a psychological reaction to experiencing or witnessing a significantly stressful, traumatic or shocking event. This might be a war, or a disaster like an earthquake, flood or fire. It might be a car crash, a rape or other physical or sexual abuse.

Any situation where there was a risk of being killed or injured, seeing others killed or injured, or sometimes even hearing about such things, can result in PTSD. However, it is important to note that these experiences do not always result in PTSD.  'Shellshock' - the distress experienced by many war veterans - was an earlier name for PTSD.
 
Some events are more likely than others to cause PTSD. Reactions to trauma deliberately caused by other people, such as torture or rape, seem to be worse than those caused by accidents or natural disasters.

It is normal to react to extreme danger or disaster with feelings of fear, horror or helplessness. Usually these feelings fade and the person is able to get on with life, even though it may be changed forever. 

Signs of post-traumatic stress disorder

Intrusive thoughts and images
With PTSD the unpleasant feelings associated with the trauma keep coming back, along with images, memories and intrusive thoughts about the event. There may be nightmares or bad dreams.

In the daytime the person may feel it is all happening again or have brief but vivid memories or 'flashbacks'. These can happen without obvious cause or can be triggered by sights, smells or the look of something and can occur randomly, much to the confusion of the individual. They are typically accompanied by intense feelings such as guilt, grief, fear or anger.

Avoidance
PTSD has an impact on the person's relationships. Individuals with PTSD may try to avoid any situations, people or events that remind them of the trauma. Families may be puzzled by the person's withdrawal into themselves.

People with PTSD may be unable to feel emotions, even for the people they love or care for. They may feel detached from others and may lose interest in things they once enjoyed. This can lead to misunderstanding, estrangement and further withdrawal. Avoidance can lead to alcohol or drug overuse, depression, and eating difficulties.

Hyperarousal
People with PTSD may be constantly watchful or jumpy. Their sleep is often disturbed and they may feel irritable and angry with themselves and others. Memory, concentration and decision-making are often affected.

Is it PTSD or a related condition?

The experiences outlined above are common in the first few weeks after a significant trauma. Some people may have PTSD symptoms that occur within a month of the traumatic event and resolve within four weeks. This is called acute stress disorder. If the symptoms persist beyond four weeks, cause the person intense distress and affect their everyday life, the diagnosis is changed to PTSD.

Sometimes there is a delay of months or even years between the event and the onset of PTSD.

Less severe reactions to disasters or non-life threatening stresses are called stress reactions or adjustment disorders. People with these reactions may have some of the symptoms of PTSD but they are milder and do not last as long.  

Who can be affected by PTSD?

PTSD can affect people of any age, gender or culture. It is more common among soldiers and refugees who have endured major traumas. People who have experienced childhood sexual or physical abuse may also experience PTSD. 

Children and PTSD

Children may be more vulnerable to PTSD than adults who have experienced the same stress or trauma. Their response to trauma may also be different. They will usually display disorganised or agitated behaviour. They may have nightmares, and they are likely to relive the trauma through repetitive play. This may be seen through artwork or in changes of behaviour towards other children, bullying, hitting, etc.  Physical symptoms may include stomach-aches, headaches and bedwetting.

Risks associated with PTSD

• People with PTSD can become depressed and suicidal, especially if PTSD is not recognised and treated
• Sometimes long-term distress and anxiety can lead to panic attacks
• By 'self-medicating' with alcohol or drugs, the person risks developing alcohol and drug abuse problems
• Some people may develop eating disorders
• People with a history of depression may be more vulnerable to experiencing PTSD.

Personal and cultural beliefs

People's cultural and personal beliefs can influence the way in which stress and trauma affects them, the types of symptoms they feel under stress and the way they respond to it. 

In some cultures people find it easier to cut themselves off from strong emotions when under stress. Others feel and express great emotion and share these with their family and friends. Some people suffering from PTSD have physical symptoms like headaches and stomach pains. Such physical effects of stress are more common in some cultures than others.

Emergency service staff like fire fighters, ambulance or police officers may protect themselves by seeing stress and trauma as part of their job, being able to joke about danger and enjoying the company of a close-knit group of colleagues.

In groups or communities where there has been a trauma or tragedy people pull together and show great strength and bravery. They may feel stronger, more connected to other people, value life more or be more aware of spiritual values.  Survivors of disasters often feel guilty that they survived when others died. 

See also: PTSD - living with; PTSD - treatment

Support groups

See the support organisations (which include helplines) under Further information and support below.

Original material provided by the Mental Health Foundation of New Zealand, 2004. Edited by everybody, May 2005.