Posttraumatic Stress Disorder (PTSD)

PTSD requires exposure to distressing events, whether firsthand, witnessing others, or through repeated exposure to trauma. It can lead to enduring effects like flashbacks, sleep disturbances, and heightened anxiety. PTSD affects individuals from all walks of life, not just combat veterans, with women being twice as likely to experience it.. They actively avoid reminders and may react strongly to triggers. Instead of improvement over time, anxiety and fear may intensify, but recovery and mitigation of PTSD's impact are possible with appropriate treatment. 

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  • Frequent experiences of heightened startle responses or fear.
  • Maintaining a constant state of vigilance for potential threats.
  • Difficulty falling or staying asleep.
  • Challenges with maintaining focus and concentration.
  • Displays of irritability, angry outbursts, or aggressive behavior.

  • Previous exposure to traumatic experiences, particularly during childhood
  • Personal experience of harm or witnessing the harm or death of others
  • Limited or insufficient social support following the event
  • Brain changes

  • Cognitive Behavioral therapy (CBT)
  • Cognitive Processing Therapy (CPT)
  • Prolonged Exposure Therapy (PET)
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)

  • Psychiatry
  • Psychology
  • Therapy

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Posttraumatic Stress Disorder (PTSD)

What is Posttraumatic Stress Disorder (PTSD)?

Experiencing fear during and after a traumatic situation is a natural and instinctive response rooted in our body's inherent "fight-or-flight" mechanism, which allows us to recognize and respond to potential threats effectively.

However, it is important to emphasise that most people gradually recover from their initial symptoms over time. Nevertheless, for those who continue to grapple with persistent challenges, a diagnosis of Post-Traumatic Stress Disorder (PTSD) may be appropriate.

A diagnosis of PTSD necessitates exposure to a distressing traumatic event. Exposure can take various forms, including firsthand experience, witnessing the event happening to others, or learning about a loved one or close acquaintance having endured such an event. Additionally, repeated exposure to distressing details of trauma, such as police officers handling child abuse cases, can contribute to the development of PTSD.

PTSD can emerge in the aftermath of a traumatic event and give rise to feelings of fear, shock, or helplessness. Its effects can be enduring and encompass symptoms like flashbacks, sleep disturbances, and heightened anxiety.

Individuals with PTSD may experience stress or fear even when they are not in immediate danger.

Historically, PTSD has been known by different terms such as "shell shock" during World War I and "combat fatigue" after World War II. However, it is vital to acknowledge that PTSD is not exclusive to combat veterans and can affect individuals from all walks of life, regardless of their ethnicity, nationality, culture, or age. In fact, women are statistically twice as likely as men to experience PTSD.

Those living with PTSD often wrestle with intense and distressing thoughts and emotions related to their traumatic experience, which persist long after the actual event has occurred. They may relive the trauma through intrusive flashbacks or nightmares, encounter feelings of sadness, fear, or anger, and may even feel detached or estranged from others. People with PTSD may actively avoid situations or individuals that serve as reminders of the traumatic event, and they may exhibit strong negative reactions to seemingly ordinary triggers such as loud noises or accidental physical contact.

Instead of experiencing gradual improvement over time, individuals with PTSD may find their anxiety and fear intensifying as time progresses. Nevertheless, with appropriate treatment, it is possible to facilitate recovery and mitigate the disruptive impact of PTSD on a person's life, even if the condition persists for an extended period.

Posttraumatic Stress Disorder (PTSD) Causes:

PTSD occurs in approximately one out of every three individuals who have experienced severe trauma. While the exact reasons for developing PTSD remain unclear, several potential explanations have been proposed.

Survival mechanism:

One theory suggests that the symptoms of PTSD arise as a result of an instinctive mechanism aimed at facilitating survival in the face of further traumatic experiences. For instance, the occurrence of flashbacks in many individuals with PTSD may compel them to contemplate the event in detail, thus enhancing preparedness in case of a recurrence. 

The state of heightened alertness, known as hyperarousal, may develop to enable swift reactions during crises. However, despite their intended purpose of promoting survival, these responses prove to be counterproductive in reality, as they hinder the processing and resolution of the traumatic experience.

Elevated adrenaline levels:

Studies have indicated that individuals with PTSD exhibit abnormal levels of stress hormones. Normally, when confronted with danger, the body releases stress hormones like adrenaline to trigger a physiological response. This "fight or flight" reaction serves to desensitise the senses and alleviate pain. 

Individuals with PTSD, however, have been found to continue producing excessive amounts of these hormones even when there is no immediate threat. This excessive release of stress hormones is believed to underlie the emotional numbness and hyperarousal experienced by some individuals with PTSD.

Brain changes:

Neuroimaging studies have revealed that individuals with PTSD exhibit differences in brain regions involved in emotional processing. Notably, the hippocampus, a region responsible for memory and emotions, appears to be smaller in individuals with PTSD. 

Changes in this brain region are thought to contribute to symptoms such as fear, anxiety, memory difficulties, and flashbacks. The impaired functioning of the hippocampus may impede the proper processing of traumatic memories, resulting in a lack of reduction in anxiety over time. 

Effective treatment for PTSD facilitates the appropriate processing of memories, leading to a gradual diminishment of flashbacks and nightmares.

Certain factors may increase the likelihood of developing PTSD, some of which are present before the traumatic event, while others become significant during or after it. Risk factors for PTSD include:

  • Previous exposure to traumatic experiences, particularly during childhood
  • Personal experience of harm or witnessing the harm or death of others
  • Feelings of horror, helplessness, or intense fear
  • Limited or insufficient social support following the event
  • Additional stressors following the event, such as the loss of a loved one, physical pain or injury, or loss of employment or housing
  • Personal or family history of mental illness or substance use

Resilience factors that can mitigate the likelihood of developing PTSD include:

  • Seeking support from friends, family, or support groups
  • Achieving a sense of self-acceptance regarding one's actions in response to the traumatic event
  • Developing effective coping strategies to navigate and learn from the traumatic experience
  • Being prepared and capable of responding to distressing events as they arise, despite experiencing fear.

Types of Posttraumatic Stress Disorder (PTSD):

Posttraumatic stress disorder (PTSD) is a recognized condition characterised by the emergence of physiological, psychological, and emotional symptoms subsequent to experiencing a traumatic event. It is important to note that the presentation of these symptoms can vary among individuals. However, in order to meet the criteria for a PTSD diagnosis, individuals must exhibit symptoms falling within the four distinct categories.

Category 1: Recurrent experiences. The first category involves the recurrence of traumatic event experiences, which can manifest as dissociative reactions like flashbacks, recurring and distressing involuntary memories, or distressing dreams (APA, 2022, pgs. 301-2). 

These recurrent experiences must be specific to the traumatic event or its immediate aftermath to fulfil the criteria for PTSD. The duration of these experiences can range from several seconds to multiple days. They are often triggered by physical sensations reminiscent of the traumatic event or environmental cues such as specific locations. 

Consequently, individuals with PTSD tend to avoid stimuli (such as activities, objects, or people) associated with the traumatic event. At least one of the intrusion symptoms must be present.

Category 2: Avoidance of stimuli. The second category involves avoiding stimuli connected to the traumatic event, with the presence of one or both of the following criteria.

Firstly, individuals with PTSD may actively try to avoid distressing thoughts, memories, or feelings associated with the traumatic event.

Secondly, they may prevent the occurrence of such memories by avoiding physical stimuli like places, individuals, activities, or particular situations that trigger the recollection of the traumatic event.

Category 3: Negative alterations in cognition or mood. The third category experienced by individuals with PTSD entails negative alterations in cognition or mood, with at least two of the following symptoms present. 

Individuals may report difficulty in recollecting important aspects of the traumatic event. It should be noted that this memory impairment is not a result of head injury, loss of consciousness, or substance use, but rather a consequence of the traumatic nature of the event itself. 

Moreover, the impaired memory may lead individuals to harbour erroneous beliefs regarding the causes of the traumatic event, often blaming themselves or others. They may also exhibit a pervasive negative state, including a generalised negative perception of oneself or others. 

Similarly to individuals with depression, those with PTSD may experience reduced interest in previously enjoyable activities and a diminished desire to engage in social interactions. Additionally, they may struggle to experience positive emotions.

Category 4: Alterations in arousal and reactivity. The fourth and final category involves alterations in arousal and reactivity, with at least two of the following symptoms present. 

Due to negative mood and heightened irritability, individuals with PTSD may display quick-tempered behaviour and act out aggressively, both verbally and physically. While these aggressive responses may be provoked, they can also occur without apparent provocation. 

These behaviours are believed to arise from heightened sensitivity to potential threats, particularly if they resemble the traumatic event. Specifically, individuals with PTSD exhibit an exaggerated startle response, easily startled by unexpected noises such as a ringing telephone or a car backfiring.

They also experience significant sleep disturbances, including difficulty falling asleep and staying asleep due to nightmares. Engaging in reckless or self-destructive behaviour and difficulties with concentration are also commonly reported symptoms.

These symptoms inevitably cause considerable distress in social, occupational, and other areas of functioning such as romantic relationships and personal life. The duration of symptoms is also a crucial factor, as a diagnosis of PTSD requires the presence of symptoms for at least one month. 

Diagnosis and Treatment


To receive a diagnosis of PTSD, a person must have at least one re-experiencing symptom, at least three avoidance symptoms, at least two negative alterations in mood and cognition, and at least two hyperarousal symptoms for a minimum of one month. These symptoms must affect the person’s ability to perform everyday activities.

During the evaluation process, a qualified psychologist or psychiatrist will inquire about the traumatic event you have been exposed to and how your symptoms are affecting various aspects of your life, such as work or school attendance, social interactions, and completing important tasks. They may also assess your overall quality of life, relationships, signs of depression or substance abuse, and any thoughts of suicide.

To gain a comprehensive understanding of your situation, the specialists may also engage in conversations with your spouse, partner, family members, or close friends. This additional input helps them gather a complete picture of your quality of life and how your symptoms are influencing your everyday activities.

Furthermore, a psychiatrist or psychologist may administer neuropsychological tests to evaluate your cognitive abilities, including attention, memory, and problem-solving skills. These tests involve a series of verbal and written assessments that provide detailed information about your thinking patterns, behaviours, and emotions. They offer valuable insights into your cognitive strengths and weaknesses.

Once the evaluation is complete, the specialists will hold a feedback session with you to discuss the findings and provide treatment recommendations.  


It is crucial to recognize that not everyone who experiences trauma will develop PTSD, and not all individuals with PTSD require psychiatric treatment. Some people find that their PTSD symptoms naturally diminish or disappear over time, while others find relief with the support of their family, friends, or religious community.

However, many individuals with PTSD require professional treatment to overcome the intense and debilitating psychological distress associated with the condition. It is important to understand that trauma can lead to severe distress, and experiencing such distress is not the fault of the individual. Fortunately, PTSD is a treatable condition, and seeking treatment can greatly improve the chances of recovery.

Psychiatrists and other mental health professionals employ various effective and research-proven methods to assist individuals in their recovery from PTSD. Both talk therapy (psychotherapy) and medication have shown to be effective evidence-based treatments for PTSD.

One particularly effective category of psychotherapy is cognitive-behavioural therapy (CBT). Cognitive processing therapy, prolonged exposure therapy, and stress inoculation therapy are examples of CBT approaches used to treat PTSD.

Cognitive Processing Therapy (CPT) is a specifically designed evidence-based cognitive-behavioural therapy aimed at treating PTSD and its associated symptoms. It focuses on changing distressing negative emotions (such as shame or guilt) and beliefs that result from the trauma. Therapists guide individuals in confronting and processing distressing memories and emotions related to the traumatic event.

Prolonged Exposure Therapy (PET) involves repeated and detailed imagining of the traumatic event or gradual exposure to symptom triggers in a safe and controlled manner. This therapy helps individuals face and gain control over their fears and distress, ultimately learning effective coping strategies. Virtual reality programs have also been utilised to help war veterans with PTSD safely re-experience the battlefield in a therapeutic setting.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment model for children and adolescents that combines trauma-sensitive interventions with cognitive-behavioral, family, and humanistic principles and techniques.

Eye Movement Desensitization and Reprocessing (EMDR) is a trauma-focused psychotherapy administered over a period of approximately three months. This therapy helps individuals reprocess traumatic memories, resulting in a different and less negative experience of the trauma. The therapist guides the patient through questions about the traumatic memory while using eye movements similar to those in REM sleep or other methods. Experiences during the session may include changes in thoughts, images, and feelings, leading to a transformation of the memory over repeated sessions.

Group therapy provides a supportive and non-judgmental environment for survivors of similar traumatic events to share their experiences and reactions. It helps participants realise that their responses and emotions are shared by many others. Family therapy can also be beneficial as it addresses how the behaviour and distress of an individual with PTSD impact the entire family.

According to guidelines from the National Institute for Health and Care Excellence (NICE), Eye Movement Desensitization and Reprocessing (EMDR) should be considered for adults with a PTSD diagnosis within one to three months after a non-combat related trauma if the individual prefers this approach. EMDR should be offered to adults with a PTSD diagnosis presenting more than three months after a non-combat related trauma.

Other psychotherapies, such as interpersonal, supportive, and psychodynamic therapies, focus on the emotional and interpersonal aspects of PTSD. These approaches can be helpful for individuals who prefer not to expose themselves to reminders of their traumas.

Remember, you do not have to face the burden of PTSD alone. Your therapist can assist you in developing stress management skills to better handle stressful situations and cope with stress in your daily life.


Medication plays a crucial role in managing the symptoms of PTSD and can enhance the effectiveness of psychotherapy.

Antidepressants are commonly prescribed to alleviate symptoms of depression, anxiety, sleep disturbances, and difficulties with concentration. Two selective serotonin reuptake inhibitors (SSRIs), sertraline (Zoloft) and paroxetine (Paxil), are FDA-approved for the treatment of PTSD.

Anti-anxiety medications are used to relieve severe anxiety and associated problems. However, due to their potential for abuse, these medications are typically prescribed for short-term use.

Medication can be used as a standalone treatment or in combination with psychotherapy and other interventions. Additional medications may be prescribed to reduce anxiety, alleviate physical agitation, or address nightmares and sleep problems frequently experienced by individuals with PTSD.

Openly communicate any side effects or concerns about medications to your doctor. It may be necessary to try different medications or adjust dosages and schedules to find the optimal treatment that suits your needs. It is common to observe improvements in mood and other symptoms within a few weeks of starting medication.

Coping with PTSD

Living with post-traumatic stress disorder (PTSD) can be overwhelming, especially when dealing with something as distressing as Flashbacks. However, there are strategies you can employ to help manage these symptoms:

  1. Focus on your breathing: During moments of fear, it's common to experience abnormal breathing patterns. To alleviate this, concentrate on slow, deliberate breaths while counting to five.

  2. Carry a grounding object: Having a tangible item that connects you to the present can be beneficial during flashbacks. Consider carrying a small object in your pocket or bag, such as a keyring or a piece of jewellery, that can serve as a reminder of the current moment.

  3. Reassure yourself of safety: Remind yourself that the traumatic event is over and that you are now in a safe environment. Writing down or recording positive affirmations when you're feeling better can provide helpful phrases to refer to during flashbacks.

  4. Seek comfort: Engage in activities that bring you comfort and relaxation. This can include wrapping yourself in a blanket, cuddling a pet, listening to soothing music, or watching a favourite film.

  5. Maintain a diary: Keeping a record of your flashback experiences can help identify patterns and potential triggers. Additionally, noting early signs of flashbacks can aid in proactively managing them.

  6. Practice grounding techniques: Grounding techniques can help you stay connected to the present moment and cope with intrusive thoughts or flashbacks. Describing your surroundings aloud or focusing on counting objects of a specific type or colour can be effective grounding exercises. For more information on grounding techniques, refer to resources on self-care for dissociative disorders.

Supporting a friend or relative with PTSD requires sensitivity and understanding. Here are suggestions to assist them while also prioritising your own well-being:

  1. Listen attentively: Give them the space to share at their own pace without pressuring them. Allow them to express their emotions related to the traumatic event, and avoid making assumptions or dismissing their experiences.

  2. Avoid judgement: Understand that healing from PTSD takes time, and it may be challenging for someone without personal experience to fully grasp the impact. Offer support and patience rather than placing blame or pressuring them to "move on."

  3. Learn their triggers: Discuss with them the situations or conversations that may trigger flashbacks or distressing emotions. By understanding their triggers, you can help avoid such situations and be prepared to provide support during flashbacks.

  4. Plan for difficult times: When your loved one is feeling well, collaborate on creating a crisis plan. Identify the symptoms to watch for, familiarise yourself with triggers, and discuss strategies for managing potential crises. However, ensure that you set boundaries and offer support that aligns with your own capabilities.

Assisting someone experiencing a flashback can be challenging, but you can still provide support without specialised training. Here are some approaches:

  1. Remain calm: Project a calm and composed demeanour to help create a sense of safety and stability.

  2. Communicate gently: Inform the person that they are currently experiencing a flashback in a reassuring and non-threatening manner.

  3. Avoid sudden movements: Prevent any sudden or jarring actions that may escalate their distress.
  1. Encourage slow breathing: Guide them to take slow, deep breaths to help regulate their physiological responses.

  2. Facilitate grounding: Encourage the person to describe their surroundings or engage with their present environment as a way to reestablish connection with reality.

Respecting personal space and being mindful of warning signs are essential aspects of supporting someone with PTSD:

  1. Give space: Understand that individuals with PTSD may feel on edge and easily startled. Respect their personal space and avoid unnecessary physical contact unless explicitly granted permission.

  2. Watch for changes: Be observant of behavioural shifts, such as mood fluctuations, decreased work performance, or changes in energy levels. These changes can indicate a decline in their well-being, and discussing their feelings may encourage them to open up.

Preparing for your appointment when seeking help for PTSD involves some essential steps:

  1. Consider bringing support: If possible, bring along a trusted family member or friend to help remember the information provided during the appointment.

  2. Prepare information: Make a list of your symptoms, including their duration, and significant personal experiences or events that triggered intense fear, helplessness, or horror. Additionally, note any activities or situations you've avoided due to stress, along with your medical history, including other diagnosed physical or mental health conditions, medications, and dosages.

  3. Ask relevant questions: Inquire about the possible causes and diagnosis of your symptoms, the expected duration and treatment options for PTSD, potential coexistence of other mental health problems, recommended lifestyle adjustments, and resources for further information.

During treatment, there are steps you can take to support your own well-being:

  1. Follow your treatment plan: Understand that therapy and medication may take time to show their effects. Regularly communicate with your mental health professional to facilitate progress.

  2. Educate yourself: Learn about PTSD to gain a better understanding of your emotions and develop effective coping strategies.

  3. Practice self-care: Prioritise restful sleep, maintain a healthy diet, engage in regular exercise, and allocate time for relaxation. Minimise or avoid substances like caffeine and nicotine, as they can exacerbate anxiety symptoms.

  4. Avoid self-medication: Resist the temptation to rely on alcohol or drugs as coping mechanisms. Substance abuse can complicate treatment outcomes and impede healing.

  5. Break the cycle: Engage in activities that divert your attention when feelings of anxiety arise. Physical exercise or pursuing hobbies can redirect your focus and help recenter your thoughts.

  6. Seek social support: Spend time with supportive individuals, whether family, friends, or community members. Sharing time with loved ones can offer comfort and contribute to the healing process, even without discussing the traumatic event itself.

  7. Consider support groups: Inquire with your mental health professional or local organisations to find support groups that cater to individuals with PTSD. These groups can provide additional understanding, empathy, and guidance.

Remember, seeking help and implementing these strategies can contribute to your recovery and well-being.

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Posttraumatic Stress Disorder (PTSD)

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