Post Traumatic stress disorder

Complex Post Traumatic Stress Disorder (PTSD) is a term used to describe the changes that people experience following multiple or repeated traumatic events. Examples include childhood sexual, physical or emotional abuse, domestic violence, being held hostage and victims of torture or trafficking.  These experiences are interpersonal (caused by a person deliberately harming another person) and become anticipated rather than occurring “out of the blue”, causing a wide range of difficulties including problems in the following areas:

• Difficulties with experiencing and managing feelings including intense anxiety, sadness, suicidal thoughts, anger, eating disorders, self-harm and substance misuse and sexual difficulties.
• Difficulties with changes in consciousness such as nightmares, flashbacks and intrusive thoughts as well as forgetting traumatic events or having episodes of feeling detached from your thoughts or body (dissociation).
• Difficulties with self identity and the way in which you see yourself.  People often describe feeling helplessness, shame, guilt, stigma and a sense of being different to other people.
• Difficulties with relationships including difficulties with trust, assertiveness and in managing relationships with others.
• Difficulties with health (somatisation). People who have experienced repeated traumatic events often have physical health difficulties including chronic pain, migraines, seizures, chronic fatigue or other long-term health problems.
• Difficulties with systems of meaning: Experiencing repeated traumatic events from an early age can interfere with a person’s ability to find meaning in life and can lead to feeling hopeless, helpless, empty, despairing or living with chronic suicidal thoughts.

Treatment

Complex PTSD is likely to take longer to resolve and you are likely to be referred to a mental health professional to help with your recovery.  Treatment is usually carried out in three phases.  The first phase involves helping you to manage your current symptoms in the here and now and is referred to as developing safety and stabilisation.  If you are still being affected by trauma memories, you may then go on to talk about your experiences in more detail. This phase acknowledges the losses that have occurred as a result of the trauma, including lost opportunities and relationships.  However, it is important to note that improvement is possible without talking in detail about the past if you do not wish to.  Phase three involves helping you to connect with people, places and activities that may help you to continue to feel better.

Caring for somebody

Caring for somebody who has experienced complex traumatic experiences (traumatic experiences which occur repeatedly over time and usually within an interpersonal context for example childhood sexual abuse, domestic violence, as well as victims of persecution, torture and trafficking) can be difficult as they may have a number of concerning difficulties over a long period of time including difficulties managing their emotions, self-harm, depression, eating disorders, difficulties within relationships as well as flashbacks, nightmares and anxiety. Caring for friends or relatives who struggle with their mental health can have a negative impact on your own health and it is important to look after yourself.

There is more information about Complex PTSD

It is normal to experience upsetting and confusing thoughts after a traumatic event, but for most people this will improve naturally over a few weeks.  Most people are unlikely to require access to specialist mental health care.

You should visit your GP if you or someone you know is still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome.

Your GP will want to discuss your symptoms with you in as much detail as possible. They will ask whether you have experienced a traumatic event in the recent or distant past and whether you re-experience the event through flashbacks or nightmares.

Your GP can refer you to mental health specialists if they feel that you would benefit from treatment.

The main treatments for post-traumatic stress disorder (PTSD) are psychological therapy and medication

Traumatic events can be very difficult to come to terms with, but dealing with your feelings and thoughts and seeking professional help has been shown by research to help in the treatment of PTSD. It is possible for PTSD to be treated many years after the traumatic event occurred which means that it is never too late to seek help.

Watchful waiting

If you have mild symptoms of PTSD, or if you have had symptoms for less than four weeks, an approach called watchful waiting may be recommended.

Watchful waiting involves carefully monitoring your symptoms to see whether they improve or get worse. It is sometimes recommended because 2 in every 3 people who develop problems after a traumatic experience get better within a few weeks without treatment.

If watchful waiting is recommended, you should have a follow-up appointment within one month.

Psychological therapy

If you have PTSD that requires treatment, psychological therapy is usually recommended first. A combination of psychological therapy and medication may be recommended if you have severe or persistent PTSD.

The treatment is carried out by trained mental health professionals who listen to you and help you come up with ways to help you resolve your problems. The main types of psychological therapy used to treat people with PTSD are described below.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) aims to help you manage your problems by changing how you think and behave. Trauma-focused CBT uses a range of psychological treatment techniques to help you come to terms with the traumatic event.

For example, your therapist may ask you to confront your traumatic memories by thinking about your experience in detail. During this process your therapist helps you cope with any distress you feel, while identifying any unhelpful thoughts.  Your therapist can help you gain control of your fear and distress by changing the negative way you think about your experience. For example, feeling that you are to blame for what happened or fear that it may happen again.

You may also be encouraged to gradually restart any activities you’ve avoided since your experience, such as driving a car if you had an accident.

Eye movement desensitisation and reprocessing (EMDR)

Eye movement desensitisation and reprocessing (EMDR) involves making side-to-side eye movements, usually by following the movement of your therapist’s finger, while recalling the traumatic incident. Other methods may include the therapist tapping their finger or playing a tone.

Although it might seem a bit strange at first, there is research evidence to show that it can be effective in resolving some of the most distressing symptoms of PTSD. 

Group therapy

Some people find it helpful to speak about their experiences with others who are experiencing similar difficulties. Group therapy can be used to teach you ways to manage your symptoms and help you understand the condition.

Medication

Antidepressants such as paroxetine, sertraline, mirtazapine, amitriptyline or phenelzine are sometimes used to treat PTSD in adults.  A combination of medication and psychological therapy can be particularly helpful.

Post Traumatic Stress Disorder can make you feel unsafe and in danger even after the threat has passed.  It is difficult to recover if you are still in danger.  It is therefore important to identify areas in your life in which you feel unsafe and, where possible, take steps to manage these. Thinking through the areas of safety below may be helpful:

Emotional safety: Do you feel safe within your emotions?  Are the ways in which you are coping with your feelings safe or unsafe: for example are you numbing or shutting off from your feelings as you fear they will overwhelm you? Are you self-harming or using substances? are you experiencing suicidal thoughts?

Relationship safety:  Are the people around you supportive? Is there anyone who is taking advantage of you emotionally, sexually or financially?  Do you find yourself pushing people away if they come too close? Do you find it difficult to trust people?

Physical safety: Are you looking after yourself physically?  Are you eating regularly, getting enough sleep, attending regular health checks, taking regular exercise?  Are you taking risks with your health?

Environmental safety:  Is the area you live in safe?  Do you feel afraid to go out?  Did the traumatic event/s occur at home and you are constantly reminded of it? Or is the trauma still happening at home or nearby?

A mental health professional can help you identify areas of risk in your life and create a safety plan to manage these. 

Psychoeducation:  Finding out more about the impact that trauma has on the brain can be very helpful.  Understanding that your symptoms are not a sign of “being weak”  but rather your body and your brain trying to process, cope with and heal from what happened can be very powerful. It can be helpful for a mental health professional to help you understand how trauma is affecting you.  There is an information booklet from NHS Inform about how to cope with PTSD.  

Managing nightmares and flashbacks: Understanding why and how nightmares and flashbacks occur can help you feel more in control of your symptoms.  Although they can be intensely powerful and distressing at the time, it is important to remember that they will pass. Identifying your specific triggers can be helpful in making you feel more in control again.  Even if you feel that they occur “out of the blue” there may be subtle cues or reminders of the traumatic event such as a specific feeling or piece of music or smell which set them off.

Grounding: Flashbacks can make you feel as if the danger is still here.   Grounding helps focus your attention on one very specific thing at a time, pulling you back into the here and now.  For example,  smelling a strong, pleasant smell such as peppermint or lavender oil, identifying five things you can hear, touch or see, picking up an object and studying it intently using all your senses to describe it.  Some people find it helpful to make a flashcard to keep with them, reminding them of the current date and time and having a “safe” word or phrase on it. 

Talking or writing about what happened:  Many people find that talking about what happened in a safe environment with a trusted person can help them make sense of what they have been through. This is best done with the guidance of a mental health professional.

Recovery from PTSD can take time.  It is important to look after your physical health in the meantime by ensuring you are eating and drinking regularly and keeping physically active.

Following a traumatic event

Immediately after a traumatic event the most important thing is to ensure that a person is safe from further danger and that their physical needs are taken care of including medical treatment if required. It is important for you to be guided by the person’s wish to talk. If they want to talk, be present and listen to them, providing comfort and consolation. Don’t pressure them to talk if they don’t want to. Encourage them to seek support from friends and family and point them towards information which explains that it is natural and normal to be upset and distressed at this time. Flashbacks, nightmares, an increased sense of threat and avoidance are normal in the early stages and most people will recover without needing further help. Encouraging people to keep to a gentle routine and look after themselves is important. However, if you become concerned that someone’s symptoms are not resolving after a month or that their distress is intense then urge them to seek help through their GP. 

Coping with flashbacks

If you are with somebody whilst they are experiencing a flashback it can be helpful to “ground” them in the here and now.  This means gently bringing them into the present by asking them to use their senses to describe what they can see, hear, or feel in the present moment. Smell is a very powerful way of doing this.  You can encourage the person to keep some favourite perfume or essential oil to hand. You can ask them to state their name, age and the current date and name three things they can see, feel and hear. Alternatively, you could ask them to hold an object such as a stone and describe it in great detail. Find out more about grounding techniques.

Managing a disclosure of other forms of trauma

If somebody discloses a traumatic event to you such as domestic violence or childhood sexual abuse it is important to listen and acknowledge what they are telling you. Hearing accounts of abuse can be distressing and confusing, particularly if it brings up issues for yourself. It is important that the person feels that they have been listened to and believed. Try to focus on them and how they must be feeling rather than your own response and gently encourage them to seek help if they want to. They can do this by contacting their GP in the first instance.

Complex PTSD

Caring for somebody who has experienced complex traumatic experiences (traumatic experiences which occur repeatedly over time and usually within an interpersonal context for example childhood sexual abuse, domestic violence, as well as victims of persecution, torture and trafficking). You can read a description of what Complex PTSD is. It can be difficult as they may have a number of concerning difficulties over a long period of time including difficulties managing their emotions, self harm, depression, eating disorders, difficulties within relationships as well as flashbacks, nightmares and anxiety. Caring for friends or relatives who struggle with their mental health can have a negative impact on your own health and it is important to look after yourself.

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site

Archway Glasgow – provides services and support to men and women aged 13 and over who have experienced rape or sexual assault within the past seven days.

Call: 0141 211 8175

Assist – provides advocacy, information and support to women and men whose partners or ex-partners are appearing in Glasgow’s domestic abuse court. 

Call: 0141 276 7710

Breathing Space – free confidential phoneline you can call when you are feeling stressed or down. 

Call: 0800 83 85 87 

Childline – free national helpline for children in trouble or danger.  It provides a confidential phone and online counselling service for any child 24 hours a day.

Call: 0800 11 11

Combat Stress is a military charity specialising in helping ex-servicemen and women.  If you are serving or have served in the UK armed forces they run a 24 hour helpline.

Call: 0800 138 1619

CRUSE is a UK charity providing support and information for people who have experienced bereavement. They run a support helpline.

Call: 0845 600 2227 (calls costs up to 8p per minute, plus your phone company’s access charge per minute)

Rape Crisis – is a UK charity providing a range of services for people who have experienced abuse, domestic violence and sexual assault. They run a free helpline service every day from 6pm-midnight

Call: 0808 8010302

The Anchor, Glasgow Psychological Trauma Services.  This is a specialist mental health service within NHS Greater Glasgow and Clyde for people experiencing complex PTSD.  Referrals can be made by GPs or other health and social care professionals

Scottish Women’s Aid provide help and support to female survivors of domestic abuse. You can phone the domestic abuse helpline

Call: 0800 027 123

Victim Support provides support and information to victims or witnesses of crime.

Self Help Resources

There are individual self-help guides from Get Self help about PTSD and Flashbacks

NHSGG&C BSL A-Z: Mental Health – Post Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder which you may develop after being involved in, or witnessing, traumatic events. A traumatic event is one where you are in danger, your life is threatened, or where you see other people dying or being injured.  Examples of traumatic events include road traffic accidents, assaults and sexual assaults, being involved in a natural disaster such as an earthquake, witnessing or experiencing war, torture or being held hostage.

It is usual for a traumatic event to cause upset and distress.  Most people will recover with the support and care offered by family and friends and by using the ways of coping that they would normally use to deal with stress.  However, some people will experience distress that is more intense and longer lasting and may result in Post Traumatic Stress Disorder (PTSD). Symptoms of PTSD include nightmares relating to the event, avoidance of things that may remind the person of the trauma, flashbacks, feeling on edge and always on the lookout for danger and negative changes in mood and thought.

NHSGG&C BSL A-Z: Mental Health – Trauma

The situations we find traumatic can vary from person to person. There are many different harmful or life-threatening events that might cause someone to develop PTSD. A traumatic event is one where you see that you are in danger, your life is threatened, or where you see other people dying or being injured.

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde