Posttraumatic stress disorder
What is posttraumatic stress disorder?
Posttraumatic stress disorder (PTSD) begins after a traumatic event. The person may experience the traumatic event directly, may witness an event that involves other people, or may learn about a traumatic event that happened to a family member or close personal friend. The event involves the actual or perceived threat of serious injury or death to the person or others. In addition, the person who experienced, witnessed, or learned of the traumatic event, reacts to it with intense fear, helplessness or horror.
Traumatic events can include, but are not limited to, the following:
- human violence (e.g. rape, physical assault, domestic violence, kidnapping or violence associated with military combat)
- natural disasters (e.g. floods, earthquakes, tornadoes, or hurricanes)
- accidents involving injury or death
- sudden, unexpected death of a family member or friend
- diagnosis of a life threatening illness
Three groups of symptoms can be seen in people suffering from posttraumatic stress disorder:
- Re-experiencing symptoms include: Intrusive memories or recurrent dreams of the traumatic event, and acting or feeling as if the event were recurring (flashbacks). Reminders of the event may lead to intense psychological discomfort or to physical arousal.
- Avoidant symptoms are ways in which the person tries to avoid anything associated with the traumatic event. A “numbing” effect, where the person’s general response to people and events is deadened, includes symptoms such as the inability to remember aspects of the trauma, showing a limited range of emotion, and having a sense of a foreshortened future.
- Hyperarousal symptoms include difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance (being on the watch for danger), and an exaggerated startle response (for example, jumping when one hears a sudden noise).
When children have PTSD, symptoms in these three categories are expressed in different ways. For example, children may re-experience the traumatic event through repetitive play (e.g. a child who witnessed a robbery may re-enact the robbery again and again using his or her toys).
PTSD can begin soon after the trauma, or there may be a delayed onset (when symptoms begin 6 months or more after the trauma). PTSD is termed “chronic” if symptoms have lasted for 3 months or longer.
Who gets PTSD?
PTSD is a medical condition that potentially affects people of all ages and from all social, economic, and ethnic backgrounds. The prevalence of PTSD may be as high as 6% to 8% of the general population in a country such as the United States, and it may be higher in a violent society such as South Africa.
It should be emphasised that most people who are exposed to traumatic events do not develop PTSD. Furthermore, many people with some symptoms (such as difficulty falling asleep) after a trauma show gradual improvement with time. Family history of PTSD, previous traumatic experiences, and other existing mental disorders may also play a role in vulnerability to developing PTSD.
Consequences of PTSD
- PTSD may be a chronic and debilitating disorder.
- The distress may negatively impact on work, family, and social functioning.
- Serious depression and substance abuse are common in people with PTSD.
- There may also be an increased risk of other anxiety or psychiatric disorders.
- Physical symptoms. Such people may go to general practitioners with a variety of physical complaints rather than with specific psychological symptoms.
What to do and where to go for help
Several antidepressants have been shown useful in the medication treatment of PTSD. It is widely accepted that cognitive-behavioural psychotherapy (CBT) is the most useful psychotherapy for PTSD.
A combination of medication and cognitive-behavioural psychotherapy will likely be helpful for many people. Medication may act to decrease symptoms fairly early on, and so help the person to carry out the CBT techniques.
Conversely, the use of CBT may be crucial in helping the person to return to a normal life, and ultimately perhaps allow them to discontinue medication without return of symptoms.
An important aspect of psychotherapy for PTSD, whether it is individual or group therapy, is that the therapeutic environment provides a safe place for people to discuss the traumatic event, their fears and reactions to the event, and their symptoms. This feeling of safety is a way for people with PTSD to begin to re-establish a sense of trust in others.
Further resources/ references
Bathuthuzele Youth Stress Clinic: +27 21 938 9162/9374
SA Depression & Anxiety Group: +27 11 783 1474/6
Survivors of Violence: +27 31 305 5500
Trauma Centre: +27 21 465 7373
Download pdf for more information : Anxiety disorders
Books about PTSD
Copshock: Surviving PTSD. Allen R. Bates. Holbrook Street Press, 1999.
Stress Response Syndromes: PTSD, Grief and Adjustment Disorders. Mardi Jon Horowitz. Jason Aronson, 1997.
Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD. Edna B Foa, Barbara O. Rothbaum. Guilford Press, 1998.