Post Traumatic Stress Disorder

What is the cause of PTSD?

All humans are complex organisms who constantly strive to adapt to the demands placed on them by their physical & social environments. When threatened they react with fear & distress – a survival function. We learn from danger and once passed we ponder on characteristics of the threat (Yule, 1999).

Post Traumatic Stress Disorder (PTSD) is a type of anxiety disorder which may develop after being involved in, or witnessing a psychologically traumatic event outside the range of normal experience (American Psychiatric Association (APA), 1987) e.g. threat to life, children’s, loved ones etc, sudden destruction of home or community & seeing people killed in accidents or physical violence such as war‘ (Yule, 1999).

The cause of PTSD may be simple to identify but it is complex anxiety due to the unpredictability of symptoms, effects and psychological processes that may arise up to 6 months after a traumatic event of exceptional severity (known as delayed-onset) (Rachman, 1997).

What are the symptoms of PTSD?

Symptoms of PTSD are a combination from 3 categories of behavioural disturbances:

• Re-experiencing (nightmares, flashbacks, intrusive recollections or cognitions)
• Avoidance (avoid thoughts, feelings, or activities; decreased interest in activities)
• Arousal (sleep problems, hyper-vigilance, exaggerated startles, problems concentrating) (Foa et al., 1992).

Children show signs of separation anxiety, uncharacteristic aggression and avoidance behaviour.

Subsequently this may lead to substance abuse (e.g. alcohol, drugs, anti-depressants, tranquillisers), cognitive impairment (e.g. memory & concentration difficulties), social relationships are adversely affected, physical health issues (e.g. tiredness, headaches, cardiovascular disorders, gastrointestinal disorders and immune response impairment etc (Yule 1999)).

The American Psychiatric Association (APA) officially recognised PTSD in 1983 & the World Health Organisation (WHO) internationally in 1993.  Although records found from The Great Fire of London 1666, Victorian transport disasters, World War I and II and Vietnam veterans show earlier studies (Yule 1999).

A relatively new term of Complex PTSD includes the symptoms of PTSD with additional symptoms:

• difficulty controlling your emotions
• feeling very hostile or distrustful towards the world
• constant feelings of emptiness or hopelessness
• feeling as if you are permanently damaged or worthless
• feeling as if you are completely different to other people
• feeling like nobody can understand what happened to you
• avoiding friendships and relationships, or finding them very difficult
• often experiencing dissociative symptoms such as depersonalisation or derealisation
• regular suicidal feelings (mind.org.uk)

Why does trauma effect some people more than others or not at all?

As babies our primary concern is to attach to our primary care giver, if we don’t achieve this we will not survive. Under ‘normal’ conditions, early parent-child interactions facilitate the development of self-regulatory structures located in the corticolimbic region of the brain’s right hemisphere.

Disruptions to the attachment process, such as maternal separation, deprivation or trauma can upset both the psycho-biological and neuro-chemical regulation in the developing brain, leading to a lasting psycho-physiological effect on the brain and behaviour. A right-brain dysfunction may develop, creating a vulnerability to PTSD and also a pre-disposition to violence in adulthood.

In addition, the absence of ‘compensatory social structures’ e.g. older generations, can also impede recovery (Bradshaw et al., 2005).

According to Mind.org.uk you are more likely to develop complex PTSD if:

• you experienced trauma at an early age
• the trauma lasted for a long time
• escape or rescue were unlikely or impossible
• you have experienced multiple traumas
• you were harmed by someone close to you.

Stressful experiences following any trauma need to be fully processed and absorbed by the individual if they are not to cause malfunctioning. If emotional processing does not happen satisfactorily, intrusive cognitions can commonly occur (Rachman, 1980 in Yule 1999). The ‘Schematic, Propositional, Associative & Analogical Representational Systems’ (SPAARS) Functional Theory of Emotions (as shown in both diagrams below) compare pictorially how normally events of the world are processed in Analogical and progress to Schematic, Associative and Propositional systems but when a traumatic event is progressed it goes to all systems, except associative and PTSD is then experienced between the three systems. Until resolved, there is a continued threat and intrusion, so avoidance & vigilance are highly adaptive ways of dealing with this. PSTD is not a disorder of cognitive system but a function of its efficiency.

Van der Kolk (1994) published evidence to show traumatic memories are encoded non-verbally on the right temporal lobe which is less accessible to verbal mediated processing. This highlighted that other complex organisms that have complex cognitive abilities such as elephants, primates, dolphins, wolves, dogs, horses and so on, may also be affected by traumatic events and similar experiences (Yule 1999). Young elephants that have watched family being shot with poaching or mass culls, show symptoms associated with human PTSD such as abnormal startle response, depression, un-predictable asocial behaviour and hyperagression and some have gone on rampages years later killing humans (Bradshaw, 2005).

What treatments are there for PTSD?

Because PTSD has strongly affected the brain itself, treatment often takes longer and progresses more slowly than with other types of anxiety disorders. In all species, Cognitive Behaviour Therapy tries to identify triggers and uses gradual exposure and habituation of traumatic memories until they become of no consequence. Good social support is also important for recovery, being isolated is not healthy for anyone. Scientists are investigating psychophysiological, neurochemical & neurophysiological treatments for humans (Yule, 1999).

According to National Institute for Health and Care Excellence (NICE) there are currently two types of talking therapies that are proven to treat PTSD:

• Trauma-focused Cognitive Behavioural Therapy (TF-CBT) CBT which is specifically for PTSD.
• Eye Movement Desensitisation and Reprocessing (EMDR) a relatively new treatment to reduce PTSD symptoms such as being easily startled.

Some people with PTSD say they have found other treatments helpful in managing their condition, such as group therapy, arts therapies or dialectical behaviour therapy (DBT). However, the NICE guidelines say that treatments that have not been designed or properly tested for people who have experienced trauma should not be used on their own (mind.org.uk).

Self Care for PTSD

Tips for Family and Friends

References & Useful Links:

• Bradshaw, G. A., Schore, A. N., Brown, J. L., Poole, J. H. and Moss, C. J. (2005). Elephant Breakdown. Nature, 433: 807.
• Rachman, S. (1997). Foreword. In: Yule, W. (Ed.) (1999). Post Traumatic Stress Disorders: Concept and Therapy. John Wiley & Sons, Chicester.
• Yule, W. (Ed.) (1999). Post Traumatic Stress Disorders: Concept and Therapy. John Wiley & Sons, Chicester.
• Mind.org.uk
• NHS.uk
• PTSD.uk
• National Institute of Mental Health
• WebMD

Image: AsimAlnamat