Post-traumatic Stress Disorder (PTSD)

Post-traumatic Stress Disorder (PTSD) is a mental health condition that can develop in people who have experienced or witnessed a terrifying event. It's characterised by persistent, distressing symptoms that occur after the traumatic event has ended. These symptoms can significantly interfere with daily life, relationships, work, and overall well-being.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the diagnostic criteria for PTSD involve exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).
2. Witnessing in person the traumatic event(s) as they occurred to others.
3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event must have been violent or accidental.
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly being exposed to details of child abuse). This does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work-related.

After this exposure, individuals with PTSD experience a cluster of symptoms across four main categories:

1. Intrusion Symptoms: These involve re-experiencing the traumatic event in distressing ways, even when the event is over. Symptoms can include:

   • Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
   • Recurrent distressing dreams in which the content or affect of the dream is related to the traumatic event(s).
   • Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. These can range from brief episodes to complete loss of awareness of present surroundings.
   • Intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event(s).
   • Marked physiological reactions to internal or external cues that symbolise or resemble an aspect of the traumatic event(s).

2. Avoidance Symptoms: These involve efforts to avoid reminders of the traumatic event(s). Symptoms can include:

   • Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
   • Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

1. Negative Alterations in Cognitions and Mood: These involve negative changes in thinking and feelings that began or worsened after the traumatic event(s). Symptoms can include:

   • Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, not due to head injury, alcohol, or drugs).
   • Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad", "No one can be trusted", "The world is completely dangerous").
   • Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame themselves or others.
   • Persistent negative emotional state (e.g., fear, horror, anger, guilt, shame).
   • Markedly diminished interest or participation in significant activities.
   • Feelings of detachment or estrangement from others.
   • Persistent inability to experience positive emotions (e.g., happiness, satisfaction, or loving feelings).

2. Alterations in Arousal and Reactivity: These involve changes in arousal and reactivity that began or worsened after the traumatic event(s). Symptoms can include:

   • Irritable behaviour and angry outbursts (typically with little or no provocation) expressed as verbal or physical aggression toward people or objects.
   • Reckless or self-destructive behaviour.
   • Hypervigilance (being constantly on guard).
   • Exaggerated startle response.
   • Problems with concentration.
   • Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

For a diagnosis of PTSD, these symptoms must last for more than one month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The disturbance must also not be attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

It's important to recognise that not everyone who experiences a traumatic event will develop PTSD. Resilience and coping mechanisms play a significant role. However, for those who do develop PTSD, effective treatments such as psychotherapy (e.g., trauma-focused cognitive behavioural therapy, eye movement desensitisation and reprocessing) and medication are available to help manage symptoms and improve quality of life. Seeking professional help is crucial for individuals struggling with PTSD.