How we react to Trauma: What is Post Traumatic Stress Disorder (PTSD) and how is it treated?

What is Post Traumatic Stress Disorder (PTSD) and how is it treated?

How each person reacts to a trauma is unique, as is each person’s recovery from their own trauma. Experiencing trauma can be horrific, yet most people recover on their own without psychological or pharmacological intervention. Having said that, some people can get stuck in their recovery. For example, people might avoid thinking or talking about what happened which makes it harder to ask for help. People cope in the best way they can, and while many people recover, other people go on to develop Post Traumatic Stress Disorder (PTSD). Cognitive Behavioural Therapies offer some very effective treatments for PTSD, but Trauma Focused Cognitive Therapy (TF-CT) in particular has been shown to be a very effective treatment for PTSD.

The theme of PTSD is threat, but more specifically current threat about a past event…so how can a past event lead to a sense of current threat? The answer lies in how the event is processed and the subsequent meaning of trauma memories. Reminders of the threat or injustice of the traumatic event can trigger a threat response (fight, flight, freeze or appease). Other emotions such as anger, depression, guilt and shame are common. Subsequent meanings of memories can change how we see ourselves, others, and the world and the future in both negative and distorted ways. 

PTSD is sometimes referred to as a disorder of memory because trauma memories are fragmented and disjointed, for example, the order of events might seem unclear, so it is hard to tell the story. Memories can sometimes come as flashbacks. Flashbacks, or a sense of being ‘back there’, can be triggered by reminders of the event or seem to come out of nowhere. These memories or images are usually only one aspect; a partial memory of what happened, perhaps the ‘worst’ parts, and taken out of context. These can be physically and emotionally upsetting. A person might even briefly lose touch with surroundings for short periods of time.

Experiencing nightmares, looking out for danger, difficulty sleeping, substance abuse, withdrawing from friends, self-blame, self-criticism, difficulty concentrating, anger, fear, avoidance, withdrawing from people, reduction in quality of life, feeling disconnected or numb are all common. Guilt may not take into account the full context and facts, and shame can lead to withdrawal and avoidance of others. Quality of life can reduce and contribute to a secondary depression. People might think they are losing control or going ‘mad’, that others aren’t to be trusted, that the world is a dangerous place, and perhaps that the future is hopeless. These are normal responses to abnormal experiences. The problem is when these beliefs remain unchallenged and reduce quality of life or stops a person reaching their potential.

PTSD can stick around many years after an event and sometimes triggered long after the event. In the same way that a person might not want to talk about their experiences, professionals may not ask for fear of making things worse. Using a structured treatment, symptoms can fall away quickly, and a person affected by a traumatic experience can regain control and reclaim their life to fulfil their potential. 

Many people recover without professional assistance, but if not, Trauma Focused Cognitive Therapy (TF-CT) is a very effective empirically sound treatment for PTSD.

The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) or the International Classification of Diseases 11th Revision (ICD 11) outline the diagnostic criteria for PTSD. If you are wondering, the ICD tends to be more concise, is published by the WHO and is free, whereas the informative DSM-5 is published by the American Psychiatric Association and is sold.