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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Post-traumatic Stress Disorder: key facts

How does it feel to have this disorder?

Post Traumatic Stress Disorder

What is PTSD?

Any of us can, without warning, be caught up a traumatic event that is overwhelming, frightening, life-threatening (to ourselves or others) and beyond our control. This could be:

  • getting a diagnosis of a serious illness
  • having (or seeing) a serious road accident
  • the unexpected injury or violent death of someone close
  • being taken hostage or assaulted
  • being a prisoner-of-war.

After such an event, most people feel distressed and can have symptoms for some time. Everyone will react differently, bit it is common to feel anxious, angry, emotional, shaky and to have difficulty putting the event out of our mind. This is called Acute Stress Reaction. Fortunately, this usually fades over a period of days or weeks.

But sometimes, the acute reaction doesn't go away and you can develop a more severe condition that we call Post-Traumatic Stress Disorder, or PTSD.

The condition can also be triggered by less acute, but equally distressing and longer-lasting traumas, such as on-going mistreatment, and physical or sexual abuse in the home.

Does everyone get PTSD after a traumatic experience?

No. Most people get an Acute Stress Reaction which has some overlap with PTSD symptoms. These usually go way, but not everyone is so lucky. About 1 in 3 people will find that their symptoms just carry on and that they can't come to terms with what has happened. It is as though the process has got stuck.

When does PTSD start?

The symptoms usually start within a few weeks of the trauma, but they can start up to 6 months later.

What does PTSD feel like?

After the traumatic event you can feel grief-stricken, depressed, anxious, guilty and angry. In PTSD you may also:

  • have flashbacks and nightmares - you relive the event in your mind, again and again
  • avoid thinking about it and feeling upset by keeping busy and avoiding anything or anyone that reminds you of it
  • be ‘on guard’ – you stay alert all the time, can’t relax, feel anxious and can’t sleep
  • get physical symptoms – aches and pains, diarrhoea, irregular heartbeats, headaches, feelings of panic and fear, depression
  • start drinking too much alcohol or using drugs (including painkillers).

Treatments that can help

Psychological (talking) therapies. These are usually delivered on a one-to-one basis with your therapist. The ones with the best evidence-base are:

  • Cognitive behavioural therapy (CBT) – helps you to think differently about your memories, so that they become less distressing and more manageable. It usually involves relaxation to help you tolerate the discomfort of recalling the traumatic events.
  • Eye movement desensitisation & reprocessing (EMDR) - uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience.

Medication. Antidepressant tablets can help. If you find them helpful, you should carry on taking them for around 12 months before slowly tailing them off. If you are so distressed that you can't sleep or think clearly, you may need sedative medication. But you should only take this for a short time, 2 weeks or so.

How do treatments compare?

CBT, EMDR and antidepressants seem to be most helpful. The evidence for other forms of psychotherapy or counselling is much weaker. Trauma-focused psychological therapies (CBT and EMDR) should usually be offered before medication.

How do I know when I've got over a traumatic experience?

When you can:

  • Think about it without becoming distressed
  • Not feel constantly under threat
  • Not think about it at inappropriate times.

How to help yourself

  • Seek help and support - from professionals, friends and family.
  • If possible, try to get back to your usual routine.
  • Talk about what happened to someone you trust and try relaxation exercises.
  • Eat regularly, take exercise and spend time with family and friends.
  • The event may have made you avoid something - perhaps driving or going out. Be aware of this and, if you think it's possible, try to overcome the fear. This may be difficult and may need to be done gradually.
  • Take care with driving - you are more likely to have an accident while you feel like this. Speak to your doctor and keep hopeful.
  • Try not to avoid other people.
  • Try not to resort to alcohol or street drugs to help you cope. These will make it more difficult to get better.
  • Body-focused therapies, such as physiotherapy and osteopathy, massage, acupuncture, reflexology, yoga, medication and Tai Chi. These can help you to control your distress, to reduce the feeling of being 'on guard' at all time, and to focus on the 'here and now' experiences rather than the past.

Most importantly, don't be hard on yourself or expect too much of yourself. PTSD is not a sign of weakness. The strongest person can get it.

How other people can help you

Some people think it can be helpful to let those around you know about your mental health problems, whether they are family, friends or colleagues at work. This may help people know what things can help you, especially during times of crisis.

It is not easy to be open with people about these issues. It may help to discuss this with your doctors or mental health team to decide if this is the right approach for you.

How can I help someone who has PTSD?

Remind yourself that they are irritable and jumpy because they are still reliving the trauma. Give them time to tell you about what happened.

 

For more in-depth information see our main leaflet: Post-traumatic Stress Disorder

This leaflet reflects the most up-to-date evidence at the time of writing.

Produced by the RCPsych Public Education Editorial Board.

Series Editor: Dr Philip Timms

Reviewed by Dr Michael Yousif

© February 2014. Due for review: February 2016. Royal College of Psychiatrists. This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.

For a catalogue of public education materials or copies of our leaflets contact: Leaflets Department, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB. Telephone: 020 3701 2552.

Charity registration number (England and Wales) 228636 and in Scotland SC038369.

 

Please note that we are unable to offer advice on individual cases. Please see our FAQ for advice on getting help.

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