Post-traumatic stress disorder (PTSD)

• Traumatic events can involve actual or threatened death, serious injury,  sexual violence or emotional abuse.
• A trauma is defined as an emotional response to a shocking, stressful or dangerous event that you see or experience or hear about, especially if it happened to someone close to you.
• After experiencing or learning about deeply distressing events, post-traumatic stress reactions are normal. These may include difficulty relaxing, nightmares or flashbacks, numbness, changes in mood or appetite, diminished ability to concentrate or socialise, and avoiding anything related to what happened.
• Post-traumatic stress disorder (PTSD) is diagnosed if your post-traumatic symptoms last longer than a month and cause you significant difficulties in your everyday functioning.
• Not everyone who experiences trauma develops PTSD. It is not a sign of weakness and post-traumatic stress and PTSD can happen to anyone. In many ways, it is a normal part of the traumatic healing process.
• PTSD can be triggered by a single traumatic event, several traumatic events at different times or ongoing traumatic circumstance (see also complex-PTSD, below).
• There is help available and most people recover or their symptoms become mild.

Causes

No one is completely sure why post-traumatic stress develops. Some theories say it could be your brain's way of trying to keep you better prepared next time something happens. Re-experiencing an event with flashbacks may be your mind’s way of trying to make sense of an overwhelming and scary experience.

PTSD can be triggered by a single traumatic event (eg, an earthquake, assault or car crash) or several traumatic events at different times. If you experience ongoing traumatic circumstances especially during childhood (eg, childhood abuse or neglect), you may also develop a condition known as complex-PTSD or C-PTSD.

Complex post-traumatic stress disorder (C-PTSD) is another type of post-trauma stress reaction. It can develop in response to being exposed to traumatic events many times over a long period in a context in which you have little or no chance to escape or prevent the event from happening. 

Who is at risk of C-PTSD?

Complex PTSD can develop in response to events in which you feel threatened and trapped, or you cannot protect yourself or someone else close to you. The trauma is experienced over a long period of time and is often at the hands of another person.

You may be at risk of C-PTSD if you:

• experienced or witnessed ongoing physical, psychological or sexual abuse as a child
• have been held hostage
• are a victim of ongoing family violence
• are/were a prisoner
• have been in a cult.

What are the symptoms of C-PTSD?

C-PTSD symptoms are the same as those of PTSD plus 3 extra groups of symptoms:

1. Emotional dysregulation – this means it is hard to manage or control your feelings, so they can quickly become quite strong and overwhelming.
2. Negative self-cognitions – this means you think of yourself in negative ways, such as feeling permanently damaged or worthless.
3. Interpersonal hardship – this means that your symptoms are affecting how you get on with other people, so you might be avoiding friendships and relationships, or finding them very difficult.

These extra symptoms are similar to symptoms of borderline personality disorder (BPD). 

Is C-PTSD a recognised condition? 

Complex PTSD is a fairly new term. Mental health experts have recognised for a while that some types of trauma can have more effects than PTSD, but have disagreed about whether this is a form of PTSD or an entirely separate condition, and what it should be called.

C-PTSD has been recognised by the World Health Organization in its latest International Catalogue of Diseases (ICD-11.). It has not yet been recognised as a separate condition by the American Psychiatric Association in its latest Diagnostic and Statistical Manual (DSM-5).

There is still some ongoing discussion about the difference between C-PTSD and BPD.

How is C-PTSD treated? 

Even though you may have been through even worse trauma than someone with PTSD, the treatment is the same. Talking therapy with someone experienced in working with PTSD and who you feel safe with and trust is the best way to recover. Medicine for anxiety or depression may help you manage your symptoms, but won’t heal the condition.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 111 or your local emergency number immediately. If you know someone who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person to keep them safe. Call 111 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room. 

What self-care can I do with C-PTSD?

C-PTSD can be challenging to live with. Here are a few tips to help you manage it.

Learn how to manage flashbacks

• Use your breathing to steady you by breathing slowly in and out while counting to five.
• Carry an object that reminds you of the present.
• Tell yourself you are safe.
• Comfort yourself by doing something like curling up in a blanket, cuddling a pet, listening to soothing music or watching a favourite film.
• Keep a diary to help you work out the triggers.
• Practice grounding techniques that help you focus on your experience now, such as breathing slowly, listening to sounds around you, walking barefoot, wrapping yourself in a blanket and feeling it around you, touching something or sniffing something with a strong smell.

Get to know your triggers

You can then plan ahead for what to do at those times.

Get support

Make sure you have a good support team around you of family/whānau, friends, peers who have been through trauma and professional help. You can ask your healthcare provider for a recommendation for a psychologist or psychotherapist, or you can find someone yourself(external link).

Give yourself time

Be kind to yourself – it takes time and good support to recover. You can only go at the pace that is right for you.

Take care of your physical health

• You might feel like you don't have the energy to do this, but looking after your physical health can help you feel better emotionally. If you're having trouble with your sleep, talk to your healthcare provider about this and read these sleep tips.
• What you eat affects how you feel. Eating some foods can improve your mood and mental wellbeing, while other foods can have a negative impact on how you feel. Read more about food and mood.
• Even if you can't manage doing too much exercise, doing some gentle walking and stretching can help. Even getting outside in the fresh air can help you feel a bit better.

Support

There may be a support group in your area for people who have had a similar experience. Ask your doctor or therapist. If you need someone to talk to urgently, phone:

• Lifeline 0800 543 354
• Healthline 0800 611 116
• Samaritans 0800 726 666
• Youthline 0800 376 633

The symptoms of post-traumatic stress are a part of a normal response to a traumatic experience. They are not a sign of weakness or inability to cope. Over time these feeling usually settle but if not they can cause ongoing distress. 

Symptoms may include: 

• being wired and on edge, watchful or jumpy
• disturbed sleep with nightmares
• avoiding situations, people or events that remind you of the event
• flashbacks of images, memories and thoughts about the event
• feeling numb and withdrawn or spacey and not present
• difficulty with memory, concentration and decision-making
• body symptoms, such as digestive problems, headaches or other non-specific pain
• changes in appetite (lack of appetite or overeating)
• increase in the use substances (alcohol, cigarettes, or drugs)
• changes in mood (tearfulness, irritability, anger, guilt)
• sense of helplessness and hopelessness.

In children, look out for agitated or changed behaviour, nightmares, repetitive play about the event or unexplained physical symptoms.

It is normal to feel shocked and upset after a traumatic event/s, but if you have disturbing thoughts and feelings for more than a month that you experience as severe, or if you feel you're having trouble getting your life back under control, talk to your doctor or a mental health professional.

Getting treatment as soon as possible can help prevent post-traumatic symptoms from getting worse and developing into PTSD.

To be diagnosed with PTSD, your doctor will ask questions to see if you meet the criteria set out in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5). 

There are 8 criteria: 

1. Exposure to actual or threatened death, serious injury or sexual violence.
2. The presence of one or more intrusion symptoms associated with the traumatic event, such as flashbacks and distressing dreams.
3. Ongoing avoidance of anything that makes you recall the event or external reminders, such as people of places.
4. Negative changes in your thinking and mood, such as believing there is something wrong with yourself or feeling fear, horror, anger, guilt, or shame.
5. Noticeable changes in your behaviours, such as how angry or reckless you are, or how well you sleep.
6. All of these changes have lasted for more than 1 month.
7. The changes are causing you significant distress or impairment in your social or work life or other important areas of functioning.
8. The changes aren’t caused by use of a substance, eg, alcohol or medicine or another medical condition.

You can read the full criteria in medical terminology(external link).

Talking therapy with someone experienced in working with PTSD and who you feel safe with and trust is the best way to recover. Medicine for anxiety or depression, in combination with talking therapies may also help you to manage your symptoms, but won’t heal the PTSD.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 111 or your local emergency number immediately. If you know someone who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person to keep them safe. Call 111 or your local emergency number immediately. Or, if you can do so safely, take the person to the nearest hospital emergency room.

• Take good care of your basic needs, such as sleep, exercise, healthy eating and quiet time.
• Tell your friends and family/whānau – they can support you.
• Some people feel that they benefit from writing about or drawing what happened, while others heal better by letting these memories fade for a while.  
• Do things that help you feel calm, such as taking a walk or a bath, reading a good book or listening to soothing music.
• Read about a PTSD app you can download onto your phone.

Apps reviewed by Healthify

You may find it useful to look at some Mental health and wellbeing apps.

There may be a support group in your area for people who have had a similar experience. Ask your doctor or therapist. If you need someone to talk to urgently, contact:

• 1737 – free text or call any time of day or night to speak to a trained counsellor 
• Lifeline 0800 543 354
• Healthline 0800 611 116
• Samaritans 0800 726 666
• Youthline 0800 376 633

Video: PTSD Lisa's story

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(NHS, UK, 2015)

Video: Post traumatic stress disorder (PTSD) | Talking about mental health - Episode 17

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(Mind, UK, 2016)

Video: Jordan's PTSD Story #PTSDandMe

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(Fixers UK, 2019)