Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) is a mental health condition that can affect people who have witnessed or been involved in a traumatic event. People with PTSD continue to feel distress and anxiety long after the traumatic event, experiencing symptoms such as flashbacks, nightmares, irritability and anger. It’s also possible for PTSD to develop several months, or even years, after a traumatic event.
PTSD has a long history and has been referred to by a number of different names in the past, including ‘shell shock’ and ‘battle fatigue’. It is commonly seen in first-response emergency workers, soldiers returning from war, refugees and people who have been physically or sexually abused.
PTSD disrupts the lives of affected people and their families, but there are treatments available that can relieve the symptoms and help those affected to feel like themselves again.
Most people experience some level of distress following a traumatic event but, with support, usually start to gradually feel better over days or weeks. In contrast, people who develop PTSD are very distressed by a range of symptoms that persist for more than a month.
There are 4 main groups of PTSD symptoms, which include the following.
- Persistently re-experiencing the event through unwanted recurring thoughts, flashbacks (reliving the event), vivid dreams and/or nightmares. There may be physical symptoms, such as sweating, panic and palpitations, when remembering the event.
- Avoidance - trying to avoid thinking about or remembering the event and avoiding things that trigger memories of the event (such as places, people, sounds or activities).
- Feeling wound up or on-guard. You may be easily upset, startled or angered, and always on the look-out for danger. Many people with PTSD feel very irritable and have trouble concentrating or sleeping. Some people become reckless or behave in a self-destructive way.
- Negative thoughts and feelings. These can include feeling emotionally ‘numb’ or ‘flat’. You may have negative thoughts about yourself, others and the world, including guilt or blame. You may also feel cut-off or detached from family and friends, withdraw from social activities and lose interest in previously enjoyable activities.
Additional symptoms in children may include upsetting dreams, becoming overly attached to a parent or another adult (‘clingy’ behaviour) and acting out the traumatic event through repetitive play. Younger children may start having extreme tantrums or regress in terms of developmental milestones (such as speech and toileting). Teenagers may start to show disruptive or destructive behaviours.
Who gets PTSD?
PTSD happens to people who have experienced very unpleasant, traumatic events in their lives. These events usually involve witnessing or being personally at risk of death, near death, or serious injury. Being involved in the horrors of war is one of the best known triggers for PTSD, but a wide variety of other situations can cause it.
These include car accidents, physical and sexual assault, armed robbery, natural disasters such as a bushfire or cyclone, or having a heart attack or other life-threatening medical diagnosis. People such as police, emergency workers and ambulance officers, whose work brings them into frequent contact with unpleasant events, are not immune and may experience PTSD.
About a quarter of all people who experience a traumatic event develop PTSD. Women are more likely than men to develop PTSD, but it can affect anyone at any age.
People who are at higher risk of developing PTSD include those who:
- are under stress;
- have experienced traumatic events in the past;
- have a pre-existing mental illness (or have had a mental illness in the past); and
- lack support from family and friends.
People with PTSD are at increased risk of alcohol and other substance abuse. PTSD commonly leads to problems with relationships. Depression and anxiety are also more common among people with PTSD.
When to get help and see a doctor
Traumatic events cause significant distress when you experience them - that’s to be expected. But if you continue to feel very distressed for weeks following a traumatic event, and you have symptoms that stop you from doing your usual activities (or wanting to do them) you should see your doctor.
Many cases of PTSD go undetected for years because people are often reluctant to talk about their unpleasant experiences and distress. Talk to your doctor if you think you could have PTSD - the sooner you get treatment the sooner you’ll feel better.
Where to get help
The best place to start is usually your local doctor - your GP - or a mental health professional at your local community mental health centre. Your doctor will be able to work out whether you are likely to have PTSD, discuss treatment options with you and provide support and understanding. They may refer you to a psychologist or psychiatrist for treatment.
In Australia, if you need immediate help, you can call Lifeline on 13 11 14. There are counsellors available 24 hours a day, 7 days a week, who can help you and refer you for further treatment.
Tests and diagnosis
Your doctor will ask about your symptoms, how long you have had them and any events that may have triggered them. While you may be reluctant (or even scared) to talk about your feelings, getting diagnosed is the first step to recovery.
Your doctor can diagnose PTSD if you have symptoms that have lasted for at least a month. If you’ve had symptoms for less than a month, you may have another type of post-traumatic mental health disorder called acute stress disorder (ASD).
People with ASD often describe ‘being in a daze’ and their symptoms cause significant distress and interfere with their daily lives. Having ASD increases your risk of developing PTSD. Treatment for ASD involves psychological therapy as for PTSD (see below). Medicines are generally not recommended.
Treatment for post-traumatic stress disorder
There are several treatments available in Australia for PTSD. Even if you have had symptoms for a long time, by finally getting treatment you can help yourself to get better. Psychological treatment (counselling) is effective and can help people make a full recovery. Sometimes medicines are also recommended.
People with complications such as depression or substance abuse (drinking too much alcohol or taking illicit drugs) may also need additional treatments for these problems.
Trauma-focussed psychological treatments are the most effective treatments for PTSD and are the first choice treatment in most cases. These therapies involve gradually confronting memories of the traumatic experience in a safe environment and challenging the way you think about and remember the event. You are shown ways to manage your anxiety while developing different ways of thinking about the event, until these memories stop causing you distress.
The main psychological therapies recommended for PTSD include the following.
- Trauma-focussed cognitive behaviour therapy (TF-CBT): a type of therapy where you are encouraged to think about the traumatic event(s) and develop different responses to the memories. Over time you should be able to manage your symptoms and stop avoiding situations that you fear will trigger your symptoms.
- Eye movement desensitisation and reprocessing (EMDR): a type of therapy that’s thought to help you process your memories of the traumatic event. It combines psychological therapy similar to TF-CBT with repetitive eye movements - during therapy, you are asked to move your eyes back and forth (for example, by following the therapists finger with your eyes).
Other types of therapy that may be of benefit include anger management, relaxation therapy and group therapy. Learning how to cope with and manage anger and stress, especially when undertaking TF-CBT, can help with the demands of confronting traumatic memories. Therapy in groups is helpful for some people, especially those who feel like they would benefit from talking to others who understand what they are going through.
Internet-based therapies are available, and may be a good option for people with PTSD living in remote areas or those with limited access to a psychologist. Talk to your doctor about this type of treatment.
Medicines may be suggested for some adults with PTSD. Medicines are usually recommended in combination with psychological treatment, or as an alternative when psychological treatment is not available.
The first choice of medicine for people with PTSD is one of the selective serotonin reuptake inhibitors (SSRIs) - a type of antidepressant medicine. SSRIs can help ease the distressing feelings associated with the trauma you experienced.
It can take several weeks before you feel the benefit of SSRIs, and possible side effects include nausea, difficulty sleeping, tiredness and loss of sex drive.
It was previously thought that psychological counselling to debrief after a traumatic event would help prevent PTSD developing. However, routine psychological debriefing that involves recounting the event has not been found to be helpful, and in some people it may actually be harmful, so it is no longer recommended.
However, practical and emotional support from family, friends and health professionals is important to help you cope with a traumatic event.
Support for people with PTSD as well as their families is very important. Finding out as much as you can about the condition helps you and your family understand the symptoms and how to deal with them. Sometimes family members feel like they are being pushed away, and it can be a relief to realise that this is usually a symptom of the illness.
Talking to others who have been affected by PTSD should help you to feel you are not alone. Understanding from others is often invaluable for people with PTSD. Search online for a local support group or talk to your doctor or psychologist about relevant groups nearby.
National organisations such as beyondblue and SANE Australia host online forums where people with mental health problems and their families can communicate, share experiences and support each other.
2. Cooper J, Metcalf O, Phelps A. PTSD - an update for general practitioners. Australian Family Physician 2014;43(11):754-7. https://www.racgp.org.au/afp/2014/november/ptsd-%E2%80%93-an-update-for-general-practitioners/ (accessed Mar 2018).
3. SANE Australia. Post-traumatic stress disorder (PTSD) (updated 2 Mar 2018). https://www.sane.org/mental-health-and-illness/facts-and-guides/post-traumatic-stress-disorder#factsheet (accessed Mar 2018).
4. Posttraumatic mental health disorders (published July 2013). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2017 Nov. https://tgldcdp.tg.org.au (accessed Mar 2018).