Post-traumatic stress disorder (PTSD)

Every professional now calls for a better environment for better mental health, either a work environment or a studying environment.

The whole world now is aware that mental health is just as important as physical health. In fact, many doctors and scientists confirm that mental health can affect one's physical health significantly. For example, conditions such as anxiety, depression and stress can affect mental health as well as disrupt one's daily life.

It can affect daily living and relationships as well as physical health. The problem is that this link can work the other way around. In other words, factors in one's life, relationships and physical factors can all contribute to the disruption of mental health.

Taking care of your mental health can preserve your ability to enjoy your life. It can be achieved if you maintain a balance between life activities, responsibilities and the efforts exerted to achieve psychological resilience. That's why the whole world now has gained a great deal of awareness about mental health.

The term mental health is so commonly used right now, however, many psychological conditions have physical roots, that's why psychiatrists always recommend excluding the physical possibilities first.

We have mentioned the term "Mental health" many times now.

What is mental health?

The definition of mental health, according to The World Health Organization, is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stress of life, can work productively and is able to make contributions to his or her community.

The World Health Organization also stresses that mental health is not just only the absence of mental disorders, in fact, peak mental health aims to ongoing wellness and happiness.

But if someone is so concerned about their mental health and always preserving and maintaining a good mental state, what can disrupt this peace of mind?

Everyone has some risk of developing a mental health problem or disorder regardless of their age, sex, income or ethnicity.

In many developed countries, mental disorders are one of the leading causes of disability.

The link between our daily life and mental health is so complicated. Many factors can shape one's mental health including social and financial circumstances, biological factors and everyday life choices.

So, we can conclude that good mental health depends on the balance between several elements of life. That's why a large proportion of people with mental health problems can have more than one condition at a time.

So, let's have a look at the factors that contribute to mental health disruption:

Ongoing social and economic pressure.

In 2013, a study conducted in Iran on 903 families identified several socioeconomic causes of mental health problems such as poverty and living in the outskirts of the city.

People with weak economic status scored highest for mental health conditions in this study.

Researchers also explained that the availability and quality of mental health treatment for different groups of people depend on two modifiable and non-modifiable factors.

Modifiable factors that affect mental health include:

Socioeconomic conditions. For example, if work is available in the local area.
Occupation.
Education.
Housing quality.
A person's level of social involvement.

Non-modifiable factors are:

Gender.
Age.
Ethnicity.

But what does gender have to do with mental health?

Researchers have found that being a female increase the risk of low mental health status by 3.96 times.

What about other Biological factors?

The National Institute of Mental Health suggests that genetic family history increases the risk of mental health conditions. Certain genes and some gene variants can increase the risk of some mental health problems.

However, other factors play a role in the development of mental health conditions.

The link between genes and mental health conditions is somehow controversial. The presence of a gene with links to mental health disorders like depression and schizophrenia doesn't guarantee that the condition will develop. In the same way, people without related genes can still have mental health issues.

There are many types of mental health disorders. In this article, we are going to focus on post-traumatic stress disorder, or also known as PTSD.

What is Post-traumatic stress disorder or PTSD?

PTSD is a mental health issue that usually develops after a distressing event. The event could be scary, shocking, life-threatening or dangerous such as:

Accidents like car accidents.
Military combat.
Fires.
Physical abuse.
Natural disasters such as tornadoes and volcanoes.
Sexual assault or rape.
Terrorist attack.
The sudden death of a loved one.
Mugging.
Robbery.
Plane crash.
Torture.
Kidnapping.
Life-threatening medical diagnosis.
Extreme life-threatening events.

This traumatic event not only could have happened to the patient, but also, they could have seen it or witnessed it happening to someone else.

You may think, isn't it normal? I mean, it is totally natural to be upset after such horrible events. A normal person will have trouble sleeping, eating, or doing regular daily activities to enjoy life.

Yes, it is true. A normal human being would have psychological troubles after traumatic events and it is natural. However, with post-traumatic stress disorder, symptoms last longer for a few months or maybe longer and interfere with the quality of life.

But in the history of psychology, what makes Post-traumatic stress disorder recognizable? Is it so common?

Yes, PTSD is quite common. For example, women who experience neglect or childhood abuse can develop PTSD more often than men because women are more likely to experience traumatic events such as domestic violence and sexual assault. Women tend to experience trauma differently than men as well.

So, from this, can we assume that some people are more likely to develop PTSD than others?

In practice, there is no way to tell or predict who will develop PTSD from a traumatic event. People of all age groups can develop PTSD.

However, doctors found out that PTSD is more common in people who experienced:

Injury during the event.
Long-lasting or repeated trauma.
Certain types of traumas especially military combat or sexual assault.
Lack of support from close people and loved ones after the traumatic event.
Previous personal history of anxiety or depression even before the traumatic event.
String initial reaction to the event such as throwing up or shaking.
Very intense trauma.
Having experienced other traumas earlier in life such as childhood abuse.
Occupations that increase the risk of being exposed to traumatic events such as emergency first responders.
Having problems with substance misuse such as alcoholism and drug use.
Having blood relatives with mental health issues such as anxiety and depression.

What causes Post-traumatic stress disorder?

Doctors aren't really sure why some people get PTSD while others don't.

But as we mentioned, it usually develops after people experience something or witness something traumatizing.

In general, PTSD is usually caused by a complex combination of:

Stressful events, including the severe traumas patients, have been through in their lives.
Temperament or the inherited features of personality.
How the brain regulates the chemicals and hormones released during times of stress.

People usually experience flashbacks and difficulty living their lives after traumatic events. What are PTSD symptoms? How is it different from a normal reaction to a traumatizing event?

Because we are human beings and we are completely different from one another, our reactions will vary.

Therefore, PTSD symptoms vary from one person to another.

Symptoms might start within one month after the traumatic event. In some reported cases, symptoms don't appear until years after the traumatizing event.

The problem with these symptoms is that they, literally, prevent people from living their everyday life. They cause significant problems socially, in work and also in relationships. They interfere in the patient's ability to do their normal daily tasks.

What are these symptoms?

Doctors classify symptoms of PTSD into four groups: intrusive memories, avoidance, negative changes in thinking and mood and changes in emotional and physical reactions.

These symptoms vary from one person to another and also vary over time in the same person.

So, let's explain each group of these symptoms in detail.

Intrusive memorie

PTSD can make the patients experience horrible unwanted memories again. And this is one of the hardest symptoms patients usually face.

Symptoms of intrusive include:

Recurrent, unwanted distressing memories of the traumatic event.
Reliving the horrible event as if it is happening again in the form of flashbacks or dreams.
Upsetting dreams or nightmares about the traumatic event.
Severe emotional distress or unexpected physical reaction to something that reminds the patient of the traumatic event.

Avoidance

Patients usually tend to avoid thinking or talking about the traumatic event. It can be so severe that they would even avoid places, activities or people that remind them of the traumatic event.

Examples include friends they met in the military service, part of the town where they experienced the trauma.

Some people might also cope with the trauma by keeping themselves so busy so they don't think about that event.

Negative changes in thinking and mood

This negative thinking gets implanted in the brain of the patient so that they hold negative thoughts about themselves, people around them or the world as a whole.

They tend to become so hopeless about the future.

They would also suffer from memory problems including not remembering important details about the traumatic event.

Patients also have a hard time socializing; they feel detached from family and friends and they lose interest in activities they used to enjoy.

It becomes so difficult for them to experience positive emotions to the extent that they would become emotionally numb.

Changes in physical and emotional reactions

These changes are also known as arousal reactions, and they include:

Being easily frightened or startled.
Always expecting danger and being on guard for danger.
Difficulty concentrating.
Difficulty sleeping.
Feeling guilt or shame.
Angry outbursts.
Aggressive behaviour.
Irritability.

Those symptoms can be experienced by adults and children who have PTSD.

But children 6 years old or younger may experience other symptoms like:

Frightening dreams that may or may not include the traumatic event.
Recreating the traumatic event or some details of it.

You should bear in mind that post-traumatic stress disorder symptoms can vary in intensity over time.

Some cases reported that their symptoms are worse when they are stressed in general or when they come across reminders of their traumatic event.

For example, some women who suffer from PTSD due to sexual assault feel extremely overwhelmed when they see a report on the news about sexual assault.

In addition to the disabling symptoms, PTSD can cause some serious complications.

But what kind of complications are we talking about?

Unfortunately, PTSD can disrupt someone's whole life, job, health, relationships and enjoyment of everyday activities.

Besides, PTSD can increase the risk of other mental health problems. For adults it can increase the risk for:

Alcohol and drug use.
Anxiety.
Depression.
Thoughts about harming oneself or others.
Problems at work or in relationships.

For children, it may lead to:

Acting out the traumatic event when playing.
Clinging to a parent or other adult.
Forgetting how to talk.
Wetting their beds even if they know how to use the toilet.

Do PTSD patients have suicidal thoughts?

Some patients can't handle the stress of the overwhelming event, they can't live with the shame or the guilt.

They might even think of committing suicide.

In this case, if you or someone you know has suicidal thoughts, get help right away through one of the following ways:

Reach out for a friend or a loved one. Talking about the traumatic event with someone who cares about you and someone whom you trust can help comfort you and reduce your stress.
Contact a minister or someone in your faith community.
If your country has a suicide hotline number, call it and get help instantly.
Contact your doctor or your mental health professional.

When to get emergency help?

If you are suffering from PTSD and you are thinking of hurting yourself or attempting suicide, call your local emergency number immediately.

And if you don't suffer from PTSD and you know someone who is in danger of attempting suicide or has already had a suicide attempt before, make sure that someone is watching that person or stays with him/her and make sure that they are safe. If you can, it is better to take that person to the nearest emergency room.

How is Post-traumatic stress disorder diagnosed?

The challenging obstacle about psychological diseases is that no scan or blood test can diagnose them.

And hence, diagnosis depends mainly on your conversation with your healthcare professional.

If you have experienced a traumatic event and you are having symptoms of PTSD, talk to your doctor.

Your doctor will evaluate your symptoms and determine if it is PTSD or not because symptoms must last for more than a month and interfere with daily life to confirm it is PTSD.

To diagnose post-traumatic stress disorder, your doctor will start with performing a physical examination. Psychologists and doctors have a golden rule which is " always exclude organic causes". Your doctor has to check for medical problems that may be causing the symptoms.

Next, your doctor will do a psychological evaluation. In this evaluation, your doctor will discuss your symptoms and signs. He or she would also discuss the traumatic event with you.

Then, your doctor will use the criteria in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to help confirm the diagnosis. It is like the guideline of psychiatrists; it is published by The American Psychiatric Association.

After all, diagnosis of PTSD requires exposure to an event that was life-threatening or included violence or serious injury.

This can happen in many ways:

Direct experience of a traumatic event.
Witnessing a traumatic event happening to others.
Knowing that someone who is close has experienced a traumatic event.
Repeated exposure to graphic details of traumatic or violent events.

How is Post-traumatic stress disorder treated?

The main target of PTSD treatment is for patients to regain a sense of control over their lives.

The first line of treatment is psychotherapy; however, doctors can also use medications or a combination of both medications and psychotherapy.

This combination can help improve the symptoms by:

Helping patients to have a positive attitude towards themselves and the world and think better about themselves.
Learning coping techniques if the symptoms arose again.
Learning skills to address their symptoms.
Treating other underlying problems that could worsen the case such as depression, anxiety or drug or alcohol misuse.

But what is psychotherapy? How does it work?

It is commonly known as talk therapy. You may have an idea about it from the movies.

Several types of psychotherapy are behavioral and they are used with children and adults.

Types of psychotherapy include:

Cognitive therapy. In this type of treatment, your doctor will talk to you about your patterns of thinking that are keeping you stuck in the traumatic event, they are known as the cognitive patterns. For example, your doctor will discuss with you your negative beliefs about yourself and how you think that traumatic events will happen to you again. This type of therapy is usually used with exposure therapy.
Exposure therapy. This behavioral therapy targets the patient's fears and bad memories. It helps the patient to safely face both the situations and memories that frighten the patient and make him overwhelmed. It helps the patient to cope with these situations effectively. This technique helps PTSD patients especially those who suffer from flashbacks and nightmares. Currently, some institutions use virtual reality programs to help the patients re-enter the setting where the traumatic event took place.
Eye movement desensitization and reprocessing (EMDR). In this technique doctors also use exposure therapy along with a series of guided eye movements that help patients to process the traumatic event and memories related to it and help them to change the way they react to it.
Learning new stress management skills. Doctors usually advise their PTSD patients to attend some stress management sessions. These sessions help patients to learn new skills to better handle stressful situations and cope with stress in general.

All these approaches are applied and are fairly effective in helping patients to face their long-lasting fears after traumatic events.

Which approach suits you?

Well, the answer to this question depends on your discussion with your mental health professional. You can decide which approach or combination works for you best and meet your needs.

You can also decide if you want individual therapy sessions, group therapy sessions or both.

Group therapy can be significantly helpful for some people because it helps them connect with people who have been through similar experiences and living similar circumstances.

This is all you need to know about behavioral therapy.

What about medications?

Medications have been also used in the treatment of PTSD including:

Antidepressants. They mainly help with the symptoms of anxiety and depression. They also improve sleep and problems and concentration. The most commonly used antidepressants with PTSD patients are the selective serotonin reuptake inhibitor and paroxetine.
Anti-anxiety medications. Because patients with PTSD can also develop anxiety, anti-anxiety medications are needed to relieve severe anxiety and its related problems. Doctors prescribe these medications cautiously and for short term use only because they are generally addictive.
Prazosin. It was used to reduce nightmares in PTSD patients; however, recent studies show that it has no benefit over placebo. Patients who consider prazosin should talk to their mental health professional first so they can together decide if prazosin is worth trying in their cases.

Some of these drugs might induce some unwanted side effects. That's why patients need to talk to their mental health professionals so they can together decide the best medications for their symptoms with the fewest side effects.

And even after choosing some types of medications over other types, side effects can always happen. Therefore, patients need to try more than one medication or multiple combinations of medications and adjust the doses until they find with their doctor the best combination for their situations.

Always remember, you don't have to try to handle PTSD on your own, always seek help and don't medicate yourself.