Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a set of reactions that can develop in people who have experienced or witnessed a traumatic event that threatens their life or safety (or of others around them). This could be a car or other serious accident, physical or sexual assault, war-related events or torture, or a natural disaster such as bushfire or flood.

In the first days and weeks after a traumatic event, people often experience heightened arousal, alertness, looking for danger and being on guard. These reactions often alternate with numbness and detachment. It also brings constant memories of the event and feelings it may happen again. It also evokes strong feelings of fear, sadness, guilt, anger, or grief. Generally these reactions and feelings will resolve on their own over the next few weeks, however if the reactions and distress continue, it may mean that the person has is at risk for developing PTSD or another mental health condition.

Anyone can develop PTSD following a traumatic event, but people are at greater risk if:

• the event involved physical or sexual assault
• they experienced intense helplessness
• the event involved something they never thought would happen to them
• they have had other traumatic experiences involving helplessness or danger including physical or sexual abuse, car accidents, criminal events, natural disasters or conflict
• they have suffered from PTSD in the past.

Symptoms of PTSD

A person with PTSD has four main types of difficulties:

• Re-living the traumatic event through unwanted and recurring memories, flashbacks or vivid nightmares. There may be intense emotional or physical reactions when reminded of the event including sweating, heart palpitations, anxiety or panic.
• Avoiding reminders of the event, such as thoughts, feelings, people, places, activities or situations that bring back memories of the event. They may feel numb, empty or detached.
• Negative changes in feelings and thoughts, such as feeling angry, afraid, guilty, flat or numb, developing beliefs such as “I’m bad” or “The world’s unsafe”, and feeling cut off from others.
• Being overly alert or ‘wound up’ indicated by sleeping difficulties, irritability, lack of concentration, becoming easily startled and constantly being on the lookout for signs of danger.

A health practitioner may diagnose PTSD if a person has symptoms in each of these four areas for a month or more, which lead to significant distress or impacts on their ability to work and study, their relationships and day-to-day life.

People with PTSD can also have what are termed ‘dissociative experiences’, which are frequently described as:

• “It was as though I wasn’t even there.”
• “Time was standing still.”
• “I felt like I was watching things happen from above.”

PTSD in children and teenagers

Older children and teenagers experience similar problems to adults when they develop PTSD. Younger children can express distress in a different way. For example, they may re-live the traumatic event through repetitive play rather than having unwanted memories of the event during the day. Many children have frightening dreams without recognisable content rather than nightmares that replay the traumatic event. Children may also lose interest in play, become socially withdrawn, or have extreme temper tantrums.

About one third of children who experience a traumatic event will develop PTSD.

Other problems that can develop alongside PTSD include anxiety or depression, defiant behaviour, attention deficit hyperactivity disorder, and in teenagers and young adults, suicidal thoughts and alcohol or drug use.

Impact of PTSD on relationships and day-to-day life

PTSD can affect a person’s ability to work, perform day-to-day activities or relate to their family and friends. A person with PTSD can often seem uninterested or distant as they try not to think or feel in order to block out painful memories. They may stop them from participating in family life or ignore offers of help. This can lead to loved ones feeling shut out.

It is important to remember that these behaviours are part of the problem. People with PTSD need the support of family and friends but may not understand what is happening to them or think that they need help.

When PTSD goes on for some time, it is not unusual for people to experience other mental health problems at the same time. In fact, up to 80 per cent of people who have long-standing PTSD develop additional problems - most commonly depression, anxiety, and alcohol or other substance misuse. These may have developed directly in response to the traumatic event or as a result of the effects of having PTSD.

Risky alcohol and drug use with PTSD

People commonly use alcohol or other drugs to blunt the emotional pain that they are experiencing. Alcohol and drugs may help block out painful memories in the short term, but they can get in the way of a successful recovery and cause other serious problems.

When to seek help for PTSD

A person who has experienced a traumatic event should seek professional help if they:

• don’t feel any better after two weeks
• feel highly anxious or distressed
• have reactions to the traumatic event that are interfering with home, work and/or relationships
• are thinking of harming themselves or someone else.

Some of the signs that a problem may be developing are:

• being constantly on edge or irritable
• having difficulty performing tasks at home or at work
• being unable to respond emotionally to others
• being unusually busy to avoid issues
• taking risks or not caring what happens to oneself
• using alcohol, drugs or gambling to cope
• having severe sleeping difficulties.

Support is important for recovery

Many people experience some of the symptoms of PTSD in the first two weeks after a traumatic event, but most recover with the help of family and friends. For this reason, for a diagnosis of PTSD is not made until a month after the event. Treatment does not usually start for at least two or more weeks after a traumatic experience. However if the event is very distressing and emotions and reactions are intense, it is advisable to seek help as early as possible to understand what is happening and help recovery to start.

It is important during the first few days and weeks after a traumatic event to get whatever help is needed. This may include accessing information, people and resources that can help you to recover. Support from family and friends may be all that is needed. Otherwise, a doctor is the best place to start to get further help.

Treatment for PTSD

If you are still experiencing problems after two weeks, a doctor or mental health professional may discuss starting treatment. Effective treatments are available. Most involve psychological treatment such as counselling to understand what is happening and to develop ways of managing reactions, but medication can also be helpful. Generally, it’s best to start with psychological treatment rather than use medication as the first and only solution to the problem.

The cornerstone of treatment for PTSD involves confronting the traumatic memory and working through thoughts and beliefs associated with the experience as part of a safe relationship with a trained person.

Trauma-focussed treatments can:

• reduce PTSD symptoms
• lessen anxiety and depression
• improve a person’s quality of life
• be effective for people who have experienced prolonged or repeated traumatic events, though treatment may be required for a longer period.

Treatment for children and teenagers with PTSD

For children and teenagers who are struggling to recover after a traumatic event, the recommended treatment is trauma-focussed cognitive behavioural therapy (CBT). This treatment involves:

• learning about the type of traumatic event experienced (e.g. how common it is) and common reactions to trauma
• teaching how to relax and manage anxiety
• helping to create a coherent story of the traumatic event, and correct any unhelpful beliefs about the event such as self-blame
• gradual exposure to trauma-related objects or situations that are feared or avoided
• helping to get back into everyday activities.

Information in your language

• Çrregullimi i stresit post-traumatik (Post-traumatic stress disorder - Albanian)
• اضطراب ما بعد الصدمة (Post-traumatic stress disorder - Arabic)
• 创伤后应激障碍 (Post-traumatic stress disorder - Chinese Simplified)
• 創傷後壓力症 (Post-traumatic stress disorder - Chinese Traditional)
• اختلال استرس پس از سانحه (Post-traumatic stress disorder - Dari)
• Διαταραχή μετατραυματικού στρες (Post-traumatic stress disorder - Greek)
• पोस्ट-ट्रॉमैटिक स्ट्रेस डिसऑर्डर (अभिघातजन्य तनाव विकार) (Post-traumatic stress disorder - Hindi)
• Disturbo post-traumatico da stress (Post-traumatic stress disorder - Italian)
• ਸਦਮੇ ਤੋਂ ਬਾਅਦ ਦਾ ਤਣਾਅ ਵਿਕਾਰ (Post-traumatic stress disorder - Punjabi)
• Ugonjwa wa mfadhaiko baada ya kiwewe (Post-traumatic stress disorder - Swahili)
• Rối loạn căng thẳng sau chấn thương (Post-traumatic stress disorder - Vietnamese)

Where to get help

• Your GP (doctor)
• Your mental health specialist, such as a psychiatrist, psychologist, counsellor or social worker
• Your local community health centre
• Australian Psychological Society Referral Service Tel. 1800 333 497
• Phoenix Australia Centre for Post-traumatic Mental Health Tel. (03) 9035 5599
• Centre for Grief and Bereavement Tel. 1800 642 066

General telephone counselling services can provide advice:

• Lifeline Tel. 13 11 14
• Griefline Tel. 1300 845 745
• Beyond Blue Tel. 1300 22 4636
• NURSE-ON-CALL Tel. 1300 60 60 24 – for expert health information and advice (24 hours, 7 days)