A history of childhood trauma can make someone more at risk of developing PTSD.
Image:Andrii Kondiuk/Shutterstock
People have probably always known about the psychological effects of
experiencing life-threatening events such as military combat, natural
disasters, or violent assault. Literature through the ages – some of it
thousands of years old – provides many vivid portrayals of these
internal struggles to recover from horrific experiences.
It was not until 1980, however, that these reactions were formally
recognised by the international psychiatric community. The name chosen
was post-traumatic stress disorder, or PTSD, and the diagnostic criteria
were agreed.
Before discussing the nature and treatment of PTSD, it’s important to
emphasise that human beings are generally resilient. Most people
exposed to potentially traumatic events recover well with help from
family and friends, and don’t develop mental health problems.
For those who don’t recover so well, PTSD is only one possibility,
with depression, substance abuse, anxiety, and physical health problems
also common. But PTSD is the only condition specifically tied to a
traumatic experience.
SymptomsPTSD is a serious psychiatric disorder characterised by three groups of symptoms:
- Reliving the traumatic event. People with PTSD describe vivid, painful images and terrifying nightmares of their experience.
- Avoidance. People with PTSD try to avoid reminders of what happened.
They become emotionally numb and socially isolated to protect
themselves from the pain.
- Being constantly tense and jumpy, always on the look-out for signs
of danger. PTSD is associated with significant impairment in social and
occupational functioning.
Causes and risk factorsThe latest Australian
National Mental Health Survey reported that over 4% of the population
experienced the symptoms of PTSD in the last year.
The incidence of PTSD varies considerably depending on the type of
trauma, with sexual assault consistently the highest (around half of
rape victims will develop PTSD). Accidents and natural disasters –
events that do not involve human malevolence – tend to be the lowest at
around 10%.
About half the people who develop PTSD recover over the first six to
twelve months. Unfortunately, in the absence of treatment, the other
half are likely to experience chronic problems that may persist for
decades.
So why do some people develop these problems and not others? The
answer is a combination of what the person was like before the trauma,
their experiences at the time, and what has happened since.
In terms of pre-trauma factors, genetic vulnerability plays a part,
along with a history of trauma, particularly in childhood, as well as
tendencies towards anxiety and depression. Not surprisingly, the more
severe the traumatic experience (the higher the life threat or exposure
to the suffering of others) the more likely the person will develop
PTSD.
The final group of risk factors appear after the event, with the most
important being social support: people who have a strong network of
friends and family to support them after the experience are less likely
to develop PTSD. Other life stressors during this period (such as
financial, legal, health, or relationship problems) can also interfere
with recovery.
Treatment
We have come a long way in improving treatments for PTSD and now have a large body of research evidence to guide our decisions.
The most effective treatment is trauma-focused psychological therapy.
There are a few different forms, including cognitive behavioural
therapies (CBT), as well as something called eye movement
desensitisation and reprocessing (EMDR). The thing they share in common
is providing the survivor with an opportunity to confront the painful
memories, and to “work through” the experience in a safe and controlled
environment. This therapy is not easy for either the patient or the
therapist, but it is very effective in most cases.
Pharmacological treatment can also be useful in PTSD, especially in
more complex cases and as an adjunct to trauma-focused psychological
therapy. The most effective drugs for PTSD are the new generation
anti-depressants – the selective serotonin re-uptake inhibitors or
SSRIs. Other drugs can also be useful, depending on the clinical
presentation.
The bottom line is that effective treatment is available if the PTSD sufferer can find their way to an experienced clinician.
We’ve come a long way in our understanding of mental health response
to trauma in the last couple of decades, but many challenges lie ahead:
Can we prevent the development of these problems? How should we respond
with whole communities following widespread disaster such as bushfires,
floods or terrorism? And can we improve the quality and availability of
treatment?
As we address these challenges, we must strive to make sure the best
possible care is available to those whose lives have been devastated by
the experience of severe trauma.
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