Post-traumatic stress disorder (PTSD)
Post-traumatic stress disorder, also known as PTSD, is an anxiety disorder that some people develop after being involved in (or witnessing) something traumatic.
The condition was first seen in war veterans and has been given various names, such as shell shock. While those involved in combat can develop the condition, we’ve since learnt that it can affect anyone who experiences a traumatic event.
What is PTSD?
When something traumatic happens to you, your body and mind can react in different ways. For some people, post-traumatic stress disorder develops. This often involves the person reliving the event through flashbacks and nightmares. These flashbacks can be triggered by everyday items and scenarios, making day-to-day life difficult.
After a traumatic event, some people will experience initial symptoms that are associated with PTSD, such as difficulty sleeping or feeling numb. For many, these symptoms will naturally disappear after a few weeks. If the symptoms last longer than a month, however, someone may be diagnosed with PTSD.
Speaking to your doctor is the best way to get a diagnosis if you suspect you have PTSD. You may be given a diagnosis of mild, moderate or severe PTSD. This has nothing to do with how upsetting/frightening your experience was, but how strongly the symptoms are affecting you.
Some other terms that may be used by your medical team include delayed-onset PTSD (if you start experiencing symptoms more than six months after the event), complex PTSD (if the trauma happened at an early age or if you experienced it for a long time) and birth trauma.
The Covid-19 pandemic brought about events unlike anything we had seen or experienced before. Thought to have the single greatest impact on mental health in England since the second world war, the true scale of how Covid-PTSD is affecting us has yet to be fully understood.
During the first wave, it has since been revealed that two in five intensive care staff in England reported experiencing symptoms of PTSD. By the time the second wave hit, more evidence began to emerge that not only frontline workers, but others have experienced trauma symptoms. According to the latest NHS forecasts, there will be an expected rise of 77,000 new cases of PTSD in England alone, bringing the total new referrals to an expected 230,000 between 2020/21 and 2022/23.
Who is most likely to experience Covid-PTSD?
While anyone can show signs or symptoms of Covid related post-traumatic stress disorder, there are a number of people more likely to be diagnosed. These include:
- frontline workers
- victims of domestic or sexual abuse
- care workers
- those who have experienced covid-related bereavement
- those who were put on a ventilator due to Covid-19
- children and young people
- those who experienced childbirth during the pandemic
Studies have shown that 35% of those who experienced severe symptoms of covid-19 resulting in the use of a ventilator will go on to experience extensive PTSD symptoms.
With record numbers of people seeking support from mental health services, the NHS is facing its biggest backlog of patients waiting for mental health support. Early intervention is key to speeding up recovery. Seeking support through your GP to access local services is recommended.
Birth trauma - a shorthand term for PTSD after birth - can occur if the experience of birth has been frightening or traumatic in some way. Perhaps the mother experienced a difficult labour with a long, painful delivery, or the baby’s heart rate dipped, leading to an emergency C-section. Maybe the mother or the baby suffered injuries during birth.
Birth trauma can also develop if the mother feels they were poorly looked after during the birth, or if they believe they were misinformed.
Birth trauma and the impact of the experience is often underestimated. While it is known that pregnancy and birth are often unexpected, nothing can prepare you for a traumatic birth. Birth trauma, as well as the recognised PTSD symptoms, can impair the relationship between mother and partner, mother and child. It can also prevent a woman from wanting another baby.
According to the Birth Trauma Association (BTA) an estimated 30,000 women a year experience birth trauma in the UK. In this video, five women talk about their experiences:
If you are experiencing some symptoms of PTSD, but the trauma happened to someone close to you, this may be referred to as ‘secondary trauma’.
Complex PTSD (sometimes shortened to CPTSD) can occur in children or adults who have experienced traumatic events repeatedly, such as abuse, neglect or violence. Someone is more likely to develop complex PTSD if:
- The event happened at a young age.
- The trauma was caused by someone they trusted (like a parent or carer).
- The trauma happened over a long period of time.
- The person was alone during the trauma.
- The person has experienced multiple traumas.
- The person is still in contact with the person who caused the trauma.
Children’s development can get affected by this, especially if the condition isn’t diagnosed. This can affect behaviour, confidence and their ability to trust people.
If you have complex PTSD you may be more likely to experience ‘emotional flashbacks’. These are when you feel the intense feelings you felt at the time of the trauma. You may react as if it is happening again, not realising you are having a flashback. Treatment for complex PTSD often involves rebuilding feelings of trust, something that can be helped by developing a trusting relationship with a therapist.
Going through trauma and living with PTSD in any form is incredibly difficult. With support, you can learn how to manage your symptoms, take control and live a full life with PTSD.
I still struggle from time to time to keep it all at bay, especially as I purposely put myself in trigger situations to show others you don't have to be trapped by your own mind. And I'm not saying it's going to be easy, but it's so worth it to keep on going and develop the strength to silence your demons.
- Read Karlette’s story.
Everyone who develops PTSD will have a unique experience of the condition. These differences will be according to the person, not the traumatic event. For example, two people who are involved in the same traumatic event and go on to develop PTSD may experience the condition in different ways.
However, there are some common symptoms associated with PTSD, including:
Flashbacks to the trauma can make you feel as if it is happening to you again, at this very moment. It may also feel like you’re watching a video of what happened, from another point of view. You may see images/partial images from the event, hear noises or feel sensations/emotions you felt at the time.
Sometimes these are triggered by something you come across in your day, sometimes they come from nowhere as intrusive thoughts or images. For many, sleep is affected and you may find you have distressing nightmares. Physical symptoms like nausea, shaking and even pain may also be experienced.
I suffered from bad dreams about the car accident and kept getting flashbacks of the accident every time I got in a car - even as a passenger.
- Read Sophie’s story.
Feeling on edge and hypervigilance
Feeling constantly on edge is common for those with PTSD. This may make you easily startled and easily upset or angry. You might struggle to concentrate or even have panic attacks and anxiety symptoms.
You may become more aware of your surroundings, feeling incredibly alert. This is called hypervigilance. Studies have shown that those with PTSD produce higher levels of stress hormones than those without PTSD, which may explain this symptom.
Avoiding certain feelings/memories
If you have PTSD, you might try to keep yourself busy to stop yourself from thinking about the traumatic event. You may avoid anything that reminds you of the event and feel emotionally detached from your feelings. You may feel physically numb and as if you aren’t in your body.
Some people may struggle to show affection, finding it difficult to trust people. Alcohol and drugs may also be used as a way to avoid certain memories or feelings.
Guilt and isolation
Some people experience guilt after a traumatic experience, blaming themselves for what happened. You may feel difficult emotions like shame and anger. If you struggle to trust people, you may believe it’s better to isolate yourself. If you feel unsafe in many situations, you may choose to stay where you feel safe, which can further isolate you.
If you have PTSD and you drive, you may need to tell the DVLA. If you’re unsure whether you need to, speak to your doctor, who can advise you further.
It’s quite common for people with PTSD to struggle with other mental health problems too. These can include depression, dissociative disorders, suicidal thoughts, self-harm and other anxiety disorders. If you feel you’re struggling with these, be sure to tell your doctor or counsellor so they can help.
Causes of PTSD
Post-traumatic stress disorder develops after an event or situation that has been very frightening or distressing, whether you were directly affected or a witness. It can also occur if you’ve experienced prolonged trauma.
Here are some examples of events/scenarios that can result in PTSD:
- road accidents
- being physically assaulted or mugged
- being sexually assaulted
- witnessing violent death/murder/suicide
- terrorist attacks
- military combat
- natural disasters
- an unexpected death/serious injury of someone close to you
- being held hostage
- severe neglect
- being diagnosed with a life-threatening illness
- any event where you fear for your life
Not everyone who experiences something traumatic will develop PTSD. While it’s not fully understood why some people develop the condition and others don’t, there are certain factors that may make a person more likely to develop the condition.
If you’ve suffered from anxiety or depression, or if you don’t tend to get much support from those around you, you may be at a higher risk of developing PTSD. Genetics may also be a factor, if a parent has a mental health condition, you may be more likely to develop PTSD. In some cases, the condition will develop immediately after the event, in other cases, it will develop weeks, months or even years later.
While it's not known exactly why PTSD develops, suggestions have been made by the medical community. These include:
One theory is that PTSD symptoms come from an instinctive mechanism designed to keep us safe from further traumas. The flashbacks and hyperarousal could have been to help us be better ‘prepared’ should something similar happen again.
Looking at brain scans, those with PTSD have a different looking hippocampus (appearing smaller). This part of the brain is related to anxiety, memory problems and flashbacks. If it isn’t processing the trauma properly it could explain why people experience anxiety long after the event. PTSD treatment allows these memories to be processed effectively, allowing this anxiety to reduce over time.
I see a diagnosis as a bonus. When you know what you’re working with, you can build on it and create a life around it - rather than letting it limit your life. You can learn about how the condition affects you, so you can put together your own coping plan, learning and adjusting as you go along. You have the power then, not it.
- Read Marie-Claire’s story.
If you recognise symptoms of PTSD, going to your GP in the first instance for diagnosis is recommended. If you’ve had symptoms for under four weeks since the event, or your symptoms are mild, they may suggest ‘watchful waiting’. This means keeping a close eye on your symptoms and seeing if things improve by themselves. You should be offered a follow-up appointment within a month to check-in and see how you’re doing.
If you are diagnosed with PTSD, you may be offered the following treatments:
Trauma-focused cognitive behavioural therapy (TF-CBT)
Cognitive behavioural therapy looks at the way our thoughts and behaviours interact, with the aim of helping you to change them to be more positive for your mental health. Trauma-focused cognitive behavioural therapy is a specially adapted form of therapy, designed to specifically help those with PTSD.
Children and young people will usually be recommended trauma-focused CBT. This will likely last eight to 12 sessions and may, where necessary, involve the child’s family.
Eye movement desensitisation and reprocessing (EMDR)
EMDR involves making rapid eye movements while thinking about the traumatic experience, under the instruction and guidance of your therapist. It’s thought that the eye movements create a similar effect to the way your brain processes experiences when you sleep. By processing the memories and the trauma, the aim is for symptoms like flashbacks and anxiety to reduce.
Those with PTSD are not typically offered medication. Your doctor may recommend it however if you are struggling with depression, have difficulty sleeping or are unable/unwilling to try talking therapies. The medication you may be offered will likely be antidepressants, your doctor will be able to talk this through with you.
Other therapies that some people with PTSD find helpful include group therapy, arts therapies and dialectical behaviour therapy (DBT). Guidelines from the National Institute of Health and Care Excellence (NICE) however highlights that these have not been designed for those with PTSD so should not be used alone.
What should I be looking for in a counsellor?
At present, there are no regulations that stipulate what level of training or qualifications a counsellor needs for treating post-traumatic stress disorder. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:
- There are a number of treatments for PTSD that are helpful. Most involve psychological treatment, but medication can also be helpful for adults.
- Many PTSD sufferers have had the symptoms for many months and sometimes years, but treatment can still be helpful. You should be offered treatment regardless of when the traumatic event happened. If you have developed symptoms recently you may get better with little or no treatment.
- Depending on what your symptoms are and when you developed PTSD, you may be offered psychological treatments that are specific for PTSD sufferers. These are: trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR).
Read the full NICE guidelines: Post-traumatic stress disorder (PTSD)