PTSD – what we know of causes, effects and therapy

PTSD (post-traumatic stress disorder) is a fairly recent ‘diagnosis’. Although hardly a recent phenomenon, it was first named as a separate, definable condition in the mid-seventies, when it was applied to Vietnam vets who developed symptoms related to their experiences in battle. Of course it’s now clear that the ‘shell shock’ suffered by first world war soldiers was also symptomatic of post-traumatic stress. And indeed, medical records of veterans the America civil war also hint strongly at this.

Soon after the condition acquired its name, PTSD broadened its definition to describe the experiences of those who had witnessed various kinds of catastrophe, or who had been seriously threatened in some way –– they too report a similar set of reactions to war veterans, such as flashbacks, repeated, frightening nightmares, plus serious distress in the daytime when memories of the same event can be stimulated by news stories connected, or unconnected, with the original experience.

So someone who has been raped, or assaulted, or who has survived a terrorist attack or a serious road accident, or even someone who has simply witnessed these things, or taken part in the rescue or clear-up, might go on to develop symptoms. 

PTSD develops over time

PTSD isn’t a term normally applied to the initial reaction to these experiences, but to the continuation of symptoms for at least a month afterwards. In some cases, it can take several months for the symptoms to appear, and at first they might not seem related to the original event –– sleeplessness, anxiety, depression, difficulty concentrating, are less obviously connected, particularly if they have come on gradually, and it may take careful questioning and listening for a definite link to be made. 

There’s some intriguing discussion among researchers focusing on the fact that we experience ‘our’ 20th and 21st century variety of PTSD in a particularly modern way –– the whole notion of ‘flashback’ when previous events are replayed in great detail in someone’s mind could be related to the way we know about the ‘flashback’ device in film and TV.

It’s possible that the mind ‘adopts’ this way of reliving experiences as a result of this familiarity –– and in the pre-TV age, flashbacks would be reported as ‘hallucinations’ or ‘visions’. It’s also possible that people describe unpleasant memories and associations as ‘flashbacks’, simply because they are familiar with the term, without intending to imply a literal re-running of the experiences.

Why PTSD? 

PTSD may be the result of the brain ‘embedding’ a traumatic experience in a different way, rather than just remembering it as we would any other event in our lives. Just as we learn skills and habits, and learned reflexes, we ’learn’ the trauma –– in neurological terms, we ‘code’ it differently in our brains, compared with our everyday ‘narrative memory’. However this hypothesis doesn’t account for the fact that only a minority of people who experience traumatic events actually develop PTSD – perhaps between a quarter and a third.

Therapy for PTSD

Various therapies have been evaluated in a Cochrane review [1] with only certain types emerging with significant, empirical support –– namely, certain stress management techniques, Trauma-focused Cognitive Behaviour Therapy, and Eye Movement Desensitisation and Reprocessing. EMDR uses eye movements to work directly on the brain, using a range of techniques to explore emotional responses and visualisations, in connection with eliciting eye movements.

There’s no evidence that rapid interventions of counselling or debriefing after the traumatic event are effective, and even some suggestion that this may eventually worsen the symptoms [2]. Not everyone needs ‘treatment’ after experiencing something frightening. Post-traumatic symptoms related to a recent event can be left alone for a month and may often improve spontaneously. If not the therapy options can be explored. 

References

1. Psychological treatment of post-traumatic stress disorder (PTSD), by Bisson J, Andrew Mink. 

2. Psychological debriefing is a waste of time, by Simon Wessely, Martin Deahl. 

Image credits: Wikimedia, Wikimedia, Reuters