Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is caused by very stressful, frightening or distressing events.

Someone with PTSD often relives the traumatic event through nightmares and flashbacks.

They may experience feelings of isolation, irritability and guilt. They may also have problems sleeping, such as insomnia, and find concentrating difficult.

The symptoms of PTSD are often severe. They can have a big impact on your day-to-day life.

Developing symptoms

In most cases, the symptoms develop during the first month after a traumatic event. In a minority of cases, there may be a delay of months or even years before symptoms start to appear.

Some people with PTSD experience long periods when their symptoms are less noticeable. This is followed by periods where they get worse. Other people have constant, severe symptoms.

The specific symptoms of PTSD can vary among individuals.

Symptoms generally fall into 3 categories:

• re-experiencing
• avoidance and emotional numbing
• hyperarousal (feeling ‘on edge’)

Re-experiencing

Re-experiencing is the most typical symptom of PTSD. This is when you involuntarily and clearly relive the traumatic event in the form of:

• flashbacks
• nightmares
• repetitive and distressing images or sensations
• physical sensations – such as pain, sweating, nausea or trembling

You may have constant negative thoughts about your experience. You may repeatedly ask yourself questions that prevents you from coming to terms with the event. For example, you may wonder why the event happened to you and if you could have done anything to stop it. This can lead to feelings of guilt or shame.

Avoidance and emotional numbing

Trying to avoid being reminded of the traumatic event is another key symptom of PTSD. This usually means avoiding certain people or places that remind you of the trauma. It could also mean that you avoid talking to anyone about your experience.

You may try to push memories of the event out of your mind, or distract yourself with work or hobbies.

You may also attempt to deal with your feelings by trying not to feel anything at all. This is emotionally numbing. This can lead to you becoming isolated and withdrawn. You may also give up pursuing activities you used to enjoy.

Hyperarousal (feeling ‘on edge’)

PTSD can make you feel very anxious and you may find it difficult to relax. You may be constantly aware of threats and easily startled. This state of mind is hyperarousal.

Hyperarousal often leads to:

• irritability
• angry outbursts
• sleeping problems
• difficulty concentrating

Other problems

PTSD also has a number of other problems, including:

• other mental health problems – such as depression, anxiety or phobias
• self-harming or destructive behaviour – such as drug misuse or alcohol misuse
• other physical symptoms – such as headaches, dizziness, chest pains and stomach aches

PTSD sometimes leads to work-related problems and the breakdown of relationships.

(Reference: https://www2.hse.ie/conditions/mental-health/post-traumatic-stress-disorder/post-traumatic-stress-disorder-ptsd-symptoms.html)

DSM-IV diagnostic criteria^9,100

A. The person has been exposed to a traumatic event in which both of the following were present:

1. The person experienced, witnessed, or was confronted with an event, or events, that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
2. The person’s response involved intense fear, helplessness or horror. Note that in children this may be expressed instead by disorganised or agitated behaviour.

B. The traumatic event is persistently re-experienced in one (or more) of the following ways:

1. Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions. Note that in young children repetitive play may occur in which themes or aspects of the trauma are expressed.
2. Recurrent distressing dreams of the event. Note that in children these may be frightening dreams without recognisable content.
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note that in young children trauma-specific re-enactment may occur.
4. Intense psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event; physiological reactivity on exposure to internal or external cues that symbolise or resemble an aspect of the event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

1. Efforts to avoid thoughts, feelings or conversations associated with the trauma.
2. Efforts to avoid activities, places or people who arouse recollections of the trauma.
3. Inability to recall an important aspect of the trauma.
4. Markedly diminished interest or participation in significant activities.
5. Feeling of detachment or estrangement from others.
6. Restricted range of affect (e.g. unable to have loving feelings).
7. Sense of a foreshortened future (e.g. does not expect to have a career, marriage, children or a normal life span).

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

1. Difficulty falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulty concentrating.
4. Hypervigilance.
5. Exaggerated startle response.

E. Duration of the disturbance (symptoms in Criteria B, C and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.