What is PTSD?

PTSDPost-Traumatic Stress Disorder (PTSD) is a complex and debilitating condition that can affect every aspect of a person's life.

 

PTSD has been known to exist since ancient times, albeit under the guise of different names.

During the First World War it was referred to as "shell shock"; as "war neurosis" during WWII; and as "combat stress reaction" during the Vietnam War.  In the 1980s the term Post Traumatic Stress Disorder (PTSD) was introduced - the term we still use today.

PTSD is essentially a memory filing error. It can happen when people are exposed to an extraordinary life-threatening situation which is perceived with intense fear, horror and helplessness.

At the time someone is being exposed to this intensely fearful situation, their mind 'suspends' normal operations and it copes as well as it can in order to survive. This might involve reactions such as 'freezing to the spot' or instead the opposite 'flight away' from the danger. Usually the individual is aware of coping in an automated manner. Many Veterans will say later that their 'training took over' and they survived.

The mind does not lay a memory for the frightening event or events in a normal way because it has delayed this until the danger passes. The rule is that once the danger has passed, the mind will try to file away the memory. This means it tries to file the facts of what happened, the emotions associated with the trauma and the sensations (eg: touch, taste, sound, vision, movement, and smell).

The problem is that when the mind presents the memory for filing it can be very distressing. The mind repeatedly and automatically presents the memory in the form of nightmares, flashbacks and intrusive unwanted memories. These "re-experiencing" phenomena are the mind's way of trying to file away the distressing memory. The re-experiencing can be very unpleasant and distressing because of the nature of the traumatic experience it exposes the sufferer to.

The individual also finds that his or her levels of arousal (awareness) change. People can become hyper-aroused and suffer intense symptoms of anxiety (both physical: with shortness of breath and a racing heart, as well as emotional: feeling on edge, looking out for signs of danger and being 'on patrol' all the time or feeling panicky).

Many also feel emotionally numb and have trouble communicating with others without feeling numb or irritable or both.

These hyper-arousal and emotional numbness symptoms become so unpleasant that then individual then starts to avoid anything linked to the original trauma, this happens automatically. The person then avoids anything that causes upset or irritation or that might represent danger occurs. Avoidance can become the main coping mechanism in most situations.

The more the individual avoids things, including confronting what happened, the less likely is it that any memory processing will occur, and the more likely it is that further attempts at filing a memory will occur automatically. This leads to further re-experiencing nightmares, flashbacks and intrusive memories. These re-experiencing symptoms then lead on to further hyper-arousal and emotional numbing, and this in turn leads on to more avoidance and so on. This is how the symptoms clusters perpetuate themselves in a vicious cycle which can go on for years.

In the majority of people, however, the three symptom clusters (which represent the immediate psychological reaction to an extraordinary situation) settles down. In some people it can 'stick' and become chronic. If this is the case, PTSD may be said to be present. This theory is based in Horowitz's Information Processing Model.

For treatment to be successful, information processing must be completed. This is why therapies aimed at helping the individual to process and work through the traumatic material are extremely beneficial. 

PTSD therefore comprises three symptom clusters:

  1. Re-experiencing of the traumatic experience
  2. Hyper-arousal and emotional numbing
  3. Avoidance.

 

It should be noted that the more people try to use avoidance as their main coping mechanism, the more likely it will be that they isolate themselves and many become depressed.

Many also avoid unpleasant irritability and hyperarousal by drinking alcohol. Some will use drugs, medications or other substances to 'feel alive'; and to counteract the emotional numbing they feel. 

In Veterans helped by Combat Stress the commonest co-morbid clinical presentation of PTSD, is PTSD presenting with depression and alcohol misuse disorders.

 

Direct links

Find out more about the symptoms of trauma that a patient might present with.

PTSD frequently asked questions.