Dual Diagnosis: Post Traumatic Stress Disorder (PTSD)

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What is Post Traumatic Stress Disorder (PTSD)?

With the right support we can and do recover. Dual Diagnosis Network can help you and carers to find the right resources to recover.

This information is for anyone who has been through a harrowing experience, who has been abused or tortured, or who knows someone who this has happened to.

What is PTSD?

In our everyday lives, any of us can have an experience that is overwhelming, frightening, and beyond our control. We could find ourselves in a car crash, be the victim of an assault, or see an accident. 

Police, fire brigade or ambulance workers are more likely to have such experiences – they often have to deal with horrifying scenes. Soldiers may be shot or blown up, and see friends killed or injured.

Most people, in time, get over experiences like this without needing help. In some people, though, traumatic experiences set off a reaction that can last for many months or years. This is called Post-traumatic Stress Disorder, or PTSD for short.

How does PTSD start?

PTSD can start after any traumatic event. A traumatic event is one where you see that you are in danger, your life is threatened, or where you see other people dying or being injured. Typical traumatic events would be:           

  • serious accidents
  • military combat
  • violent personal assault (sexual assault, physical attack, abuse, robbery, mugging)
  • being taken hostage
  • terrorist attack
  • being a prisoner-of-war
  • natural or man-made disasters
  • being diagnosed with a life-threatening illness.

Even hearing about the unexpected injury or violent death of a family member or close friend can start PTSD.

When does PTSD start?

The symptoms of PTSD can start immediately or after a delay of weeks or months, but usually within 6 months of the traumatic event.

What does PTSD feel like?

Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms:

Flashbacks & nightmares

You find yourself re-living the event, again and again. This can happen both as a ‘flashback’ in the day and as nightmares when you are asleep.

These can be so realistic that it feels as though you are living through the experience all over again.  You see it in your mind, but may also feel the emotions and physical sensations of what happened – fear, sweating, smells, sounds, pain.

Ordinary things can trigger off flashbacks. For instance, if you had a car crash in the rain, a rainy day might start a flashback.

Avoidance & numbing

It can be just too upsetting to re-live your experience over and over again. So you distract yourself. You keep your mind busy by losing yourself in a hobby, working very hard, or spending your time absorbed in crosswords or jigsaw puzzles. You avoid places and people that remind you of the trauma, and try not to talk about it.

You may deal with the pain of your feelings by trying to feel nothing at all – by becoming emotionally numb. You communicate less with other people who then find it hard to live or work with you.

Being ‘on guard’

You find that you stay alert all the time, as if you are looking out for danger. You can’t relax. This is called ‘hypervigilance’. You feel anxious and find it hard to sleep. Other people will notice that you are jumpy and irritable.

Other symptoms

  • muscle aches and pains
  • diarrhoea
  • irregular heartbeats
  • headaches
  • feelings of panic and fear
  • depression
  • drinking too much alcohol
  • using drugs (including painkillers).

Does everyone get PTSD after a traumatic experience?

No. But nearly everyone will have the symptoms of post-traumatic stress for the first month or so. This is because they can help to keep you going, and help you to understand the experience you have been through.

This is an ‘acute stress reaction’. Over a few weeks, most people slowly come to terms with what has happened, and their stress symptoms start to disappear.

Not everyone is so lucky.  About 1 in 3 people will find that their symptoms just carry on and that they can’t come to terms with what has happened.

It is as though the process has got stuck. The symptoms of post-traumatic stress, although normal in themselves, become a problem – or Post-traumatic Stress Disorder – when they go on for too long.

What makes PTSD worse?

The more disturbing the experience, the more likely you are to develop PTSD. The most traumatic events:

  • are sudden and unexpected
  • go on for a long time
  • are when you are trapped and can’t get away
  • are man-made
  • cause many deaths
  • cause mutilation and loss of arms or legs
  • involve children.

If you continue to be exposed to stress and uncertainty, this will make it difficult or impossible for your PTSD symptoms to improve.

What's the difference between stress and PTSD?

Everybody feels stressed from time to time. Unfortunately, the word ‘stress’  is used to mean two rather different things:

  • our inner sense of worry, feeling tense or feeling burdened

or

  • the problems in our life that are giving us these feelings. This could be work, relationships, maybe just trying to get by without much money. 

Unlike PTSD, these things are with us, day in and day out. They are part of normal, everyday life, but can produce anxiety, depression, tiredness, and headaches.

They can also make some physical problems worse, such as stomach ulcers and skin problems. These are certainly troublesome, but they are not the same as PTSD.

How can I tell if I have PTSD?

Have you experienced a traumatic event of the sort described at the start of this leaflet? If you have, do you:

  • have vivid memories, flashbacks or nightmares?        
  • avoid things that remind you of the event?
  • feel emotionally numb at times?
  • feel irritable and constantly on edge, but can’t see why?
  • eat more than usual, or use more drink or drugs than usual?
  • feel out of control of your mood?
  • find it more difficult to get on with other people?
  • have to keep very busy to cope?
  • feel depressed or exhausted?

If it is less than 6 weeks since the traumatic event and these experiences are slowly improving, they may be part of the normal process of adjustment.

If it is more than 6 weeks since the event, and these experiences don’t seem to be getting better, it is worth talking it over with your doctor.

What are the treatments for PTSD?

Helping yourself

Do

  • keep life as normal as possible
  • get back to your usual routine
  • talk about what happened to someone you trust
  • try relaxation exercises
  • go back to work
  • eat and exercise regularly
  • go back to where the traumatic event happened
  • take time to be with family and friends
  • be careful when driving – your concentration may be poor
  • be more careful generally – accidents are more likely at this time
  • speak to a doctor
  • expect to get better.

Don’t

  • beat yourself up about it – PTSD symptoms are not a sign of weakness. They are a normal reaction of a normal person to terrifying experiences.
  • bottle up your feelings.  If you have developed PTSD symptoms, don’t keep it to yourself because treatment is usually very successful.  
  • avoid talking about it
  • expect the memories to go away immediately; they may be with you for quite some time
  • expect too much of yourself. Cut yourself a bit of slack while you adjust to what has happened.
  • stay away from other people
  • drink lots of alcohol or coffee or smoke more
  • get overtired
  • miss meals
  • take holidays on your own.  

What can interfere with getting better?

You may find that other people may:                  

  • not let you talk about it
  • avoid you
  • be angry with you 
  • think of you as weak
  • blame you.

These are all ways in which other people protect themselves from thinking about gruesome or horrifying events. It won’t help you because it doesn’t give you the chance to talk over what has happened to you. And it is hard to talk about such things.

A traumatic event can put you into a trance-like state which makes the situation seem unreal or bewildering. It is harder to deal with if you can’t remember what happened, can’t put it into words, or can’t make sense of it.

Treatment

Just as there are both psychological and physical aspects to PTSD, so there are both psychological and physical treatments for it.

Psychotherapy

All the effective psychotherapies for PTSD focus on the traumatic experience – or experiences – rather than your past life. You cannot change or forget what has happened. You can learn to think differently about it, about the world, and about your life. 

You need to be able to remember what happened, as fully as possible, without being overwhelmed by fear and distress.

These therapies help you to put your experiences into words. By remembering the event, going over it and making sense of it, your mind can do its normal job of storing the memories away, and moving on to other things.

When you start to feel safer, and more in control of your feelings, you won’t need to avoid the memories as much. You will be able to only think about them when you want to, rather than having them burst into your mind out of the blue.

All these treatments should all be given by PTSD specialists. The sessions should be at least weekly, with the same therapist, for 8-12 weeks.  Although sessions will usually last around an hour, they can sometimes last up to 90 minutes.

Cognitive Behavioural Therapy (CBT) is a talking treatment which can help us to understand how ‘habits of thinking’ can make the PTSD worse – or even cause it. CBT can help you change these ‘extreme’ ways of thinking, which can also help you to feel better and to behave differently.

EMDR (Eye Movement Desensitisation & Reprocessing)

This is a technique which uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience.  It may sound odd, but it has been shown to work.

Group therapy

This involves meeting with a group of other people who have been through the same, or a similar traumatic event.

It can be easier to talk about what happened if you are with other people who have been through a similar experience.

Medication

SSRI antidepressant tablets may help to reduce the strength of PTSD symptoms and relieve any depression that is also present. They will need to be prescribed by a doctor.

This type of medication should not make you sleepy, although they all have some side-effects in some people. 

They may also produce unpleasant symptoms if stopped too quickly, so the dose should usually be reduced gradually. If they are helpful, you should carry on taking them for around 12 months. Soon after starting an antidepressant, some people may find that they feel more:

  • anxious
  • restless
  • suicidal

These feeling usually pass in a few days, but you should see a doctor regularly.

If these don’t work for you, tricyclic and MAOI antidepressants may still be helpful. 

Occasionally, if someone is so distressed that they cannot sleep or think clearly, anxiety-reducing medication may be necessary.  These tablets should usually not be prescribed for more than 10 days or so.

Body-focussed therapies

These don’t help PTSD directly, but can help to control your distress and hyperarousal, the feeling of being ‘on guard’ all the time. 

These include physiotherapy and osteopathy, but also complementary therapies such as massage, acupuncture, reflexology, yoga, meditation and tai chi. They can help you to develop ways of relaxing and managing stress.

What works best?

At present, there is evidence that EMDR, Cognitive Behavioural Therapy, behaviour therapy and antidepressants are all effective.

There is not enough information for us to show that one of these treatments is better than another. There is not yet any evidence that other forms of psychotherapy or counselling are helpful for PTSD.

Which treatment first?

Guidelines from the National Institute for Health and Care Excellence (NICE) suggest that trauma-focused psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.

Disclaimer

This resource provides information, not advice.  

The content in this resource is provided for general information only. It is not intended to, and does not, amount to advice which you should rely on. It is not in any way an alternative to specific advice. 

You must therefore obtain the relevant professional or specialist advice before taking, or refraining from, any action based on the information in this resource.

If you have questions about any medical matter, you should consult your doctor or other professional healthcare provider without delay.  

If you think you are experiencing any medical condition, you should seek immediate medical attention from a doctor or other professional healthcare provider.  

Although we make reasonable efforts to compile accurate information in our resources and to update the information in our resources, we make no representations, warranties or guarantees, whether express or implied, that the content in this resource is accurate, complete or up to date. 

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With the right support we can and do recover. Dual Diagnosis Network can help you and carers to find the right resources to recover.

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Author Shehrina Rooney shrugs off the stigma, busts myths, and translates the diagnostic criteria into everyday language. She explains the brain science of emotion dysregulation and shares her favorite strategies and skills for weathering the storm.

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