Post Traumatic Stress Disorder (PTSD) – Who Suffers?

Q. What proportion of adults and children suffer Post Traumatic Stress Disorder (PTSD) after a traumatic event or disaster?

A. In any serious disaster situation:

• 25% of survivors may have no particular reaction
• 25% of survivors experience transient post traumatic symptoms dissipating over 6 weeks
• 50% of survivors experience more significant, persisting symptoms with which they will need professional help
• Of this 50%, half will go on to develop Post Traumatic Stress Disorder, and half will develop anxiety, depression or problems of substance abuse
• Half the cases of PTSD will remit spontaneously in the first year
• Overall 25% to 33% of people will have long-term problems

Q. Are particular individuals at risk?

A. Three main factors influence whether a survivor is at risk of developing post traumatic stress disorder or syndrome:

• Pre-Existing Factors
• Sex (PTSD is twice as common in women)
• Previous trauma
• Previous depression or anxiety
• Avoidant or anxious personalities
• Family instability
• Deprivation
• Experiences During the Incident
• The more severe the experience (intensity/length/exposure to death) the greater the traumatic reaction

• Recovery Environment
• Having a non-supportive social (work/family) environment

Post Traumatic Stress Disorder (PTSD) – What are the Symptoms?

Q. What sort of reactions/psychological symptoms will survivors have?

A. The framework provided by the DSM-IV definition of Post Traumatic Stress Disorder lists most of the symptoms. Of course there will be many people who only have a few of these symptoms, and who do not qualify for a diagnosis of PTSD proper. Many suffer significantly without attracting any formal diagnosis. Post Traumatic Stress Disorder may be acute or chronic.

• Re-experience phenomena
  These include flashbacks, dreams, “as if” phenomena (a very intense reminder, almost like a hallucination, that the event is happening again), distress on reminder, and physiological reactions (physical anxiety type symptoms such as sweating, shaking etc) if the person re-enters the situation.
• Avoidance/numbing phenomena
  These are really two sets of symptoms. Avoidance is of thoughts or feelings about the event, or of situations that remind the person of the event (e.g. not wanting to go back to the place at work where the incident happened). Some people fail to recall the traumatic event at all. Numbing involves loss of interest (work & leisure activities), feelings of detachment from others, a restricted range of feelings and a sense that the future has been cut short.
• Increased arousal
  These are symptoms related to the body being physically over aroused – poor sleep, irritability, concentration difficulties, hyper vigilance (being constantly on the look-out for threat), and exaggerated startle (jumpiness).

Q. Do survivors suffer problems other than Post Traumatic Stress Disorder?

A. Yes. They can suffer anxiety disorders, depression, and are vulnerable to substance abuse – alcoholism, drug abuse (prescription and illegal), and tobacco abuse. There are also shorter lived disorders such as Acute Stress Reactions and more general disorders such as Adjustment Disorders.

Post Traumatic Stress Disorder (PTSD) – What are the Treatments?

Q. Can Post Traumatic Stress Disorder be prevented?

A. The answer to this question is not clear. It was thought that Psychological Debriefing might prevent PTSD but this is probably not the case. The causes of PTSD are complex and it would be simplistic to think that a short series of interventions, however well received, would prevent PTSD in an “at risk” individual. It is natural that people have reactions to traumatic events – these cannot be avoided. However, it is clear that unavoidable distress can be minimised by crisis intervention techniques such as Critical Incident Stress Management. Such interventions set up a support network in the workplace for the early detection of PTSD and prompt treatment.

Q. Is there a test for PTSD that I could give so that I can know who needs help?

A. People at risk with high symptom levels can be screened for. This should be used as part of a good intervention programme should pick it up.

Q. If it cannot be prevented, how can it be treated?

A. Successful treatment packages for PTSD include the following:

• Account giving
• Education concerning reactions to trauma
• Identification of negative thinking/cognitive distortions
• Stress Inoculation Training/Anxiety Management
• Exposure treatment