Written by Philippa Walsh
What is PTSD?
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can result from experiencing a traumatic or extremely stressful event.
An individual suffering from PTSD can find themselves re-living the traumatic event through nightmares and flashbacks, which can lead to hypervigilance and feelings of isolation, irritability or guilt.
How is PTSD caused?
The type of events that can cause PTSD include:
- Serious road traffic accidents
- Violent assaults, such as sexual assault, mugging or robbery
- Prolonged sexual abuse, violence or severe neglect - this is referred to as developmental trauma or complex PTSD
- Witnessing violent deaths
- Military combat
- Being held hostage
- Terrorist attacks
- Natural disasters, such as severe floods or earthquakes
PTSD can develop right after a disturbing event is experienced or weeks, months or even years after it has occurred.
How many people does PTSD affect?
It is estimated that PTSD affects 1 in 3 people who have a traumatic experience; but it is not clear why some people develop the condition and others don't.
Common symptoms of PTSD
The symptoms of post-traumatic stress disorder (PTSD) can have a significant impact on your day-to-day life. In most cases, the symptoms develop during the first month after a traumatic event. However, 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, followed by periods where they get worse. Other people have constant, severe symptoms.
The specific symptoms of PTSD can vary widely between individuals, but generally fall into the categories described below:
Re-experiencing is the most typical symptom of PTSD. This is when a person involuntarily and vividly re-lives the traumatic event in the form of: flashbacks, nightmares, repetitive and distressing images or sensations. and physical sensations such as pain, sweating, nausea or trembling.
Some people have constant negative thoughts about their experience, repeatedly asking themselves questions that prevent them from coming to terms with the event. For example, they may wonder why the event happened to them and if they could have done anything to stop it, which 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, or avoiding talking to anyone about your experience.
Many people with PTSD try to push memories of the event out of their mind, often distracting themselves with work or hobbies. Some people attempt to deal with their feelings by trying not to feel anything at all. This is known as emotional numbing. This can lead to the person becoming isolated and withdrawn, and they may also give up pursuing activities they used to enjoy.
Hyperarousal (feeling 'on edge')
Someone with PTSD may be very anxious and find it difficult to relax. They may be constantly aware of threats and easily startled. This state of mind is known as hyperarousal. Hyperarousal often leads to: irritability, angry outbursts, sleeping problems (insomnia) or difficulty concentrating on daily activities.
PTSD sufferers may experience other problems, including: depression, anxiety or phobias, drug misuse or alcohol misuse and a number of physical symptoms such as headaches, dizziness, chest pains and stomach aches. PTSD can sometimes lead to work-related problems or relationship difficulties.
How to cope with flashbacks
Grounding techniques can be very useful in times of acute distress. Especially if we feel unreal or detached.
A flashback is how the brain tries to process a traumatic experience, so that it can be filed away as a past memory (rather than a current threat). This will enable your healing. By allowing flashbacks to happen, rather than fighting or avoiding them we can help to speed up the natural healing process. By getting our heads out of the past (trauma) and into the present (safety)using grounding techniques, flashbacks become less traumatic.
Anxiety can make us feel very detached or unreal. Grounding techniques help to bring us back to the here and now, with an awareness of our own bodies. They are strategies that help us to be in the present moment, in reality, rather than in the traumatic experience of the past or current distress.
Practice them, and learn what works best for you - whether it's a mental strategy like telling yourself you're safe now, or maybe doing something more physical. The aim is to turn your focus of attention away from the past or current distress, and into the here and now of reality and safety.
- Tell yourself you are having a flashback or anxiety attack and that this is okay and normal.
- Ask yourself questions in order to bring yourself into the present. Write down your own questions, for example: Where am I, right now? What day is it? What year is it? How old am I? Where do I live?
- The worst is over - it happened in the past, but it is not happening now. Tell yourself: That was then, and this is now. However terrible you feel right now, you survived the awfulness then, which means you can survive and get through what you are remembering now. Open your eyes and put a light on (if it's dark).
- Look around the room, notice the colours, the people, the shapes of things. Make it more real. Listen to and really notice the sounds around you: the traffic, voices, washing machine, music etc. Notice your body, the boundary of your skin, how your clothes feel on your skin, movement in your hair as you move your head, really feel the chair or floor supporting you - how that feels in your feet, your legs, your body.
- You may wish to gently pinch yourself: That feeling is in the now, the things you are re-experiencing happened in the past. That was then, and this is now.
- Stand up and put your feet firmly on the ground: Move about: stretch, stamp your feet, jump up and down, dance, run on the spot, rub your arms and legs, clap your hands, walk, remind yourself where you are right now.
- Use 5,4,3,2,1: Think about 5 things you can see, 4 things you can hear, 3 things you can touch (and touch them), 2 things you can smell or like the smell of, and 1 slow, deep breath. Notice what is right now - and notice how different it is to the distressing memory.
- Breathe mindfully: Breathe deeply down to your belly; put your hand there (just above your navel) and breathe so that your hand gets pushed up and down. Imagine you have a balloon in your tummy, inflating it as you breathe in, and deflating as you breathe out. When we get scared, we breathe too quickly and shallowly and our body begins to panic because we're not getting enough oxygen. This causes dizziness, shakiness and more panic. Breathing slower and deeper will stop the panic.
- Describe (and say out loud if appropriate) what you are doing right now, in great detail. Or describe doing a routine activity. Try to think about different things, almost like playing mental games, for example: count backwards in 7s from 100, think of 10 different animals, 10 blue things, one animal or country for each letter of the alphabet, say the alphabet slowly, say the alphabet backwards etc.
- Carry a comforting object with you: It can help to hold or carry around a small object of personal meaning to remind you that you are her and safe. Objects can provide comfort.
- Use Positive Coping Statements: You might prepare a coping statement, for example: "I am (name), I am safe right now, this is just a memory - that was then and this is now. I am in (place) and the date is (date). This flashback will pass". Make an emergency or soothe box you can use another time, and fill it with meaningful and helpful objects or reminders.
- When you feel ready, you might want to write down about the flashback or anxiety attack, and how you got through it. This will help to remind you that you did get through it, and can again.