I have left this final post in this blog series on anxiety to last because it is vast and complex. Post traumatic stress disorder (PTSD) is an intricate subject in itself, and the associated but distinct area of Complex Trauma is particularly complex. Here I can only provide an overview of causes, symptoms and treatment of both PTSD and Complex Trauma.
I will begin with an overview of PTSD.
..defined by NICE (National Institute of Health and Care Excellence) as a disorder that develops following a stressful event or situation that is exceptionally threatening or catastrophic. Such events need not, of course, simply refer to major incidents such as a natural disaster, terrorist attack or other large scale disaster such as a plane crash. They can equally apply to catastrophic incidents for an individual - loss of a loved one, a car crash, an illness or undergoing surgery.
A diagnosis of PTSD usually happens..
.. when one or more of the symptoms outlined below persist for one month or more. It is important to recognise that symptoms may not manifest for months or even years after the event(s).
Symptoms can be summarised as:
- Re-experiencing: reliving intrusive and distressing recollections such as flashbacks and nightmares; physical sensations eg. pain; extreme distress at real or symbolic reminders of the trauma
- Emotional numbing: feelings can be suppressed, avoided and denied and great efforts may be made to avoid situations, places or people that are reminders of the trauma; there may be complete memory loss of the trauma; drugs or alcohol may be misused in order to avoid emotional memories or the effects of re-experiencing
- Hyperarousal: there can be difficulties with sleeping and concentrating; feelings of being constantly 'on edge'; heightened irritability or nervousness
- Negative thoughts and feelings: these can often be overwhelming and may include difficulty trusting others, believing others do not understand, thinking that there is nowhere that is safe, feeling responsible for the trauma or feeling angry, sad or ashamed.
Other related issues can be mental health issues such as depression, anxiety or phobias; self harming or excessive use of drugs or alcohol; headaches. chest pains, racing heart and panic attacks.
Since PTSD first became recognised in war veterans, there has been a huge amount of research into not only what it is and why it happens, but most significantly how those who suffer from it can be helped. In the UK NICE recommends the following:
- CBT trauma-focused talking therapy
EMDR: a relatively new treatment involving rhythmic eye movement while recalling the traumatic event.
Medication is not routinely prescribed for PTSD unless it is for associated issues of depression or difficulty sleeping. It is also worth noting that some people recover from PTSD relatively quickly with no interventions.
Complex trauma is ..
.. a less well-know phenomenon. It is sometimes referred to Complex PTSD or Developmental Trauma Disorder. It is characterised by an exposure to repeated traumatic events over a period of time, sometimes a considerable period of time and this often occurs during childhood, hence the term Developmental Trauma Disorder. Such repeated traumas include severe physical and emotional neglect, physical, sexual and emotional abuse or repeatedly witnessing violence or abuse. However, complex trauma can also occur in adults who have suffered repeated or on-going experiences such as exposure to war, domestic violence or long-term enforced prostitution. The long-term psychological harm from such trauma are generally felt to be particularly severe when:
- it occurs in childhood
- it is caused by a parent or caregiver
- it was endured for a considerable period of time
- the person was alone
- there was no means of escape or protection
- the person still has contact with the perpetrator
Those who have suffered such trauma can have an array of symptoms:
- inability to trust others
- difficulty controlling emotions
- feelings of isolation, emptiness and loneliness
- feeling alienated, worthless, shame and guilt
- dissociate experiences or dissociative disorders
- self-harm and suicidal feelings
For such complex traumatic impact specialist and careful treatment is required. A three staged framework is generally the model used in working with people who are dealing with the impact of complex trauma. The area of PTSD and Complex Trauma are area in which I have a particular interest and specialism in, reflected in past and on-going advanced training in this area. For further information in my work in this field please call me or email me using the form available on the contact page of this website.