Shall we talk about Post-Traumatic Stress Disorder (PTSD)?

Imagine that you have experienced a traumatic event that you have never experienced before. It could be a major car accident, a natural disaster, or the sudden death of a loved one. After the event, you may feel overwhelmed, anxious, and overwhelmed. Sometimes you may relive the event over and over again, as if it were really happening again. This is what we are going to talk about today, called Post-Traumatic Stress Disorder (PTSD). This is something that can affect many people, so it is important to be aware of it.

What is PTSD simply?

Simply put, PTSD is a mental health condition that some people develop after experiencing a severe, traumatic event. This event may have been life-threatening, or it may have had a significant impact on your physical and mental well-being. PTSD can affect anyone of any age, from young children to adults.

A person with PTSD experiences intense, distressing thoughts and feelings related to the traumatic event. This can continue long after the event has occurred. PTSD can cause stress-related symptoms such as:

• Constantly feeling anxious ( anxiety ), sad ( depression ), or guilty or ashamed .
• Feeling like the event is really happening again (flashbacks) or having nightmares about it.
• Avoiding places, things, and activities associated with that event.

These symptoms can cause a lot of stress and can interfere with your ability to carry out your daily activities .

What is a traumatic event?

A trauma , or a dangerous event, is anything that seriously threatens your survival or safety. It doesn't have to be a single event (like a one-time car accident). It can also be a long-term trauma . Think about things like living in a time of war or experiencing domestic violence.

And, this trauma doesn't have to happen to you directly. You may have witnessed a terrifying event with your own eyes. Or, you may develop PTSD after learning that something terrible has happened to someone close to you.

Here are some examples of dangerous events:

• Serious accidents (e.g., a serious car accident).
• A serious physical injury or sudden serious illness.
• Warand military conflicts (people in our country also have experience with this).
• Natural disasters (e.g. tsunamis, earthquakes, floods , wildfires).
• Physical abuse .
• Verbal abuse (constant scolding, threats).
• Sexual assault or abuse.
• Bullying at school or in the workplace.
• Sudden death of a loved one.

Are there types of PTSD?

Yes, there are two other conditions that are very similar to PTSD.

• Acute Stress Disorder: This is a short-term mental disorder that can occur within the first month after a traumatic event. However, if symptoms last longer than four weeks, it may be PTSD.
• Complex PTSD (CPTSD): This condition occurs when you are exposed to a trauma over a long period of time. For example, repeated physical or sexual abuse as a child, prolonged domestic violence, or war. People with CPTSD usually have significant problems with managing emotions , thinking about themselves, and relating to others, in addition to the symptoms of PTSD.

How common is this condition?

PTSD is a very common condition. Between 5% and 10% of people who experience a traumatic event develop PTSD. That means it doesn't happen to everyone, but it does affect a significant number of people.

What are the symptoms of PTSD?

For a doctor to diagnose PTSD, symptoms must last for more than a month. Also, the symptoms must cause you significant distress or interfere with your daily functioning.

PTSD symptoms can be divided into four main categories:

1. Intrusive thoughts and experiences (Intrusion Symptoms)

This means that the terrible event keeps coming back to your mind over and over again.

• Constant, uncontrollable recollection of the event. It's like watching the events of that time over and over again like a movie.
• Having scary dreams, especially dreams related to the event.
• Flashbacks are when you feel like the event is really happening again. This is very vivid, you can feel like you are there at that moment. Sometimes you can even smell it, or hear it.

2. Avoidance Symptoms

This involves trying to stay as far away as possible from everything that reminds you of that terrible event.

• Avoiding people, places, activities, things, and situations associated with the event. For example, you may avoid going down the road where the accident happened.
• I avoid thinking about that incident and remembering it.
• You avoid talking to others about what happened or how you feel about it.

3. Changes in Thinking and Mood

This can make a big difference in the way you look at the world, the way you think about yourself, and the way you feel.

• Persistent fear, panic, anger, guilt , or shame.
• Important parts of that terrible event are being forgotten.
• Persistent negative and distorted thoughts and feelings about oneself or others. You may think things like, "I'm wrong," "No one can be trusted."
• Misjudging the cause or consequences of an event and blaming oneself or others.
• Feeling isolated and alone from others.
• The things that used to bring joy no longer bring any joy.
• The inability to feel positive emotions. It seems like you can't feel things like happiness and love.

4. Changes in Arousal and Reactivity

In this, your body is constantly "on alert," reacting to even the smallest things.

• Irritability and quick anger.
• Acting recklessly and in a way that harms oneself (e.g., driving too fast, drinking too much alcohol).
• Being overly vigilant about one's surroundings (Hypervigilance). Constantly afraid of danger.
• The slightest noise makes you jump.
• Difficulty concentrating or not being able to sleep.

What happens when young children develop PTSD?

When young children develop PTSD, they may have difficulty putting into words exactly what they are feeling. Or they may have experienced a trauma that you don't know about. They may be restless, fidgety, or have difficulty paying attention or doing things in an orderly manner.

These symptoms can sometimes be confused with those of a condition called Attention-Deficit/Hyperactivity Disorder (ADHD). Therefore, if your child has these symptoms, it is important to see a specialist (e.g., a child psychiatrist) who has experience diagnosing PTSD.

What other problems can PTSD cause?

People with PTSD are more likely to experience these conditions, and they can make PTSD symptoms worse:

• Mood disorders - e.g. depression.
• Anxiety disorders.
• Even conditions like diseases related to the nervous system, such as dementia.
• Substance use disorder / Alcohol use disorder.

Most importantly, people with PTSD are at increased risk of suicidal thoughts and attempts.

If you or someone you know is feeling down, please don't be alone. Talk to someone you trust immediately, see a doctor, or call an emergency mental health helpline like 1926 (Sumatiri) in Sri Lanka. Don't be afraid to ask for help, you are not alone.

What causes PTSD?

In fact, between 61% and 80% of the population will experience a traumatic event at some point in their lives. However, not all of them will develop PTSD. Of this group, between 5% and 10% will develop PTSD.

It's not entirely clear why some people develop PTSD and others don't, even after experiencing the same event. However, research has found that people with PTSD have abnormal levels of certain neurotransmitters and hormones . They may also have changes in how their brains function .

Changes in Neurotransmitters and Hormones

Studies have shown that people with PTSD, despite ongoing stress, may have normal or low levels of a hormone called `(Cortisol)` (also known as the "stress hormone"). They also have high levels of `(Corticotropin-Releasing Factor - CRF). This `(CRF)` stimulates the release of a chemical called `(Norepinephrine). This `(Norepinephrine)` triggers our body's `(fight or flight)` response. This is what causes these things to happen:

• Increased heart rate.
• Increased blood pressure.
• Increased alertness and quick-temperedness.

In addition, changes in the function of some other neurotransmitter systems have been shown, for example:

• Gamma-aminobutyric acid (GABA)
• Glutamate
• Serotonin

These are all like little messengers in our brains, and problems like these arise when their work isn't done properly.

Brain changes

PTSD is associated with certain changes in the function and structure of your brain:

• The size of the part of your brain called the ``Hippocampus'' decreases. This ``Hippocampus'' is an important part that controls our motivation, emotions, learning, and memory.
• The amygdala (which controls our emotions and fear responses) is overactive in people with PTSD. This means that they become very afraid and anxious about even the smallest things.
• The part called the Medial Prefrontal Cortex (which helps control emotions in the Amygdala) has also been found to be smaller and less responsive in people with PTSD.

While this may seem a bit complicated, the simple truth is that PTSD is not just something in the mind, it is also related to chemical and structural changes in our brain.

Who is at higher risk of developing PTSD?

It's impossible to say for sure who will develop PTSD after a traumatic event, but the following people are at a slightly higher risk of developing PTSD:

• Especially those who have experienced some severe trauma (e.g., experiencing severe combat during military service, being sexually assaulted).
• Those who faced trauma in childhood.
• Those who were physically injured in that incident.
• Those who experienced intense fear, helplessness, or panic at the time of the incident.
• Those who did not receive adequate support from society, family, and friends after a traumatic event.
• Those who have experienced prolonged or repeated trauma .
• Those who already have other mental health problems and/or substance abuse .

How do you know if you have PTSD?

There is no specific test to diagnose PTSD. Instead, a doctor will diagnose the condition after asking you about:

• Your symptoms.
• Your medical history.
• Your mental health history.
• About the traumatic events you faced.

You may find it difficult to talk about the incident. In such cases, you may want to bring a trusted person (family member, friend) with you to the doctor. This will provide you with comfort and can help you explain your symptoms and changes in behavior.

Doctors use the criteria in the American Psychological Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The most recent version is the DSM-5-TR. To be diagnosed with PTSD, you must have at least one of the following symptoms for at least one month :

• At least one intrusive thought or experience (intrusion symptom).
• At least one avoidance symptom.
• At least two changes in thinking and mood.
• At least two disturbing changes in body and mind.

Your doctor may do a physical exam and do some blood tests to see if there is another physical cause for some of your symptoms.

What are the treatments for PTSD?

The main treatment for PTSD is psychotherapy or talk therapy. In particular, a type of therapy called Cognitive Behavioral Therapy (CBT) is very effective.

This treatment is provided by a trained, licensed mental health counselor.. That could be a psychiatrist or a psychologist. They provide support, education, and guidance to you and your family, to help you live well and improve your mental well-being.

There are several specific CBT treatments for PTSD:

• Cognitive Processing Therapy: This is a treatment specifically designed for PTSD. It focuses on changing painful negative emotions (such as shame and guilt) and beliefs that are caused by the trauma. It also helps you cope with distressing memories and emotions.
• Eye Movement Desensitization and Reprocessing (EMDR) therapy: In this method, you move your eyes in a specific way while you process traumatic memories. The goal of EMDR is to help you recover from trauma or other stressful life experiences. Compared to other treatments, EMDR is a relatively new approach. However, several clinical trials have shown that it is effective and can help people recover faster than other methods.
• Group Therapy: This involves people who have gone through similar traumatic experiences coming together to share their experiences and feelings in a comfortable, non-judgmental environment. Since the challenges of PTSD can affect the entire family, family therapy can also be helpful.
• Prolonged Exposure Therapy: In this treatment, you are exposed to repeated, detailed images of the trauma or to things that trigger your symptoms in a safe, controlled manner. This helps you face your fear, control it, and learn to live with it.
• Trauma-focused cognitive behavioral therapy (CBT): This treatment helps you learn how your body responds to trauma and stress. It also helps you identify and change problematic thinking patterns and learn skills to manage your symptoms. It also includes exposure therapy.

Medication for PTSD

Currently, there are no medications specifically approved by the US Food and Drug Administration (FDA) for PTSD. However, doctors may prescribe certain medications to help manage some of the symptoms of PTSD. For example:

• Antidepressants - such as Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs).
• Anti-anxiety medications.

Your doctor will decide whether or not to use these medications, and what to use. Never use these medications without medical advice.

Can PTSD be cured? What's the future?

The prognosis of PTSD can vary from person to person. However, in most cases, treatment can help you recover. With treatment, about 30% of people recover completely. Another 40% get much better with treatment, but some mild symptoms may remain. For some people, with the support of loved ones, PTSD symptoms go away over time, even without professional treatment.

The most important thing is to ask for help and seek treatment. Then the chances of recovery are much higher.

Can PTSD be prevented?

Unfortunately, we can't always prevent a traumatic event from happening. However, some studies have shown that there are steps you can take after the event to help prevent the development of PTSD. These are called "protective factors." Here are some of them:

• Seeking support from others (such as friends and family) after the incident. This creates a sense of security.
• Joining a support group after a traumatic event is a great way to talk to people who have had similar experiences as you.
• Learning to think positively about how you acted in the event of an accident.
• Practicing healthy coping strategies after a traumatic event (e.g., exercising, doing things that calm the mind, instead of trying to forget problems with alcohol).
• Being able to act and respond effectively, even when you feel scared.
• Helping others, especially if it's a traumatic event that affects several people, like a natural disaster.

When should I see a doctor?

It is very important to see your doctor and/or a mental health counselor regularly after a traumatic event. If your symptoms get worse, be sure to talk to your doctor. Don't be ashamed or afraid. This is not your fault.

When should you go to the Emergency Department?

If you are having thoughts of suicide or harming yourself , this is a very serious situation. In such a case, please go to the nearest hospital emergency room immediately, or call an emergency mental health helpline such as 1926 (Sumatiri).

Seeking professional help after a traumatic event can be a difficult thing to do. But remember, PTSD is a treatable condition. Over time, with treatment, you will start to feel better. Talk to your doctor about treatment options. Remember, they are always there to help and support you.

Finally, things to remember

It's normal to experience emotional distress after a traumatic event. However, if those distresses persist and interfere with daily functioning, it could be PTSD.

• You are not alone: ​​PTSD is a condition that affects many people.
• This is not your fault: no one develops PTSD willingly.
• There is help: There are treatments that can help you recover.
• Don't be afraid to talk: talk about your feelings with someone you trust, such as a doctor.

If you or someone you know is experiencing this, please seek help. Your mental health is just as important as your physical health.

` PTSD, Post-Traumatic Stress Disorder, depression, trauma, mental health, stress, treatment