What is Post Traumatic Stress Disorder (PTSD) and What Causes it?
According to the DSM-IV diagnosis of anxiety disorders, Post Traumatic Stress Disorder (PTSD), occurs following an event in your life that is deemed seriously threatening to yourself (or others), which resulted in intense fear, helplessness or horror. Symptoms include intrusive memories of the traumatic events (e.g. nightmares, flashbacks), avoidance, numbing and hyper-arousal. Acute Stress Disorder (ASD), lasts for a maximum of four weeks. After this time, this presentation is diagnosed as PTSD.
With PTSD the main concerns focus on an enduring sense of a fear of danger, although anger, disgust, guilt, grief and shame can be prominent too. Generally, those suffering from PTSD can recall fragments of the traumatic event or events in detail, but the entire picture is jumbled or incomplete (Foa & Riggs, 1993). Those experiencing PTSD often have very vivid ‘flashbacks’ of the event, which leaves them feeling that they are re-experiencing the trauma all over again and that danger is a current and serious threat (Ehlers & Clark 2000). It is also common for PTSD sufferers to experience nightmares and other less vivid recollections. Most of the memories experienced are very visual, although recollections of the traumatic event can also be experienced as sounds, physical sensations and smells.
These memories are also disconnected from the person’s intellectual understanding of the trauma. This is why it is so difficult to put these memories into some kind of perspective and enable the sufferer to tolerate them better. In an attempt to manage their high anxiety levels, PTSD sufferers often use avoidance techniques both physically and mentally to inhibit these intrusive memories. A common way of coping is to avoid the triggers for these memories. However, this may ‘help’ in the short term but in the long term this prevents the processing of the memory (i.e. reviewing the traumatic content so that it can be linked with information about the time, place and outcome and therefore put into the past where it belongs), so the memory remains a dis-connected, emotionally charged recollection, which in itself triggers high levels of stress.
It is also common that those experiencing PTSD make misinterpretations from the traumatic experience, for example ‘This proves no man can be trusted’, or ‘I brought this on myself through carelessness.’ Again these sorts of thoughts are adding to the vicious circle, and actually maintain these highly provocative memories. Thoughts about the PTDS symptoms themselves such as ‘I am weak’, or ‘I am going crazy’ can make the distress worse associated with the intrusion and in turn can lead to increased stress and then more safety behaviours. In addition the cycle of PTSD can be maintained by a selective memory process, which distorts recollections, so that they are biased towards negative aspects of the trauma, which then in turn heightens the distress. An over-estimation of perceived danger is also common and it is not unusual for trauma victims to over estimate current threats to their safety, again this can lead to heightened stress levels and the need to revert to safety behaviours such as avoidance. This means that many trauma victims neglect activities that contributed to their well being before the trauma, activities such as socialising or exercising.
NICE Guidelines 2005 state that ‘ All people with PTSD should be offered a course of trauma-focused psychological treatment (trauma-focussed cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). EMDR is especially beneficial if the sufferer finds it difficult to talk about the trauma.
The goals of treatment are to help sufferers to process traumatic memories fully and thus reduce re-experiencing them, to identify and amend unhelpful thoughts and ways of thinking which maintain the sense of an ongoing threat, and to stop using safety behaviours.
Treatment is often multi-faceted and includes psycho-education, looking at how their symptoms manifest and the impact they are having on the persons life, a gentle ‘revisiting’ the trauma often using all the senses in a safe and supported space, and helping sufferers to re-engage in activities that were previously important to them. All the while, sufferers are shown ‘self soothing’ skills such as relaxation and breathing techniques. Behavioural experiments can also be carried out to gradually start to challenge avoidance of people, places or objects. A combination of these techniques can help to test unhelpful ways of thinking, aid the processing of memories, to tell their story and to give it a beginning a middle and an end and help the sufferer to gain new perspectives into the traumatic memory. In other words, leaving the memory in its rightful place, the past. Above all, working with the notion that talking about the event does not make it worse.
What Support is out there for Birth Trauma and postnatal illness?
Your family and friend can play a big part in helping your recovery. For them to be able to help it is important you are honest with your friends and family about how you are feeling, and don’t bottle up your emotions as this can cause tension. Allow them to carry out small tasks for you, such as house work, taking your baby for a walk, or simply looking after your baby for one hour every other day to allow you to do something you want. It is important you allow yourself to have some ‘me time’.
Self-help groups can offer you good advice and support on how to cope with postnatal depression as well as comfort to know that other mums are feeling the same as you, hearing other individuals experiences of postnatal depression can be a huge benefit, as you will be able to discuss techniques on how to cope, and have an understanding of each other’s feelings. PANDAS Support Groups offers just that, in a non-judgmental safe environment.
The most important support aid you can have is being able to talk to someone and be honest about your feeling and emotions. Ensure you write down on a piece of paper or a notebook the numbers of people you can call when you are feeling your worst, and make sure the list is readily available, so if you feel you are becoming aggressive, upset, angry or anxious you can call someone and no that you are not on your own. You can add PANDAS Help Line on your list 0843 28 98 401, and we will always be here to listen.