Post traumatic stress disorder: A condition we are likely to see more of

Post traumatic stress disorder (PTSD) has featured prominently in the media of late. A psychologist told a US trial that Amber Heard suffered from post-traumatic stress disorder due to physical and sexual abuse at the hands of her ex-husband Johnny Depp.

And just last week, reporter Fergal Keane featured in a BBC 2 programme, Living with PTSD, in which he explores his experience, since 2008, with the condition and the potential for healing.

In his case, the horrific scenes of war emerging from Ukraine had a personal impact. From a hotel room in Kyiv, Keane was aware that "the part of me that wanted to tell one of the biggest stories of my lifetime longed to stay. But it is also the part that is drawn to danger and has brought anguish into my personal life in the form of PTSD.

“Did I really want to end up in hospital again, my nerves jumping at any loud noise, unable to sleep, exhausted by the depression that invariably comes with my PTSD, and the sense of guilt at the stress felt by my loved ones watching me report from an active frontline.”

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At one level Keane’s story mirrors the origins of the concept of trauma.

Narrow view

Historically, much of the clinical thinking about trauma has taken a narrow view, assuming that trauma (derived from the Greek for “wound”) necessitated the infliction of physical wounds and harms. In the early 20th century, clinicians recognised manifestations of trauma in soldiers, using terms such as “shell shock” and “war neurosis”. Subsequently, a collection of frequently observed after-effects of trauma were reconceptualised as PTSD.

More recently, our understanding of the nature of the trauma needed to precipitate PTSD has widened. We now know that events that are not directly life-threatening, including behaviours such as emotional abuse, financial abuse, bullying and neglect, can lead to post-traumatic reactions and responses.

For Keane, the old and the new concepts of PTSD have come together. “War repeated the nervous stress, and the powerful compulsion to prove I could survive, that I had experienced as a child growing up in a home fractured by the effects of my dad’s alcoholism. In war zones I could prove I was no longer a scared child. I had a voice,” he says.

According to the World Health Organisation, around 70 per cent of people experience at least one traumatic event in their life. Research shows that just under 6 per cent of those people will develop PTSD.

It has also emerged that when traumas compound or occur at key developmental ages, a person may develop complex post-traumatic stress disorder (C-PTSD), which involves difficulties related to a person’s self-concept, emotional development, thinking and interpersonal functioning. In complex PTSD, the trauma is not a one-off event, but something repeated and sustained, such as torture, domestic violence or childhood abuse.

Combination of therapy

Complex PTSD, while less common, includes the same symptoms as PTSD, plus additional ones called called “disturbance in self-organisation”. The term refers to problems in regulating emotions (for example, feeling numb or having sudden anger outbursts), feeling distant from others, and having extremely negative views about yourself.

Since getting a formal diagnosis back in 2008, Keane has used a combination of therapy – the “talking cure” – and anti-depressant medication. “My therapy was CBT [cognitive behavioural therapy] which examines negative thoughts associated with trauma and tries to replace them with positive ones.The mix of talking and medication have helped to ease the symptoms and show me a healthier way to live,“ he says.

As the number of traumatised Ukrainian refugees arriving in Ireland multiplies, we can expect to see more cases of PTSD in those around us.

Common PTSD symptoms – Nightmares, flashbacks, ruminating on the traumatic experience – Avoidance of images, thoughts, places which could trigger anxiety related to the trauma – Hyper vigilance: constantly on the alert for potential threats to your physical wellbeing – Hyper arousal: exaggerated responses to noises, smells, movements – Emotional detachment which can cause a feeling of being numb – Short temper – Depression

[ mhouston@irishtimes.com ]