Symptoms of post-traumatic stress disorder (PTSD) include avoidance and reliving the experience. The Department of Psychiatry at Singapore General Hospital explains its risk factors, symptoms and diagnosis and treatment.
An eyewitness to the event can also develop this type of anxiety disorder, originally associated with shell shock suffered by soldiers on the battlefield.
Fear, shock, anger, sadness and guilt are common reactions to a traumatic event, and it is natural for the victim, and onlookers, to relive the trauma even days later. However, if these emotions persist after the traumatic event, and have a significant impact on daily functioning, the person is likely to be suffering from PTSD.
“People who have PTSD feel constant fear and stress even when the danger no longer exists,” says
Dr Tan Shian Ming, Consultant,
Department of Psychiatry,
Singapore General Hospital (SGH), a member of the
SingHealth group. “The trauma from the event typically creates problems in relationships as well as in work and social situations.”
PTSD can develop in children and adults. The progression of PTSD varies from patient to patient, with some recovering in a few months and others taking a few years.
Risk factors for PTSD
- Pre-existing mental health conditions such as depression and anxiety
- A family history of mental illness
- A job in the military or with a high exposure to traumatic events
- Lack of a strong family and friends’ support network
PTSD symptoms typically appear within three months of a traumatic event. In rare cases, they may appear years after the event. PTSD symptoms are grouped into 3 main categories:
1. Reliving the experience
- Flashbacks of the traumatic experience accompanied by physical symptoms, e.g. sweating and a racing heart
- Nightmares of the event
- Obsessive thinking about the event
- Severe emotional and physical reaction when reminded about the event
- Avoiding people, places or objects that trigger memories of the event
- Being unable to talk about the traumatic event
3. Arousal (inability to relax)
- Jumpy, easily startled and frightened
- Easily irritated and annoyed
- Inclined to have emotional outbursts or feeling emotionally numb
- Unable to concentrate
- Difficulty sleeping
“PTSD patients may also suffer from depression and other anxiety disorders,” says Dr Tan.
Small children who develop PTSD after a traumatic event may display physical symptoms such as:
- Inability to talk
- Excessive clinging to the parent
PTSD diagnosis and treatment
PTSD is diagnosed if symptoms persist for at least a month. The patient should have at least one “reliving the experience” symptom and a couple of symptoms each from the “avoidance” and “arousal” categories, to be diagnosed with PTSD.
A mental health professional may use a combination of medication and psychotherapy to treat a patient suffering from PTSD. Psychotherapy, however, is the primary treatment for PTSD.
Medication: This includes antidepressants, anti-anxiety drugs and tranquilisers to control anxiety and depression, and stabilise the patient’s mood.
Psychotherapy: Psychotherapy, also called talk therapy, helps PTSD patients understand their thought patterns, learn how to cope with them, and gradually change them. The therapies used can include the following:
Cognitive-behavioural therapy (CBT): Helps patients recognise their fearful thoughts and replace them with adequate, positive ones.
Exposure therapy: Helps patients face their fears by exposing them to the feared situation in the absence of danger.
Eye-movement desensitisation and reprocessing (EMDR) therapy: Uses guided eye movements to help patients process their painful memories.
Additionally, family therapy may be used to teach family members how to support a PTSD patient.
“The support of family and friends is an important factor in the treatment of PTSD,” says Dr Tan.
Most patients learn to cope effectively with the traumatic event that triggered the post-traumatic stress disorder and are able to return to normal functioning.