What is post-traumatic stress disorder?

Around 12% of Australians will experience post-traumatic stress disorder in their lifetime. How can you recognise the signs in yourself or others, and where can you seek help?

Dr Lindy Alexander
July 2018

Post-traumatic stress disorder, or PTSD, is a mental health condition that can develop after a frightening or distressing experience.

People with PTSD commonly experience powerful feelings of anxiety, fear, helplessness or dread, and this can have a big impact on their self-esteem, sleep and relationships.

What causes PTSD?

“Typically, the incidents involve some level of physical threat, such as physical or sexual assault, combat, serious car accidents, industrial accidents or natural disasters such as bush fires or earthquakes,” says Professor Mark Creamer, a clinical and consulting psychologist from the Department of Psychiatry at The University of Melbourne. A difficult childbirth, for example, an emergency caesarean or a problematic labour, can also lead to PTSD in some women.                                    

“These events all have in common the fact that they’re a serious threat to the life or physical integrity of the person exposed to them, or to their loved ones.”

Prof Creamer says that PTSD can be triggered by a single event or as a result of cumulative exposure to trauma.

“We see emergency service workers or military personnel who seem to cope perfectly well with repeated exposures to some horrible events as part of their job,” he says. “They can cope for years and sometimes a relatively small incident will be enough to trigger a whole range of [traumatic memories] that haven’t previously troubled them.”

What are the symptoms of PTSD?

“There are four primary groups of symptoms,” says Prof Creamer. “The first is the memories coming back and being haunted by the past horror. This is about pictures, images or memories, or sometimes it can be other sensations, like smells that come back into the person's mind in a very vivid way.”

The second is about avoidance. “People try to avoid any reminders of the trauma because they don't want these horrible memories to come back,” says Prof Creamer. “They try to avoid thinking about it, they avoid places, people and activities that might remind them of the trauma.”

Third is general symptoms of distress, which Prof Creamer says overlap with depression and anxiety. “This is about negative thoughts and negative mood,” he says.

Then there’s persistent hyperarousal. “This includes being always on the lookout for signs of danger,” Prof Creamer says. “People are tense, on edge and jumpy.”

A lot of these symptoms appear in depression or anxiety, but Prof Creamer says it's only when the 4 groups appear together that a diagnosis of PTSD is made.

Experiencing PTSD

Queensland police officer Daryl Elliot Green was sitting in a patrol car, in May 2000, when he was shot in the face and shoulder. The next decade was tumultuous for Green, who underwent two facial reconstructions and received treatment for PTSD.

Although the symptoms and impact of PTSD can vary, for Green it was debilitating.

“I had nightmares, depression, inability to sleep, hyperarousal [such as being “on edge”], anxiety, anger, flashbacks and suicidal thoughts,” he says.

What treatments can help?

A police psychologist supported Green through desensitisation treatment, which is therapy used to gradually reduce the emotional intensity of a response to a trauma or phobia.

“It was confronting,” says Green. “He had me describe the night of the shooting. When I got to the point of describing the bullet hitting my face, the memory was so raw and sharp that I jolted from the chair, opened my eyes and gasped for breath.

“Over the coming months I went through this treatment a further 5 to 6 times, by the end of which, I could talk about the shooting, step by step, without any adverse reactions. I found the treatment extremely helpful.”

Prof Creamer agrees that this can be an effective approach: “There’s a very good evidence base for prolonged exposure [to remembering and engaging with the memory of the event], which is helping the person, gently and in a controlled way, to confront what happened, to go through the memories and face up to them.

“They want to block the memories out because they’re so horrible, but that doesn’t work in the long run.”

Prof Creamer commonly uses prolonged exposure and a second intervention called cognitive therapy in his treatment of people with PTSD. He says that cognitive therapy helps people to identify thoughts that have developed as a result of the trauma.

“We help people identify various negative thoughts and beliefs that have arisen as a result of the trauma,” he says. “It challenges those negative beliefs and replaces them with something more realistic, rational and adaptive,” he says.

Promising research is also underway into non-invasive technological treatments, such as augmented reality, virtual reality and wearable technologies (using smart watches and smart phones).

Soldier.ly, a start up participant in the 2018 HCF Catalyst program, uses the biofeedback received from smart watches to alert veterans when they’re highly stressed or anxious and gives them coping techniques to alleviate these symptoms.

The incidence of PTSD among veterans indicates that there’s a real need for this kind of intervention. A recent government report stated that of the people who leave the military, 46% have a mental health issue. Yet many don’t ask for help.  

The Soldier.ly app, called Overwatch, is the first in its field, aiming to improve veterans’ quality of life. While the Overwatch technology was initially focused on veterans, founder Chris Rhyss Edwards, a veteran himself, says that there are many civilians who could benefit from the app.

“While we’ve launched our product for a military target audience, with 1,000,000 Australians experiencing PTSD right now, we see a global need for it,” he says.

Getting help for PTSD

The symptoms of PTSD can have a devastating impact on not only the person with PTSD, but also loved ones.

If you’re experiencing symptoms of PTSD, it’s important see your GP so they can refer you to a psychologist or psychiatrist and the best path of treatment. Beyondblue (1300 22 4636) has useful resources and a number you can call for support 24 hours a day, 7 days a week. If you’re a present or ex-member of the Australian Defence Force you can visit the Department of Defence for support details.

For family members and friends caring for those with PTSD, the Black Dog Institute has resources and details of how to help others and how to find support groups.