post traumatic stress disorder: the stress of terror
by Barbara Millar
When tragic events take place, whether it is terrorist attacks in America, famines in Africa or earthquakes in India, the shock can touch us all. The emotional after-effects are felt not only by bereaved families, rescue workers and emergency medical staff but just about everyone who watches tragedies unfold on their television screens.
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For some people – who are either directly affected by such traumas or particularly distressed by what they see – the shock can take years to fade. Some of these people may be diagnosed as suffering post traumatic stress disorder (PTSD).
what is post traumatic stress disorder?
Once called 'shell shock', PTSD affects hundreds of thousands of people who have survived or witnessed disasters, ranging from terrorist bombs to earthquakes, train crashes to rape. To be described as PTSD, the person should have faced an extraordinary disaster with the threat of death, not just a bad accident. Children too may be affected by PTSD.
According to the National Center for PTSD in the US most disaster survivors suffer only mild, normal stress reactions and the experience may even promote personal growth. But as many as one in three experience severe stress symptoms which may lead to lasting PTSD, anxiety disorders or depression. Certain people, such as those with previous psychological problems or living under already stressful conditions, may also be at higher risk of developing PTSD.
In many ways, PTSD is a natural response to an abnormal situation. Yet even though the disorder has clear symptoms it is often misunderstood or misdiagnosed. The symptoms may disappear with time or persist for years and they may accompany or lead to other psychiatric illnesses, such as depression or anxiety. You might like to go to the mind section and check out the feature on depression.
Not everyone who experiences trauma needs treatment – some recover with the help of family or friends. But many do need professional help to repair the psychological damage of experiencing or witnessing an overwhelming traumatic event.
symptoms of PTSD
According to experts in PTSD, symptoms usually appear within three months of a trauma but sometimes later. They fall into three categories:
Intrusion: Memories of the trauma recur unexpectedly and 'flashbacks' intrude into everyday life. Sudden, vivid memories – sometimes actual hallucinatory phenomena – accompanied by painful emotions may overwhelm the person's attention. These may be so strong it is as if they are actually experiencing the trauma again and can last for days or weeks.
Avoidance: At first the person feels numb and can complete only routine activities. Later, they may alternate between a flood of emotions and inability to feel or express anything at all. They avoid situations which are a reminder of the original event and a few may feel guilty because they survived the disaster while others did not.
Hyperarousal/hypervigilance: The person may feel constantly threatened by the original trauma and expect it, or another disaster, to happen again. They can become irritable and explosive, have trouble concentrating or remembering information and may develop insomnia through terrifying nightmares. Many people use alcohol or other drugs to excess to help blunt their memories. They may also suffer physical symptoms, like headaches, nausea and chest pain.
treating PTSD
Psychiatrists and other mental health professionals have had good success treating PTSD sufferers using various methods. These include:
- cognitive behavioural therapy (CBT) – focusing on correcting painful and intrusive thought and behaviour patterns
- psychodynamic psychotherapy – helping examine personal values and the impact of the traumatic event if perhaps the experience has 'pushed buttons' from the person's past
- family therapy – may help if family relationships interact with the experience of the trauma
- discussion groups or peer counselling groups – survivors of similar events share their experiences.
expert help in the US
After the terrorist attacks in the US in 2001, a team of 10 volunteers from Cruse Bereavement Care in the UK flew to New York to work alongside British Consulate officials and Scotland Yard police officers offering emotional and practical support to the relatives of British victims out there.
'The relatives who went out were remarkably resilient,' says Dr Arthur O'Hara, a consultant psychiatrist with the Foyle Health and Social Services Trust in Northern Ireland who was one of the Cruse volunteers. 'But no doubt some of these people will have continuing emotional difficulties because of the uncertainty of the situation.'
help with PTSD in the UK
There are several centres in the UK working specifically to help victims of PTSD. Usually, people need to be referred to a centre by their general practitioner and this may entail a lengthy wait.
Wales
The Traumatic Stress Centre (Wales) in Swansea helps patients referred by their general practitioners. The centre was originally set up for army and emergency services staff diagnosed with PTSD. But as it became clear there was a wider need for PTSD treatment among the general public it has broadened its scope.
Centre director David Bennett says: 'Lots of people mock PTSD but it is not a joke,' he says. 'It is serious and, if not picked up early, it can affect people emotionally, physically and mentally.'
Scotland
The Aberdeen Traumatic Stress Centre was founded after the Piper Alpha oil platform explosion in 1988, which caused 167 deaths and huge suffering for survivors, bereaved families and helpers.
Now 150 patients a year are referred to the centre by doctors, the emergency services, prison service and the military. The centre has also helped victims of other Scottish tragedies, including the Lockerbie air crash and the Dunblane shootings.
London
Staff at the Traumatic Stress Clinic in Charlotte Street, London, helped people affected by the King's Cross underground fire in 1987. The clinic has also received national recognition for its work with Gulf war veterans.
Head of the clinic Dr Stuart Turner says: 'Most people involved in a disaster will get over it. Only a small proportion will go on to get long term persisting problems, such as PTSD. But, if they do get these problems, it is imperative that they are offered the treatment and support they need as quickly as possible.'
real life experiences of PTSD
the soldier's story
John Thompson developed PTSD 18 years after leaving the army. A member of the Scots Guards in the Falklands war, he was 19 when he saw many fellow soldiers killed and severely injured in fighting. A bout of 'flu triggered the return of the trauma.
'He began to neglect himself – not washing or changing his clothes,' says Mona, John's wife. 'He became more and more stressed and overwrought, having constant nightmares and flashbacks, until finally he took a massive overdose and tried to end his life. He was then admitted to a psychiatric hospital and has been on a high dose of antidepressants ever since.'
The family – the couple have two young children – have had some help from the Traumatic Stress Centre in Wales but life is still a struggle. 'Some days John is absolutely fine but, on other days, the slightest thing will cause him to explode,' says Mona. 'We now take the future a day at a time.'
the motorcyclist's tale
Bob Wilson, a senior oil industry professional, was riding his motorcycle, on his way to meet a client, when he was involved in a major road accident four years ago. He had to have 12 operations, a major muscle graft and plastic surgery.
'My physical symptoms were bad enough but, while I was still in hospital
after the accident, I started to experience PTSD,' says Bob. 'I was angry with the medical staff, I would not respond to treatment or advice and I kept having flashbacks to the event.'
Bob has attended the Aberdeen Traumatic Stress Clinic ever since. The sessions have helped but he says: 'I still get flashbacks. Something triggers it off in the middle of the night and I get so anxious I cannot sleep.' He still has problems driving a car and will never be able to ride a motorbike again.
'The least thing can trigger a fit of rage. I also find it difficult to concentrate. Previously I held down a responsible job and had the ability to juggle six or seven issues. Now I can only focus on one thing at a time.'
coping with traumatic events
We all go through experiences which are distressing. The US Center for PTSD suggests these tips to help overcome trauma:
- Spend time with other people. Coping with stressful events is easier when people support each other.
- If it helps, talk about how you are feeling and listen to others who need to talk.
- Get back to everyday routines. Familiar habits can be comforting.
- Take time to grieve and cry if you need to. You will feel better in the long run if you let your feelings out instead of pushing them away or hiding them.
- Ask for support and help from family or friends, church or other community resources.
- Join or develop support groups.
- Set small goals to tackle big problems. Take one thing at a time instead of trying to do everything at once.
- Eat healthy food and take time to walk, exercise and relax, even if just for a few minutes at a time.
- Do something that feels good to you, like taking a warm bath or going for a walk.
- Get away from reminders of the event sometimes. Turn off TV news bulletins and distract yourself by doing something you enjoy.
helping children deal with trauma
- Let them know you understand their feelings.
- Tell them that they really are safe.
- Keep to your usual routines.
- Protect them from seeing too many frightening pictures of the event.
help and info
Channel 4 is not responsible for the content of third party sites.
If you want more information about depression, anxiety or other mental health issues check out the mind section.
Channel 4's complementary medicine website has a feature on anxiety and panic attacks.
organisations
Aberdeen Centre for Trauma Research
Bennachie
Royal Cornhill Hospital
Aberdeen AB25 2ZH
Tel: 01224 557892
Website: www.gpct.org.uk/actr
Aims to provide a focus for high quality research into the various aspects of trauma, and runs training courses for those who wish to heighten their awareness of the impact of trauma and to learn how to deal with survivors of trauma and their families.
Aberdeen Traumatic Stress Clinic
Bennachie
Royal Cornhill Hospital
Aberdeen AB25 2ZH
Tel: 01224 557892
Website: www.gpct.org.uk/actr
Provides specialist assessment and treatment for survivors of a miscellany of trauma, such as road traffic accidents, industrial accidents and assaults.
ASSIST (Assistance Support and Self-Help in Surviving Trauma)
11 Albert Street
Rugby CV21 2RX
Helpline: 01788 560800 (Mon-Fri 10am-4pm, answerphone out of hours)
E-mail: help@assist-trauma-care.co.uk>
Website: www.traumatic-stress.freeserve.co.uk
A national charity providing telephone support, information and counselling for people experiencing post traumatic stress disorder (PTSD). Also provides face-to-face counselling and support.
British Association for Behavioural and Cognitive Psychotherapies
(BABCP)
Globe Centre
PO Box 9
Accrington BB5 2GD
E-mail: babcp@babcp.com
Website: www.babcp.org.uk
The leading body for cognitive-behavioural therapy in the UK. The website has a search facility to find an accredited therapist and gives information on how the therapy works.
British Association for Counselling and Psychotherapy
35-37 Albert Street
Rugby CV31 2SG
Tel: 0870 443 5252 (Mon-Fri 8.45am-5pm)
E-mail: bacp@bacp.co.uk
Website: www.bacp.co.uk
BACP can provide you with a list of private counsellors in your area, plus information on counselling and choosing a counsellor.
Cruse Bereavement Care
126 Sheen Road
Richmond TW9 1UR
Helpline: 0870 167 1677 (Mon-Fri 9.30am-5pm)
Helpline E-mail: helpline@crusebereavementcare.org.uk
General E-mail: info@crusebereavementcare.org.uk
Website: www.crusebereavementcare.org.uk
Runs a helpline and offers counselling, advice and support to anyone who has been bereaved.
Refuge
2-8 Maltravers Street
London WC2R 3EE
Helpline: 0808 2000 247 (24 hours)
E-mail: info@refuge.org.uk
Website: www.refuge.org.uk
Provide counselling, support and welfare rights for women and children escaping domestic violence as well as accommodation and refuge.
Samaritans
c/o Chris
PO Box 90 90
Stirling FK8 2SA
Helpline: 08457 90 90 90 (24 hours)
E-mail: jo@samaritans.org
Website: www.samaritans.org.uk
The Samaritans exists to provide confidential emotional support to any person, irrespective of race, creed, age or status who is in emotional distress or at risk of suicide; 24 hours a day. Can be contacted by e-mail, telephone, writing, or by visiting one of over 200 local branches (details are on the website)/p>
Traumatic Stress Centre (Wales)
17 Ruggles Terrace
Morriston
Swansea SA6 7JB
Tel: 01792 521063
Website: www.trauma999.co.uk
Aims to assist the healing process by offering a confidential service providing free help and advice. Run a 24-hour helpline, backed by an emergency 24-hour mobile number, and a range of courses relating to PTSD.
websites
Helping Children and Adolescents Cope with Violence and Disasters
www.nimh.nih.gov/publicat/violence.cfm
Run by the US National Institute of Mental Health to help children and adolescents cope with violence and disasters, this site identifies post traumatic stress disorder and the way in which children and adolescents react to it. Offers sources of advice and treatment.
The International Society for Traumatic Stress Studies
www.istss.org
Intended for both health professionals and the general public, this site has factsheets and useful resources and links.
The National Center for Post Traumatic Stress Disorder
www.ncptsd.org
Set up to address the needs of veterans with military-related PTSD, this site is an educational resource concerning PTSD and other enduring consequences of traumatic stress. This US-based website has extensive information, factsheets, links, FAQs and suggested reading.
The Road to Resiliance
www.apahelpcenter.org/featuredtopics/feature.php?id=6
Article and further resources on building resiliance after serious or traumatic events. Produced by the American Physiological Association.
Trauma Information Pages
www.trauma-pages.com
Comprehensive, informative site focusing on emotional trauma and traumatic stress, including PTSD, whether following individual traumatic experience(s) or a large-scale disaster. Aimed primarily at clinicians, researchers and students in the traumatic-stress field. American-based.
UK Trauma Group
www.uktrauma.org.uk
Contains information on PTSD, features details of local specialist centres providing diagnosis and treatment for sufferers, and links to relevant websites.
reading
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Coping with Life's Traumas by Gladeana McMahon (Gill and Macmillan, 2000) |
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Life After Trauma by Dena Rosenbloom, Mary Beth Williams and Barbara Watkins (Guilford Publications, 1999) |
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Overcoming Traumatic Stress by Claudia Herbert and Ann Wetmore (Constable Robinson, 1999) |
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Trauma and Post-traumatic Stress Disorder by Michael Scott and Stephen Palmer (eds) (Continuum International Publishing Group, 1999) |
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(updated November 2002, resources updated May 2005)
