Post Traumatic Stress Disorder - Kevin Gournay

I hope this article is of help to people...

Post Traumatic Stress Disorder

By Professor Kevin Gournay

Used Feb. 95 and Oct 99

Post Traumatic Stress Disorder, (PTSD), is an age-old complaint but has only been labelled as such in the last 20 years or so. Previously it was called many things, including shell-shock, battle fatigue, anxiety reaction, etc. Over the years there have been many attempts to define this problem and recently the World Health Organisation and the American Psychiatric Association, who publish the two main classification systems in psychiatry, have agreed on the principles included under this term.

There are probably many members of No Panic who have one form or another of PTSD. They may have developed this as a result of a car accident, a physical assault, mugging or a range of other frightening events including, major accidents and disasters. Over the years I have seen many patients suffering from this condition, ranging from victims of the ‘Moorgate’ tube disaster, the ‘Kings Cross’ fire, the ‘Herald of Free Enterprise’ sinking, the inner city riots of the 1980’s, various terrorist atrocities, victims of armed robbery, etc. However, perhaps most commonly, I see people who have been involved in accidents on our roads and motorways. In PTSD the person involved has to have experienced, witnessed or have been confronted with events that have involved actual or threatened death or serious injury or a threat to the physical integrity of others. Therefore, in order to be traumatised, the person may not actually have suffered a real physical injury, but nevertheless has developed a great deal of fear or horror. (The above definition is derived from the diagnostic criteria of the American Psychiatric Association which is similar to the World Health Organisation definition).

Thus the condition may start with a trauma which involves, for example, a belief that one is about to die by being trapped in a life-threatening situation or being seriously injured. However, one may also be traumatised by witnessing an horrendous event. An example of this was the post traumatic stress suffered by people who witnessed the tragedy at ‘Hillsborough’ football stadium.

The symptoms of PTSD are manifest in three distinct categories. First of all there is a re-experiencing of the event, typically by the person suffering recurrent dreams or nightmares. There may also be vivid flashbacks occurring during waking times or the victim may be reminded of the trauma and this may also trigger intense distress. For example, a patient I saw who had been involved in a particularly horrendous armed robbery, had a panic attack whenever she heard gunfire on the television or saw anything which resembled the event in which she was involved. Reminders of the traumatic event will often lead to tremendous physical distress which may culminate in a panic attack.

People with PTSD often have considerable avoidance behaviour, often avoiding anything connected with the trauma and going to extreme lengths to avoid places or people connected with the trauma. Sometimes, there is a loss of memory of the events which is in effect a “blocking out” of the horror, or alternatively the person detaches or disengages themselves from others and, may appear aloof. In association with this avoidance behaviour, the sufferer may have a very bleak outlook on life in general and complain that they are unable to experience emotions such as love or joy towards others. There are a whole range of other symptoms which can be experienced, including problems with sleep, outbursts of anger for no apparent reason, being very jumpy and going through periods of acute depression.

Many cases of PTSD come to the attention of mental health professionals because the person who has suffered the stress takes to self-medicating drink or drugs in order to alleviate the distress. This has occurred most graphically in the case of war veterans from Vietnam and many of these people, who have experienced horrendous incidents, are still in a combined state of addiction and traumatic stress reaction, perhaps now in a state of permanent disablement.

What can be done about such conditions? First, it is important that this condition becomes much more recognised so that people can take preventative action. Thus, for example, after a road traffic accident, it is very important for the person involved to start travelling again as quickly as possible. In the case of this, and indeed other traumatic incidents, it is also important for the person to be able to ventilate their feelings and to have some time with somebody who is a good listener. Very often, going over the story of the incident is therapeutic in itself and the person, in a sense, exposes themselves to the original trauma thus, reducing their fear. However, in some cases, the trauma itself can become a total preoccupation obsession and this can be the reason why people are referred to professional services. In these cases, thoughts of the incident may fill every waking moment and be the sole topic of conversation. However, for most people quick re-exposure to the environment where the trauma took place and the opportunity to talk about the trauma (sometimes called debriefing) is very helpful.

In those cases where the PTSD has become a problem, referral to a specialist in cognitive/ behaviour therapy is essential. There is some evidence that in addition to cognitive/behaviour therapy, some patients need to be prescribed antidepressant drugs. These are sometimes helpful for dealing with the profound depression which occurs but there is also evidence that in some patients they are genuinely helpful in reducing the very high level of physical symptoms. Also, it is important that people who have been involved in accidents have thorough physical investigations as sometimes head injury itself can complicate the psychological reaction. In the case of people who have experienced head injury with loss of consciousness and who have developed PTSD, it is probably essential for them to be seen by a specialist neurologist or perhaps even a psychologist who specialises in neurological injury before they embark on a course of treatment. Sometimes, such head injuries can cause damage to the central nervous system and this of course needs to be identified. Today, we have at our disposal a range of techniques which allows us to study the brain and this new generation of scanners, in particular magnetic resonance imaging (MRI) scans can be very helpful in assisting diagnosis in cases where brain injury may have occurred.

Treatment for PTSD, carried out by a cognitive/behaviour therapist, normally consists of several strands. First of all, it is essential that the person be given adequate time to describe their feelings and, as mentioned above, this can be therapeutic in itself. Indeed, an extension of this approach may be to ask the person to write a detailed account of their problems. In some cases I have asked patients to compile a scrapbook of the event, drawing upon photographs, newspaper clippings, film and video or even asking for the assistance of the police to supply photographs. The compiling of such background information can often be very distressing for the patient but, the re-exposure involved can be extremely helpful. It is usually important to help the person break their avoidance behaviour by exposing them to the original environment where the trauma took place or, for example, travelling by the means of transport in which they suffered their accident. One family I treated from the ‘Herald of Free Enterprise’ needed to travel on a cross-channel ferry before their treatment was complete. This particular family made an excellent recovery from their symptoms. Treatment may also incorporate anxiety management training and homework exercises aimed at repeated exposure. As mentioned earlier, treatment may or may not be given in combination with antidepressant drugs and in some cases these drugs have to be taken over a period of many months.

I must mention the new technique for treating PTSD, which has recently been the source of considerable debate among health service professionals. This is called Eye Movement Desensitisation (EMDR). The procedure involves getting the person to imagine the original trauma and at the same time asking the person to perform specific eye movements by following the therapist’s finger movement with their eyes. This technique is apparently based on the idea that the brain can be “reprogrammed” and there are now several dramatic claims in journals regarding its effectiveness. In my opinion it is probably too early to say whether this technique can be widely applied as there is necessity, as in all treatments, for further research to determine its outcome. I would however go as far as to say that this treatment looks promising and provided it is offered by a properly trained psychiatrist or psychologist, I see no reason why the patient should not take advantage of the offer of treatment. If this procedure is going to work, it seems it will do so fairly quickly and therefore, bearing in mind the probability that there is very little risk attached to the procedure, it would be well worth trying if it is offered.

I must mention an emerging area where PTSD is a significant feature. It has been increasingly recognised that people who have been subjected to sexual abuse during childhood may develop a state which is no different from conventional PTSD and is very similar to the state shown by women who have suffered rape. Although the post traumatic stress associated with rape is now becoming much more commonly recognised, PTSD associated with child sexual abuse is not. This is obviously a very difficult and sensitive area and my advice is that treatment for the traumatic stress associated with sexual abuse of one kind or another should be given within specialist services rather than a general psychiatric department.

In conclusion, PTSD is a commonly occurring problem which can cause considerable distress and major handicap to those who suffer it. However, the outcome with treatment is good and can be provided by specialist services. It must also be said, however, that the most effective treatment is probably very early debriefing and rapid re-exposure to the situation where the trauma took place. Readers of this Newsletter may be interested to know that the Institute of Psychiatry (which is attached to the Maudsley Hospital) continues to provide treatment for this condition and both Professor Isaac Marks and Professor William Yule, who work at the Institute lead teams of therapists and researchers. I am sure that, should the need arise, they would be pleased to accept referrals from patients’ GPs and it may be worth contacting them to provide further information.

Hi Nicola

Thanks for posting this.

I have suffered anxiety/p.a's for a while.

I think mine came about from being involved in a triple fatality car crash.

As much as my life has maintained a reasonably normal one, or I thought it was. I was never helped with any impartial counselling which would have helped imensely.

J

Hi Nicola,
Good post and makes sence...I have suffered pts for over a year now, was in a motorbike crash with my boyfreind and we were very badly inuried, still now ive more ops and our lifes can never been the same due to our injuries..had very little help a few councilling sessions and on a 8 month waiting list for other help..i belive i would of being able to conquer this nightmare if more help was availble on nhs , instead they fill you full of drugs and you have to wait until you crack up to get assesed..this site is a godsend....now looking at jackies post i feel i have no right to moan..so sorry to here what she went through..hope all gets better for future.sam

Hello Nicola,
thank you so much for sharing this article. This is my first day signing up for No More Panic! I have been depressed for many years except last year I had a nervous break down.
I have been searching for years my condition yet this article brings a new level of awareness. When I have been diagnose with post traumatic stress due to over working, I didn´t realize how much witnessing wars and accidents from my childhood has contributed to my reactions and kinda weakened my will and energy. For example, when my brother was in a fatal accident, I stopped driving for many years. but never thought of that before that have a connection with my depression and anxiety.
Thank you for everything!
Aseel

Hi Nicola, Re PTSD, I am wondering if my dad was troubled with it all his life. Can this be possible. It was only 2 years ago ( When he was 82 or 83 years old) that he told me he was getting flash backs to the war. He told me that when he was in the Air Force and working on Halifax Bombers, part of the job was to go and get dead bodies out of crashed airplanes and that some of them were even cut in half!!

Now my dad has been an extremely negative and unhappy man all his life. You would think his life depended on all the negative things you can think of. He went out of his way to argue with and critisise people. He was full of rage and would explode at the slightest thing. He was always right and you were wrong. If you did not think what he did or agree with him, he could not handle it and you were stupid. If you made any mistakes, you were an idiot, stupid or useless. He would get angry for the lightest and most insignificant things. Like the day he was at my "Aunties" with my mum. Dad was telling "Aunty and "Uncle" a joke and "Uncle" came out with the punch line. Dad was so mad he got up and walked out and drove the 20 miles home without so much as a thank you for his tea or anything!!! Or another time he was in N. Ireland with my mum. They had gone to see an old relative they had not seen for 30 years and would likely never see again and my dad went and argued with this elderly Uncle about politics in Northern Ireland and ended up walking out on him too!!!!!!!!!! My dad has hurt many people over the years and when he argues or is angry, any respect goes out of the window. I cant tell you how often I have been abused by my dad. In fact I would say that my dads behavior amounted to emotional abuse as he would even turn his back on me when I was ill and when I needed him most and he never told me he loved me. I was his emotional punch bag. His negativity was limitless. He was given a detached bungalow for a wedding present and he told everybody he was hard done by!!! I tried to tell him that all the country would love to have a bungalow like that and no mortgage but he would not have it! He was even going to sue (Not that he would have attempted to do so really, but it was bad enough that he was thinking about it) the hospital for leaving him in pain following three aneurysm repairs that saved his life!!!! He really could not see the good in anything or anyone and went out of his way to dislike people too. And only in the last couple of years, he told me that he did not care about how he made people feel and he did not care about what they thought either. But that was obvious the way he was with people.

He actually died on Fathers Day this year. He was in physical pain and had developed a Gall Bladder Infection that turned into Septicemia and that killed him. I think his emotional pain was worse than the physical pain though. Now I am saddened that my dad was so dissatisfied with life and everything in it.

Can all the above be down to PTSD that was never addressed? Of course they weren't aware of such things till "recently" and I cant believe that my dad was just a nasty piece of work without there being something else to it. Something has driven him to all the awful behavior. Do you feel it could be PTSD and that it has just got worse over the years?

Thanks

BasilCat

Not really sure Basil as it is not my area of expertise but it could well be PTSD or some form of anxiety as well.

Thanks Nichola, I am trying to find out why my dad was so negative about life and everything/everyone in it. I want to know that he did not reject me because he thought I was awful or he didn't like me or didn't want me. I am trying to get to the bottom of why he felt the need to be the way he was and that he really did like me and want me deep down. So I am looking at the PTSD idea as a strong possibilty, and as you point out, perhaps some sort of anxiety.

Thanks again.
Shirl

thank you soooo much for this xxx

Just thought i should share with you guys the latest news about PTSD that's apparently been experiencing by US Veterans.

United States veteran health care is currently in a labyrinth of inadequacy. Add to this the fact that some crucial medications do not work, as reported by a brand new study in the Journal of the American Medical Association. According to the study, probably the most widely prescribed Post Traumatic Stress Disorder (PTSD) narcotics are no more useful than placebos at curing the condition, yet still have severe side effects like weight gain and exhaustion.

Article source: Antipsychotics fail to alleviate PTSD symptoms in veterans

This case should be taken seriously, considering the fact that US Veterans are fighting for a cause, and their health should be prioritized in any way possible.

Basil
I read your post with great interest as during my therapy sessions I discussed my father's depression & greatly troubled life. Although fairly positive he did have a very short fuse & had a number of 'nervous breakdowns' for which he took medication and was treated as an inpatient with electric shock treatment of which he was terrified. He was also a perfectionist who thought everyone else should be too! The worse part of his condition was the classic problem of drs taking all his symptons to be in his imagination, many times they were so wrong.

It wasn't until he was seriously ill & given a few months to live (they still said it was his nerves!) that he went into a specialist hospital & had a new psychiatrist that someone finally sat down to talk to him. The change in Dad was immense he became more open, less stressed & would talk about his experiences during the war. He didnt have another breakdown after that and prescribed different medication. Before knowing this we'd always put it down to his mother dying when he was 3 & his father abandoning him, he never saw his father again.

Although as far as i know he was never diagnosed with PTSD but clinical depression, talking to my psychologist she feels that was probably what he was suffering from. I realise now that a lot of what he talked about were flashbacks, he had nightmares & generally mistrusted people.

I was diagnosed with PTSD 3yrs ago following a physical assault& I feel sad that my Dad didnt have the opportunity of working with a therapist as I've had, he was a wonderful intelligent man who I idolised, I just wish he hadnt had to suffer so much misunderstanding. :weep: however working with my T has allowed me to explore my childhood & the anger I felt at him not being around when I needed him (i had a difficult relationship with my mother)
I can now hold him in my heart knowing that he loved me & did the best he could.