Trauma & mental health
Posttraumatic stress disorder (PTSD)
More than one-quarter of a million Australians experience PTSD in any one year and around five per cent of Australians have had PTSD at some point in their lives. Serious accidents are one of the leading causes of PTSD in Australia.
PTSD is a set of reactions that can develop in people who have experienced or witnessed an event which threatened their life or safety, or that of others around them, and led to feelings of intense fear, helplessness or horror. It could be a car or other serious accident, physical or sexual assault, war or torture, or natural disasters such as bushfires or floods. Other life changing situations such as being retrenched, getting divorced or the expected death of an ill family member, are very distressing and may cause serious mental health problems, but are not events that can cause PTSD.
Anyone can develop PTSD following a traumatic event but people are at greater risk if the event involved physical or sexual assault, they have had repeated traumatic experiences such as sexual abuse or living in a war zone, or they have suffered from PTSD in the past.
Signs and symptoms
People with PTSD often experience feelings of panic or extreme fear, which may resemble those felt during the traumatic event. A person with PTSD has three main types of difficulties:
- Re-living the traumatic event ─ through unwanted and recurring memories and vivid nightmares. There may be intense emotional or physical reactions, such as sweating, heart palpitations or panic, when reminded of the event.
- Being overly alert or wound up ─ sleeping difficulties, irritability, lack of concentration, becoming easily startled and constantly being on the look out for signs of danger.
- Avoiding reminders of the event and feeling emotionally numb ─ deliberately avoiding activities, places, people, thoughts or feelings associated with the event. People may also lose interest in day-to-day activities, feel cut off and detached from friends and family, or feel flat and numb.
People with PTSD can also have what are termed ‘dissociative experiences’, such as:
“…it was as though I wasn’t even there…”, “…time was standing still…”,
“…I felt like I was watching things happening from above…”
“…I can’t remember most of what happened…”
Talk to your doctor at any time if you feel very distressed or your reactions are interfering with your work and relationships.
A health practitioner may diagnose PTSD if a person has a number of symptoms in each of these three areas listed for a month or more, and they lead to significant distress, or impact on their ability to work and study, their relationships and day-to-day life.
It is not unusual for people with PTSD to experience other mental health problems at the same time. These may have developed directly in response to the traumatic event or have followed the PTSD. These additional problems are more likely to occur if PTSD has persisted for a long time. Up to 80 per cent of people who have long-standing PTSD develop additional problems, most commonly depression and anxiety. Many also start misusing alcohol or drugs as a way of coping.
Impact of PTSD on relationships and day-to-day life
"It’s as if she isn’t here anymore. She does everything that she is supposed to, looks after the kids and everything but she doesn’t seem to enjoy anything anymore. I can’t even begin to imagine what she’s been through and I’m afraid to ask questions just in case I upset her….she just can’t seem to move on. I just don’t know what to do anymore."
PTSD can affect people's ability to work, perform day-to-day activities or relate to their family and friends. People with PTSD can often seem disinterested or distant as they try not to think or feel in order to block out painful memories. They may stop participating in family life, ignore offers of help or become irritable. This can lead to loved ones feeling shut out. It is important to remember that these behaviours are part of the problem. People with PTSD need the support of family and friends but may not know that they need help. There are many ways you can help someone with PTSD.
Treatment for PTSD
It’s never too late to start addressing PTSD
Many people experience some of the signs of PTSD in the first couple of weeks after the traumatic event but most recover on their own or with the help of family and friends. For this reason, formal treatment does not usually start until about two weeks after a traumatic experience.
It is important during those first few days and weeks to get whatever practical help is needed. This might include information and access to people and resources that can assist recovery. Support from family and friends may be all that is needed. Otherwise, a doctor is the best place to start to get further help.
Screening, assessment and diagnosis
The following simple questions can help a health professional decide if it is likely that someone who has been through a traumatic event has PTSD:
- Have you had nightmares about the event, or thought about it when you did not want to?
- Do you try hard not to think about the event, or go out of your way to avoid situations that remind you of it?
- Are you constantly on guard, watchful, or easily startled?
- Have you felt numb or detached from others, activities, or your surroundings?
Download this Screen for PTSD (PDF)
If a person answers 'yes' to two or more of these questions, there is a good chance that they have PTSD1.
More information about screening for PTSD is available in the PTSD Guidelines Summary (PDF) and a list of other screening measures is available in the The Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder (PDF).
If a person has been identified as having PTSD, the health practitioner will then make a thorough assessment by asking them about:
- The difficulties being experienced
- Other experiences or problems which may impact on wellbeing
- How these problems may be impacting on day-to-day life
- What strengths and supports the person can draw on.
More information about assessment and diagnosis is available in the PTSD Guidelines Summary (PDF).
Wherever possible, family members should be included in the assessment process, education and treatment planning, and their own needs for care considered alongside the needs of the person presenting for treatment. This should be done with the person’s consent.
1Prins, et al. (2004). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9, 9-14.
Effective treatments are available
If a person feels very distressed at any time after a traumatic event, they should talk to their doctor. If they experience symptoms of PTSD that persist after two weeks, a doctor or mental health professional may discuss starting treatment. Effective treatments are available. Most involve psychological treatment, but medication can also be prescribed. Generally, it’s best to start with psychological treatment rather than use medication as the first and only solution to the problem.
The cornerstone of treatment for PTSD involves confronting the traumatic memory and working through thoughts and beliefs associated with the experience. Trauma-focussed treatments can reduce PTSD symptoms, lessen anxiety and depression, and improve a person’s quality of life. They are also effective for people who have experienced prolonged or repeated traumatic events, but more time may be needed.
Drug treatments should not be used within four weeks of symptoms appearing unless the severity of the person’s distress cannot be managed by psychological means alone.
For information about duration of treatment, medication, and the treatment of other mental health problems co-occuring with PTSD, see: