As part of my role as a therapist, I keep myself updated with emerging knowledge and new developments and treatment approaches around the difficulties that I work with. I’ve recently been doing some extra exploration around PTSD (post-traumatic stress disorder) and what I’ve found so striking is the amount of PTSD that is being missed or mis-diagnosed. Studies have suggested that the proportion of people with PTSD that remain undiagnosed may be substantial. An article in the British Medical Journal (BMJ) discussed that whilst it’s important not to conflate stress with trauma and trauma with PTSD (experiencing stress is not the same as experiencing trauma, and not everyone that experiences trauma goes on to develop PTSD), there is evidence to suggest that PTSD is underdiagnosed. The article points to research indicating that less than half of adults and two fifths of young people who meet the criteria for PTSD have sought help from any health professional. One study done in the USA that I came across reported that only 11% of adult patients in primary care (i.e. those accessing frontline healthcare such as a GP) that met diagnostic criteria for PTSD had a recorded diagnosis of PTSD. That’s a lot of missed PTSD. My own experience working in clinical practise also suggests that awareness of PTSD could do with a bit of a boost - I’ve seen that it’s not unusual for people, some of whom are aware of PTSD and very attuned to mental health issues, to not recognise that they are experiencing symptoms of PTSD - this is not a criticism, this is an observation around the need for more education. An obvious impact of this is that many people may be suffering due to their symptoms being missed, or mis-diagnosed - often as depression or other anxiety disorders - and this is preventing people from accessing the specific, evidence based PTSD treatments that could reduce their symptoms, lead to recovery and improve their quality of life. Raising awareness of PTSD - what situations can lead to it emerging, its key symptoms and effective treatments - is important to reduce the burden of suffering on people brought about by PTSD.
What situations can lead to the development of PTSD? A PTSD diagnosis is only considered if a person has been exposed to an extremely threatening or horrific event which happened at least one month ago. Examples include experiencing a serious accident eg a car crash or fire, physical or sexual assault, complicated childbirth experiences, serious health problems or being in intensive care, being diagnosed with a life-threatening illness, war and conflict, terrorist attack, man-made or natural disasters, witnessing a violent death.
However, as mentioned, not everybody that experiences such types of events will go onto experience PTSD. Many people can experience grief, sadness, anxiety, guilt and anger after a traumatic experience. This does not necessarily mean that someone has PTSD.
Some people can develop a type of PTSD known as complex post-traumatic stress disorder (CPTSD or c-PTSD). This type of PTSD can develop in people who are currently experiencing or have experienced an event or series of events that are extremely threatening or horrifying, and quite often these events will have been prolonged and difficult or impossible to easily escape from or avoid. These may include situations of torture, slavery, genocide campaigns, living in a war zone, prolonged domestic violence or repeated childhood sexual or physical abuse or neglect.
What are the key symptoms of PTSD?
The 3 main symptoms of PTSD are:
1 Re-experiencing - experiencing feelings of the trauma happening all over again, having nightmares about it or having memories about it come into our mind in a way that we have no control over.
2 Avoiding anything that reminds us of our traumatic experience or talking about it, this can include avoiding associated memories or thoughts, certain people, certain tv and media, associated locations or situations.
3 Hypervigilance - feeling on “high-alert” or being easily startled.
As well as the 3 main symptoms of PTSD, with complex PTSD we might also have extremely negative beliefs about ourselves as ‘diminished, defeated or worthless’, find it very difficult to regulate our emotions and emotional responses and struggle to maintain or keep relationships or feel close to other people.
Experiencing symptoms of PTSD can be frightening and confusing, and the symptoms may feel insurmountable, but please know, PTSD is common - you are not alone, it does not mean you’re ‘going mad’ as it may at times feel like, it is very, treatable and with effective treatment your quality of life can improve as the PTSD symptoms reduce.
What are the recommended treatment approaches for PTSD?
Trauma Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) are the NICE (National Institute for Health and Care Excellence) and WHO (World Health Organisation) recommended treatments for PTSD and yoga therapy can also be useful in it’s treatment – you can read more about this on my website here.
Also, I really recommend checking out the PTSDUK website https://www.ptsduk.org/ which has lots of useful information and resources
References
Gagnon-Sanschagrin, P., Schein, J., Urganus, A., Serra, E., Liang, Y., Musingarimi, P., ... & Davis, L. L. (2022). Identifying individuals with undiagnosed post-traumatic stress disorder in a large United States civilian population–a machine learning approach. BMC psychiatry, 22(1), 630. https://pubmed.ncbi.nlm.nih.gov/36171558/
Meltzer, E. C., Averbuch, T., Samet, J. H., Saitz, R., Jabbar, K., Lloyd-Travaglini, C., & Liebschutz, J. M. (2012). Discrepancy in diagnosis and treatment of post-traumatic stress disorder (PTSD): treatment for the wrong reason. The journal of behavioral health services & research, 39, 190-201. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310322/
Tully, J., Bhugra, D., Lewis, S. J., Drennan, G., & Markham, S. (2021). Is PTSD overdiagnosed?. bmj, 373. BMJ 2021;373:n787
Post-traumatic stress disorder (PTSD) | Royal College of Psychiatrists. (n.d.). www.rcpsych.ac.uk. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/post-traumatic-stress-disorder