PTSD: Recognising and treating post-traumatic stress disorder

PTSD can develop following a traumatic event associated with an extraordinary threat or of catastrophic proportions. In this context, trauma refers to an experience that is perceived as an existential threat. It can shake one’s understanding of oneself and the world and trigger a mental health condition.

PTBS and PTSD refer to the same condition. PTSD is the abbreviation of the English term ‘Post-Traumatic Stress Disorder’. How the consequences of a trauma unfold cannot be determined solely by the nature of the experience.

In Germany, around 2 to 3 per cent of the population experience PTSD at least once in their lifetime. This should be distinguished from the one-month prevalence, which describes the proportion of people affected within a given month and stands at 1.5 per cent.

PTSD often manifests as a persistent state of inner alertness. Those affected feel tense or threatened, even in a safe environment. The nature and severity of the symptoms vary from person to person.

• Heightened vigilance can lead those affected to constantly scan their surroundings for potential dangers.
• Even unexpected noises, movements or other stimuli can trigger a strong startle response.
• Sleep disturbances can impair night-time rest and reduce resilience during the day.
• Flashbacks are sudden, intense re-experiences in which the events may feel as though they are happening in the present.
• A recurring nightmare may revisit events or emotions associated with the traumatic experience.
• Irritability can manifest as inner restlessness, a short temper or strong reactions to everyday situations.
• A smell, a sound or a particular environment can trigger memories and strong physical reactions.
• Intense feelings of guilt may relate to one’s own behaviour during or after the event.
• Feelings of shame can make it difficult to talk about what happened or to accept support.

Avoidance can also be a symptom of PTSD. Those affected may, for example, avoid places or people that could trigger memories of the trauma.

Distressing feelings following a traumatic event do not automatically mean that someone has PTSD. Key factors include the duration of the symptoms and their impact on daily life. Other mental health problems may also be associated with similar symptoms.

It all begins with an event that is experienced as exceptionally threatening or catastrophic. The trauma can trigger a sense of helplessness and shake fundamental assumptions about safety, control and trust. However, such an experience does not necessarily lead to post-traumatic stress disorder.

Possible triggers include, for example, a serious accident or a natural disaster, provided the event is experienced as an exceptionally threatening situation or as an event of catastrophic proportions. It is not merely the nature of the event that is decisive, but also its impact on the person affected.

Several factors together determine how a person processes trauma. Risk factors do not allow for a reliable prediction. Even with increased vulnerability, PTSD does not necessarily develop.

• Genetic factors can increase the likelihood of developing PTSD following a traumatic event.
• Environmental factors can influence how distressing an event is experienced and processed.
• Previous learning experiences can affect how a person reacts to threats and prolonged stress.

The development of PTSD cannot therefore usually be attributed to a single cause. Some people develop the condition, whilst others do not develop a persistent disorder following a comparable experience. Blaming those affected is not objectively justified.

Complex post-traumatic stress disorder is a distinct diagnosis for the consequences of prolonged or repeated extreme stress. Such traumatic experiences can profoundly affect a person’s self-image, emotional regulation and ability to form relationships.

In addition to the reactions already described, persistent difficulties may arise in managing emotions, maintaining a stable sense of self and forming interpersonal relationships. A professional assessment distinguishes this form from other mental health conditions.

PTSD is diagnosed when symptoms persist for more than four weeks and impair functioning in key areas of life. These may include work or school, family life, social interactions and the ability to cope with everyday tasks.

During the diagnostic consultation, the symptoms are assessed in relation to the traumatic experience. This involves examining their duration and the impact on the person’s life. The professional assessment also serves to rule out other possible causes of the symptoms.

Further overviews cover psychiatry and psychotherapy, as well as psychosomatics and psychotherapy.

Further information is available in the article on mental health disorders in children.

Treatment primarily consists of trauma-focused psychotherapy. In this approach, therapists specifically incorporate the traumatic event and its consequences into their work. The current S3 guideline recommends that this approach be offered as a priority to people with PTSD.

Among the best-researched approaches are trauma-focused cognitive behavioural therapy and Eye Movement Desensitisation and Reprocessing, or EMDR for short. In EMDR, memories are processed using, amongst other things, guided eye movements. Patients do not enter a trance during this process.

PTSD can generally be treated on an outpatient basis. If this is not sufficient due to the severity of the symptoms, inpatient admission to a PTSD clinic may be advisable. This also applies if the person affected requires a special safe space.

The article on psychotherapy explains the procedures and organisational framework. Medication can complement psychotherapy in certain situations. Support may be provided through antidepressants; it often takes several weeks before any effect is noticeable. Particular caution is required with sleeping pills and tranquillisers from the benzodiazepine group.

The course of post-traumatic stress disorder varies from person to person. Symptoms may subside, persist for a prolonged period or fluctuate in severity. If they persist for a long time, the condition may become chronic. The triggering event alone does not allow for a reliable prediction of how the condition will progress.

According to the professional association’s website, around half of people with PTSD recover even without treatment. However, this does not guarantee a spontaneous recovery.

Treatment may also be beneficial as long as the person affected is still able to cope with some aspects of their daily life. It is designed to address the symptoms and their effects in a targeted manner. Whether and how quickly an improvement occurs depends on the individual’s personal situation and the course of their condition.

Immediately after a traumatic experience, reliable emotional and practical support are particularly helpful. Family members can listen attentively, take the person’s feelings seriously and help with specific everyday tasks. Where possible, the person affected should be able to decide for themselves what support they wish to accept.

Mental health support should not be imposed following a traumatic event. In an early psychological debriefing, the events are discussed promptly and in a structured manner. Studies have shown that this approach does not reduce the subsequent risk of PTSD. It should therefore be distinguished from support that is tailored to the wishes of the person affected.

For some people, early psychotherapeutic treatment following a traumatic event can be helpful. The need for such treatment depends on the symptoms, the level of distress and the wishes of the person affected. Attentive social support can make it easier to access help, but it is no substitute for specialist treatment.

The decision to seek professional assessment depends on the duration and impact of the symptoms. For a diagnosis of PTSD, the symptoms must have persisted for more than four weeks and must be limiting the person’s ability to function.

If someone is having suicidal thoughts, immediate action is required. If a person expresses such thoughts, medical help should be sought straight away. In the event of an acute risk of suicide, relatives must organise professional help.

Relatives should take any comments about suicide seriously.