Post Traumatic Stress Disorder

The number of cases of Post Traumatic Stress Disorder or PTSD following a pandemic should be of significant public health concern.

In a review of 88 studies looking at the number of cases of PTSD following the Sudden Acute Respiratory Syndrome (SARS), H1N1, Poliomyelitis, Ebola, Zika, Nipah, Middle Eastern respiratory syndrome coronavirus (MERS-CoV), H5N1, and Coronavirus disease 2019 (COVID-19) pandemics -

the overall prevalence of post-pandemic PTSD across all populations was 22.6%. Healthcare workers had the highest prevalence of PTSD at 26.9% followed by infected cases at 23.8% and the general public at 19.3%.

A pandemic can exacerbate existing mental health conditions and cause new stress-related symptoms.

PTSD is a condition that relates to witnessing, learning about, or experiencing trauma in some way. Someone may experience the trauma directly or through a loved one. It can affect people differently.

For example, in the Covid-19 pandemic, it has affected:

  • Those who were hospitalised with severe Covid-19. They may have had an experience that caused them trauma and for their loved ones.

  • Those with Long Covid experienced months of denial, lack of validation and treatment, and medical gaslighting.

  • Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae including PTSD.

  • Those who may have experienced trauma from the environment that the COVID-19 pandemic has created, such as:

- being unable to see loved ones

- having feelings of isolation

- experiencing disruption to daily lives and routines

- domestic and child abuse

  • Those who may have experienced grief due to the death of a loved one.

  • Those frontline hospital staff and other key workers who have a higher chance of experiencing mental health conditions during the pandemic.

To delve deeper into PTSD I have in parts quoted the Hidden Disabilities article “Post Traumatic Stress Disorder”

What is PTSD?

PTSD is a condition that some people develop after experiencing or witnessing a traumatic, life-threatening event or serious injury. It’s estimated that 50% of people will experience a trauma at some point in their life. For the majority of people exposed to traumatic events they will experience some short-term distress, but eventually, their trauma fades to a memory – painful, but not destructive. However, around 20% of people who experience a trauma go on to develop Post Traumatic Stress Disorder (PTSD). In the UK, that’s around 6,665,000 people, yet it is still an incredibly misunderstood and often misdiagnosed, stigmatised condition.

There is a second, subtype of PTSD, called Complex PTSD, or C-PTSD. This is usually a result of repeated, or sustained traumas, which presents in a similar way to PTSD, but with some additional symptoms too.

PTSD can occur in all people, of any ethnicity, nationality, gender, occupation, culture and at any age.

How is PTSD caused?

PTSD can affect anyone who has been exposed to a traumatic event such as assault, road traffic accidents, burglary, natural disasters, domestic abuse, acts of terrorism, traumatic childbirth, bereavement, being told you have a life-threatening illness or miscarriage.

If someone is exposed to one of these intensely fearful and traumatic situations, their body and mind ‘suspends’ normal operations and it copes as well as it can in order to survive. This might involve reactions such as ‘freezing to the spot’ or sometimes the opposite, ‘flight away’ from danger.

Until the danger passes, many systems in the body are put on hold or adapted: your digestive system pauses, your muscles may tense up to be ready to flee or fight, your heart rate will increase, pupils dilate and the ‘unimportant’ task of memory creation is put on hold. This means that the mind does not produce a memory for this traumatic event in the ‘normal’ way.

Eventually, when the mind presents the ‘memory’ of the trauma for ‘filing’, or it is triggered by a smell, a place, or a person etc, it does not recognise it as a memory. As it understands, ‘the brain is in the middle of the dangerous event – it is not ‘outside’ looking in at this event, and therefore the entire system is not easily subject to rational control’. These flashbacks are incredibly distressing. Reliving the trauma as if it were happening RIGHT NOW. The elements, such as the facts of what happened, the emotions associated with the trauma and the sensations: touch, taste, sound, vision, movement and smell, can be presented by the mind as real time information.

What are the symptoms of PTSD?

In addition to the flashbacks mentioned above, PTSD can cause a variety of life-altering and intrusive symptoms, resulting in substantial distress and disruption of social and occupational functioning, which can cause major problems in relationships and jobs.

The hyper-arousal that often comes with PTSD creates a disproportionate response to stimuli. For example, if snow was to fall from the roof of your home, a ‘typical’ response would be to jump or startle and possibly look around. For someone with PTSD, their reaction is likely to be much more severe: jumping out of their seat, turning fully around or hiding under a table, heart pumping with fists clenched ready to meet an imagined threat. This ‘hyper vigilance’ is exhausting – constantly looking for threats in everything and everyone around you.

Many PTSD sufferers also feel emotionally numb and have trouble communicating with others about the way they feel – this may make them more anxious and irritable.

Quite often the feelings and symptoms of PTSD become so unmanageable and uncomfortable, that the sufferer starts to avoid anything linked to the original trauma which, as you can imagine, can affect day to day life.

In summary there are four main symptom types that characterize PTSD. These are:

  • Reexperiencing the trauma: nightmares or flashbacks

  • Avoiding certain situations that remind them of the traumatic experience.

  • Experiencing negative changes in emotions and beliefs: A person may experience changes in the way they think about themselves and others around them. They may also forget about parts of the event and be unable to experience loving feelings toward others.

  • Experiencing hyperarousal: Those with PTSD may experience difficulty sleeping and concentrating, and they may become easily startled.

What are the treatment options for PTSD?

Just over a decade ago people still thought that PTSD was an incurable condition. However, more recent evidence and research proves it is possible for PTSD to be successfully treated many years after the traumatic event occurred. This means that it is never too late to seek help.

For some the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy.

NICE guidance (updated in 2018) recommends trauma-focused psychological treatments such as:

Eye movement desensitisation and reprocessing (EMDR). - this is a fairly new treatment that can reduce PTSD symptoms such as being easily startled. It involves making rhythmic eye movements while recalling the traumatic event. The rapid eye movements are intended to create a similar effect to the way your brain processes memories and experiences while you're sleeping.

EMDR UK & Ireland - a professional association of EMDR clinicians and researchers - provides extensive information about EMDR on its website.

Trauma-focused Cognitive Behavioural Therapy (CBT) - this is a form of cognitive behavioural therapy (CBT) specifically adapted for PTSD. NICE recommends that you are offered 8–12 regular sessions of around 60–90 minutes, seeing the same therapist at least once a week. See our pages on CBT for more information about this therapy.

These two treatments can effectively eliminate all PTSD symptoms in many sufferers.

Other treatments include:

  • Dialectical behaviour therapy (DBT) - this is a form of talking therapy based on Cognitive Behaviour Therapy (CBT) but it's specially adapted for people who feel emotions very intensely.

The aim of DBT is to help you:

  • understand and accept your difficult feelings

  • learn skills to manage them

  • become able to make positive changes in your life.

‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting yourself and changing your behaviour might feel contradictory. But DBT teaches that it's possible for you to achieve both these goals together.

  • Some find medication for depression and sleeping problems beneficial

  • Art therapies

  • Breathwork and mindfulness, calming vagal tone.

The most important thing is if you, or a loved one, are concerned that you maybe suffering from PTSD you need to contact your GP for a referral to an appropriate PTSD specialist. Please note that this can occur in children too and we should be watchful for that.

PTSD UK is the only charity in the UK dedicated to raising awareness of PTSD, it's causes, symptoms and the treatments available, no matter the trauma that caused it. If you’d like to find out more about the condition, what they do or how you can support them, please visit their website:

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