Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a mental illness.

It is caused by horrific experiences that the sufferer has had, for example, a disaster, violence, sexual abuse, or a serious accident.

These experiences are referred to as trauma. The term means something like “psychological injury”. The illness can occur after a traumatic experience. There are extreme situations that are sometimes difficult to process – both the victim and witnesses can then suffer from PTSD.

It is typical of PTSD that memories of what has been experienced recur and badly stress the sufferer. Some people are really thrown off the rails. In this situation it is important that other people provide support. For example, psychotherapy can help process the traumatic experiences and get on top of them.

The following symptoms indicate post-traumatic stress disorder:

Flashbacks

The trauma keeps being relived. Sufferers often have sudden flashbacks. These are very clear memories that cannot be suppressed. These images and feelings intrude, and they are experienced as if the situation were happening again. Many people also have nightmares. Flashbacks and dreams cause anxiety, helplessness, feelings of being threatened, blame, and shame. Physical symptoms such as pain might also recur.

Hyper-irritability

People with PTSD are often in a type of constant alarm mode. They have problems concentrating, sleep badly, are quick to get annoyed, and react impulsively. They also respond very strongly to stimuli that remind them of the experience, for example, particular smells, noises or images. Symptoms may then include heart palpitations, tightness in the chest, breathing difficulties and trembling.

Avoidance behavior

Sufferers try to avoid situations, activities, thoughts and conversations that might remind them of what they experienced. They also stay away from places and people who are connected with it.

Isolation and breaking off contact

Some people with PTSD withdraw and break off social contacts. They also seem disinterested in things which used to be important to them. Some have the feeling of being alienated from their own life, while others feel emotionless and numb inside. Sometimes, too, people with PTSD blank out their trauma so strongly that they no longer remember parts of the event. It is often impossible to make sense of, and process, the experience.

Negative thoughts and moods

Many people have lost faith in themselves and others. They often lose a lot of self-esteem. They feel weak and powerless. They often torture themselves with questions such as: Why did this happen to me? Could I have avoided it? Am I (also) to blame?

In children, post-traumatic stress disorder often takes on a different form. Children often repeatedly re-enact their experience symbolically, for example with different scenarios, images and people.

Trauma can bring on other mental illnesses. For instance, depression, anxiety and addiction. A so-called dissociative disorder may also develop. This involves, for example, the memories being deleted, or parts of the personality being changed (“splitting”). Some people also suffer from chronic pain, an eating disorder, or psychosis.

When the PTSD is mild, the symptoms are less severe. Sometimes problems only occur temporarily in certain situations that bring back the memories. Everyday life can then be lived almost normally. When it is serious, the mental problems may be serious. Some people are so badly affected that life is almost impossible without help.

The nature of the symptoms does not just depend on the event. It is also linked to how someone can cope with stress.

Post-traumatic stress disorder follows a traumatic experience. For those affected, it is a matter of their own survival. The event is experienced as life-threatening – for oneself and, perhaps, for others too. This experience causes serious physical or mental harm. Post-traumatic stress disorder can be caused by, for example, war, violent crime, sexual abuse, a traffic accident, a natural disaster, and medical emergencies such as a heart attack or life-threatening bleed. News, for example that a friend or relative has died or is seriously ill, may also be traumatic.

Events such as losing one’s job, a separation, or bullying do not cause post-traumatic stress disorder. But they can trigger individual symptoms that are also typical of PTSD. Sometimes those affected also suffer from depression or anxiety as a result.

The following factors influence whether and to what degree post-traumatic stress disorder develops:

• what exactly happened – in getting it under control, there are differences between if the trauma was caused by violent experiences or by some kind of fateful event such as an accident or natural disaster
• how intense and lasting the experience was
• whether the traumatic situation was repeated
• how mentally strong someone is
• what protecting influences there are

How an experience is perceived and evaluated impacts strongly whether a post-traumatic stress disorder will occur. A key role is played by how intense the anxiety, helplessness and loss of control were. Also crucial is whether the traumatic situation was felt to be life-threatening, and whether someone had to experience violence from someone else.

The risk of post-traumatic stress disorder is greater in people who have mental problems, such as depression, anxiety or addictions. How often a post-traumatic stress disorder develops depends very much on the trigger. The following figures give a rough idea – PTSD is likely in: 

• 50% of victims of war, rape and torture
• 25% of victims of violence
• 20% of soldiers after combat
• 10% of people who have had a serious traffic accident or life-threatening illness

Around 2% of people in Germany will develop post-traumatic stress disorder at least once at some point in their lives.

How often it happens depends very much on the life circumstances. There are certain job groups that have a higher risk because they are faced with dramatic situations more often. These include police, firefighters, train drivers and emergency personnel. People in war zones are also affected far more often.

However, post-traumatic stress disorder is not the norm. While it may be true that a lot of people who have experienced trauma often get sad or down when memories surface, their everyday life and their feelings are not affected in the long term and the feelings often get milder over time.

How post-traumatic stress disorder develops depends on different factors.

The first symptoms can occur during or shortly after the traumatic situation. But they may also not appear until some time later. Memories of the trauma can also become problematic only a long time after the experience. For example, someone might only develop post-traumatic stress disorder years later. This is seen more often in soldiers. But memories of war from one’s childhood or youth only become stressful to some people in old age.

Symptoms of post-traumatic stress disorder can vanish after a few weeks, but they may also last for many years and become chronic. Phases with weaker or more intense symptoms may alternate.

Many people succeed in overcoming what has happened. They come to terms with their memories. Some people with PTSD get much better within a year, often even without therapy. In around 30%, the symptoms last for 3 years or more. It is not uncommon that these sufferers develop other problems such as an addiction.

Intense symptoms often have a huge impact on the sufferer’s everyday life. This can often cause people to lose their job. Because they are sleeping badly and can no longer concentrate, they are no longer able to fulfill their professional tasks. They might also keep remembering the event at their workplace. This can make it difficult to remain in the job. After abuse, sexual problems can also occur.

Immediately after a traumatic event, practical and emotional support is important for those affected so that they can better process their experience. A safe environment, in which those affected feel protected and get support, is helpful. Whether consolation, security or organizational help, for example, are to be provided depends on the trauma. Medication as a preventive measure is not suitable.

One only speaks of post-traumatic stress disorder when the symptoms have lasted for more than 4 weeks. After a traumatic event, most people are initially so badly stressed that it takes a while to process their experience.

Symptoms that occur immediately afterwards are called an acute stress reaction.

Post-traumatic stress disorder is diagnosed via the symptoms. For this purpose there is a consultation with a doctor or psychotherapist. The main thing then is to find out how severe the symptoms are, and how badly the person’s everyday life is affected. Their life circumstances, such as their family, job and home situation, are relevant here. A self-evaluation questionnaire is also sometimes used. If children are affected, painting and playing can be a way of accessing what they have experienced.

After serious accidents, the focus is often on physical injuries, which means that a post-traumatic stress disorder can easily be overlooked. It can also happen that sufferers do not see any link between their psychological symptoms and a stressful event in the past. Other people find it very difficult to talk about particular events and problems. So in forming the diagnosis, developing mutual trust is very important. Diagnostic conversations are usually very careful. What was experienced is only touched upon – there is no need to go into more detail.

Traumatic events can cause other mental illnesses. These include anxieties and depression. So the diagnosis should take these into account, too.

Which therapy is suitable for PTSD depends on various things.

To begin with, the sufferer’s needs and treatment goals should be clarified: which are the key symptoms? Which treatment goals are realistic and can be achieved with the therapies available? What additional help is required? Is therapy even needed? A psychotherapist can help with these questions.

Some sufferers need psychotherapy to process what they have experienced. Other people get sufficient help from their family, friends or psychological counselors. Medication is only recommended in particular situations. In hospitals in particular there are also options such as physical, art and music therapy.

A number of psychotherapeutic methods are available. 

• Cognitive behavioral therapy (CBT): With this, the focus is on re-evaluating thoughts or feelings that are engaged with the traumatic situation. CBT is most commonly used with post-traumatic stress disorder.
• Psychodynamic therapy: This evolved out of psychoanalysis. Psychodynamic therapy focuses more on current and past relationships and experiences.

An EMDR treatment may also be administered during psychotherapy. EMDR stands for Eye Movement Desensitization and Reprocessing. EMDR treatment involves the patient being exposed to certain stimuli during therapeutic sessions. An example is that the therapist moves a finger steadily backwards and forwards, with the patient’s eyes following the movement. This technique is said to help process the trauma.

If the PTSD is accompanied by other mental illnesses a decision is made in each situation as to which disorder will be given priority in terms of therapy.

For more detailed information, for example on treating PTSD with drugs, go to gesundheitsinformation.de.

A traumatic can throw a person’s life off the rails. Many people do succeed in overcoming what has happened. But a great deal of support, attention and time is required before that becomes the case.

Both the victims and other people can suffer from PTSD. As trust in other people often vanishes after a traumatic event, the effects can also affect social contacts. Sufferers sometimes find it hard to maintain relationships or form new ones. PTSD can also cause a dysfunctional sexual life. Some people with PTSD withdraw both emotionally and socially. So social support is important for healing. Friends and family need to show patience, as the relationship can be tougher than before.

Another factor that can weigh heavily is if sufferers have to deal with legal battles for years after an accident or violent crime. In cases like these, good legal support is important in easing the situation.

There are various programs to help people get back on top of everyday life, re-engage with social life, and get back into work again after a traumatic experience. Examples include work re-integration based on the Hamburg model, and psychosocial rehabilitation options.

If the problem is acute, the TelefonSeelsorge hotline provides support. They can put people in touch with other assistance. There are also various advice options.

The Federal Chamber of Psychotherapists in Germany (Bundespsychotherapeutenkammer) website has a therapist search tool, and the German Society for Psychotraumatology (Deutsche Gesellschaft für Psychotraumatologie) has a search tool for specialists in psychotraumatology.

Other points of contact include:

The national “Gewalt gegen Frauen” (Violence Against Women) hotline is free of charge and has counselors available in 17 languages, around the clock.

Sexual Abuse Help Portal

Victim Assistance Work Group