Post-traumatic stress disorder (PTSD)

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

It is caused by frightening experiences, for example, a disaster, violence, sexual abuse, or a serious accident.

These experiences are referred to as trauma. In this context, trauma can be understood as a “psychological injury”. There are extreme situations that are sometimes difficult to process. Both victims and witnesses can suffer PTSD as a result.

It is typical of PTSD that memories of what has been experienced recur and badly stress the sufferer. Some people feel that their lives have been completely derailed. In this situation it is important that other people provide support. For example, psychotherapy can help people to process the traumatic experiences and get on top of them.

The following symptoms indicate post-traumatic stress disorder (PTSD):

Flashbacks

The trauma keeps being relived. Sudden flashbacks occur. 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 easily irritated 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 people 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 with PTSD lose trust 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?

Trauma can bring on other mental illnesses. These include depression, anxiety and addiction. A dissociative disorder may also develop. This involves, for example, the memories being deleted or parts of the personality “splitting off”. 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 severe, the person may experience serious mental problems. Some people with PTSD are so badly affected that life is almost impossible without help.

The symptoms depend not only on the original event but also on the individual’s ability to cope with stress.

Children and adolescents often experience post-traumatic stress disorder differently to adults. They frequently re-enact their experience symbolically over and over again, for example with different scenarios, images and people. Many develop behavioral issues, for example, they may become very anxious or aggressive. Children and adolescents with complex post-traumatic stress disorder find it particularly difficult to regulate their emotions. Their perception of themselves and others is severely impacted and they experience difficulties forming trust-based relationships.

A brochure about trauma in children and adolescents is available from gesundheitsinformation.de.

Post-traumatic stress disorder (PTSD) is preceded by a traumatic experience that is perceived to be life-threatening – for the person themselves but possibly also for others. This experience causes serious physical or mental harm.

Causes of PTSD include:

• war
• violent crime
• sexual abuse
• traffic accidents
• natural disasters
• medical emergencies such as a heart attack or a life-threatening hemorrhage

News, for example that a loved one 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. However, they can trigger individual symptoms that are 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 (PTSD) 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 the person is
• what protective influences there are

How an experience is perceived and evaluated impacts strongly whether PTSD 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. Factors that determine whether a person develops PTSD include personal mental resilience and whether emotional support and comfort have been provided to them.

People in certain occupations are more likely to be faced with dramatic situations. These include police, firefighters, train drivers and emergency personnel. In addition, the risk is much higher for people in war zones.

Around 2% to 3% of the German population will experience post-traumatic stress disorder (PTSD) at least once in their lives.

How frequently it occurs depends to a large extent on the person’s life circumstances and on the trigger.

Post-traumatic stress disorder develops in approximately:

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

However, PTSD is not the norm. Many people who have experienced trauma often get sad or down when memories resurface. However, their daily lives and feelings are not affected in the long term and the feelings often fade over time.

The outlook for people who develop post-traumatic stress disorder (PTSD) depends on various factors.

The first symptoms can occur during or shortly after the traumatic situation. However, 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 may develop PTSD 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% of people, the symptoms last for 3 years or more. It is not uncommon for these people to develop other problems, such as an addiction.

Intense symptoms often have a huge impact on the person’s daily life. This can often cause people with PTSD 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 people feel protected and receive support, is helpful. Whether consolation, security or organizational help, for example, is most appropriate depends on the trauma. Medication is not a suitable preventive measure.

Doctors only speak of post-traumatic stress disorder (PTSD) when the symptoms have lasted for more than 4 weeks. After a traumatic event, most people are initially so distressed that it takes a while for them to process their experience. Symptoms that occur immediately are called an acute stress reaction.

PTSD is diagnosed on the basis of symptoms. For this purpose there is a consultation with a doctor or psychotherapist. The priority is to find out how severe the symptoms are and the extent to which they impact the person’s daily life. 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. Conversations with parents or other people close to the child also play an important role in diagnosis.

Following a serious accident, the focus is often on physical injuries. As a result, 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 anxiety disorders and depression. So the diagnosis should take these into account, too.

Which therapy is most suitable for post-traumatic stress disorder (PTSD) depends on various factors.

Personal needs and the goals of treatment should be clarified at the outset:

• What 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 people with PTSD need psychotherapy to process what they have experienced. Others get sufficient help from their family, friends or psychological counseling services. 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): This type of therapy focuses 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 and focuses more on current and past relationships and experiences.

An EMDR treatment may also be administered during psychotherapy. EMDR is short for “eye movement desensitization and reprocessing”.

The treatment involves the patient being exposed to certain stimuli during therapeutic sessions. For example, 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 about treating PTSD with medication, see gesundheitsinformation.de.

A traumatic event can derail a person’s life. Many people succeed in overcoming what they have experienced. However, a great deal of support, attention and time is required before that can happen.

As trust in other people often vanishes after a traumatic event, the effects can also impact the individual’s social environment. People with post-traumatic stress disorder (PTSD) sometimes find it hard to maintain relationships or form new ones. Some people become emotionally and socially withdrawn. PTSD can also cause a dysfunctional sexual life. Social support is therefore important for healing. Friends and family need to show patience, as relationships can be more difficult than before.

Another factor that can weigh heavily is if people with PTSD have to deal with legal battles for years after an accident or violent crime. Good legal support is important in easing this type of 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 supports also. There are also various advice options.

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

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

Other points of contact include:

Sexual Abuse Help Portal

Victim Assistance Work Group