Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event, such as a natural disaster, a serious accident, an act of terrorism, war/combat, rape, or other violent personal attacks . People with PTSD suffer from intense, disturbing thoughts and feelings related to this traumatic experience(s) that last long after the traumatic event has ended and last for at least one month. You can relive the event(s) through flashbacks or nightmares; you may feel sadness, fear or anger; you may feel separated or alienated from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as common as a loud noise or accidental touch.
- Occurrence of PTSD in the Netherlands
- PTSD symptoms and characteristics
- Intrusive (intrusive) memories
- Avoidance
- Negative changes in cognitions and mood
- Changes in physical and emotional responses
- Causes of PTSD
- Risk factors
- Biological factors
- Psychological factors
- Environmental factors
- Differential diagnoses
- Therapy
- Psychotherapy for PTSD
- Medications for PTSD
- Prognosis
- Complications
- Prevention
Occurrence of PTSD in the Netherlands
Post-traumatic stress disorder (PTSD) is relatively common in the Netherlands. The chance of developing PTSD in your life is 7%.
PTSD symptoms and characteristics
The symptoms and characteristics of PTSD can begin within a month of a traumatic event, but sometimes symptoms do not appear until years after the event. These symptoms cause significant distress or limitations in social, occupational or other important areas of your life. The symptoms can also interfere with your ability to perform your normal daily tasks.
The symptoms of PTSD generally fall into four groups: intrusive memories , avoidance, negative changes in thinking and mood, and changes in physical and emotional responses. Symptoms may vary over time or vary from person to person.
Intrusive (intrusive) memories
Symptoms of intrusive memories can include:
- recurrent, involuntary, painful memories of the traumatic event
- reliving the traumatic event as if it happened again (flashbacks)
- unpleasant, disturbing dreams or nightmares about the traumatic event
- intense or prolonged psychological distress when exposed to internal or external stimuli that represent an aspect of the psychotraumatic event(s)
Avoidance
Avoidance can include:
- trying not to think or talk about the traumatic event(s)
- avoiding places, activities, or people that remind you of the traumatic event(s)
Negative changes in cognitions and mood
Symptoms of negative changes in cognitions and mood may include:
- inability to remember an important aspect of the psychotraumatic event(s).
- persistent and exaggerated negative beliefs or expectations about yourself, others, or the world
- persistent, distorted beliefs about the cause or consequences of the psychotraumatic event(s), leading you to blame yourself or others for it.
- persistent negative mood
- decreased interest or participation in important activities
- experiencing feelings of detachment or alienation from others
- difficulty experiencing positive emotions
Changes in physical and emotional responses
- Changes in physical and emotional responses may include:
- irritable behavior (agitation) and outbursts of anger (verbal and/or physical)
- reckless or self-destructive behavior
- hypervigilance (constant vigilance)
- exaggerated startle responses
- concentration problems.
- disruption of sleep
The duration of the disorder is longer than one month. So the complaints must last at least one month.
Causes of PTSD
You can develop post-traumatic stress disorder after exposure to one or more psychotraumatic events. In 2023, it is not clear why some people get PTSD. As with most mental health problems, PTSD is likely caused by a combination of several factors, such as:
- stressful experiences that you have already experienced in your life
- innate mental health risks (increased chance of developing depression or anxiety)
- characteristics of your personality (character traits or temperament)
- the way your brain regulates the chemicals and hormones your body releases in response to stress
The most common events that lead to the development of PTSD are:
- exposure to war
- physical abuse in childhood
- Sexual violence
- abuse
A car accident can cause PTSD / Source: Dmitry Kalinovsky/Shutterstock.com
- being threatened with a weapon
- car accident
- fire
- natural disaster
- raid
- robbery
- plane accident
- torture
- kidnapping
- life-threatening medical diagnosis
- terrorist attack
- other extreme or life-threatening events
Risk factors
Men and women of all ages can develop post-traumatic stress disorder. However, some factors increase the risk of developing PTSD after a traumatic event, such as:
Biological factors
In women, the stress response lasts longer and PTSD often lasts longer in women. In addition to psychological and social factors, estrogens, cortisol and oxytocin play an important role in explaining gender differences in PTSD. The
hereditary influence on PTSD is estimated at approximately 30%. Several genes are involved, and vulnerability to PTSD mainly involves interactions between genetic factors and environmental factors. For example, people with the short variant of the 5-HTTLPR gene, the gene that regulates the transport of the mood-determining neurotransmitter serotine, have an increased risk of PTSD if they also have risk factors in the environment, such as lack of social support.
A small hippocampal volume is a risk factor for PTSD after experiencing a trauma. The hippocampus is the part of the brain that plays an important role in storing information in memory, spatial orientation and controlling behavior that is important for survival.
Women with PTSD who are in the last month of their pregnancy have babies with lower cortisol levels, indicating an increased stress response and a hypersensitive stress axis. This concerns a so-called epigenetic effect, in which a traumatic event influences the sensitivity to stress in the next generation.
Psychological factors
Psychological factors important for the risk of PTSD after a traumatic event include your ability to regulate emotions and coping skills. Premorbid vulnerability factors include:
- previous traumatization (nature, severity, duration and significance of the trauma and the age at which the event occurred)
- psychosocial functioning
- have other mental health problems, such as anxiety or depression
- neuroticism
- intelligence
- occurrence of psychopathology in family history
Environmental factors
Trauma is by definition a necessary environmental factor for the development of PTSD, but lifestyle and other environmental factors are also important, such as:
- having a job that increases your risk of exposure to traumatic events, such as military personnel and ambulance personnel
- substance abuse problems, such as excessive alcohol or drug use
- lack of a good support system of family and friends
Differential diagnoses
PTSD is not the only disorder that can be caused by a traumatic event. Differential conditions (and indicators) to take into account are:
- depression (low mood, lack of energy, loss of interest, suicidal thoughts)
- specific phobias (fear and avoidance limited to certain situations)
- adjustment disorders (in response to the emotional and psychological stress that arises from major life changes)
- acute stress disorder (where the complaints are limited to a duration of three days to one month after exposure to the psychotraumatic event)
- lasting personality changes after catastrophic experience (prolonged extreme stressor)
- dissociative disorders (mental condition in which dissociation is the main characteristic)
- traumatic brain injury: neurological damage resulting from injuries sustained during the trauma
- psychotic disorders/psychosis (hallucinations, delusions)
- anxiety disorders and obsessive-compulsive disorder
- personality disorders (interpersonal problems that started or worsened after exposure to trauma)
- conversion disorder (functional-neurological-symptom disorder)
PTSD can also co-exist with many of the above disorders, especially depression and anxiety disorders.
Psychotherapy for PTSD / Source: Wavebreakmedia/Shutterstock.com
Therapy
There are two main types of treatment for PTSD, namely psychotherapy and medication. Psychotherapy and medication are often used in combination.
Psychotherapy for PTSD
The treatment focuses on the dysregulated fear system and on the recovery of irrational cognitions and the confidence in the world that has been lost. In acute PTSD, offering a single session of cognitive behavioral therapy (CBT) at an early stage appears to work well. Trauma-focused psychotherapy, which focuses on the memory of the traumatic event or its meaning, is the most effective treatment for (chronic) PTSD. There are different types of trauma-focused psychotherapy, such as:
- Cognitive Processing Therapy (CPT), where you learn skills to understand how traumatic events have changed your thoughts and feelings. Changing how you think about the trauma can change your feelings.
- Narrative exposure therapy (NET): this focuses on a form of exposure of the trauma, which means that you confront the (most) fear-evoking stimuli of the trauma.
- Eye Movement Desensitization and Reprocessing (EMDR), where you focus on sounds or hand movements while talking about the trauma. Despite extensive research, in 2023 the precise mechanism of action behind EMDR is still unknown.
- Brief Eclectic Psychotherapy for PTSD: this involves allowing painful feelings and thoughts, after which you process them and regain control of your life.
Medication for PTSD / Source: Stevepb, Pixabay
Medications for PTSD
Medicines can also be given. Some specific SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), used to treat depression, also work for PTSD. These include sertraline, paroxetine, fluoxetine and venlafaxine. Benzodiazepines and atypical antipsychotics should generally be avoided for the treatment of PTSD because they do not treat core PTSD symptoms and can be addictive.
Prognosis
Most people who experience traumatic event(s) experience a brief acute response to the stressful situation and do not develop a lasting pathological response. However, a small proportion of people will develop PTSD, which is sometimes complicated with comorbid disorders such as depression, generalized anxiety disorder, or substance abuse. The transition from acute to chronic and the course of the disease is varied and is partly determined by risk and protective factors, such as availability of treatment, social support and effective coping strategies. All these and other factors can influence recovery. The severity of exposure, loss of property and death of other people (especially loved ones) can be associated with a long and complicated course of the disease.
The average duration of the complaints after treatment is 36 months and the average duration of the complaints in those who have not been treated is 64 months. In addition, almost 50% experience a significant reduction in symptoms, but more than a third of people never become completely free of symptoms.
Complications
PTSD can disrupt your entire life. Your work, relationships, health and your enjoyment of everyday activities can suffer significantly. PTSD can also increase the risk of other mental health conditions, such as:
- depression and anxiety
- problems with drug or alcohol use
- eating disorders
- suicidal thoughts and actions
Prevention
After experiencing a traumatic event, many people initially experience symptoms similar to PTSD, such as being unable to stop thinking about what happened. Fear, sadness, anger, depression, guilt are all common responses to trauma. However, the majority of people who experience a traumatic event do not develop long-term PTSD complaints. By getting timely help and support, you can prevent normal stress reactions from worsening and developing into PTSD. This may mean turning to family and friends who are willing to listen and offer comfort. It may also mean seeking professional help for PTSD treatment. Some people experience support in their religious community. Getting support can keep you from turning to unhealthy coping mechanisms, such as abusing alcohol or drugs.