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About this leaflet

This leaflet is for anyone who has been through a harrowing experience, who has been abused or tortured, or who knows someone to whom this has happened.


Introduction

In our everyday lives, any of us can have an experience that is overwhelming, frightening, and beyond our control. We could find ourselves in a car crash, be the victim of an assault, or see an accident. Police, fire brigade or ambulance workers are more likely to have such experiences – they often have to deal with horrifying scenes. Soldiers may be shot or blown up, and see friends killed or injured.

Most people, in time, get over experiences like this without needing help. In some people, though, traumatic experiences set off a reaction that can last for many months or years. This is called Post-traumatic Stress Disorder or PTSD for short.


Complex PTSD

People who have repeatedly experienced:
  • severe neglect or abuse as an adult or as a child
  • severe repeated violence or abuse as an adult, such as torture or abusive imprisonment can have a similar set of reactions. This is called 'complex PTSD' and is described later on in this leaflet.

How does PTSD start?

PTSD can start after any traumatic event. A traumatic event is one where you see that you are in danger, your life is threatened, or where you see other people dying or being injured. Typical traumatic events would be:
  • serious accidents
  • military combat
  • violent personal assault (sexual assault, physical attack, abuse, robbery, mugging)
  • being taken hostage
  • terrorist attack
  • being a prisoner-of-war
  • natural or man-made disasters
  • being diagnosed with a life-threatening illness.
Even hearing about the unexpected injury or violent death of a family member or close friend can start PTSD.


When does PTSD start?

The symptoms of PTSD can start immediately or after a delay of weeks or months, but usually within 6 months of the traumatic event.


What does PTSD feel like?

Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms:


1. Flashbacks & nightmares

You find yourself re-living the event, again and again. This can happen both as a 'flashback' in the day and as nightmares when you are asleep. These can be so realistic that it feels as though you are living through the experience all over again. You see it in your mind, but may also feel the emotions and physical sensations of what happened - fear, sweating, smells, sounds, pain.
Ordinary things can trigger off flashbacks. For instance, if you had a car crash in the rain, a rainy day might start a flashback.


2. Avoidance & numbing

It can be just too upsetting to re-live your experience over and over again. So you distract yourself. You keep your mind busy by losing yourself in a hobby, working very hard, or spending your time absorbed in crosswords or jigsaw puzzles. You avoid places and people that remind you of the trauma, and try not to talk about it.
You may deal with the pain of your feelings by trying to feel nothing at all – by becoming emotionally numb. You communicate less with other people who then find it hard to live or work with you.


3. Being 'on guard'

You find that you stay alert all the time, as if you are looking out for danger. You can’t relax. This is called 'hyper vigilance'. You feel anxious and find it hard to sleep. Other people will notice that you are jumpy and irritable.


Other symptoms
  • muscle aches and pains
  • diarrhoea
  • irregular heartbeats
  • headaches
  • feelings of panic and fear
  • depression
  • drinking too much alcohol
  • using drugs (including painkillers)

Why are traumatic events so shocking?

They undermine our sense that life is fair, that it is reasonably safe and that we are secure. A traumatic experience makes it very clear that we can die at any time. The symptoms of PTSD are part of a normal reaction to narrowly-avoided death.


Does everyone get PTSD after a traumatic experience?

No. But nearly everyone will have the symptoms of post-traumatic stress for the first month or so. This is because they can help to keep you going, and help you to understand the experience you have been through. This is an 'acute stress reaction'. Over a few weeks, most people slowly come to terms with what has happened, and their stress symptoms start to disappear.

Not everyone is so lucky. About 1 in 3 people will find that their symptoms just carry on and that they can’t come to terms with what has happened. It is as though the process has got stuck. The symptoms of post-traumatic stress, although normal in themselves, become a problem – or Post-traumatic Stress Disorder – when they go on for too long.


What makes PTSD worse?

The more disturbing the experience, the more likely you are to develop PTSD. The most traumatic events:
  • are sudden and unexpected
  • go on for a long time
  • are when you are trapped and can’t get away
  • are man-made
  • cause many deaths
  • cause mutilation and loss of arms or legs
  • involve children
If you continue to be exposed to stress and uncertainty, this will make it difficult or impossible for your PTSD symptoms to improve.


What about ordinary 'stress'?

Everybody feels stressed from time to time. Unfortunately, the word 'stress' is used to mean two rather different things:
  • our inner sense of worry, feeling tense or feeling burdened
or
  • the problems in our life that are giving us these feelings. This could be work, relationships, maybe just trying to get by without much money.
Unlike PTSD, these things are with us, day in and day out. They are part of normal, everyday life, but can produce anxiety, depression, tiredness, and headaches. They can also make some physical problems worse, such as stomach ulcers and skin problems. These are certainly troublesome, but they are not the same as PTSD.


How do I know when I’ve got over a traumatic experience?

When you can:
  • think about it without becoming distressed
  • not feel constantly under threat
  • not think about it at inappropriate times

Why is PTSD often not recognised?
  • None of us like to talk about upsetting events and feelings.
  • We may not want to admit to having symptoms because we don't want to be thought of as weak or mentally unstable.
  • Doctors and other professionals are human. They may feel uncomfortable if we try to talk about gruesome or horrifying events.
  • People with PTSD often find it easier to talk about the other problems that go along with it - headache, sleep problems, irritability, depression, tension, substance abuse, family or work-related problems.

How can I tell if I have PTSD?

Have you experienced a traumatic event of the sort described at the start of this leaflet? If you have, do you:
  • have vivid memories, flashbacks or nightmares?
  • avoid things that remind you of the event?
  • feel emotionally numb at times?
  • feel irritable and constantly on edge, but can’t see why?
  • eat more than usual, or use more drink or drugs than usual?
  • feel out of control of your mood?
  • find it more difficult to get on with other people?
  • have to keep very busy to cope?
  • feel depressed or exhausted?
If it is less than 6 weeks since the traumatic event and these experiences are slowly improving, they may be part of the normal process of adjustment.
If it is more than 6 weeks since the event, and these experiences don’t seem to be getting better, it is worth talking it over with your doctor.


Children and PTSD

PTSD can develop at any age. Younger children may have upsetting dreams of the actual trauma, which then change into nightmares of monsters. They often re-live the trauma in their play. For example, a child involved in a serious road traffic accident might re-enact the crash with toy cars, over and over again.

They may lose interest in things they used to enjoy. They may find it hard to believe that they will live long enough to grow up.

They often complain of stomach aches and headaches.


How can PTSD be helped?

Helping yourself
Do …
  • keep life as normal as possible
  • get back to your usual routine
  • talk about what happened to someone you trust
  • try relaxation exercises
  • go back to work
  • eat and exercise regularly
  • go back to where the traumatic event happened
  • take time to be with family and friends
  • be careful when driving – your concentration may be poor
  • be more careful generally – accidents are more likely at this time
  • speak to a doctor
  • expect to get better

Don’t …
  • beat yourself up about it - PTSD symptoms are not a sign of weakness. They are a normal reaction of a normal person to terrifying experiences.
  • bottle up your feelings. If you have developed PTSD symptoms, don’t keep it to yourself because treatment is usually very successful.
  • avoid talking about it
  • expect the memories to go away immediately; they may be with you for quite some time
  • expect too much of yourself. Cut yourself a bit of slack while you adjust to what has happened.
  • stay away from other people
  • drink lots of alcohol or coffee or smoke more
  • get overtired
  • miss meals
  • take holidays on your own. 

What can interfere with getting better?

You may find that other people may:
  • not let you talk about it
  • avoid you
  • be angry with you
  • think of you as weak
  • blame you.
These are all ways in which other people protect themselves from thinking about gruesome or horrifying events. It won’t help you because it doesn’t give you the chance to talk over what has happened to you. And it is hard to talk about such things.

A traumatic event can put you into a trance-like state which makes the situation seem unreal or bewildering. It is harder to deal with if you can’t remember what happened, can’t put it into words, or can’t make sense of it.


For friends, relatives & colleagues

Do …
  • watch out for any changes in behavior – poor performance at work, lateness, taking sick leave, minor accidents
  • watch for anger, irritability, depression, lack of interest, lack of concentration
  • take time to allow a trauma survivor to tell their story
  • ask general questions
  • let them talk, don’t interrupt the flow or come back with your own experiences.

Don’t …
  • tell a survivor you know how they feel – you don’t
  • tell a survivor they’re lucky to be alive – it doesn't feel like that to them
  • minimise their experience – “it’s not that bad, surely…”
  • suggest that they just need to "pull themselves together"
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