A.D.V.I.C.E group - Topic 10: Post - Traumatic Stress Disorder (PTSD)

What is Post-Traumatic Stress Disorder (PTSD)?

The official definition of Post-Traumatic Stress Disorder (PTSD) from the NHS is:
Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.

The general feeling is that PTSD just affects the Military and not the civilian population. This is understandable as the disorder was highlighted following on from the Vietnam War and more recently, in Iraq and Afghanistan where HM Forces were present.

To try an explain what PTSD means, a Veteran once wrote:

Surrounded by loved ones, yet I am alone,
Feeling so trapped in my solitary zone.
Thoughts of chaos as my anger overtakes,
Feelings of happiness my past dominates.
Laughter and smiles, they never seem to last,
I am haunted and hunted, by memories from my past.
Roaming in my head with nowhere to go,
Visions of the past, in my head, a film show.
In my head I scream, but no one can hear,
Past demons of death are always so near.
Voices from my past, like a long-playing song,
Breaking the man, I was, he was strong.
How long will it take, until I feel right?
It's exhausting me, this battle every night.
Each new day I try, to make a new stand,
But when I sleep, they come back on command.
I can't give up, my family need me strong,
Smiling and happy like nothing is wrong.
In this living state I find I'm in,
Dealing with my past, and memories from within.

However, PTSD has been around since the Human Race has experienced trauma. Previous generations knew PTSD as Shell Shock, Soldiers Heart, Combat Fatigue and War Neurosis. As the names suggest, they all have links to the Military. Despite the long history of PTSD, it was only officially recognised in 1980 by the American Psychiatric Association.

As you can see from the NHS definition above, it does not differentiate from Military and Civilian.

What Causes PTSD?

Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt. Types of events that can lead to PTSD include, but not limited to:

• Serious accidents.
• Physical or sexual assault.
• Abuse, including childhood or domestic abuse.
• Exposure to traumatic events at work, including remote exposure.
• Serious health problems, such as being admitted to intensive care.
• Childbirth experiences, such as losing a baby.
• War and conflict.
• Torture.

The above are not just applicable to those directly involved, but can also affect those who may witness a very stressful, frightening or distressing event. We have seen recently both in the Rail and Construction industries that some incidents have had a serious effect on some of our colleagues and families.

In 2016, Network Rail introduced its own standard for Trauma Incident Management which includes how to manage the risk of trauma related mental ill health in the workplace.

Symptoms of PTSD

Symptoms can vary in intensity over time. You may have more symptoms when you’re stressed in general or when you run into reminders of what you went through. For example, you may hear a car backfire and relive combat experiences or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault.

People react to traumatic experiences in a variety of ways. Some may experience symptoms of trauma which dissipate after a number of weeks. However, if symptoms of trauma continue for longer then PTSD may be present. Symptoms vary from person to person, but some examples are:

• Flashbacks (Acting or feeling like the event is happening again). The detail of the flashback can vary depending on the individual’s experiences. Flashbacks can last a second, minutes, hours or even longer.
• General things that happen during a PTSD flashback include:

1. Seeing full or partial images of the traumatic event.
2. Noticing any sense that is related to the trauma (such as hearing, smelling or tasting something).
3. Sensing that the person(s) involved in the traumatic event are physically present.
4. Feeling physical symptoms that you experienced during the trauma, such as pain or pressure.
5. Experiencing the emotions that happened during the trauma (this could be almost anything such as fear or even rage).
6. Nightmares (either of the event or of other frightening things).

• Feelings of intense distress when reminded of the trauma.
• Work-related or relationship problems.
• Inability to remember important aspect of the trauma.
• Loss of interest in activities and life in general.
• Sense of a limited future.
• Feeling numb and empty.
• Avoidance of people and places.
• Feeling isolated.
• Frequent periods of withdrawal into oneself.
• Increased anxiety and emotional arousal.
• Hypervigilance (On constant ‘red alert’).
• Intense physical reactions to reminders of the event (e.g. Pounding heart, nausea, muscle tension, sweating).
• Irritability or outbursts of anger and aggressive behaviour.
• Irrational and intense fear.
• Reduced tolerance to noise (hyperacusis).
• Difficulty concentrating.
• Being easily moved to tears.
• Panic attacks/anxiety/depression/mood swings.
• Feeling jumpy and easily startled.
• Difficulty falling or staying asleep.
• Thoughts of suicide.
• Tense muscles.

Tips for dealing with PTSD

• Speak to relatives or friends who will support you and help you to discuss any experiences and thoughts, or emotions that you are struggling to deal with.
• Try to overcome the feeling of helplessness by doing something positive like exercise, volunteering and so on.
• Avoid alcohol and drugs at all costs as these will not solve the problem in the long term.
• Spend time outdoors in a relaxing environment with positive people who you trust.
• Join a support group where you can meet other people who are experiencing the same kind of emotions and difficulties as yourself.
• Try to find out what triggers you to feel the symptoms of PTSD and pull together a plan to avoid these triggers.
• Seek professional treatment to help you to overcome your PTSD and take steps towards recovery and wellbeing. You can also speak to your Mental Health First Aider in your Company.
• Understand that relatives and friends will find it difficult to see you struggling, so allow them to understand what you are going through.

Complex PTSD

Complex PTSD may be diagnosed in adults or children who have repeatedly experienced traumatic events, such as violence, neglect or abuse. As a result, it could be some time before the symptoms of complex PTSD are recognised.

They are similar to PTSD but could also include suicidal thoughts, difficulty in trusting other people and destructive or risky behaviour. Complex PTSD is thought to be more severe if:

• The traumatic events happened early in life.
• The trauma was caused by a parent or carer.
• The person experienced the trauma for a long time.
• The person was alone during the trauma.
• There's still contact with the person responsible for the trauma.

Your company should employ a Mental Health First Aider who can act as the first point of contact. All discussions will be totally confidential and they should be able to assist should you need help.

For further information on PTSD, access the following links:

• Walking With The Wounded (WWTW) - https://walkingwiththewounded.org.uk/ or call 01263 863 900.
• Combat Stress - https://combatstress.org.uk/ or call 0800 1381619.
• Mind - https://www.mind.org.uk/information-support/a-z-mental-health/ or call 0300 123 3393.
• Able Futures - https://www.able-futures.co.uk/ or call 0800 321 3137.
• Samaritans - https://www.samaritans.org/ or call 116 123.
• PTSD UK - https://www.ptsduk.org.

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