Post-Traumatic Stress Disorder (PTSD)

Overview

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after a person experiences or witnesses a terrifying, traumatic event or series of events. These events might include combat exposure, physical or sexual assault, accidents, natural disasters, or other experiences that involve actual or threatened death, serious injury, or violence.

While it's normal to have upsetting memories or feel anxious after such events, PTSD is diagnosed when these reactions persist, are severe, and significantly interfere with a person's daily life.

It's important to understand that PTSD is not a sign of weakness, but rather a complex psychobiological injury resulting from exposure to overwhelming stress.

Encouragingly, PTSD is treatable, and various therapeutic approaches, including established therapies and newer interventions, are showing favourable results in helping individuals manage symptoms and improve their quality of life.

Symptoms

PTSD symptoms can vary significantly from person to person and can fluctuate in intensity over time. They generally fall into four main categories:

1. Intrusion Symptoms (Re-experiencing the Trauma):

  • Recurrent, unwanted, and distressing memories of the traumatic event.

  • Upsetting dreams or nightmares related to the event.

  • Flashbacks, where the person feels or acts as if the traumatic event is happening again.

  • Intense emotional distress or physical reactions (e.g., sweating, heart palpitations) when reminded of the event.

2. Avoidance Symptoms:

  • Actively trying to avoid thoughts, feelings, or memories associated with the trauma.

  • Avoiding people, places, activities, objects, or situations that trigger distressing memories of the event.

3. Negative Changes in Mood and Cognition:

  • Difficulty remembering important aspects of the traumatic event (not due to head injury or substances).

  • Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," "No one can be trusted").  

  • Distorted thoughts about the cause or consequences of the event, leading to blaming oneself or others.

  • Persistent negative emotional states, such as fear, horror, anger, guilt, or shame.

  • Markedly diminished interest or participation in significant activities.

  • Feeling detached or estranged from others.  

  • Persistent inability to experience positive emotions (e.g., happiness, satisfaction, loving feelings).  

4. Changes in Arousal and Reactivity:

  • Irritability and angry outbursts (with little or no provocation), often expressed as verbal or physical aggression.

  • Reckless or self-destructive behaviour.  

  • Hypervigilance (being constantly on guard or alert for danger).

  • Exaggerated startle response.

  • Problems with concentration.

  • Sleep disturbances (difficulty falling or staying asleep).

Complex PTSD (C-PTSD): When trauma is prolonged or repeated (e.g., ongoing abuse, captivity), individuals may develop C-PTSD, which includes the core PTSD symptoms plus additional difficulties with emotional regulation, relationships, and self-perception. This often requires a more tailored therapeutic approach.

Diagnoses

A diagnosis of PTSD is typically made by a qualified mental health professional (like a psychiatrist or psychologist) following a comprehensive assessment.

Key diagnostic criteria include:

  • Exposure to a qualifying traumatic event.

  • Presence of symptoms from all four categories (Intrusion, Avoidance, Negative Mood/Cognition, Arousal/Reactivity).

  • Persistence of these symptoms for more than one month.

  • Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  • The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.  

To aid in diagnosis and assess symptom severity, clinicians may use standardized assessment tools. Examples mentioned in the provided information include:

  • Clinician-Administered PTSD Scale (CAPS-5): A detailed interview to assess PTSD symptoms.

  • PTSD Checklist for DSM-5 (PCL-5): A self-report questionnaire assessing symptom presence and severity.

  • Generalized Anxiety Disorder Scale (GAD): Measures general anxiety symptoms.

  • Patient Health Questionnaire (PHQ): Screens for depression and other common mental health issues.

  • Adverse Childhood Experiences Score (ACE): Assesses exposure to childhood trauma, which can be a risk factor.

Treatment

The primary goals of PTSD treatment are to reduce symptoms, improve coping mechanisms, enhance daily functioning, and restore a sense of control and well-being. Treatment is often multifaceted and tailored to the individual. Common approaches include:

  • Psychotherapy (Talk Therapy): This is a cornerstone of PTSD treatment. Evidence-based therapies include Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Prolonged Exposure (PE) therapy. These therapies help individuals process traumatic memories, challenge negative thought patterns, develop coping skills, and manage triggers.  

  • Medication: Antidepressant medications, particularly SSRIs and SNRIs, are sometimes prescribed to help manage symptoms like anxiety, depression, and sleep problems associated with PTSD.

  • Innovative Interventions: Research continues into new treatment approaches. One such intervention mentioned is the Stellate Ganglion Block (SGB), also referred to as the Dual Sympathetic Reset (DSR).

    • What it is: SGB involves injecting a local anaesthetic near the stellate ganglion, a collection of nerves in the neck (around C4-C6 vertebrae).

    • Proposed Mechanism: It aims to calm an overactive sympathetic nervous system – the body's "fight-or-flight" response system – which is often dysregulated in PTSD. It may also work by increasing cerebral blood flow.

    • Target Symptoms: This procedure has shown promising results in reducing specific PTSD-related symptoms like anxiety, hypervigilance, sleep disturbances, and difficulty concentrating, supporting emotional and physiological recovery.

    • Procedure: It is described as a minimally invasive procedure, available in both un-sedated outpatient and sedated inpatient settings.

    • Research: Ongoing research explores its effectiveness, including its potential to significantly reduce suicidal ideation in individuals with PTSD.

Effective treatment often involves a combination of approaches, and finding the right plan may take time. Support groups and lifestyle adjustments (e.g., exercise, mindfulness) can also play a valuable role in recovery.

In conjunction with the Stella Centre (Australia), Dr Paul Verrills at MetroPain is one of the leading experts in administering the Stellate Ganglion Blocks (SGB) treatments to sufferers of PTSD, complex pain of the head, neck and arm (upper quadrant) and ⁠autonomic dysfunction,

If you feel you may be suffering from PTSD, please reach out and we can assist with both referral and treatment of your condition.

Disclaimer 
Please note the contents contained in this Patient Fact Sheet are not intended as a substitute for your own independent health professional’s advice, diagnosis or treatment. Our specialists assess every patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative, and evidence-based treatments tailored to suit each patient. As such, recommended treatments and their outcomes will vary from patient to patient. If you would like to find out whether our treatments are suitable for your specific condition, please speak to your doctor at the time of your consultation.

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