Post Traumatic Stress Disorder Sadia Khan Durrani Supervisor: Sharon Christie

What is Trauma? It is a very upsetting experience where our mind and feelings are hurt and are unable to preform properly. It upsets our thinking and makes us depress and feel bad. It changes our everyday life. It is caused by a disturbing event Before talking about PTSD, we should know what trauma is? It is a very upsetting and depressing experience that impact our mind and feelings. Due to such an upsetting event/ situation we are hurt and are unable to preform properly. It impacts the way we think. It makes us feel so bad that we can’t do anything we feel as if this is the end or we pray let it end. It not only affects us but also affects our surroundings. یہ ایک بہت پريشان تجربہ ہے جہاں ہمارے ذہن اور احساسات کو تکلیف پہنچائی ہیں اور خوش اسلوبی سے کام نہیں کر سکے

Disturbing incidences include: Wars (death, explosions, gunfire…) Natural disasters (floods, tornados, fires…) Accidents (harmful/fatal accidents) Abuse (physical, sexual, emotional and/or verbal) The events/ situation/ or incidents that cause us trauma includes Wars: where there are gunfire's, explosions, death, destruction, every where there is chaos. You are not even safe in your own home. You don’t know what the next minute will be like. Will you make it or will you die. Even if you make it you would live in fear for the rest of your live. Natural disasters: some of the examples are floods, tornadoes, hurricanes, fire, tsunami, storms, thunder etc. The affects of natural disasters is devastating. Some call it the wrath of God, some call it climate change. Whatever name you give it, it brings destruction and disruption in our live. For example tsunami in Japan, you might have watched its impact on TV. They call it 3:11. Accidents: which can include car accidents, sports accidents, aircraft accidents. Even when you are putting nail in the wall and instead hit your fingers with the hammer. (Personal story) Abuse: any abuse whether physical, sexual, emotional or verbal can cause trauma.

Symptoms of PTSD can start Right away and last less than 3 months. After few months and last more than 3 months Sometimes there are no symptoms at first but might appear long after the event We can group PTSD into three groups depending on it symptoms. If after an incident the symptoms that we experience are severe but last less than three months than that is know as acute PTSD, if the symptoms last more than three months then it is called Chronic PTSD, however it is delayed PTSD if we start experiencing the symptoms at least 6 months after the disturbing event. (this is very common with individuals who were sexually abused as children)

Symptoms of reliving or re-experiencing trauma includes... Upsetting memories about the event, Anxiety or distress when reminded of the stressful event Flashbacks, where the event seems to be happening again and again, Repeated nightmares of the event, Strong, uncomfortable reactions to conditions that remind you of the event After an upsetting event we sometimes Relive or re-experience the trauma. We have upsetting memories and flashbacks after the event. It seems as if the event is happening again and again. We cant stop thinking about the incident. This usually involves having vivid images about the trauma come up again and again even when you do not want to have them. For example, if you were physically attacked, you might keep remembering your attacker's face. Or, if you were in a car accident, you might have strong memories about the sound of the crash or a vivid picture of blood all over yourself or someone else involved. Some people with PTSD become extremely upset or feel very anxious when they are reminded of the incident. You might see people that have been through a depressing incident when think about that event have so much fear and distress in the face as if they have seen a ghost. Sometimes they will cry, other times they will be unable to talk, they will act as if they have been possessed. They will have nightmares about the event. When they think about the event they will experience the same pain and fear as if they are in the real thing.

Symptoms of avoidance Avoiding places, people, or thoughts that remind you of the event Being unable to remember important parts of the event Feeling as if you don't care about anything Having lack of interest in normal activities Feeling like you have no future They will try to avoid things, people and situation that remind them of the event. Many people with PTSD will try very hard to avoid anything that is associated with, or reminds them of, the traumatic event they experienced. Reminders can include: ◦Circumstances (e.g., the actual date of the event, clothes worn, place where the event occurred, etc.) ◦Things associated with the trauma (e.g. being in a car if the trauma was a car accident) ◦General signs of danger (e.g. TV shows about violence, news programs, police or fire department sirens, fire alarms, etc.) Avoiding thoughts, feelings, or memories related to the trauma. Although many people with PTSD will avoid any reminders of their traumatic experience, it is also common for people to avoid even thinking about what happened. For example, you might avoid talking to anyone about the trauma, and if you have thoughts or memories about what happened, you might try to push them out of your head. Not able to recall parts of the trauma. It is not uncommon for people who have lived through a trauma to have difficulty remembering parts of it, or the entire trauma, or to be confused about the timeline of events. Reduced interest in previously enjoyed activities. For example, after a trauma, you might stop wanting to spend time with friends and family, or you might stop all activities that you used to enjoy (such as sports or hobbies). Feeling detached/estranged from others. People with this symptom describe feeling cut off from others, even though they might have family and/or friends around them. Feeling numb/unable to experience feelings. Some people with PTSD will say that they generally feel numb, and don't experience loving feelings anymore (such as love, joy, or happiness). People with this symptom might have a hard time even describing how they feel, and are not able to recognize when they are happy, sad, or angry. Feeling of foreshortened future. It is not uncommon for people with PTSD to say that they have a feeling of "impending doom"; that is, they say that they don't expect to live long, that something bad is likely to happen again soon, or that they feel hopeless about the future.

Symptoms of increased distress and fear includes... Anger or bad temper Difficulty paying attention or listening Startling easily Feeling more aware (hyper-vigilance) Having trouble falling or staying asleep The third symptoms category is increased anxiety (worry) •Anger or bad temper: people that are suffering from PTSD feel more irritable and angry. They will snapping at people, or get extremely angry in a situation that reminds them of the incident. For example, if you were in a car accident, and while driving someone cuts you off, you might get very angry and even yell. •Concentration difficulties. Many people with PTSD report that they have a hard time paying attention or concentrating while completing daily tasks. Sometimes it happens that when we are afraid, or anxious we cannot concentrate properly. •Hypervigilance. Often, people with PTSD feel as if they are "on guard" or "on alert" all the time. People with this symptom will be very easily startled, and will jump at the slightest sound (for example, the telephone ringing, door bell, someone tapping you on the shoulder). Sleep difficulties. Some people with PTSD will have trouble falling asleep or staying asleep. This often happens when you feel quite anxious throughout the day or when you have nightmares.

Some other symptoms of PTSD Tension or nervousness Dizziness Fainting Feeling your heart beat in your chest Headache Feeling your heart beat in your chest: when we are afraid, we feel as if we are getting a heart attack. It is beating so fast that you can literally feel it by putting your hands on your chest.

Why do some people get PTSD and other people do not? Not everyone gets PTSD Two factors play a part in who gets PTSD and who doesn’t You are more likely to get PTSD if you have Risk factors. You are likely not to get PTSD if you have Resilience factors. It is important to remember that not everyone who lives through a dangerous event gets PTSD. In fact, most will not get the disorder. Many things play a part in whether a person will get PTSD or not. There are two factors that determine whether someone will develop PTSD or not. They are risk factors and resilience factors. The risk factors are those that make a person more likely to get PTSD. Other factors, called resilience/resistance/strength factors, can help reduce the risk of the disorder. Some of these risk and resilience factors are present before the trauma and others become important during and after a traumatic event. What are the risk and resilience factors I will tell in other slides.

Risk Factors for developing PTSD You are more likely to get PTSD if; Living through dangerous events and traumas Getting hurt Seeing people hurt or killed Having little or no social support after the event Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.

Resilience factors Resilience factors that may reduce the risk of PTSD include: Finding a support group after the disturbing incident. Having a coping strategy, or a way of getting through the bad event and learning from it Seeking out support from other people, such as friends and family

Women They not only experience a greater number of PTSD symptoms than men, but also experience them more often and for longer time. The most common events for women to develop PTSD can be rape, physical attack, being threatened with a weapon, and childhood physical abuse.

Young Children’s Might have extreme reaction to trauma but symptoms might be different Symptoms possible in young children's includes, but not limit to; Having nightmares Acting out the scary event during playtime Being unusually clingy with a parent or other adult. Having physical symptoms such as headaches and stomachaches Losing interest in activities

Teenagers Symptoms of PTSD are more like adults May also develop troublemaking, disrespectful, or destructive behaviours. May feel guilty for not preventing injury or deaths. They may also have thoughts of revenge

Treatment Treatment depends on people Treatment that works on one person may not work on another. Important to be treated by professional mental health caregiver experienced with PTSD Main treatment includes psychotherapy, medicine or both Treatment for PTSD depends on people and their experiences and circumstances. One treatment that treated one person might not work on another person. It is also important that we get treatment from a professional mental health caregiver who is experience or has knowledge about PTSD. Treatment includes, psychotherapy; that is talk therapy, medicine; where we are treated with taking medicines or both where both talk therapy and medicines help in treatment.

Psychotherapy It is a talk therapy Involves talking to a professional Can occur one-on-one or in a group Can last 6-12 weeks but can take more time Research shows that family and friend support is an important part of therapy Psychotherapy is “talk” therapy. It involves talking with a mental health professional to treat a mental illness. Psychotherapy can occur one-on-one or in a group, both are affective. Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but can take more time depending on person and their trauma. Research shows that if a person having PTSD has support from family and friends, it can help in therapy and recovery.

Overcoming PTSD through Psychotherapy Psychotherapy helps people as follows: Teach about trauma and its effects. Teach relaxation and anger control skills. Provide tips for better sleep, diet, and exercise habits. Help people identify and deal with guilt, shame, and other feelings about the event. Focus on changing how people react to their PTSD symptoms. For example, therapy helps people visit places and people that are reminders of the trauma. How psychotherapy help people cope; it educate people about trauma and its impact on people. It gives person skills to relax and control anger

Medication... They may help control PTSD symptoms such as sadness, worry, anger, and feeling numb May make it easier to go through psychotherapy. Side effects includes headache, nausea, agitation, sleeplessness or drowsiness They may help control PTSD symptoms such as sadness, worry, anger, and feeling numb inside. Taking these medications may make it easier to go through psychotherapy. Sometimes people taking these medications have side effects. The effects can be annoying, but they usually go away. However, medications affect everyone differently. Any side effects or unusual reactions should be reported to a doctor immediately. The most common side effects of antidepressants like sertraline and paroxetine are: Headache, which usually goes away within a few days. Nausea (feeling sick to your stomach), which usually goes away within a few days. Sleeplessness or drowsiness, which may occur during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects. Agitation (feeling jittery). Sexual problems, which can affect both men and women, including reduced sex drive, and problems having and enjoying sex.

Helpful hints for yourself Try to rest a bit more Contact friends Have someone stay with you for at least a few hours or periods for a day or so Eat well-balanced and regular meals (even when you don’t feel like it) Fight against boredom Physical activity is often helpful

Helpful hints for yourself Re-establish a normal schedule as soon as possible Express your feelings as they arise Talk to people who love you Find a good counsellor if the feelings become prolonged or too intense Try to keep reasonable level of activity

Help For Family Members and Friends Listen carefully Spend time with the person having PTSD Offer your help even if they have not asked for help Help them with everyday tasks like cleaning, cooking, caring for the family, looking after children Give them some private time Don’t tell them that they are “lucky it wasn’t worse”— Instead, tell them that you are sorry such an event has occurred and you want to understand and assist them Don’t tell them they are “lucky it wasn’t worse”– because for them that incident was the worst.