PTSD – Hello Doctor

Could you be suffering from complex PTSD?

March 18th, 2020 by Content Editor

Post-traumatic stress disorder (PTSD) develops in people who have experienced a shocking, scary, or dangerous event. It can be caused by traumatic events, like a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse.

When the underlying trauma is severe and repetitive, some mental health professionals make a distinction between PTSD and complex PTSD (CPTSD).

Complex PTSD, also known as c-PTSD or CPTSD, is a condition where you experience some symptoms of PTSD along with additional symptoms, including :

Difficulty controlling emotions
Feeling hostile or distrustful towards the world
Constant feelings of emptiness or hopelessness
Feeling permanently damaged or worthless
Feeling different to others
Feeling like no one can understand what happened to you
Avoiding friendships and relationships, or finding them difficult
Frequent suicidal feelings
Preoccupation with perpetrator (becoming obsessed with the abuser, dissecting the relationship with the abuser, and/or becoming preoccupied with revenge)
Changes in self-perception

C-PTSD vs PTSD

While PTSD can develop in response to short-term exposure to a single traumatic event, C-PTSD develops only when you have experienced severe, repetitive trauma over a long period of time.
The World Health Organization made the decision to include C-PTSD as its own separate diagnosis in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), published in June 2018.

What causes complex PTSD?

The types of traumatic events that can cause complex PTSD include:

Childhood abuse, neglect or abandonment
Ongoing domestic violence or abuse
Repeatedly witnessing violence or abuse
Being forced to become a sex worker
Torture, kidnapping or slavery
Being a prisoner of war.

You are more likely to develop complex PTSD if:

You experienced trauma at an early age
The trauma lasted for a long time
Escape or rescue were unlikely or impossible
You were harmed by someone close to you
You’ve experienced multiple traumas

Risk factors

While anyone can develop CPTSD, some people may be more likely to develop it than others. Aside from having past traumatic experiences, additional risk factors include:

Underlying mental illness, like anxiety or depression, or a family history
Inherited personality traits
How your brain regulates hormones and neurochemicals in response to stress
Not having a strong support system or having a dangerous job

Treating complex PTSD

Treatment will depend on your personal circumstances. You may be offered therapies used to treat PTSD, like trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing (EMDR).

Treatment for other problems like depression or alcohol addiction will also be addressed.
If you’ve had symptoms of post-traumatic stress for at least a month which interfere with your daily life, your doctor will likely start with a diagnosis of PTSD.

Depending on the traumatic event and whether you have additional symptoms, like ongoing relationship problems or trouble controlling emotions, it’s possible you will be diagnosed with CPTSD.

References:

Healing trauma with eye movement

November 9th, 2017 by The Hello Doctor Team

Did something happen in your past that still haunts you today? None of us are exempt from life’s distressing moments – and for some, it really takes a lifetime to heal. A simple eye movement may be just what you need to overcome disruptive life experiences.

Healing through your eyes

Thanks to Dr Francine Shapiro, an American psychologist, EMDR (eye movement desensitization and reprocessing) is an effective treatment to resolve symptoms of trauma and life-disturbing experiences.

Feelings that linger and remain unprocessed can affect the nervous system. This can result in flashbacks, ongoing anxiety and nightmares. Trauma can make you avoid certain situations with people or locations. This eye therapy is used to safely address and process traumatic experiences and your overwhelming emotions. In this way, you confront the memories and behaviours that stem from there.

How does it work?

With your eyes, you track a therapist’s back-and-forth finger movements, and at the same time, replace your negative thoughts with positive ones. Think of a hypnotist’s swinging pocket watch.

Step-by-step progress

According to the EMDR Institute, the relatively new but popular treatment runs in eight steps.

History: You and the therapist will develop a treatment plan that considers your past life events, current, and future needs or concern. This will target the cause of your emotional distress. The point here is to develop skills and behaviours that you will need in the future. The root of the problem, which perhaps stems from your childhood, may be the starting point.
Preparation: Your therapist will use imagery to teach you how to reduce your stress. These are techniques you can (and should) use in your daily life to keep you in a peaceful state of mind.
Assessment: Your therapist will record, evaluate and measure imagery of your memory and help you target these associated feelings. This also outlines the negative thoughts you have about yourself that may be linked to the targeted memory. In contrast to this, the therapist lets you choose a positive thought or memory. The belief will be measured against the negative one to determine how true it feels to you. Your therapist will record your physical symptoms too.
Desensitisation: Bilateral stimulation (the core of EMDR), involves eye movements, tones, or taps that are used to reprocess the distressing event. The therapist takes a break after each set to check in on you and what may have happened during the stimulation.
Installation: During the bilateral stimulation phase your selected positive thought is the target. Your therapist will often check to see how true your chosen belief feels to you.
Body scan: You will now scan your own bodily sensations while thinking of the image and the positive belief. Processing is not complete until you can bring the traumatic memory into your consciousness without feeling tension. Any sensations that your therapist finds in the process will be targeted with further bilateral stimulation until the tension is gone.
Closure: Closure may include guided imagery or a discussion of the session. This phase happens at the end of a session regardless of the memory being fully processed, either at a functional level or not. The completion of EMDR therapy may take several sessions.
Re-evaluation: The next session begins here. This phase consists of examining the progress made. If the target remains unresolved, the session will resume with desensitisation.

Why does it work?

After 26 years of research, there have been enough evidence of the effectiveness of EMDR, that many psychologists now get training in this technique. However, there are also skeptics within the scientific community, who are not convinced about this treatment. The main reason, though, is that the underlying neural mechanism is unknown. Since the treatment poses no dangers, and good results, it’s definitely worth giving a try!

Need EMDR therapy?

EMDR can be effective in a wide range of psychological problems. Find a qualified psychologist or psychiatrist who specialises in this form of treatment. The South African Depression and Anxiety group also reiterates that EMDR is not limited to simply taking symptoms away. It addresses the past, present and future. The goal is to allow the person to achieve a complete state of emotional health.

References:

Why almost every South African needs a counsellor

October 31st, 2017 by The Hello Doctor Team

Updated crime statistics for South Africa were released in October, and they paint a bleak picture. 52 murders, 146 robberies and 46 hijackings per day… and these are just the incidents that are reported. Evidence suggests that over a period of 5 years, close to 70% of all South Africans have becomes a victim of crime at least once. Besides physical injury, being exposed to any type of trauma, be that rape, a mugging, a car accident or even bullying, has implications to multiple regions in your brain. This is one of the reasons why mental health concerns, specifically Post Traumatic Stress Disorder (PTSD) interferes with so many different aspects of your daily life.

How your brain responds to trauma

Reactions to trauma vary and not everyone experiences it in the same way. Generally, however, when you experience a traumatic event your brain responds in the following way:

The prefrontal cortex (the “Thinking Centre”) which is responsible for rational thought, problem-solving and awareness of self and others is UNDER activated.
The anterior cingulate cortex (the “Emotion Regulation Centre”), responsible for regulating emotions (i.e. ensuring we don’t do things we regret) is UNDER activated
The amygdala (the “Fear Centre”), responsible for filtering information into ‘threat’ or ‘non-threat’ is OVER activated, causing you to feel afraid, reactive and vigilant.

Has your brain been traumatised?

For some people, adjusting and coping to life after trauma is temporary. But for others, symptoms of their traumatic event can linger on for months, even years and have a drastic impact on quality of life. These kinds of symptoms are generally grouped into 4 types:

Intrusive memories: reliving the event, nightmares or distress to something that reminds you of what happened
Avoidance: avoiding people or places that remind you of the event, feeling emotionally numb and detached from others, having recurrent negative thoughts
Changes to physical and emotional reactions: insomnia, irritability, anger, self-destructive behaviour (drinking too much or driving too fast)

Just like any type of mood disorder, the intensity of these symptoms can range from mild to completely overwhelming. If a traumatic event is extreme, it’s likely that symptoms will become extreme; whereas a minor event, like a bumper bashing, may have symptoms that only last for a few weeks. Learning to recognise the symptoms of PTSD, which are not always obvious, is the first step in getting the help you need.

First aid for a traumatised brain

Having PTSD may also increase your risk for developing depression, substance abuse issues and eating disorders. The sooner you can address the underlying trauma, the better for your long-term health. The trauma you experienced, or witnessed, caused structural changes to your brain. Undoing these takes time and a whole lot of patience. It also needs the help of a trained professional who, depending on your situation, might suggest:

Medications to control anxiety and depression
Cognitive therapy – talking about your experience and learning to recognise fear “triggers”
Exposure therapy – being exposed to your fear in a safe and controlled environment
Group therapy – sharing your experience with others who have been through similar trauma

The goal of treatment is to help you regain sense of control over your life and thoughts. Here are a few other ways that you can start to heal:

Avoid alcohol and drugs – these are not a long term solution
Stay connected – you don’t need to worry alone!
Take care of your self – eating well, exercising and prioritising sleep goes a long way in giving you the energy you need to change your way of thinking
Break the cycle – have a list of activities to do when feelings of anxiety arrive. Go for a walk or take up a new hobby to re-focus your brain
Know all there is to know about PTSD – knowledge is power! Learning more about PTSD can help you develop your own personal coping strategies

It is normal to feel angry, sad and guilty. However, if you, or someone else you know, experiences extreme symptoms or suicidal thoughts, seek immediate medical attention. You can either contact one of our doctors, or SADAG on 0800567567.

References

https://www.psychologytoday.com/blog/workings-well-being/201703/is-your-brain-trauma
https://www.medscape.com/viewarticle/831940
https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
http://www.csvr.org.za/publications/latest-publications/1778-an-overview-of-the-consequences-of-violence-and-trauma-in-south-africa
http://www.sadag.org/index.php?option=com_content&view=article&id=1835&Itemid=174#t

The ripple effect of shock: PTSD

July 18th, 2016 by The Hello Doctor Team

Have you ever been in a car accident? Perhaps you’ve experienced an armed robbery, a mugging or some other traumatic event? Even if you didn’t get hurt, you may still find it hard to concentrate at times, or that sudden noises make you jump. It could be Post Traumatic Stress Disorder – also known as PTSD.

Continue reading “The ripple effect of shock: PTSD”

Murder accused Shrien Dewani is back in SA, but will he stand trial?

April 8th, 2014 by The Hello Doctor Team

3 ½ years ago, Shrien Dewani and his young wife Anni made international headlines when the couple were allegedly hijacked on the outskirts of Cape Town, while on honeymoon. Anni was shot and killed, and what followed was a series of events which saw Dewani leaving the country within days of his wife’s murder. You can read the full details of the Dewani case here.

Continue reading “Murder accused Shrien Dewani is back in SA, but will he stand trial?”

C-PTSD vs PTSD​