Symptoms of PTSD and C-PTSD: Info for Healthcare Professionals
It’s estimated that 50% of people will experience a trauma at some point in their life and although most people exposed to traumatic events experience some short-term distress, around 20% of people go on to develop PTSD or C-PTSD. In the UK, that equates to around 6,665,000 people, yet it is still an incredibly misunderstood, often misdiagnosed and stigmatised condition.
At their core, both PTSD and C-PTSD are essentially ‘memory filing errors’ caused by the brain suspending normal functions during a traumatic situation.
If someone is exposed to an intensely fearful and traumatic situation, many systems in the body are put on hold or adapted to allow the body to cope as well as it can in order to survive. This might involve reactions such as ‘freezing to the spot’ or instead the opposite ‘flight away’ from the danger (it’s been recognised that there are 5 main reactions to trauma – fight, flight, freeze, fawn and flop). Additionally, the digestive system pauses, muscles may tense up to be ready to flee or fight, heart rate will increase, pupils dilate and the ‘unimportant’ task of memory creation is put on hold. This means that the mind does not produce a memory for this traumatic event in the ‘normal’ way.
In these cases, the body and mind are doing things they SHOULD do when presented with a threat. But humans are ‘designed’ for this to be an immediate fix, a short-term solution which allows the body to settle once the threat has been resolved. But with PTSD and C-PTSD, it is almost perpetual. The trauma can physically injure the brain meaning it stays in the alert state for so long that it gets ‘stuck’ there, and so begins to affect other systems of the body and mind.
When the body and mind get ‘stuck’ in this perpetual trauma mode, it can cause a huge variety of life-altering and intrusive physical, cognitive and emotional symptoms alongside substantial distress and disruption of social and occupational functioning with major problems in relationships and jobs.
Symptoms usually begin within 3 months of the traumatic incident, but sometimes they begin years afterward, and the symptoms can vary in intensity over time.
PTSD and C-PTSD symptoms vary from person to person, but these are some common signs and symptoms to look out for:
Re-experiencing is the most typical symptom of PTSD & C-PTSD. This is when a person involuntarily and vividly relives the traumatic event
- Flashbacks—reliving the traumatic event, and feeling like it happening right now including physical symptoms such as a racing heart or sweating
- Reoccurring memories or nightmares related to the event
- Distressing and intrusive thoughts or images
- Physical sensations like sweating, trembling, pain or feeling sick.
Thoughts and feelings can trigger these symptoms, as well as words, objects, or situations that are reminders of the event.
Trying to avoid being reminded of the traumatic event is another key symptom of PTSD & C-PTSD: avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience.
- Staying away from places, events, or objects that are reminders of the experience
- Feeling that you need to keep yourself busy all the time
- Using alcohol or drugs to avoid memories
- Feeling emotionally numb or cut off from your feelings
- Feeling numb or detached from your body
- Being unable to remember details of the trauma
Avoidance symptoms may cause people to change their routines.
Alertness and Reactivity Symptoms
You may be ‘jittery’, or always alert and on the lookout for danger. You might suddenly become angry or irritable.
- Being jumpy and easily startled
- Feeling tense, on guard, or “on edge” – this is called hypervigilance
- Having difficulty concentrating on even simple and everyday tasks
- Having difficulty falling asleep or staying asleep
- Panic attacks
- Feeling irritable and having angry or aggressive outbursts
- Self-destructive or reckless behaviour
- Aversion or difficulty in tolerating sound
Feeling and Mood Symptoms
The way you think about yourself and others may change because of the trauma.
- Trouble remembering key features of the traumatic event
- Feeling like you can’t trust anyone
- Distorted thoughts about the trauma that cause feelings of blame and guilt
- Overwhelming negative emotions, such as fear, sadness, anger, guilt, or shame
- Loss of interest in previous activities
- Feeling like nowhere is safe
- Difficulty feeling positive emotions, such as happiness or satisfaction
Some people actually learn to ‘manage’ their symptoms and so have long periods when their symptoms are less noticeable, followed by periods where they get worse. Other people have constant severe symptoms, or may only have symptoms when they’re stressed in general, or when they run into reminders of what they went through.
Many symptoms of PTSD and C-PTSD seem to bear no relation or correlation to the original trauma, so they often get overlooked, but can have severe life-impacting results. As such, it is vital that healthcare professionals are aware of the symptoms to look out for in their patients to allow a correct diagnosis, which can then lead to sustained treatment and recovery.
One of the most well-known symptoms of PTSD and C-PTSD are flashbacks. It’s important to understand, this isn’t a ‘reimagining’ of the trauma but an actual re-experiencing of it.
Under ‘normal’ or non-traumatic circumstances, when information comes into our memory system (from sensory input such as what we can see, hear, taste, and smell), it needs to be changed into a form that the system can cope with, so that it can be stored. If the encoding doesn’t take place due to a traumatic situation – the memory can’t be processed. Instead, it is stored randomly, in pieces, in a variety of places within the brain.
Eventually, when the mind presents the fragments of the memory of the trauma for ‘filing’, or it is triggered by a smell, a place, or a person etc, it does not recognise it as a memory. As it understands, ‘the brain is in the middle of the dangerous event – it is not ‘outside’ looking in at this event and therefore the entire system is not easily subject to rational control.’
These flashbacks are incredibly distressing. Reliving the trauma as if it were happening RIGHT NOW. The elements such as the facts of what happened, the emotions associated with the trauma and the sensations like touch, taste, sound, vision, movement and smell are presented by the mind as real time information. They may also present as nightmares and intrusive unwanted memories.
These re-experiences and flashbacks are a result of the mind trying to file away the distressing memory and understandably can be very unpleasant and frightening because they repeatedly expose the sufferer to the original trauma. The body enters a state of hypervigilance so it is acutely (and sometimes inappropriately) aware of other ‘dangers’ around it, with increased startle responses.
This danger response also sets off other stress reactions in the body which can cause deranged cortisol and adrenaline levels and so may present as other conditions such as high blood pressure, skin conditions such as eczema or psoriasis, increased heart rate, hair loss, allergies, high blood sugar levels, unexplained weight gain or loss, icy hands or feet, digestion issues, joint pain, and hearing issues such as hyperacusis, phonophobia, and tinnitus.
As the mind continues to try to repeatedly process the memory and the brain keeps re-triggering itself into ‘danger’ mode, people also find that their levels of awareness might change.
They can find it difficult to control their emotions and suffer intense symptoms of anxiety. This can present itself as both physical; shortness of breath, tight muscles, profuse sweating and a racing heart, as well as emotional: feeling on edge, hypervigilance (looking out for signs of danger all the time), avoidance of reminders of the trauma, self-destructive behaviours, or feeling panicky. Many people with PTSD or C-PTSD also feel emotionally numb and have trouble communicating with others about the way they feel – this may make them more anxious and irritable.
Ultimately, the brain is programmed to process memories and so the more the person avoids thinking about the trauma, the less likely is it that any memory processing will actually occur, and the more likely that further attempts at ‘filing’ a memory will occur automatically.
This will lead to further nightmares, flashbacks and intrusive memories which lead on to further hyperarousal and emotional numbing and this in turn leads on to more avoidance and so on. This is how the symptom clusters perpetuate themselves in a vicious cycle which can go on for years – and when it goes untreated, PTSD and C-PTSD can last for decades.
In some cases, symptoms can have a cumulative effect and can get worse rather than better over time, which is why some PTSD and C-PTSD sufferers ‘manage’ for such a long time without help, but they then worsen over time and eventually the symptoms become unmanageable.
The good news is that there are effective treatments for PTSD and C-PTSD. Unfortunately, many people do not know that they have the condition or do not seek treatment due to stigmatisation, they don’t believe they can be helped, they fear discussing their trauma or not wanting to acknowledge their problems in coping.
For treatment to be successful, information and memory processing must be completed. This is why therapies such as EMDR aimed at helping the individual to process and work through the traumatic material are extremely beneficial. For some people, treatment can get rid of PTSD or C-PTSD altogether. For others, it can make symptoms less intense.
PTSD is as ancient as humankind and can occur in all people, of any ethnicity, nationality, gender, occupation or culture, and at any age and despite its prevalence across the world, is still a very misunderstood condition and many people have pre-conceived ideas of what it is, and particularly what can cause it.
It’s vital that healthcare providers are aware if they (or a patient or even loved one) have suffered any trauma, they should be mindful of trauma symptoms, and the possibility of PTSD or C-PTSD.
If you or your workplace would be willing to have a stand with/hand out leaflets and booklets about PTSD – please do drop us an email with your name, address and some information about what you need.
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