Post-Traumatic Stress Disorder
Updated: Sep 29, 2020
Hollywood actor Alex Winter, star of the Bill and Ted films (the third instalment of which is out now), has spoken about his struggles with post-traumatic stress disorder.
For him, his PTSD was caused by prolonged abuse while growing up as a child actor on Broadway. He suffered the effects of the condition for years, and describes it as wreaking havoc on him, and particularly on the way in which he related to the world around him, and to himself.
The effects of PTSD have been known for centuries, even if it took until the 20th Century for it to be identified as a psychiatric injury. Symptoms resulting from traumatic experiences, which we would now recognise as PTSD, have been described by Homer, Shakespeare and Dickens. During the 19th Century, symptoms in soldiers who had fought in battles, or accident victims, were assumed to be the result of physical injuries. Even in the First World War, "shell shock" was thought to be the result of brain damage caused by exploding shells.
After the Second World War, and with the continued development of psychiatry as a field of medicine and better analysis of the evidence of PTSD, the condition came to be accepted as a psychiatric one. In 1980, PTSD was added to the 3rd edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (known as DSM-3).
The DSM, now on its 5th edition (DSM-5) is widely used across the world to assist with diagnosing specifically what disorder someone with symptoms has. Whilst there is of course an element of trying to pigeonhole people's symptoms when the reality is that victims can be affected in a whole variety of ways, the current criteria to diagnose PTSD are as follows:
Exposure to a traumatic event, such as threat of death or serious injury, or sexual violence, either as the direct victim, witnessing it, or in certain circumstances experiencing it indirectly.
Intrusive re-experiencing of the trauma, such as nightmares, flashbacks or becoming distressed at reminders of the trauma.
Avoiding reminders of the traumatic event.
Changes in thoughts or mood, such as inability to recall features of the traumatic event, excessive negative thoughts, excessive blame of oneself or others for causing it, or low mood.
Alterations in arousal or reactivity, such as being nervous about some other traumatic event happening, being jumpy, poor sleep or concentration, irritability, or risky or destructive behaviour.
That the symptoms last longer than a month, that they cause distress or day to day problems with things like work or relationships, and that the symptoms are not caused by something else like drugs or another illness.
Of course any accident or other traumatic event will be upsetting to some degree. It is not unusual for someone who is involved in an accident to feel shaken up or to lose sleep in the first few days. People will often be nervous about getting back behind the wheel of their car, or getting back on their bike, but most of the time they can conquer their nerves.
It is when these kinds of feelings don't go away by themselves that there might be a risk of there being PTSD. Usually, but not always, PTSD symptoms start within six months of the initial trauma. Given how destructive PTSD can be, it is important to act to get treatment. Untreated, it can carry on damaging people's lives in very serious ways for years and years.
In my experience, PTSD is often missed by doctors following injuries suffered in accidents. This is not usually the fault of the doctors. Naturally the focus of the patient after an accident will be on the physical symptoms. They will see the hospital fracture clinic, or the physiotherapist, or their GP for pain relief, but it often doesn't occur to the patient that they might have a psychiatric injury. Why would it? If someone hasn't suffered from anything similar before, the natural assumption is often that feeling shocked or shaken by the accident is normal, and will fade away with time. It therefore doesn't get mentioned to the GP, and the GP never knows there is a problem.
But PTSD is very treatable. "Talking therapies" such as cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) are known to be effective treatments. Drug therapies such as antidepressants can be used, but are a second choice to the talking therapies and tend to be aimed at tackling the symptoms rather than the causes.
The point is to try to recognise when PTSD might be a problem. If you aren't getting over the mental trauma of an accident, speak to your doctor about it. PTSD isn't rare or exotic. In America about 7-8% of the population will suffer from it at some point in their lives. Your doctor will be familiar with it, and will be able to identify whether you might have it, and to arrange treatment.