Post-Traumatic Stress Disorder Awareness Month: Symptoms, causes and treatment

With each passing day, more people realise the importance of addressing mental health and making efforts to learn about the different factors leading to its deterioration. Anxiety, depression and stress are known but trauma is also one of the significant issues that affect people not only around the world but also closer home in India due to various factors, according to experts.

Owing to the internet and various films and television shows, many people now understand the meaning of trauma more than ever, but to know about the long-term effects of it that is "post-traumatic stress disorder", is equally important. Every year, June is observed as Post-Traumatic Stress Disorder Awareness Month in the United States of America (USA), but we all know it as a condition that affects people worldwide. The day is dedicated to creating awareness about the effects of the condition more commonly referred to as PTSD.

While it is often difficult to gauge how many people suffer from PTSD because many people still don't report it, there is more than one reason for people in India suffering from it. According to Dr Mehezabin Dordi, clinical psychologist at Sir HN Reliance Foundation Hospital in Girgaon, "PTSD is a significant mental health concern globally and India is not an exception. India has faced various traumatic events such as natural disasters, terrorist attacks, communal violence and other forms of trauma, which can contribute to the prevalence of PTSD."

Mid-day Online spoke to Dr Dordi and Dr Austin Fernandes, psychiatrists at Dr LH Hiranandani Hospital in Powai to understand more about the condition. The Mumbai-based experts explain the causes of PTSD, the symptoms that one should look out for, the challenges and also how it can be prevented. At the same, they remind how many Indians are prone to the condition due to various factors.

What is Post-Traumatic Stress Disorder? On an average, how many people suffer from it in India?
Fernandes: Post-traumatic stress disorder (PTSD) is a mental health problem caused by a stressful experience such as battle, sexual assault, natural catastrophes, or accidents. It is believed that 8 per cent of the Indian population suffers from PTSD.

Dordi: Post-traumatic Stress Disorder (PTSD) is a mental health condition that can develop in individuals who have experienced or witnessed a traumatic event. It is characterised by a range of symptoms that may include intrusive thoughts or memories of the event, nightmares, flashbacks, severe anxiety or distress, avoidance of triggers associated with the trauma, emotional numbness, difficulty sleeping and hyper-arousal. Regarding the prevalence of PTSD in India, it's challenging to provide an exact figure as the available data may vary. However, PTSD is a significant mental health concern globally and India is not an exception.

According to a study published in the Journal of Traumatic Stress in 2019, the estimated lifetime prevalence of PTSD in India was found to be around 2.7 per cent. Another study conducted in 2018 by the National Institute of Mental Health and Neurosciences (NIMHANS) estimated the prevalence of PTSD in the general population of India to be around 3.8 per cent. These figures provide an approximate range. It's important to note that the actual prevalence might be higher due to underreporting, stigma and lack of awareness regarding mental health issues.

What are the causes of PTSD? Which is the age group and gender that is usually affected by PTSD?
Fernandes: It can be induced by a variety of circumstances, including seeing or experiencing a terrible incident, a family history and one's own methods of coping. PTSD can impact individuals of every generation and age, although research indicates that women are more susceptible than males.

Dordi: PTSD can be caused by experiencing or witnessing a traumatic event that poses a threat to one's life or physical integrity. Some common causes of PTSD include:

Combat exposure: Military or defence personnel who have been involved in combat situations or war zones may develop PTSD.

Physical or sexual assault: Survivors of physical or sexual assault, including domestic violence or childhood abuse, are at higher risk.

Accidents: Being involved in a severe car accident, natural disasters, or other traumatic incidents can trigger PTSD.

Terrorism: Individuals who have experienced or witnessed acts of terrorism may develop PTSD.

Medical trauma: People who have undergone serious medical procedures, such as surgeries or intensive medical treatments, can develop PTSD.

Sudden loss: The sudden death of a loved one, particularly due to violent or unexpected circumstances, can lead to PTSD.

PTSD can impact individuals across different age ranges and genders. However, certain patterns have been observed. One research suggests that women are more likely to develop PTSD compared to men. This is partly due to a higher incidence of sexual assault and interpersonal violence experienced by women. However, men can also experience PTSD, particularly as a result of combat-related trauma.

What are the symptoms of PTSD? Can people recognise it themselves or do they have to visit a doctor for diagnosis?
Fernandes: Reminiscing the frightening event, evasive actions, heightened emotions, negative mood swings and hypervigilance are all indications of PTSD. While certain symptoms may be recognised by the individual, it is always advisable to seek medical attention for a diagnosis.

Dordi: Symptoms of PTSD majorly fall into the following four categories. Specific symptoms can vary in severity:

1. Intrusion: Intrusive thoughts such as repeated, involuntary memories; distressing dreams; or flashbacks of the traumatic event. Flashbacks may be so vivid that people feel they are reliving the traumatic experience or seeing it before their eyes.

2. Avoidance: Avoiding reminders of the traumatic event may include avoiding people, places, activities, objects and situations that may trigger distressing memories. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it.

3. Alterations in cognition and mood: There is inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to distorted beliefs about oneself or others, distorted thoughts about the cause or consequences of the event. It may also manifest as wrongly blaming self or other; having feelings of ongoing fear, horror, anger, guilt or shame; much less interest in activities previously enjoyed; feeling detached or estranged from others; or being unable to experience positive emotions (almost like a void of happiness or satisfaction).

4. Alterations in arousal and reactivity: Arousal and reactive symptoms may include being irritable and having angry outbursts; behaving reckless or self-destructive; being overly watchful of one's surroundings in a suspecting way; being easily startled; or having problems concentrating or sleeping.

It is possible for individuals to recognise these symptoms themselves. However, a formal diagnosis of PTSD can only be made by a qualified mental health professional, such as a psychiatrist or psychologist. These professionals are trained to assess and diagnose mental health conditions based on the symptoms, duration, and impact on daily functioning.

If someone suspects they may be experiencing PTSD, it is advisable to seek professional help. Early intervention and support can significantly improve the management and recovery from PTSD.

How can PTSD be prevented in a particular situation that may have a long-lasting effect on any individual?
Fernandes: Developing resilience prior to a traumatic event occurs via self-care, peer interaction and stress-management tactics, is an essential component to preventing PTSD. Seeking expert care as quickly as possible after a stressful experience may significantly decrease the likelihood of acquiring PTSD.

Dordi: While it is not possible to completely prevent the occurrence of PTSD after a traumatic event, there are certain measures that can be taken to potentially mitigate its impact and reduce the risk of developing the disorder. Here are some strategies:

1. Establish a strong support system: Having a supportive network of family, friends, or support groups can provide emotional comfort, understanding and a safe space for individuals to express their feelings and thoughts. This support system can contribute to resilience and coping mechanisms.

2. Seek professional help early: If someone has experienced a traumatic event and is struggling with distressing symptoms, it is important to seek professional help as early as possible. Mental health professionals can provide appropriate interventions and therapies that may reduce the likelihood of developing chronic PTSD.

3. Psychological first aid: In the immediate aftermath of a traumatic event, providing psychological first aid can be beneficial. This includes creating a safe environment, providing reassurance, actively listening, and offering practical support to those affected. Encouraging individuals to express their feelings and emotions without judgment can promote emotional processing and prevent the suppression of distressing experiences.

4. Education and awareness: Raising awareness about PTSD and its symptoms can help individuals recognize and understand their own reactions after a traumatic event. Education programmes that provide information about coping strategies, self-care, and available resources can empower individuals to seek help when needed.

5. Resilience-building activities: Engaging in activities that promote resilience and emotional well-being, such as regular exercise, relaxation techniques (e.g., deep breathing, meditation), maintaining a healthy lifestyle, and participating in hobbies or interests, can help individuals cope with stress and potentially reduce the impact of trauma.

Can PTSD be treated and can it not be reversed?
Fernandes: Cognitive-behavioural therapy, prescription drugs, as well as assistance groups are all viable options for the treatment of PTSD. The duration of recuperation differs from individual to individual, however prompt therapy might contribute to a speedier recovery.

Dordi: Yes, PTSD can be treated, and many individuals with the disorder experience significant improvement in their symptoms and overall well-being with appropriate treatment. The duration of treatment and the rate of recovery can vary depending on various factors, including the severity of the PTSD, individual circumstances and the effectiveness of the chosen treatment approach.

Psychotherapy, particularly trauma-focused therapies, is often the primary treatment for PTSD. Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) are two evidence-based therapies commonly used for PTSD. These therapies help individuals process the traumatic memories, challenge negative beliefs and develop effective coping strategies. In some cases, medications may be prescribed to help manage specific symptoms associated with PTSD, such as anxiety, depression, or sleep disturbances. Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed antidepressants that can be effective in treating PTSD. Peer support groups, support from family and friends and participation in support programmes specifically designed for trauma survivors can provide validation, understanding and a sense of belonging. These interventions can complement formal treatment and provide additional sources of support.

What are the challenges that a person with PTSD can face and how can they address it?
Fernandes: Someone suffering from PTSD may confront a number of difficulties, including trouble in interactions, feelings of isolation and, in extreme circumstances, dependency on drugs. Seeking professional treatment, forming a support network, and applying self-care habits are all beneficial with these issues.

Dordi: People with PTSD can face various challenges that can significantly impact their daily lives and overall well-being. Here are some common challenges experienced by individuals with PTSD and strategies to address them:

1. Avoidance behaviours: Individuals with PTSD may engage in avoidance behaviours to prevent triggers or reminders of the traumatic event. However, this can lead to isolation, limited functioning and reduced quality of life. Addressing avoidance can involve gradually facing feared situations with the support of a mental health professional, gradually exposing oneself to triggers, and learning effective coping strategies to manage distress.

2. Hyperarousal and anxiety: Hyper-arousal is a state of heightened anxiety, irritability and being constantly on guard. Techniques such as deep breathing exercises, mindfulness meditation, progressive muscle relaxation and grounding techniques can help manage anxiety and promote relaxation.

3. Negative thoughts and beliefs: PTSD can be accompanied by negative thoughts and beliefs about oneself, others and the world. Challenging and reframing these negative thoughts through cognitive restructuring techniques, as part of therapy or self-help, can promote more adaptive and positive thinking patterns.

4. Relationship difficulties: PTSD can strain relationships, as individuals may have difficulty expressing emotions, being emotionally available, or experiencing intimacy. Couples or family therapy can be beneficial in improving communication, understanding, and support within relationships.

5. Emotional regulation challenges: People with PTSD may struggle with regulating their emotions, leading to intense anger, irritability, or emotional numbing. Learning emotion regulation skills through therapy can help individuals identify and express their emotions in healthy ways.

6. Sleep disturbances: PTSD can disrupt sleep, leading to difficulties falling asleep, frequent nightmares, or restless nights. Practicing good sleep hygiene, establishing a relaxing bedtime routine, and seeking professional help for sleep disorders can promote better sleep.

7. Substance abuse: Some individuals with PTSD may turn to substances like alcohol or drugs as a way to cope with distressing symptoms. Addressing substance abuse issues through substance abuse treatment programmes or dual diagnosis treatment (simultaneous treatment for both PTSD and substance abuse) is important for long-term recovery.

Does the probability of PTSD increase with the kind of job a person does? (For example: Army personnel, doctors, journalists)
Fernandes: Due to the nature of their occupations, some professions, among them soldiers, firefighters, even reporters reporting horrific events, are prone to acquire PTSD.

Dordi: Certain professions can involve a higher risk of exposure to traumatic events, and therefore the probability of developing PTSD may be influenced by the nature of the job. However, it's important to note that not everyone in these professions will develop PTSD, and individuals' responses to trauma can vary. Professions that involve exposure to traumatic events or high levels of stress can potentially increase the risk of developing PTSD. Some examples include:

1. Military personnel: Military service members, particularly those deployed in combat zones, may experience traumatic events and combat-related stressors, which can increase the risk of developing PTSD.

2. First responders: Firefighters, police officers, and paramedics often face situations involving accidents, violence, and life-threatening emergencies, which can contribute to the development of PTSD.

3. Healthcare professionals: Doctors, nurses, and other healthcare workers may encounter traumatic situations, witness suffering, or be exposed to high levels of stress, especially in emergency departments or during disaster response.

4. Journalists and war correspondents: Professionals covering conflicts, disasters, or traumatic events as part of their job may be exposed to traumatic experiences and witness the aftermath of violence, which can potentially increase the risk of developing PTSD.

While these professions have a higher likelihood of exposure to traumatic events, it's important to recognise that not everyone in these fields will develop PTSD. Factors such as individual resilience, available support systems, and access to appropriate coping mechanisms can influence the outcome. Additionally, efforts are often made within these professions to provide training, support, and resources to minimise the impact of trauma exposure and promote psychological well-being.

9. Does eating any kind of food help in the treatment of PTSD?
Fernandes: While no single meal will cure PTSD, a diet that is well-rounded can assist in improving general wellness.

Dordi: While certain dietary factors may indirectly support overall mental health and well-being, there is no specific food or diet that can directly treat or cure PTSD. However, a healthy and balanced diet and proper hydration can contribute to overall physical and mental well-being, which can indirectly support individuals with PTSD.

Has the Covid-19 pandemic accelerated the possibility of PTSD in people?
Fernandes: The Covid-19 epidemic has raised the risk of PTSD in people owing to the possibility of trauma triggered by illness or the loss of loved ones, joblessness, and social isolation. It is critical to seek assistance if you or a loved one are experiencing symptoms of PTSD.

Dordi: The COVID-19 pandemic has had a significant impact on the mental health of individuals worldwide, and it has the potential to contribute to the development or exacerbation of mental health conditions, including PTSD. While not everyone who experiences the pandemic will develop PTSD, the widespread and prolonged nature of the crisis can increase the risk for some individuals. Here are some factors related to the pandemic that can potentially contribute to the development of PTSD:

1. Direct exposure to trauma: Some individuals may directly experience or witness traumatic events related to the pandemic, such as the death or serious illness of a loved one, medical emergencies, or experiencing the virus themselves. These traumatic experiences can increase the risk of developing PTSD.

2. Indirect exposure to trauma: Even if individuals themselves do not directly experience trauma, they may be indirectly exposed to distressing events through media coverage, witnessing the impact of the pandemic on others, or hearing about traumatic experiences from others. This can also contribute to the risk of developing PTSD.

3. High levels of stress and uncertainty: The pandemic has brought about significant stressors, including fear of illness, financial strain, loss of social connections, disruptions to daily routines, and uncertainty about the future. Prolonged exposure to these stressors can increase the risk of developing mental health conditions, including PTSD.

4. Isolation and social disconnection: Measures such as lockdowns, social distancing, and quarantine have led to increased feelings of isolation and reduced social support. Lack of social connection and support can have a negative impact on mental health and increase vulnerability to developing PTSD.

5. Pre-existing mental health conditions: Individuals who already have pre-existing mental health conditions, such as anxiety or depression, may be more susceptible to the effects of the pandemic and have an increased risk of developing or exacerbating PTSD.