What is post-traumatic stress disorder (PTSD)?

Years ago, some of the soldiers coming back from war were sometimes described as suffering from shell shock. We now know the same condition can affect anyone who’s been exposed in one way or another to a threatening or horrific event or events, not just those who’ve been to war. We also don’t call it shell shock any more. Nowadays it’s known as post-traumatic stress disorder (PTSD). 
 

What is PTSD?

PTSD is a mental health disorder – an anxiety disorder, says the NHS (i) – that can cause significant problems in almost all areas of your life. For instance, having PTSD can lead to relationship difficulties and breakdowns as well as work-related problems. It can also affect your family, social and educational functioning.

 
PTSD affects one to 12 per cent of populations around the world (ii). Here in the UK, the most up-to-date figures from the Adult Psychiatric Morbidity Survey of Mental Health and Wellbeing in England 2014 suggest 3.7 per cent of men and 5.1 per cent of women were experiencing PTSD, with women aged 16 - 24 the most likely to screen positive (only in the 55 - 64 age group were men more likely to screen positive than women) (ii).     Meanwhile, according to Patient UK, up to three per cent of adults have PTSD at any one time (iii).

 

PTSD symptoms

Many people experience traumatic events – experts from the Royal College of Psychiatry claim a third of adults in England are affected by at least one traumatic event during their lifetime (iv). But not everyone who experiences a traumatic event goes on to develop PTSD. 
 

What are the symptoms of PTSD?

After a traumatic experience, it’s normal to have reactions such as fear, grief, anxiety, anger and guilt, especially straight after the event. This is called an acute stress reaction. For most people, the distress gradually gets better in time, usually within a month or two. One in three, however, develop symptoms that last longer (v). If you’ve experienced a traumatic event and any of the following symptoms are having a persistent and significant impact on your day-to-day life and/or are making you feel extremely distressed, you may have developed PTSD:
 

PTSD flashbacks (Re-experiencing)

The most typical symptom of PTSD is called re-experiencing. This can cause things like:
 

• Flashbacks where you feel as if the event is happening again (flashbacks are also called dissociative reactions)

• Dreams and nightmares about the event

• Intrusive thoughts and memories of the event

• Physical reactions such as a rapid pulse and breathing very quickly, particularly when you’re reminded of the event

 

PTSD avoidance 

These symptoms include being unable to remember parts of what happened (dissociative amnesia) as well as:
 

• Detachment (when you avoid spending time with people or places who remind you of the trauma)

• Avoiding talking about the event or even thinking about it

• Trying not to feel anything at all (emotional numbing)

 

Hypervigilance symptoms 

Some people with PTSD find it hard to relax because they’re very anxious and constantly aware of what’s going on around them, this is sometimes called hyperarousal. Other hyperarousal symptoms that could be signs of PTSD include:      :
 

• Concentration difficulties

• Sleep difficulties (including having nightmares) 

• Anger, irritability and aggressiveness

• Overreacting to sudden sounds or movements

• Dangerous or self-destructive behaviours (eg. alcohol or drug misuse)

 

PTSD mood swings 

PTSD can affect your mood in a number of ways, causing the following:
 

• Thinking negatively about yourself as well as other people

• Negative emotions (fear, anger, guilt, shame or horror)

• Inability to experience positive thoughts and emotions

• Self-blame or blaming others for the traumatic event

• Lack of interest in things you used to enjoy previously

 

PTSD complications

Many people with PTSD can develop other problems. Some experience mental health disorders such as depression, anxiety, panic attacks and phobias, and are also more likely to abuse drugs or alcohol. PTSD complications also include general health conditions including muscle and joint pain, headaches, dizziness, gastrointestinal problems and chest pains. There is also evidence of a link between PTSD and cardiovascular disease in older people (viii). 
 

PTSD symptoms in women and men 

While both sexes can experience the whole spectrum of PTSD symptoms, a number of studies have suggested that the response to stress can present differently depending on sex. For example, often men with PTSD experience more externalising symptoms such as hyperarousal, aggressiveness, and risk-taking behaviours, while women are more likely to experience internalising symptoms such as sadness, loss of pleasure, and social difficulties.
 

PTSD in children 

Meanwhile, children with PTSD can have similar symptoms as adults, with symptoms in children also including behavioural difficulties and re-enacting the traumatic event over and over during play. 
 

What is complex PTSD?

Complex PTSD (sometimes abbreviated as ‘c-PTSD’) is a type of PTSD diagnosed in people who develop symptoms after experiencing repeated or prolonged traumatic situations – often where escape is difficult or impossible – such as torture, sex trafficking, slavery, war, prolonged domestic violence, childhood sexual or physical abuse or neglect.       
 

What are the symptoms of complex PTSD?

Symptoms of complex PTSD are similar to those of PTSD but may also include others, including:
 

• Feelings of worthlessness or guilt 

• Not being able to regulate your emotions

• Having difficulties connecting with other people and keeping relationships

 
People with complex PTSD are usually treated in a similar way to those with PTSD, but additional treatments may also be necessary. 
 

What triggers PTSD?

Anyone who witnesses a severe traumatic event is at risk of developing PTSD. Examples of traumatic events include:
 

• Seeing someone killed

• Physical or sexual assault

• Serious health problems

• Childhood or domestic abuse

• Serious accidents

• Childbirth traumas (such as losing a baby)

• Bereavement

• Torture 

• Wars and other military or violent conflicts

 
However, why PTSD develops in some people and not others isn’t clear. There are a few different theories why PTSD happens:
 

• Survival instinct   Some people may instinctively develop PTSD symptoms to help protect themselves should they have another traumatic experience. Flashbacks, for instance, may develop to teach you what to do if the same thing happens to you again.  

• High adrenaline   According to the NHS, studies suggest people with PTSD have abnormally high levels of stress hormones such as adrenaline (vii), which may explain why they experience at least some of the symptoms.  

• Brain changes   Brain scans have shown that emotional processing can be different for some people with PTSD, as part of the brain called the hippocampus that’s involved in processing memories is smaller than usual (and therefore not working properly). 

 

Who’s at risk of developing PTSD?

Anyone is at risk of developing PTSD if they experience a traumatic event, but some have a higher risk of being affected than others, including:
 

• Rape victims

• Police, firefighters, ambulance workers and other emergency service staff

• Social workers

• Hospital staff who work in intensive care units 

• People working in war zones (eg. members of the armed forces)

• Prisoners of war

• Refugees and asylum seekers 

• People with a history of mental illness

 
Meanwhile, certain other factors can make your risk of developing PTSD higher than that of others, including:
 

• Being female

• Coming from a poor background

• Coming from an ethnic minority

• Having a history of mental illness or mental illness in your family

• Low education status 

• Low social support

• Having experienced a traumatic event in the past

 

How long after trauma does PTSD start?

According to the NHS, in most cases, PTSD symptoms develop during the first month after a traumatic event, though some people can start having symptoms months or even years afterwards (vi). For some, the symptoms are constant. Others, however, may have times when their symptoms are less noticeable combined with periods when they get worse. If the symptoms are left untreated, however, they can last for many years. 
 

What are PTSD treatments?

If you’re diagnosed with PTSD – usually when you’ve had symptoms for more than four weeks or if your symptoms are severe – you may be treated by your GP or another health professional such as a psychologist, psychological therapist, community psychiatric nurse or psychiatrist.
 
If you’ve been having symptoms for less than a month, or your symptoms are very mild, you may not need any treatment at all to begin with. Instead, your symptoms may be monitored carefully to see if they become better or worse – this is called active monitoring. If your symptoms do get worse or don’t improve after four weeks or so, there are two main types of treatment you may be offered: talking therapy or medication.
 

PTSD therapy 

Talking therapies are usually the first type of treatment your doctor or specialist will recommend to treat PTSD. These include cognitive behavioural therapy (CBT), which aims to help you change how you think and act in order to manage your problems better. People with PTSD are usually offered trauma-focused CBT, during which you may have to describe your traumatic experience to learn how to cope with how you feel. This is also the type of treatment offered to children and young people with PTSD.
 

EDMR therapy

Another type of therapy used to treat PTSD is called eye movement desensitisation and reprocessing (EMDR). It’s not clear how this method works, but it aims to help you change the negative thoughts you have about your traumatic experience. There are several techniques used to achieve this, including talking about your traumatic experience while moving your eyes (by following your therapist’s finger, for instance).
 

PTSD medication

The two main medicines recommended to treat PTSD are both types of antidepressants called selective serotonin reuptake inhibitors (SSRIs). They are only used in certain circumstances, however, including when someone with PTSD decides not to take part in talking therapies, if they’ve tried talking therapies but are still experiencing symptoms and if they have another medical condition that makes talking therapies less effective.
 
Meanwhile, according to Patient UK, combining an SSRI antidepressant with a talking therapy such as CBT may work better for some people than being treated with one or the other on its own (v).
 
SSRIs for PTSD are usually prescribed for at least a year. They can however cause side effects, which your doctor will make you aware of, as well as withdrawal symptoms if they’re stopped suddenly (this is why experts recommend that these medicines are reduced and stopped gradually).
 
Anti-anxiety medicines can also sometimes be prescribed in the short term for people who are struggling with anxiety, irritability and sleep problems.
 

Self help for PTSD 

If you’re being treated for PTSD there are also other things you can do to help yourself manage your symptoms as well as support your recovery. Some of the things you can do include the following:
 

• Stick to a routine if you can, as making your life as normal as possible can help make you feel more grounded. Going back to work, school or college/university is one way to get a sense of routine – but only do so if you feel you can cope.

• If you can, talk about your experiences with someone you trust – if possible someone you know who has had a similar experience.

• Be aware of your triggers – for instance, these may be people, sights, sounds, smells or places that trigger symptoms such as flashbacks. If you know certain things remind you about your traumatic event, it could help you to plan for times and situations when you may be around them.

• Look after yourself by eating regularly – even when you don’t feel that hungry  – and by staying as active as you can (this can also help if you’re having problems sleeping).

• Find time to relax – try a variety of relaxation techniques and stick to one or two that you enjoy. Anything from meditation to absorbing hobbies can be helpful.

• Don’t expect to feel better immediately. Recovery can take time – just keep reminding yourself that you will get better eventually.

• Try to socialise as much as possible. If you’re on your own too much, it can make you feel isolated. Spending time with others may help give you a sense of being supported.

• Whenever possible avoid alcohol, caffeine and nicotine, all of which may make you feel better in the short term but can make your symptoms worse in the long term. There’s more information you may find helpful in our guide to alcohol misuse and giving up smoking. 

• Establish a sleep routine and try to stick to it – this can be especially helpful if you’re struggling with sleep issues. Try, for instance, to go to bed at the same time every night and get up at the same time every morning (even when your schedule allows you to stay up and get up later). For more tips on getting a better night’s sleep, read our guide to sleep and insomnia. 

• Spend time in nature as often as you can, as being outdoors in a natural, green space may be good for your overall wellbeing.

 

Vitamins for mental health support 

Making sure your diet is as healthy and balanced as possible can give your health an overall boost, which may help support you as you recover from PTSD or any other mental health condition. Certain nutrients may also be useful, either in food or supplement form. Some of these include:
 

Multivitamin and mineral  

 
Even when think you’re eating reasonably healthily you may still be missing out on certain nutrients that can be beneficial if you’re experiencing stress on any level. To make sure you’re getting all the essential nutrients your body needs, try supplementing your diet with a good-quality multivitamin and mineral. Some studies even suggest taking a multi could help you cope better with stressful situations (ix) – which could be helpful if you have PTSD. Research elsewhere has found taking multivitamins may help boost your mood and your feelings of wellbeing (x).
 

B Complex  

 
It’s well known that they’re essential for your overall health, but B vitamins may be useful for combating stress too. A review of clinical trials, for instance, has found B vitamins have benefits for both healthy people and those who have a high risk for problems with stress (xi). B complex supplements typically contain all of the B vitamins, but you can also get these from foods such as eggs, leafy green vegetables, wholegrains, meat, dairy foods and legumes.
 

Vitamin D

 
Probably best known for its role in a healthy immune system and for helping your body absorb calcium, vitamin D has also been associated with PTSD – for instance, one study suggests PTSD may be linked to having reduced vitamin D levels and vitamin D deficiency (xii). Another study found 62 per cent of participants with PTSD were deficient in vitamin D (xiii).
 
Unfortunately, many people living in northern hemisphere countries like the UK are thought to be at risk of vitamin D deficiency, especially during the autumn and winter, as our main source of vitamin D is sunlight exposure. This is why the UK government’s Department of Health and Social Care advises everyone considers taking a daily supplement containing 10 micrograms of vitamin D during the autumn and winter (xiv).
 
Those who are also at high risk of not getting enough vitamin D during the spring and summer, however, are advised to take vitamin D all year round. People with dark skin may also not make enough vitamin D from sunlight and are also advised to consider taking a supplement throughout the year.
 
The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D that your skin makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans – but thankfully vegan vitamin D3 supplements sourced from lichen are now more widely available.

Taking a vitamin D supplement is considered important because it may not be easy to get all you need from your diet (food sources include oily fish, liver, egg yolks, red meat and fortified foods).
 

Vitamin C 

 
A water-soluble vitamin with antioxidant properties, vitamin C may help if you’re feeling stressed or anxious. In one study, participants with anxiety – in this case high school students – took vitamin C supplements, with results suggesting the nutrient may well help reduce stress and anxiety levels (xv). One of the reasons this may happen is that vitamin C’s antioxidant properties may help control cortisol levels in the body (cortisol is a stress hormone). There’s a wide range of vitamin C supplements available, plus you can get it in many foods such as citrus fruit, berries, broccoli, red and green peppers, grapefruit and potatoes.
 

Vitamin E  

 
Studies looking at vitamin E and its role in preventing PTSD are limited and involve animals rather than humans, which make them less robust than human studies. But like vitamin C, vitamin E also has antioxidant properties, so it too may help keep cortisol levels down. Studies meanwhile suggest there’s a link between PTSD and oxidative stress – a process that produces cellular damage caused by an imbalance of antioxidant and free radicals (oxidants) in the body (xvi). If this is indeed the case, taking vitamin E supplements (as well as other antioxidants) may help by redressing that balance. You can also increase your vitamin E levels by eating more nuts, seeds, avocados, asparagus, red peppers, wheatgerm and sunflower oil.
 

Magnesium  

 
An essential mineral needed for a wide range of functions in the body, magnesium is found in foods such as nuts, seeds, fish and green leafy veg. Experts have discovered links between low magnesium intake and high stress levels, plus there’s some evidence your body’s level of magnesium may be low when you’re under a lot of stress (xvii). If you’re thinking of trying a supplement, look for a form that’s well absorbed by the body such as magnesium citrate.
 

Zinc  

 
Stress is also thought to deplete your body’s zinc reserves, so it may be a good idea to make sure you’re eating plenty of zinc-rich foods – such as nuts, seeds, beans, eggs, meat, eggs and wheatgerm – or take a zinc supplement (zinc in its citrate form is a good choice as it is easily absorbed).
 

Omega 3      

 
The omega-3 fatty acids found in oily fish such as salmon, sardines, mackerel, herring and fresh tuna may help you cope with stress too, with studies suggesting omega-3s may help the body manage stress more effectively (xviii).
 
These days even vegetarians and vegans can enjoy the benefits of omega-3 fatty acids found in fish, as supplements containing omega-3s sourced from marine algae are now more widely available.
 

Valerian root  

 
This herbal remedy has a history of traditional use for mild anxiety, and there is some evidence valerian may help keep you feeling calm in stressful situations (xix). Indeed, according to the charity PTSD UK, valerian root is thought to be one of the best teas for calming down (xx). You can of course make tea from the dried herb, but valerian is also available in supplement form.
 

Theanine  

 
Found almost exclusively in green, black, oolong and pekoe tea, theanine is a non-protein amino acid that’s thought to help your brain produce calming alpha waves. Studies suggest taking a theanine supplement may help you feel more relaxed without making you drowsy (xxi).
 

Lemon balm  

 
Tea made from the herb lemon balm is also often used to help aid relaxation. Small-scale studies have also found it may help to reduce anxiety levels (xxii), plus there’s evidence that combining lemon balm with valerian could help if your anxiety is contributing to increased stress levels (xxiii). If you don’t fancy lemon balm tea, supplements are available.
 

5-HTP  

 
This amino acid is often used as a natural remedy for depression and low mood as it’s thought to help increase the body’s production of the hormone serotonin. 5-HTP has also been studied to find out if it could help people with anxiety disorders, with results suggesting it may well be effective (xxiv).
 

St John’s wort  

 
Another herbal remedy, St John’s wort is used for the relief of slightly low mood and mild anxiety based on traditional use only. It may be useful if you’re experiencing depression alongside PTSD, as there’s some evidence it may be more effective than a placebo at treating mild to moderate depression (xxv), with studies suggesting it’s as effective as some popular prescription antidepressants (xxvi).
 
Take care, however, if you’re taking St John’s wort alongside other medication, as it can affect medicines including the oral contraceptive pill (ask a pharmacist for details if you’re not sure).

 

Want to know more about PTSD?

Some of the charities and other organisations that offer further advice and support to those with PTSD include:

• PTSD UK

• Combat Stress (specialising in helping ex-servicemen and women)

• Rape Crisis

• Victim Support

• CRUSE (for people who have experienced bereavement)

• Anxiety UK

• Birth Trauma Association

• The National Association for People Abused in Childhood (NAPAC)

• Help for adult Victims of Child Abuse (HAVOCA) 

• Meanwhile, if you need information about a variety of other health conditions, visit our pharmacy health library. 

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 
 

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