PTSD – A Simple Guide

Post Traumatic Stress Disorder [PTSD] is a mental health condition triggered by a shocking, dangerous or terrifying event – either having directly experienced it, or having been witness to it.

Experiencing fear is a natural response during and after a traumatic event designed to ultimately protect us from harm in dangerous situations, often requiring split second life and death decisions.

Nearly everyone will experience some form of reaction to trauma. For most people these reactions will be temporary and recovery from the effects of trauma is a natural process that can be resolved with a little help and self-care fairly quickly.

For some people, the initial reactions to a traumatic event will persist with symptoms that may get worse and interfere with day-to-day functioning. These people may have PTSD.

It is important to note that PTSD is a fairly common condition for which there is wide range of help available from suitably trained professionals with great success in treatment of this disorder. Too often it is the case that some people will allow the symptoms to get worse and not seek help because of a perception of stigma associated with seeking help for a mental illness.

Experience has shown that the earlier the symptoms are recognised, diagnosed and suitable treatment starts, the earlier people can start to get better and the shorten their recovery times.

Our understanding of PTSD and the way it affects people’s lives has improved greatly through research and treatment experience so that PTSD is no longer the invisible illness as it has been perceived for so long.

Around the world military and emergency service organisations have been very proactive in identifying opportunities for preventative measures, building resilience and early identification and intervention for their staff because they are much more likely to be exposed to the possibility of trauma.

There is no need for you, or a loved one,
to suffer in silence any longer.

What are the PTSD risk factors ?

Anyone can develop PTSD in response to a traumatic event, which can include events such as war, disaster, physical violence, sexual abuse and accidents (any event in which a person was in danger or feared for their safety). War veterans, for example, have a much higher incidence of PTSD because of their higher exposure to traumatic events when deployed to war zones.

Trauma is not limited to experiencing personal danger and in some cases can also be the result of witnessing traumatic events or from personal loss.

Other factors that have been found to influence the likelihood of developing PTSD as previous loss and danger, childhood experiences, and a genetic predisposition to susceptibility for developing PTSD.

Historically females have generally shown to be more likely to develop PTSD than men, but this may now be changing because of increased awareness of PTSD in general and a concerted effort to remove the stigma associated with seek help for mental illness.

Is PTSD increasing in prevalence ?

PTSD as an identified mental illness has increased in the last decade and there are 3 major reasons for this.

One of the major drivers of the incidence of PTSD as a mental illness amongst the general population is increased exposure to traumatic events. Increased incidence (and reporting) of violent crime, sexual abuse, road accidents and terror related activities all lead to increased exposure to trauma events. Military in particular have experienced greatly increased exposure to trauma but the same can be said of our other emergency services.

Another is the increased awareness of PTSD and its symptoms. In the past the stigma associated to mental illness has meant many people with PTSD in the past suffered in silence and their illness remained undiagnosed. As their inability to cope started showing up in other symptoms including violence, substance abuse, self harm, anxiety and depression the underlying PTSD sometimes remained undiagnosed for many years,

Finally a reclassification of PTSD within the diagnostic standards used by the medical community to identify and classify mental illness means a we now have a better ability to diagnose PTSD more precisely. This increased precision in classification will naturally affect PTSD statistics.

Figures vary between sources but generally between 3%-5% of Australians are suffering from PTSD at any time, and between 7%-12% with suffer from PTSD during their lifetime. Incidence with military and emergency response staff are much higher because they are more at risk with a higher risk exposure to trauma events.

5%, or even 3%, is not an insignificant number of people and the severity of PTSD symptoms will vary individually. It is not uncommon for PTSD to present with a number of other contributing mental illnesses such as depression, anxiety, drug and alcohol abuse and the likelihood of this increases with time.

What symptoms to look for ?

Generally people who are exposed to a trauma will experience reactions and changes in their life immediately following the traumatic event and in most cases these responses will resolve themselves quickly.

Not everybody will develop on going (chronic) PTSD or short term (acute) PTSD.

PTSD symptoms usually begin early (within 3 months of the trauma) but sometimes it can be years afterwards.

It is important to seek medical advice whenever the symptoms below are present so that your treating doctor is aware of the onset and severity of the symptoms and make appropriate recommendations to help relieve the condition.

Each person will experience symptoms, emotional and physical reactions differently however the symptoms to look out for can be separated into 4 main categories.

1. Re-experiencing the traumatic event.

These are called intrusive memories and include such things as flashbacks [reliving the trauma as if it was happening again], dreams/nightmares about the trauma, emotional distress [severe reactions to things that remind of the trauma].

This can also include physical reactions such as a racing heart, rapid breathing, sweating and nausea.

2. Avoidance of remembering the trauma.

It is natural not to want to be reminded of the harrowing experience. These symptoms are about trying to purposefully avoid anything that will remind the person of the trauma.

This can include avoiding to think about the event; not wanting to talk about the trauma; avoiding places, people and activities that will trigger memories; and anything that evokes the same emotions that are associated with the trauma.

3. Feeling negative and emotionally numb.

PTSD sufferers can experience a general feeling of emptiness, alienation and detachment from family and friends; negative thoughts about self and surroundings (guilt, blame, hopelessness); and a lack of interest in the things that were once enjoyed.

It can also include difficulty experiencing happiness and positive emotions, and a shut down of memory, exhibiting a difficulty to recall important aspects of the trauma.

4. Being overly alert and reactive.

Hyper vigilance; a persistent sense of impending danger; and being overly cautious are common symptoms of PTSD, as are being easily startled; and a tendency for over reacting or exhibiting angry out-bursts.

Irritability, aggressive behaviour, trouble concentrating, disrupted sleep patterns and overwhelming feelings of guilt and shame are also common.

In Summary.

Diagnosis of PTSD requires the existence of a number of these symptoms for a period longer than 4 weeks, but can also be for shorter periods if the symptoms are having a severe affect a persons ability to work or study; or make is difficult to maintain personal and social relationships.

To further complicate matters, it is not unusual for people with PTSD to also suffer from other types of mental illness such as anxiety, depression and substance abuse, which can be a direct result of the trauma, or may have developed subsequent to the trauma.

What to do if you have PTSD symptoms.

Understanding that PTSD can have a devastating effect on your health and your relationships with the people in your life will improve you ability find remedy. Not every case of PTSD can exhibit extreme examples of the symptoms that we have outlined above, but if left untreated this illness can get progressively worse.

It is important to maintain an open mind and to find out as much as you can about PTSD, but it is just as important to be able to feel confident about talking with someone who understands and can point you in the right direction.

The first step is to speak to your doctor who can give you the best advice. If you need to find a doctor with experience in PTSD, MediBrain can help with some suggestions in the south eastern Melbourne area.

There are also many organisations that have been established to assist PTSD sufferers both on line and through peer assistance. A simple search in PTSD in Google will reveal 35 million hits with the first page normally showing the organisations in your area that are equipped to assist you.

An important word on the subject of self-harm.

An unfortunate part of a mental illness such as PTSD is for some people in their despair and suffering to consider self harm and have suicidal thoughts.

Coping on your own under such circumstances is tough, so it is important to reach out for help if any such thoughts enter your mind.

Talking about your feelings with someone who is there to listen, understand and guide you through such a tough time is very important.

If you or anyone you know is considering self harm in Australia you should call Lifeline 13 11 14   or Emergency Services 000.  If you are reading this overseas, each country has help lines than can help you.

How to help someone suffering with PTSD.

1. Learn as much as you can About PTSD.

It is of paramount importance to try to understand how they are suffering and what they are going through.

Today there are many sources available to help understand the symptoms of PTSD, the treatment options available and the consequences of leaving PTSD untreated.

Knowing what to expect will prepare you with an appreciation of why they are behaving this way and that they may not be have tools to be able to help themselves.

By being armed with the knowledge and with care, you will be able to talk about the problem in an empathetic way that encourages treatment. If you are not in a position to diffuse potential flashpoints, at will at least know how not to contribute to inflaming them.

2. Understand our help is important… But it’s not enough.

 Being supportive is so very important and there are many ways you can help, but it is important to also recognise that PTSD is a complex mental illness that needs professional help. It is not something your love and care alone can remedy.

You can help by removing some of the stresses of life and providing an uncomplicated environment as far as it is possible.

One of the easiest ways is to become a good listener and by being available to understanding but not to try to give any directive advice. Never push a person with PTSD to talk about the trauma because they may not be yet ready to relive the event.

3. Provide Social Support.

People with PTSD have a tendency to withdraw from friends and family.

Try to understand why they feel that way. It may be they feel no one understands them; or ashamed or fear they may lose control; or do not want to be pitied or judged; or that they may not want to be a burden on their loved ones.

By understanding how they feel you can assist in building some social bridges.

Create a sense of safety and being close by when you are needed and find opportunities to share love from family and friends. There is a fine balance between respecting personal boundaries and gently encouraging the therapeutic benefits of social contact.

4. Be Prepared.

It is important to learn how to anticipate situations that might trigger the original trauma to seem real again.

Once you learn the triggers you can also learn to avoid them and to understand that you will not be able to avoid them all of the time.

Expect PTSD sufferers to occasionally experience flashbacks, panic attacks and nightmares and be prepared to make the situation less painful.

Work with them to have a plan in place with what may work when they need grounding in times of distress. Sometimes it is as simple as letting them know they are experiencing a panic attack, and that it will pass… perhaps you can encourage them to breathe deeply and focus elsewhere.

5. Encourage Treatment.

It can be very difficult to discuss treatment when someone suffering with PTSD steadfastly refuses. Don’t push the issue without expecting some push back.

It may be good to change the focus from comprehensive treatment to the specific benefits of smaller issues like dealing with anxiety, improving concentration or anger management.

Acknowledging their apprehension towards treatment will allow you to pick your timing carefully. For example, it is never a good idea to start a conversation about treatment in the middle of an argument or a panic attack.

6. Make Time for Yourself.

It is most important that you find a way to take care of yourself.

Caring for someone with PTSD will take a lot out of you and if your own health is affected, it is unlikely you will be of any help to either yourself or your family.

Support groups and help forums are a good place to refocus on striking the right balance between helping yourself and helping the person you are caring for.

MediBrain PTSD Research Program

The Melbourne MediBrain Centre has had significant experience and expertise in the proper diagnosis and treatment of PTSD.

We have a highly specific skill set in assisting people suffering with PTSD and specifically those from high risk careers such as Military, Police and Emergency Services.

This year we are working with the International Institute of Psycho Pharmacology to research the importance of triage for people from a Military background showing signs of suffering from PTSD.

We believe that Veterans and serving ADF personnel can greatly benefit when people with training in Military related PTSD are included at the very beginning of diagnosis and treatment, and that such expertise can be of immense value in formulating a treatment plan that takes into account that expertise.

Our research will also identify the type of training treating practitioners would find useful to provide the best standards of support.

If you would like to find out more about this program we would be happy to provide a more detailed understanding about the research parameters.

5 Proven Ways To Help Improve Happiness

 

OK, we’ve all heard the song…Don’t worry, be happy… but when we are feeling down, the last thing that we need is someone telling us to cheer up.

Like … ‘Yeah, thanks mate… why didn’t I think of that ?’

Don’t get upset… these people care, which is why they are trying to help…. most people have great intentions, but they don’t have the tools to help…maybe because the nature of being down is different for everyone…and sometimes even different for the same person … at different times.

It would probably be better if they just said:

“Look, I can see you are going through some tough times.
I’m here to help in any way I can… you can lean on me…any time.”

Knowing you have someone to reach out to is always comforting, even if you never end up reaching out to them. I don’t pretend to have the answers … but here are few techniques that have proven to improve happiness in people who have applied them diligently.

1. Be Kind To Yourself

I know that at times we can be our own worst critics… just as there are times when real self evaluation is important. But it is important to recognise how negative self talk impacts on our wellbeing. When we are down… our thoughts generally gravitate towards thoughts that are unkind towards ourselves …and we all know how detrimental that can be to our state of happiness.

What we don’t want is to develop an endless cycle of down…we also need some up thoughts to balance things out. Practice positive internal dialogue. Stop any negative or violent self talk as soon as they start.

It is important to maintain a healthy kindness balance by immediately changing negative internal dialogue to positive internal dialogue. Pay attention to your internal tone and catch yourself at the beginning of unkind thoughts and reframe them as positive thoughts.

I sometimes find it is useful to start a Kindness Journal … where you make note of all your positive thoughts….the physical act of writing them down has a very positive effect on how your brain rewires positive self worth … and serves as a ready reminder when finding positive thoughts are difficult to access.

2. Be Kind to Others

Many of us have perfected sarcasm to an art form… and for most of us there have been times when we found the need to manipulate others to achieve particular outcomes. It is part of human nature … but it is important to recognise that this behaviour can easily become toxic…toxic for relationships … and toxic for our own happiness.

It is important to practice noticing when we being too negative and unkind toward others. Again internal dialogue is an important source for identifying the impetus of toxic behaviour towards others.. and a change of position is required.

Practice having kind thoughts and positive internal dialogue toward others …and practice intervening any toxic behaviour toward others as soon as it is noticed.

It will have a positive impact on relationships … but also improve your relationship with yourself.

3. Be Happy For Others

When we see others being happy, successful … or trying change for the better… be happy for them. In your mind, congratulate them…recognise that they a being proactive…smile with them.

The old adage of ‘if you want to be happier, surround yourself with happy people’…actually does work.. if we share in their happiness.

The latest studies in neuroplasticity (the ability for the brain to rewire itself to adapt to changing needs) have shown that our brains are constantly rewiring themselves…making new neural pathways…and the reorganisation that takes place in the brain is heavily influenced by positive and negative mind-states.

Practice positive internal dialogues when you notice happiness around you.

  • When you see someone jogging feel good for them that they are being proactive with their health.
  • When you notice someone is changing their diet to Paleo, Gluten Free or Vegan, acknowledge that they trying to change because they want to feel better.
  • When someone has had a major success in work, business or personal relationship, smile and enjoy their success.
Seeing the good and positive in things takes practice … it can be difficult… but it does have a very powerful positive impact on your own mind-state … and will improve your happiness as well.

4. Relax To The Max

Achieving a relaxed state is something you can learn.

Some people breathe to 10… others meditate…others take a walk, do yoga, tai chi, …others practice mindfulness. Learning to relax is quick.. and its easy… but it does take some practice.

Trying to wind down when you are wound up it very hard… so it is not the best time to practice relaxing. It is very important to find a way to de-stress the nervous system that works for you..

Consistency is the key to succeeding. A little time spent de-stressing the nervous system each day…as little as 5 minutes a day.. will build resilience and resistance to stress build up.

As a start I found that linking relaxation practice to your existing routines works really well… as they can trigger to practice relaxation.

  • Practice mindfulness while brushing your teeth
  • Practice breathing while waiting for the kettle to boil
  • Find ‘me time’ by getting out of the lift 2 floors earlier or disembarking the tram one or two stops earlier

Finding productive ‘me time’ is the key to successful relaxing of the nervous system.

Even students who study 30 minutes followed by 30 minutes ‘me time’ have shown higher mental resilience, memory capacity, alertness and retention than those who study much more intensely with shorter breaks.

5. Where’s Good ?

Seeing the good in situations is critically important to being happy. There is good everywhere… from little thing like someone giving up a seat to someone who is expecting … new cures for illnesses… videos of cats playing the piano.

Sometimes it difficult to see the good … when your mind is expecting to see bad things… and there a plenty of negatives to choose from. When your mind is tuned to seeing negative things … there will always be plenty of negatives to take notice of.

We can learn to filter out the negatives … and look for the positives. This will have an enormous impact on your mind-state.

So Where Do I Start ?

Well that all depends on you… but there is no specific order. ……
Yoda from Star Wars would say,

‘Start somewhere you must’

Start now… today … right now….

Start with this article… Make a decision…It is either a bunch of hogwash … or an insight for you to consider taking some control on how you view things.

Try it out for a while.

Pick one method …pick two … or pick them all. Give it a week… and see if there is any change in your happiness level. You will be able to tell if there is a change.

It won’t happen over night .. but it will happen.

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5 Myths About Adult ADHD


In September our medical director Dr Natalie Krapivensky spoke at the Melbourne Medibrain Centre to a group of Melbourne GPs on the topic of Adult ADHD.  Our workshops are designed to provide GPs with direct access to leading Melbourne Psychiatrists in an open discussion forum to assist in the development of best practice in medical care for patients with mental illness.  With the significant interest in Adult ADHD, here is an article on the topic in and easy to use format that you can share with anyone interested in Adult ADHD.

Myth #1: ADHD Is Just Another Name For Bad Parenting

We often associate ADHD with undisciplined children who are fidgety, ill-mannered and show an inability to listen …or to do as they are told. They refuse to concentrate on simple tasks. Often it is simply considered to be just a case of bad parenting.

Fact: ADHD is a complex disorder of the brain’s management system and exhibits symptoms of inattention, hyperactivity, impulsivity and significantly interferes with functioning and development.

People suffering with ADHD exhibit impairment in focus, organisation, motivation, emotional modulation and memory.

ADHD is essentially problem of the chemistry which controls the brains’ management system. DSM-5 is the standardised diagnostic manual used by Psychiatrists and GPs in Australia to identify mental disorders so they can appropriately apply treatments for their patients.

A detailed DSM-5 diagnostic description of ADHD can be found here. http://bit.ly/ADHDDef

Myth #2: Only Children Suffer From ADHD

People suffer from ADHD throughout their lives. It is a natural misconception that only children suffer from ADHD because we first notice the symptoms of ADHD in children. At first most people consider ADHD to be a problem of children who simply refuse to sit still and are unwilling to listen… but as awareness of ADHD has increased within communities … acceptance of ADHD as an illness is now all but universal … but we still feel it is something that affects only children.

As patients became older, with the application of appropriate treatment and behavior management strategies, the symptoms of ADHD became less obvious … and importantly …they had less of a disruptive impact on surrounding environments. Management strategies and medication are designed to restore function and social behavior and as a result of successful treatment … symptoms became less obvious … so we tend not see ADHD as an illness afflicting adults.

Fact: ADHD is a complex and chronic disorder which requires life long treatment.

Underactivity of the brains management system is typical of people suffering from ADHD and if left untreated, can cause more serious problems with learning, relationships and development, which can further develop into more serious mental disorders such as chronic depression, anxiety or substance abuse. In many cases adult ADHD sufferers have struggled all of their lives with undiagnosed childhood ADHD which has manifested in adult life as a complex combination of mental disorders.

Adults suffering from ADHD are 6 times more likely to also suffer from another mental illness.

Myth #3: Only Males Suffer ADHD

Again this belief stems from the times that we first recognise the symptoms of ADHD… and while it may be true that boys are twice as likely to be diagnosed with ADHD … girls are just as likely to suffer from ADHD.

Fact: The medical incidence of ADHD is equal among males and females.

This leads us to the conclusion, that females are more likely to suffer with undiagnosed ADHD. Left undiagnosed, ADHD can have a devastating impairment affect on adult mental health. The reason for non-diagnosis of ADHD can stem from a range of factors, including gender specific behavior norms, severity of presented symptoms and socioeconomic considerations.

If girls sit quietly and ‘daydream’ they will draw less attention to themselves than boys misbehaving disruptively. According to DSM-5 ADHD can exhibit inattentiveness, hyperactivity … or both.

Myth #4: Certain Foods Trigger ADHD Hyperactivity

Most of us have heard that red cordial can trigger hyperactivity in kids, but is there any proof that certain food additives can trigger ADHD symptoms?   ADHD has been the subject of much research over the last 30 years and while successful treatments have been identified and well researched, much of the research points to a hereditary predisposition to ADHD.

Fact: There is no conclusive evidence to show any causal relationship between food coloring additives and ADHD.

However, is this the best way to look at this issue ?  If these is no conclusive evidence that food additives can cause ADHD,  does this also mean the opposite is true ?  Does it for example prove that food additives do NOT contribute to ADHD?

Certainly not. There is renewed interest in this subject matter and at best we can say that the findings are so far inconclusive.  It is worth mentioning here that the EU have mandated warning statements on labeling for foods containing artificial food colorings, and certain manufacturers have removed artificial colorings from their products altogether..

There is no direct scientific evidence that any specific dietary behavior can help cure ADHD but recent studies have found a strong relationship between gut bacteria and brain function. Science is making great progress in this import field of research but we cannot recommend replacing medications and therapy with diet.

For more information on dietary considerations for ADHD sufferers, here’s a relevant article from The Harvard Medical School. http://bit.ly/ADHD-HMS

Myth #5: ADHD Medications Are Addictive

Medical treatments for ADHD are well researched and effective. Appropriate treatment of ADHD are stimulants which help to improve the functionality of an underactive brain management system.

There is a generally held belief that long term use of ADHD stimulant medications will lead to addiction, substance abuse or other health problems.

Fact: ADHD medications are well controlled by medical practitioners.

ADHD medications are well supervised and cannot be prescribed without specialist psychiatric supervision and management,  and ADHD medications used are among the best researched in the world.  The risks of using appropriate medications to treat ADHD are minimal.

We cannot overstate the risks of leaving ADHD untreated. or inadequately treated.  The risks are very significant and left untreated ADHD will often severely impair personal relationships, family life, learning, careers and risk behavior.

ADHD Is A Lifelong Condition

People do not simply outgrow ADHD.  Adult ADHD is a complex and chronic condition.  With appropriate medication and therapy adults suffering with ADHD can lead quite functional and very fulfilling lives.

If you (or someone you care for) feel they may be suffering from ADHD
Melbourne Medibrain Centre can help.
Feel free to call us to discuss available options.

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