PTSD and Complex PTSD 2021 PDF Version
PTSD and Complex PTSD 2021 PDF Version
PTSD and Complex PTSD 2021 PDF Version
Contents
What is PTSD? ..................................................................................................................................... 2
What are the symptoms? ................................................................................................................... 3
What causes PTSD? ............................................................................................................................. 7
What is complex PTSD?....................................................................................................................... 9
How can I help myself? ..................................................................................................................... 12
What treatments are available? ....................................................................................................... 15
How can friends and family help?..................................................................................................... 18
Useful contacts.................................................................................................................................. 21
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What is PTSD?
Post-traumatic stress disorder (PTSD) is a mental health problem you may develop after
experiencing traumatic events. The condition was first recognised in war veterans.
It has had different names in the past, such as 'shell shock', but it is not only diagnosed in
soldiers. A wide range of traumatic experiences can be causes of PTSD.
"When something traumatic happens in your life it rocks you to the core. The
world is no longer a safe place. It becomes somewhere that bad things can and
do happen."
When is it diagnosed?
When you go through something you find traumatic it's understandable to experience
some symptoms of PTSD afterwards, such as feeling numb or having trouble sleeping.
This is sometimes described as an 'acute stress reaction'.
Many people find that these symptoms disappear within a few weeks, but if your
symptoms last for longer than a month, you might be given a diagnosis of PTSD. Your GP
might refer you to a specialist before this if your symptoms are particularly severe.
"I started experiencing symptoms of PTSD after my boyfriend died. I suffered extremely
vivid flashbacks that could happen at any time, anywhere, and were deeply distressing… I
threw myself into another relationship very quickly to try and avoid how I was feeling, but
then also would not express much affection to my new partner."
Delayed-onset PTSD – if your symptoms emerge more than six months after
experiencing trauma, this might be described as 'delayed PTSD' or 'delayed-onset
PTSD'.
Complex PTSD – if you experienced trauma at an early age or it lasted for a long
time, you might be given a diagnosis of 'complex PTSD'. See our section
on complex PTSD for more information.
Birth trauma – PTSD that develops after a traumatic experience of childbirth is also
known as 'birth trauma'. See our resource on PTSD and birth trauma for more
information.
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If you experience some PTSD symptoms while supporting someone close to you who's
experienced trauma, this is sometimes known as secondary trauma.
See our resource on trauma for more information on how traumatic experiences can
affect your mental health.
"I couldn't understand why I felt like my brain wasn't functioning – I couldn't remember
things, I couldn't process things. It was like my brain had just slowed down and ground to
a halt."
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"My heart was constantly racing and I felt permanently dizzy. I couldn't leave the house
and became afraid of going to sleep as I was convinced I was going to die."
"The lack of sleep and the sense of never being at peace are exhausting."
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Studies have shown that someone with PTSD will continue producing these hormones
when they're no longer in danger, which is thought to explain some symptoms such as
extreme alertness and being easily startled.
Some people also experience physical symptoms similar to symptoms of anxiety, such
as headaches, dizziness, chest pains and stomach aches.
"I thought I was coping quite well to start with. Then a few weeks after the event, I began
experiencing unpleasant physical symptoms, similar to those of a heart attack: chest pain,
tightness and dizzy spells so severe that I thought I would pass out."
You might notice that particular places, people or situations can trigger a flashback for
you, which could be due to them reminding you of the trauma in some way. Or you might
find that flashbacks seem to happen at random. Flashbacks can last for just a few
seconds, or continue for several hours or even days.
You can read some tips on how to cope with flashbacks in our section on self-care for
PTSD.
"I feel like I'm straddling a timeline where the past is pulling me in one direction and the
present another. I see flashes of images and noises burst through, fear comes out of
nowhere. My heart races, my breathing is loud and I no longer know where I am."
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If you drive you may have to tell the DVLA that you have PTSD. For more information on
your right to drive, including when and how to contact the DVLA, see our legal resource
on fitness to drive.
"My behaviour changed and became erratic. I would alternate from wanting to shut myself
away and not see or talk to anyone to going out to parties in the middle of the week and
staying out late."
anxiety disorders
depression
dissociative disorders
self-harm
suicidal feelings.
"I was also deeply depressed and experiencing huge amounts of anxiety, refusing to go
anywhere alone or go near any men that I didn't know… I would lock my bedroom
windows and barricade my bedroom door at night."
See our resources on anxiety and panic attacks, sleep
problems, phobias, depression, dissociative disorders, self-harm and suicidal feelings for
more information on these topics.
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Evidence suggests that pandemics can cause psychological trauma. If you're looking for
support during the coronavirus pandemic you can find more information on looking after
your mental health in our coronavirus and mental health hub.
"I was mugged then about a year later I was on the Tube when the police were trying to
arrest someone who had a gun. In neither experience was I physically injured – although
in the second one I thought I was going to die and that I was going to see lots of other
people die."
Secondary trauma
If you experience symptoms of PTSD while supporting someone close to you who has
experienced trauma, this is sometimes known as 'secondary trauma' or 'secondary
traumatic stress'.
'Secondary' means that although the original (primary) trauma happened to someone
else, the impact it's having in your life is traumatic for you. It doesn't mean it's any less
significant than any other kind of PTSD, or any easier to deal with. Our section for
friends and family has some tips on looking after yourself.
Repeatedly witnessing or hearing about traumatic events in the course of your job is
also sometimes called 'secondary trauma', although this experience is increasingly
thought of by professionals as an original (primary) trauma.
See our resources on trauma, how to manage stress, bereavement, abuse, money and
mental health, anxiety and panic attacks and depression for more information on these
topics.
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For example, you may find some doctors or therapists still use one of the following
terms:
enduring personality change after catastrophic experience (EPCACE)
disorders of extreme stress not otherwise specified (DESNOS) – this term is
more common in America than the UK.
"At times I felt nothing was going to end the distress, experiencing more than 10
flashbacks a day... It was a long process of recovery, with lots of bumps along the road,
but the right medication and long-term therapy with someone I came to trust, has changed
my life."
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"Developing PTSD after experiencing domestic violence was not something I was
prepared for. Physically I left my old home. Mentally I am still there. The prison is no
longer that house – it is my mind. My thoughts. My memories."
Professionals disagree about when it's helpful to diagnose someone with a personality
disorder or when another diagnosis or description is better. To find out more see our
resource on why personality disorders are controversial?
If you're worried that the diagnosis you've been given doesn't fit the way you feel, it's
important to discuss it with a mental health professional so you can make sure you're
getting the right treatment to help you.
See our resources on borderline personality disorder and personality disorders for
more information on these diagnoses.
Our resource on seeking help for a mental health problem provides information on how
to make sure your voice is heard, and what you can do if you're not happy with your
doctor.
"My PTSD is rooted in the abuse I received as a teenager, and I have spent most of my
adult life running away from it... I have suffered from anxiety and depression as a
consequence."
Read Clare's story
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"You can't stop the waves but you can learn to surf; through my PTSD recovery journey
I've learnt that emotions come and go in waves. It's best not to fight against them but ride
with them."
smells
sounds
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words
places
particular types of books or films.
Some people find things especially difficult on significant dates, such as the anniversary
of a traumatic experience. It can help to plan ahead for these times and use these self-
care tips to help you.
Confide in someone
When experiencing PTSD it can be hard to open up to others. This may be because you
feel unable to talk about what has happened to you or because you find it difficult to trust
others after your traumatic experience.
You don't need to be able to describe the trauma to tell someone how you are currently
feeling though. It could help to talk to a friend or family member, or a professional, such
as a GP or a trained listener at a helpline.
See our resource on telephone support for more information about helplines. Our
resource on talking to your GP also has tips on how to start difficult conversations about
your feelings with your doctor.
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See our resource on coping with sleep problems for more information.
"My determination to be a positive force in my children’s life was the reason I stayed and
tried to work through my issues."
Read Matt's story
NICE may recommend other talking treatments in future if they are found to help with
PTSD, but more research is needed.
"One of the most disturbing things has been the feelings of aggression and anger towards
anyone who looks like the person who attacked me... EMDR therapy has been massively
helpful."
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If you are offered medication for PTSD, this will usually be an antidepressant. While
PTSD is not the same as depression, this type of medication has been found to help.
NICE recommends four antidepressants in particular:
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Accessing treatment
Here are some ways you could access treatment:
Your GP. To get treatment on the NHS, you could visit your GP. For advice on
preparing for a GP appointment, see our resource on talking to your GP.
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Free NHS therapy services. You might be able to directly contact Improving Access
to Psychological Therapies (IAPT) services in your area, if you live in England. You
can search for these on the NHS website.
Specialist organisations. See our useful contacts for organisations that may offer
therapy or be able to put you in touch with local services.
Local trauma services. Some organisations offer free or low-cost trauma therapy.
Your local Mind on Mind's Infoline may have information about services in your
area.
Private therapists. Finding a private therapist is another option some people choose
to explore.
See our resources on seeking help for a mental health problem and talking treatments for
more information about accessing treatment.
It can be really hard to see someone you care about experiencing the symptoms of PTSD
or complex PTSD. This section has some suggestions for ways you can support them
while also looking after your own wellbeing.
Listen to them
If you feel able to, you could help by:
giving them time to talk at their own pace – it's important not to pressure them
allowing them to be upset about what has happened
not making assumptions about how they feel right now, or how they felt in the past
not dismissing their experiences by saying ‘it could have been worse’ or
questioning why they didn't say or do something differently.
"No one around me understood what I was going through. I found it hard to explain.
Words just couldn't do justice to what I was going through."
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to normal, but it's important not to blame them or put pressure on them to get better
without the time and support they need.
This can help them to avoid crises or manage them differently in future where possible.
When having these conversations, make sure you also think about how much you can
cope with and try to only offer support that you feel able to give. It is important to look
after yourself too.
For more information see our resources on planning for a crisis, helping someone else
seek help and advocacy.
See our sections on what flashbacks are and tips for coping with flashbacks for more
information.
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a change in their mood, such as often feeling low, anxious, upset, angry or
irritated
a change in performance at work, such as lateness or missing deadlines
a change in energy levels, such as extreme alertness or a lack of concentration.
If you notice these sorts of changes in someone close to you, you could ask them how
they are feeling. This might encourage them to open up.
look through the list of relevant organisations in our useful contacts for PTSD
see our resources on supporting someone who is self-harming and supporting
someone who feels suicidal if someone you care about is harming themselves or
struggling with thoughts of suicide.
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Useful contacts
Mind's services
Helplines – our Infolines provide information and support by phone, email and
text.
Local Minds – provide face-to-face services across England and Wales. These
might be talking therapies, peer support and advocacy.
Side by Side – our supportive online community for anyone experiencing a
mental health problem.
Other organisations
Anxiety UK
03444 775 774 (helpline)
07537 416 905 (text)
anxietyuk.org.uk
Advice and support for people living with anxiety.
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Combat Stress
0800 1381 619
combatstress.org.uk
Treatment and support for armed forces veterans who have mental health problems.
Disaster Action
disasteraction.org.uk
Information and support for people affected by major disasters in the UK and overseas.
Lifecentre
0808 802 0808 (freephone)
07717 989 022 (textline)
lifecentre.uk.com
Support for survivors of sexual abuse and anyone supporting them, including a helpline,
text support and email counselling.
Moodjuice
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moodjuice.scot.nhs.uk
Online self-help guides on topics including depression, anxiety and stress.
NHS UK
nhs.uk
Information about health problems and treatments, including details of local NHS services
in England.
PTSD Resolution
0300 302 0551
ptsdresolution.org
Helps veterans, reservists and their families with trauma and distress.
RoadPeace
08454 500 355
roadpeace.org
Information and support for people bereaved or seriously injured due to road crashes.
Victim Support
0808 168 9111
victimsupport.org.uk
Provides emotional and practical support for people affected by crime and traumatic
events.
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