最後更新日期 六月 8, 2021.
People who have been through traumatic events like natural disasters, wars, abuse and accidents are likely left with distress and devastation that may be hard for outsiders to understand. Failure in coping with such feelings for a prolonged period of time can lead to post-traumatic stress disorder (PTSD). PTSD is a serious mental disorder raising as much concern in the local scene as it does globally, as a recent research estimated the prevalence of suspected PTSD in Hong Kong to be 12.8% following the social unrest in 2019.
Learn more about the causes, symptoms and diagnosis of PTSD and get tips for finding a trauma-focused therapist in Hong Kong in this article.
What is PTSD?
According to the American Psychiatric Association (APA), post-traumatic stress disorder, commonly referred to as PTSD, refers to a psychiatric disorder in people that some people experience following a traumatic event in the past. The severity of the traumatic event and the person’s subjective experiences both play important roles in determining whether a person will develop PTSD or not.
What are traumatic events?
Traumatic events usually involve life threats that lead to negative emotional responses. Patients with PTSD do not necessarily have to be involved in the traumatic experience. Witnesses of the traumatic event are also at risk of developing PTSD.
The following is a list of traumatic events which may cause PTSD:
- Natural disaster (e.g., earthquake, tsunami)
- Serious accident
- Terrorist attack
- Sexual violence or rape
- Serious injury
- Physical or emotional abuse
- Terminal illness or life-changing illness (e.g., heart attack, cancer)
- Loss of life
- War or combat
- Traffic accident
- Firearm threat
- Refugee trauma
What are the risk factors of developing PTSD?
Not every individual will develop PTSD after experiencing a traumatic event. A number of factors will affect the chance of a person developing PTSD:
Individuals with less social support are more likely to develop PTSD because social support can foster recovery, as well as help patients progress in moving on from the memories of the traumatic event.
Certain coping strategies
Coping strategies are actions or thought processes people use to deal with stressful and unpleasant situations. People who rely on negative coping strategies, namely self-isolation, avoidance of reminders of the traumatic situation, self-blame and rumination, will have a higher chance of developing PTSD.
People who have low resting cortisol, a hormone that helps the body to respond to stress, are more likely to develop PTSD because cortisol can help shut down the sympathetic nervous system activity, which is highly related to stress levels.
History of mood and anxiety disorder
Individuals previously diagnosed with mental illnesses such as depression and anxiety are more likely to develop PTSD. Previous research has found that PTSD, depression and anxiety disorders are all stress-related disorders.
Underlying neurotic personality
Neurotic individuals are more likely to develop PTSD because neurotic personality lowers the chance of an individual overcoming traumatic experiences. Other research also suggested that PTSD patients generally score higher in neuroticism.
Previous history of trauma
Individuals with a previous history of trauma increase the chance of suffering from PTSD. This is because traumatic experiences in the past trigger the onset of PTSD.
What are the symptoms of PTSD?
Patients with PTSD suffer from a wide range of symptoms. According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), major symptoms of PTSD include:
- Recurrently experience the traumatic event as nightmares, images, reminders of the trauma and flashbacks.
- Persistently avoid the stimuli related to the traumatic event.
Negative cognitions and mood
- Experience feelings of detachment, negative emotions like shame or anger, negative alterations in cognition and emotion related to the trauma and distorted blame.
Arousal and reactivity
- Overtly focus on information associated with the traumatic event.
- Excessive response (high arousal and reactivity) to stimuli related to the traumatic event.
Diagnosis of PTSD
If you have encountered a traumatic event in the past and experienced the above symptoms, you may consider getting a diagnosis for PTSD. A brief screening instrument for PTSD may be considered for those who have experienced a traumatic event. However, the results of self-report scales should not be relied entirely to confirm PTSD as this procedure only provides a brief and initial diagnosis. Patients suspected to have PTSD should seek help from psychiatrists or psychologists for a professional diagnosis.
Below are several examples of self-report scales commonly used for PTSD:
- Impact of Event Scale (Horowitz et al., 1979)
- Post-traumatic Diagnostic Scale (PDS; Foa et al., 1997)
- Davidson Trauma Scale (Davidson et al., 1997)
- PTSD Checklist (Weathers & Ford, 1996)
Treatment options for PTSD
The primary goal of psychotherapy for PTSD is to provide emotional support, encourage recall of the traumatic events to integrate them into the patient’ s experience and to facilitate working through the associated emotions. They would thus benefit PTSD patients by helping them reduce stress and anxiety related to the trauma.
Medications play an essential role in treating PTSD, especially if the PTSD leads to a significant co-existing depressive disorder. Short-term anxiolytics would also help with decreasing the level of arousal and insomnia, helping PTSD patients to overcome the traumatic experience.
Prolonged exposure therapy requires PTSD patients to be exposed to stimuli associated with the trauma through videotapes or conversations about the traumatic event. The role of therapists is to educate patients to keep calm when recalling the event. As a result, patients will obtain practical skills (e.g., breathing techniques) to cope with the trauma.
CBT therapists will focus on helping PTSD patients to identify their thought processes and ultimately to reduce their anxious feelings by changing their cognitions. For example, therapists may invite patients to describe the event verbally and to identify their irrational thoughts.
EMDR first requires the PTSD patient to picture the scene of the traumatic event. After that, therapists will invite the patient to recall a positive event. During the treatment, the therapist will also move his or her finger back and forth in front of the eyes of the patients. This intervention approach aims to replace negative thoughts with positive ones.
Cognitive-behavioral therapies are more appropriate for PTSD patients with less severe conditions, while prolonged exposure therapies and EMDR are more suitable for PTSD patients with more severe conditions. Trauma-focused therapies encourage patients to move on from the traumatic event. The effectiveness of trauma-focused therapies would only be optimal if patients are committed to the intervention. PTSD patients may consult their therapist before deciding the best treatment option.
What if I develop thoughts of suicide?
In case of need for immediate support, especially those who have developed suicidal ideation, please do not hesitate to reach out for professional help. Below is a list of hotlines with 24-hour support.
Suicide prevention hotlines