What post-traumatic stress disorder is

In short: PTSD

Post-traumatic stress disorder (PTSD) is a trauma- and stressor-related mental disorder. It can be caused by experiencing stressful – traumatic – events. The stressful experiences can be of short or long duration. In most cases, they are of such an exceptionally threatening or catastrophic nature that they can cause lasting psychological distress in almost anyone.

Traumatic events that may lead to PTSD include:

  • War
  • Participation in a military combat mission
  • physical and sexual violence
  • Torture
  • Escape
  • serious accidents
  • Robberies
  • Abuse
  • Natural disasters
  • as well as witnessing traumatic events

Here you will find:

Symptoms of PTSD

Post-traumatic stress disorder describes a range of psychological symptoms that can occur in response to a traumatic event.

PTSD encompasses four main symptom groups:

  • Remembering and reliving: The traumatic event is repeatedly experienced in the form of uncontrollable thoughts, images (known as flashbacks) and nightmares.
  • Avoidance: Thoughts, activities, places or people that may trigger memories of the trauma are avoided.
  • Negative perception and mood: Feelings are almost exclusively limited to joylessness, fear, shame and guilt, a constant feeling of numbness and emotional dullness, indifference towards other people, apathy towards one's surroundings.
  • Constant inner restlessness: Difficulty falling asleep and staying asleep, excessive jumpiness, extreme alertness, difficulty concentrating or pronounced irritability.

Further information

  • After a traumatic experience, it is very important and helpful for those affected to realise the following: the symptoms of stress that occur are not a sign of weakness, but a normal reaction to an abnormal event. The body and soul are trying to process the stressful event.

Progression of PTSD

Not everyone who experiences or witnesses trauma automatically develops post-traumatic stress disorder. Psychological distress usually occurs shortly after the traumatic event. It is then possible to experience symptoms of PTSD.

When remembering the event, those affected are often confronted again and again with their own painful memories and great sadness. Many report strong feelings such as anger, fear, guilt and horror. The symptoms often subside after a few days, weeks or months, and there are no lasting psychological effects.

Further information

  • A traumatic experience can fundamentally change a person's outlook on life. Often, previously established ways of thinking about self-image, attitudes towards other people, world views or thoughts about one's own future are completely questioned and rethought and lived in a whole new direction.

Unprocessed traumatic experiences carry a risk of PTSD.

For some people, the experiences from the traumatic event cannot be fully processed within a reasonable period of time and the symptoms persist. In such cases, there is a risk that normal trauma reactions will develop into longer-lasting PTSD symptoms.

Some sufferers try to avoid painful memories of the traumatic experience. Such an avoidance strategy is understandable. However, it prevents sufferers from learning to deal with their memories and the triggers of those memories in an appropriate manner and from finding a meaningful place for them in their personal life story.

Whether a person develops PTSD depends on many factors. Personal performance or resilience alone is not decisive. For British Armed Forces soldiers, foreign deployments carry an increased risk of developing PTSD or other post-traumatic stress disorders.

Further information

  • Developing post-traumatic stress disorder is not a sign of weakness, lack of ability or inadequate military skills. It can affect anyone after a traumatic experience.

Early treatment has a positive effect

Post-traumatic stress disorder manifests itself slightly differently in each person affected. In most cases, effective treatment started at an early stage has a positive effect on the course of the disorder.

It is impossible to predict how long PTSD will last or how severe its effects will be. Those affected experience phases in which the symptoms remain relatively stable for a longer period of time, but are then characterised by severe fluctuations. The symptoms intensify particularly during times of increased stress or at times that are reminiscent of the trauma. This is the case, for example, on anniversaries of the event.

The sooner professional treatment begins after the traumatic experience, the shorter the treatment period will generally be. Nowadays, there are good and effective treatment methods for PTSD.

Nevertheless, it is possible for PTSD to last a lifetime. But even then, professional treatment can contribute significantly to a marked improvement in symptoms.

Further information

  • For soldiers, post-traumatic stress disorder (PTSD) does not have to lead to incapacity for service or the end of a military career that has been successful up to that point. In most cases, PTSD can be treated while continuing to serve in the country.
  • It is important to seek professional treatment in good time in order to set the course for improvement of PTSD symptoms at an early stage.

Which risk factors contribute to PTSD

Certain factors increase the likelihood of a person developing PTSD after a traumatic experience. These include the circumstances of the person affected prior to the trauma, the nature of their personal experience of the traumatic event, and their ability to process the trauma after the event.

Factors contributing to PTSD:

Before a traumatic event

  • Participation in a Bundeswehr mission abroad
  • Presence of a mental disorder or addiction in one's own family
  • previous traumatic experiences, e.g. experiences of abuse or maltreatment in childhood
  • existing mental impairments

During a traumatic event

  • The conviction that one must die
  • Dissociation: psychological separation or detachment from oneself and one's surroundings, provided this persists after the event
  • extreme helplessness as real fear of death
  • serious wound or injury
  • Experiencing a severe panic attack

After a traumatic event

  • Lack of social support
  • Lack of understanding within the family or among friends
  • Problems with superiors
  • the addition of further stressful life circumstances, e.g. separation or divorce, change of place of work, lengthy military service disability or incapacity proceedings (WDB and DU).

Recognising PTSD

No one wants to have PTSD. Soldiers in particular find it difficult to properly assess their state of mind after a traumatic experience, to accept it and to seek help when they themselves can no longer cope.

What are normal reactions after a foreign assignment?

After returning from a foreign deployment, it is not uncommon for soldiers to exhibit changes in behaviour and emotional life as a result of the extreme stress they experienced in the country of deployment.

Soldiers must expect these reactions after serving abroad:

  • Fears
  • Lack of energy
  • Negative thoughts
  • Nervousness
  • Irritability
  • Withdrawal
  • Mood swings
  • Sleep disturbances, possibly accompanied by nightmares and rumination
  • Addictive behaviour

Adjustment reactions after working abroad are normal

Many of the issues that arise among soldiers in the first six to twelve weeks after returning from overseas deployment can be considered normal adjustment reactions. Initially, they are not a cause for concern. After the traumatic events they have experienced in the country of deployment, participants must readjust to life in their home country.

Life at home has a different rhythm, the demands of everyday life are different from those of deployment, and family routines need to be re-established after a long period of separation. During this phase, it is important for mental health that interactions with one another are characterised by understanding and patience.

Further information

  • An unusual state following a traumatic experience does not necessarily mean PTSD.

Criteria for assessing mental state

Using a number of criteria relating to the severity of stressful symptoms, those affected can initially assess their own mental health themselves.

Minimal impairment

If the traumatic experience occurred less than three months ago and does not significantly affect the person concerned in their service, at work, in relationships or at school, it may be sufficient for the person concerned to simply observe the symptoms initially to see if they improve on their own.

Significant impairment

If symptoms have not improved three months after the traumatic experience, affected soldiers should urgently contact the military doctor or a specialist examination centre for psychiatry and psychotherapy in order to initiate any necessary support measures.

Further information

  • Soldiers can obtain information and self-assessment tests if they suspect they may be suffering from PTSD or another post-traumatic stress disorder in the free smartphone app. Coach PTSD. The app cannot provide a definitive diagnosis. However, a questionnaire can be used to gain insights into the severity of any PTSD symptoms and how they change over a certain period of time.
  • Whether PTSD is actually present based on stressful symptoms can ultimately only be determined by psychologically trained professionals after a consultation or examination.

When professional help is advisable

If symptoms persist after the transition period or even worsen, urgent action is required. Anyone who suspects they may be suffering from PTSD or another psychological disorder resulting from their deployment should consult a doctor or psychotherapist immediately.

Many soldiers do not do this. They wait and see what happens. Some try to deal with their problems on their own or with support from family and friends. Such social support is very important, but on its own it usually does not lead to the desired success. Even if loved ones mean well, this type of support is usually not enough to maintain or restore the mental health of soldiers after trauma.

Signs that help is needed

The following behaviours or sensitivities are an indication that professional help is urgently recommended:

  • Feeling sad and depressed for more than two weeks
  • frequent disruptions to daily life due to feelings of anxiety, restlessness or stressful thoughts
  • Problems at work or in interpersonal relationships
  • Worry about not being able to fulfil everyday duties
  • difficulties in caring for the family
  • be very annoyed most of the time
  • Consumption or increasing consumption of alcohol, illegal drugs or prescription drugs, as well as taking these substances to cope with problems
  • sleep problems
  • Eating problems; significant unintended weight gain or loss
  • other people show concern or advise seeking help

Further information

  • Under the free and anonymous trauma helpline The Bundeswehr helpline – 0800 588 7957 – provides soldiers and their families with round-the-clock assistance on the subject of PTSD.
  • If you are experiencing suicidal thoughts (intentions to kill yourself) or thoughts of hurting or killing someone else, you should immediately call for help via the emergency number 112 or go to the nearest hospital emergency room.

PTSD can be treated effectively.

There are now multiple treatment methods for PTSD. These include various psychotherapy methods, or a combination of psychotherapy and medication.

Further information

  • Psychotherapy is the targeted treatment of mental disorders that are classified as illnesses. These include PTSD and other post-traumatic stress disorders such as depression or anxiety disorders. Psychotherapy is essentially based on personal conversation and a trusting relationship between patient and psychotherapist. To this end, exercises are taught that are intended to lead to a change in behaviour and perception. Psychotherapy will only be successful if the patient decides to undergo psychotherapy of their own accord.

Which therapies help with PTSD and other trauma-related disorders?

The psychotherapeutic treatment of traumatised soldiers is carried out mainly about three forms of therapy, which we will briefly introduce below. All three forms of therapy are suitable for treating PTSD and other trauma-related disorders. Their positive effectiveness is scientifically proven.

These therapeutic methods are used for soldiers:

Depth psychology-based psychotherapy (TP)

The treatment focuses on the patient's unconscious and past (childhood and adolescence). Together with the therapist, the patient attempts to identify and work through the often repressed cause of the disorder.

Duration of treatment: 25 to 50 sessions.

Behavioural therapy (BT)

This involves treating the patient's current disorders. One of the most important basic assumptions in this form of therapy is that behaviour associated with the disorder has been learned and can also be unlearned. The aim of the therapy is to help patients help themselves.

Duration of treatment: 25 to 45 sessions.

Analytical psychotherapy (AP)

The treatment focuses on the patient's unconscious and on the past (childhood and adolescence). It is based on psychoanalysis and its further development. The focus is often on the patient's personality structure, which is reflected in patterns of thought, behaviour and movement.

Duration of treatment: approximately 100 sessions.

Treatment with medication

In some cases, medication, known as psychotropic drugs, may be prescribed alongside psychotherapy to treat PTSD. However, the use of medication is carefully considered in trauma therapy.

Further information

  • A therapy session with a psychotherapist is considered to be meeting . As a rule, a therapy session lasts 50 minutes.

    Double sessions (100 minutes) are possible as part of so-called exposure exercises or trauma-focused therapy sessions.

Treatment makes it easier to return to normal life

Shortly after experiencing trauma, it is almost impossible for those affected to imagine that they will ever overcome their suffering. A Trauma-specific counselling helps Those affected then, open up perspectives and facilitated the Transition back to normal life.

In retrospect, many of the soldiers affected are grateful that they took advantage of such assistance.

Further information

  • It is almost impossible to forget trauma. However, it is possible to overcome trauma and continue living with it without major impairment.
  • After a traumatic experience, soldiers may develop PTSD or, instead of PTSD, other psychological disorders resulting from deployment develop depression or an anxiety disorder, for example.

What professional treatment costs

Treatment for PTSD or other psychological disorders resulting from military service is largely free of charge for active soldiers and reservists wounded in service as part of the free military medical care (utV) programme.

The costs of outpatient, inpatient and psychotherapeutic treatment in civilian facilities are also largely covered by the Armed Forces, provided that the prescribed procedures are followed.

Further information

  • Further information on the care of soldiers following a post-traumatic stress disorder is available in a other contribution described.
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