October 10, 2013
Three out of every four Australians will be exposed to a traumatic event in their lifetime, in the form of serious accidents or injuries, war, natural disasters or sexual and physical assault. For some, this will develop into post-traumatic stress disorder or PTSD: a condition that was first diagnosed in the 1980s, as a huge number of Vietnam War veterans struggled to adjust after returning home, haunted by atrocities they had witnessed and committed in combat.
According to Dr Andrea Phelps, Director of Policy and Service Development at the Australian Centre for Post-traumatic Mental Health, around 5-10 per cent of Australians will experience PTSD over the course of their lifetime, with motor vehicle accidents the most common event leading to PTSD in adults.
PTSD presents in a range of symptoms that can emerge after experiencing trauma – ranging from a persistent sense of vigilance and hyper-arousal to recurrent and intrusive ‘re-experiencing’ of the traumatic event. If left untreated, PTSD can become a chronic condition and can develop into other related mental health problems, including depression and anxiety.
The Australian Centre for Post-traumatic Mental Health undertakes trauma-related research, policy advice, service development and education, and this year has released revised national guidelines for the treatment and diagnosis of PTSD Australia-wide. Approved by the National Health and Medical Research Council, the guidelines include recommendations for identification, assessment and treatment of acute stress disorder and post-traumatic stress disorder. For the first time, the guidelines include recommendations for children and adolescents as well as adults.
Dr Phelps notes that although the same types of experiences are likely to lead to PTSD in both children and adults, the rate at which children are exposed might be different.
“The most common experiences for adults leading to PTSD are motor vehicle accidents and war. When the trauma is intentional and interpersonal – such as physical or sexual abuse – it is much more likely to lead to PTSD,” says Dr Phelps.
“Unfortunately, children are at a higher risk of being exposed to these types of experiences. Two out of three children on average will experience a traumatic event before the age of sixteen.
“We used to think that kids were just more resilient and that these things didn’t affect them, but in fact it’s likely that PTSD is under-recognised in children,” she says.
In developing the guidelines, the Centre has brought together key trauma experts from throughout Australia, as well as a broader reference group comprising professionals in psychiatry, social work, mental health, nursing, and a range of practitioners from the community. According to research PTSD is second only to depression and one of the most common mental health disorders in Australia.
But not everyone who is exposed to a traumatic event will develop PTSD. The question of why some traumatic events result in PTSD and others don’t is the “million dollar question” in the field of post-traumatic mental health, according to Dr Phelps.
While a number of risk factors have been identified – for example, where the person exposed has an existing mental illness or predisposition to mental illness – the most important determinant in PTSD has been found to be the presence or absence of strong social support structures following exposure to a traumatic event.
Consistently, those who have a robust support network are significantly less likely to develop PTSD than those who don’t. This is a positive thing, says Dr Phelps, because it means there is scope for preventive work in the field.
“We work with a lot of industry partners, including the Australian rail industry,” says Dr Phelps. “There’s not a lot you can do about train drivers being exposed to suicides, but there is a huge amount that can be done in terms of offering effective support services so that after exposure to this type of trauma, they have the tools and assistance at work and at home to make a full recovery.”
Dr Phelps notes that in most cases of exposure to traumatic events, people do recover without professional help in the first few weeks.
“We know now that some people actually cope better in that immediate aftermath by not talking about it – by getting on with it and being busy at work and other places. For some people, it can actually do more harm than good to talk about the event immediately afterwards,” says Dr Phelps.
“As a result, in these guidelines we no longer recommend routine psychological debriefing after a traumatic event.”
For people who are suffering from PTSD, it’s never too late to seek treatment: talking about their trauma is the cornerstone of effective treatment.
“It’s important for the community to understand that PTSD is not a life sentence. Treatment is available, and it’s never too late to seek help,” Dr Phelps says.
“A lot of Vietnam War veterans didn’t receive treatment for many years, because the kind of support that is in place now wasn’t available. Some of those people we’re seeing in treatment now, and even forty years after trauma, treatment can still be effective and have a hugely transformative impact on one’s life.”
The guidelines include separate booklets for adults, teenagers and children who have experienced trauma, as well as a practitioner guide for mental health professionals who work with children, adolescents and their families.