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Trauma and PTSD: When trauma leaves its mark

By Will Sutherland

A traumatic event involves fear-inducing circumstances, like actual or threatened death (war and natural disasters), serious injury and sexual violence¹. However, people can experience trauma by witnessing or repeatedly being exposed to details of a fear-inducing event (first responders seeing dead bodies and police officers hearing details of child abuse). It’s normal for these circumstances to cause people distress. However, for some, that distress continues long after the event, including: hypervigilance, panic attacks and intrusive memories of the event². Often, people will then avoid circumstances or stimuli to try and stop those symptoms from occurring. This prolonged experience of symptoms and avoidant behaviour are the main components of Posttraumatic Stress Disorder (PTSD). 

75% of Australian adults have experienced a traumatic event at some point in their life². 12% will develop PTSD³ from those events. Genetics factors, level of support and comorbid conditions are correlated with higher levels of PTSD. Additionally, sexual assault is more likely to lead to PTSD than other traumatic events. Although relatively few people will develop PTSD from a traumatic incident, prolonged PTSD can have serious effects. This includes using illicit substances to attempt to avoid their symptoms⁵. Others may have difficulty with their work and relationships due to difficulty concentrating, self-destructive behaviour and aggression. 80% of those with prolonged PTSD will also experience comorbid disorders like anxiety and depression.

So, why does this happen? An evolutionary perspective suggests this was a survival advantage. Our brains likely developed a way of fortifying fear-inducing situations to memory to ensure we remember to avoid danger later7. In fact, the neurochemicals that help strengthen memories are mostly induced by stress and fear, like norepinephrine, and cortisol⁸. So, PTSD may be an unhelpful extension of what was an evolutionary advantage.

Fortunately, there are many effective treatments for PTSD, including cognitive behaviour therapy, Eye-movement desensitization reprogramming, exposure therapy and medication. These can help people to manage their symptoms and reduce their severity and frequency. Trauma Informed Care (TIC), is a recently developed framework that assists many different practitioners to provide effective PTSD treatment. TIC takes into consideration the specific needs of those with PTSD, like safe spaces and empowerment⁶. Others find support and recover through PTSD support groups. Eye Movement Desensitisation Reprogramming involves guiding the patient through remembering the traumatic event whilst engaging in bi-lateral eye movement (left-to-right)⁹. This is a relatively recent development but is very effective at desensitizing someone to the intense negative symptoms associated with the memory. 

There are many promising treatment options for those with PTSD. However, it’s important to ensure the provider is trauma-informed and qualified. Unfortunately, improper treatment can re-traumatize people and make their symptoms worse⁶.

If you have any questions or would like to book in with our trauma-informed practitioners, please contact our Client Connect Team on 9809 1000.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
2. Post-traumatic stress disorder (PTSD). (2015, August 11). SANE. https://www.sane.org/information-and-resources/facts-and-guides/post-traumatic-stress-disorder#:~:text=How%20common%20is%20PTSD%3F
3. Australian Bureau of Statistics. (2018). National Health Survey: First results [Review of National Health Survey: First results]. Australian Government. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release
4. ‌Australian Bureau of Statistics. (2008, October 23). National Survey of Mental Health and Wellbeing: Summary of Results, 2007 | Australian Bureau of Statistics. Www.abs.gov.au. https://www.abs.gov.au/statistics/health/mental-health/national-study-mental-health-and-wellbeing/latest-release
5. Health Direct. (2019, February 3). Anxiety – symptoms, treatment and causes. Healthdirect.gov.au; Healthdirect Australia. https://www.healthdirect.gov.au/anxiety
6. Trauma and young people: Moving toward trauma-informed services and systems. (2015). Orygen. https://www.orygen.org.au/trauma
7. Cantor C. (2009). Post-traumatic stress disorder: evolutionary perspectives. The Australian and New Zealand journal of psychiatry, 43(11), 1038–1048. https://doi.org/10.3109/00048670903270407
8. Sherin JE, Nemeroff CB. Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues Clin Neurosci. 2011;13(3):263-78. doi: 10.31887/DCNS.2011.13.2/jsherin. PMID: 22034143; PMCID: PMC3182008.
9. American Psychological Association. (2017, May). Eye Movement Desensitization and Reprocessing (EMDR) Therapy. American Psychological Association. https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing

 

Personality Disorders

What are they?

Erratic behaviours, long-term dysfunction and tumultuous relationships. Personality disorders (PDs) are severe mental health conditions that cause distress and dysfunction. Personality can be defined as a pattern of thoughts, feelings and behaviours that are consistent across time and different situations. Our personalities are often viewed as the summation of different traits, like extraversion and agreeableness¹. Similarly, those with PDs experience dysfunction and distress, in consistent and long-term patterns. Including difficulty forming relationships, perceiving the world and sustaining employment.

How do they relate to Depression?

PDs are similar but different from mood disorders. Depression and Borderline personality disorder (BPD) share similar symptoms like low mood. However, PDs tend to produce more dysfunctional behaviours and thoughts². For example, BPD is more associated with suicidality and erratic behaviours in relationships. Whereas depression is more associated with mood and feeling. Another key difference between personality and mood disorders is the duration and frequency of symptoms. BPD and bipolar are both associated with mood swings. Those mood swings are typically more frequent and quicker to change with Borderline than Bipolar³.

PDs are often ego-syntonic whereas other psychological disorders are ego-dystonic. This refers to how someone feels about their dysfunctional thoughts, feelings and behaviours⁴. A good example is OCD and OCD Personality disorder. Those with OCD are ego-dystonic, meaning their OCD behaviours and thoughts do not align with their values. They are aware of how much it affects their life. If they perform a compulsion it’s due to the intensity of the obsession not because of a genuine desire to do it. However, those with OCD Personality disorder are ego-syntonic, meaning their OCD thoughts and behaviours do align with their values. They may even believe that their OCD is beneficial, with no downside. People with PDs often can’t see the negative effect of their condition. This can make treatment more difficult.

What are the different types?

There are ten different types of PDs, which are divided into three clusters⁵. The different types within a cluster share common symptoms.

Cluster A contains PDs involving odd and eccentric behaviours and thinking⁶. These include Paranoid, Schizoid and Schizotypal Personality Disorders. Cluster B containsPDs involving unstable emotions and impulsive behaviours. These include Antisocial, Histrionic, Borderline and Narcissistic personality disorders. Cluster C contains PDs involving anxious and fearful thoughts and behaviours. These include Avoidant, Obsessive-compulsive and Dependent personality disorders.

PDs are commonly diagnosed by a psychiatrist or a psychologist. The first step is often consulting with your G­­­­P. PDs can be managed and treated with medication and psychotherapy. For example, Dialectical Behaviour Therapy is an extension of Cognitive Behaviour Therapy designed specifically for BPD⁷. Crisis management resources are also important when personality disorders lead to harmful behaviours.

If you have any questions or would like to book in with our psychologists or psychiatrists, please contact our Client Connect Team on 9809 1000.

By Will Sutherland

References

1.  12.1 Personality and Behaviour: Approaches and Measurement – Introduction to Psychology – 1st Canadian Edition. (2014, October 17). Opentextbc.ca. https://opentextbc.ca/introductiontopsychology/chapter/11-1-personality-and-behavior-approaches-and-measurement/

2.  Health, P. B. (2022, April 12). What’s the Difference Between a Personality Disorder and a Mood Disorder? Promises Behavioral Health. https://www.promises.com/addiction-blog/difference-between-personality-disorder-and-mood-disorder/

3.  Mental Health Conditions. (n.d.). NAMI Chicago. Retrieved July 2, 2022, from https://www.namichicago.org/mental-health-conditions

4.  Syntonic and Dystonic. (n.d.). Richard B. Joelson, DSW. https://richardbjoelsondsw.com/articles/syntonic-dystonic/

5.  Robitz, R. (2018, November). Psychiatry.org – What are Personality Disorders? Psychiatry.org. https://psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders

6.  Health direct. (2019, January 11). Personality disorders: an overview. Healthdirect.gov.au; Healthdirect Australia. https://www.healthdirect.gov.au/personality-disorders

7.  Behavioral Tech. (2021). What is dialectical behavior therapy (DBT)? Behavioral Tech – Training, Continuing Education in Dialectical Behavior Therapy (DBT). https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/

8.  Mayo Clinic. (2016). Personality disorders – Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/personality-disorders/symptoms-­­­causes/syc-20354463

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Psychologists & Psychiatrists, What’s the Difference?

Navigating psychological disorders and life stressors can be a formidable task, and finding the right support is often perplexing. Two primary mental health professionals, psychologists and psychiatrists, play crucial roles in assisting individuals with similar challenges, yet their approaches differ. Psychiatrists, armed with a medical degree, specialize in mental health disorders and can prescribe medications, address medical issues, and employ psychotherapeutic techniques. On the other hand, psychologists delve into the science of human behavior and employ evidence-based therapies to tackle psychological disorders and life stressors. Both professionals often collaborate with general practitioners. For those grappling with severe disorders, engaging a variety of specialists, including psychologist Melbourne, can address diverse needs, although financial considerations may guide the choice.

Psychiatrists

What do they do?

Psychiatrists are qualified to prescribe medications, address medical issues, and utilize psychotherapeutic techniques, working in hospitals, community health services, or private practice.

When would you see one?

Seek a psychiatrist if experiencing severe symptoms from psychological disorders like PTSD, severe depression, or anxiety. When psychotherapy or other interventions prove insufficient, considering a psychiatrist is appropriate. They can provide an official diagnosis of psychological disorders.

Psychologists

What do Psychologists do?

Psychologists study human behavior and its relation to thoughts and feelings, employing evidence-based therapies for psychological disorders and life stressors. These may include anxiety, depression, trauma, grief, financial stress, relationships, parenting, crime victimhood, or aging. They work in hospitals, community health services, or private practice.

When should one consider seeking assistance from psychology Melbourne?

Engage a psychologist when experiencing significant distress that impairs crucial areas of life, especially when struggling to understand or function in various aspects. Psychologists, often the first line of intervention for mental health issues, can offer mental health assessments and, in some cases, an official diagnosis.

Key Differences

	Psychiatrists	Psychologists
Prescribe Medication	✅	❌
Officially Diagnose	✅	Certain psychologists like clinical psychologists can. It’s best to check with the psychologist first.
Psychotherapeutic interventions	Some might specialise in diagnosis and medication and less so in psychotherapies and counselling. It’s best to check with the psychiatrist first.	✅
General counselling	Some might specialise in diagnosis and medication and less so in psychotherapies and counselling. It’s best to check with the psychiatrist first.	✅

What next?

If you would like to see a psychiatrist or a Melbourne based psychologist, we suggest seeing your GP for assistance. They can give you specific advice and write you a referral. Most psychiatrists require a referral before you can see them, but you can see a Melbourne psychologist without one. A referral will entitle you to a significant rebate from Medicare.

This resource from Health Direct (https://www.healthdirect.gov.au/question-builder) can help you to articulate yourself when speaking to a mental health or medical professional.

If you have any questions or would like to book in with our Melbourne psychologists or psychiatrists please contact our Client Connect Team on 9809 1000.