Trauma and PTSD in Adults

Trauma & Post-Traumatic Stress Disorder / Complex Post Traumatic Stress Disorder (PTSD / C-PTSD)  (Adults)

PLEASE NOTE PATHWAY CHANGE – all those with post-traumatic stress disorder, whether following a single event, or complex experiences, should be referred to the relevant CMHT.

People with psychological trauma may present with a range of mental health issues. These issues can follow single event traumas such as a life-threatening assault or accident, following more chronic and inescapable trauma such as childhood abuse or torture, or a combination of a range of traumatic experiences across the lifespan.

A range of psychological treatments are available for the treatment of the consequences of trauma including both group and individual treatment. These may include such treatments as Trauma Focussed CBT and Eye Movement Desensitisation and Reprocessing (EMDR), as well treatments focussing on the interpersonal consequences of traumatic experience.

Clinically significant PTSD can only be diagnosed after 4 weeks, with persistent and severe symptoms. Many patients will have upsetting symptoms following distressing events, but this does not necessarily mean they have, or will develop, PTSD. Many of these symptoms will settle over time and will respond to continued communication with social support, reassurance and explanation.

Patients will be offered a full assessment appointment, and a treatment protocol will be developed based on their individual circumstances and suitability for therapeutic approach. Treatment options will be discussed including individual or group treatment based with colleagues in the sector mental health teams, individual treatment at the Rivers Centre (for those most affected by complex developmental trauma) or options within the third sector.

Please also consider the PTSD self-guided course, which has been made available for NHS Lothian (Midlothian) but available to patients throughout Lothian: Post-Traumatic Stress Disorder – Midlothian Psychological Therapies Service (nhslothian.scot)

PTSD

Diagnostic criteria for PTSD (ICD-11).

Post-traumatic stress disorder (PTSD) is a disorder that may develop following exposure to an extremely threatening or horrific event or series of events (typically experienced to be life threatening). It is characterised by experiencing all of the following:

1) Re-experiencing: This takes the form of severe and persistent re-experiencing of the traumatic event or events in the present in the form of vivid and intrusive memories, flashbacks, or nightmares. These would typically be accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations. This should not be confused with conscious rumination or other forms of repeated and deliberate thinking over of difficult events, such as a significant loss, which can be a normal adaptive process. People can present with an adverse adjustment to a significant life event or loss which they experience as traumatic but it is important to be clear about the distinction between this and PTSD.

2) Avoidance: This includes overt and persistent avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event or events.

3) Persistent perceptions of heightened current threat:  This is typically indicated by a persistent hypervigilance, or a persistent enhanced startle reaction to stimuli such as unexpected noises. For a diagnosis of clinically significant PTSD the symptoms persist for at least several (4+) weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Complex Post-Traumatic Stress Disorder and other Trauma Related Presentations

Diagnostic criteria for C-PTSD (ICD-11).

Complex post-traumatic stress disorder (C-PTSD) is a disorder that may develop following exposure to a series of events of an extremely threatening or horrific nature. These are most commonly prolonged or repetitive events from which escape is difficult or impossible. Examples might be; torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse.

All diagnostic requirements for PTSD as described above are met. In addition, Complex PTSD is characterised by:

1) Severe and persistent problems in affect regulation.

2) Severe and persistent beliefs about oneself as diminished, defeated or worthless. These are often accompanied by feelings of shame, guilt or failure related to the traumatic event.

3) Severe and persistent difficulties in sustaining relationships and in feeling close to others. For a diagnosis of clinically significant C-PTSD the symptoms persist for at least several (4+) weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Please see Resources and Links for additional sources of help.

C.M. & A.B. 31-12-24