Trauma and PTSD (Adults)

People with psychological trauma may present with a range of issues.

There are two main pathways within NHS Lothian to access treatment as outlined below, depending on whether the person has single event or complex PTSD. Please note that patients can no longer self-refer.

Please note that patients can no longer self-refer.

The Voluntary Sector will also offer alternatives.

Services available.

For single-event PTSD, the Rivers Centre will organise an initial assessment. This will give the patient an opportunity to speak one-to-one about their trauma, how it is affecting them in their life, and a management plan will be collaboratively developed.

Where appropriate individual treatment will be provided tailored to the specific needs of the patient. This may include such treatments as Trauma Focussed CBT and Eye Movement Desensitisation and Reprocessing (EMDR).

Patients presenting with more complex PTSD should be referred to the relevant sector mental health team for initial assessment.

1.    PTSD – Single Event

People presenting with symptoms indicative of a primary diagnosis of PTSD to a single event trauma (eg physical assault, sexual assault, road traffic collision), can be referred directly to The Rivers Centre.

Patients will be offered a full assessment appointment, and a treatment protocol will be developed based up on their individual circumstances and suitability for therapeutic approach. Treatment options will be discussed including individual treatment based at the Rivers Centre, treatment with colleagues in the sector mental health teams, or options within the third sector.

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.

2.      Complex Post-Traumatic Stress Disorder and other Trauma Related Presentations

People presenting with Complex Post-Traumatic Stress Disorder (C-PTSD) or other psychological difficulties associated with a history of sustained and repeated trauma in childhood or adulthood should be referred to the sector-based mental health team.

These people will be offered assessment by their local mental health team and options regarding treatment can be discussed.  Treatment options will include group based as well as individual treatment.

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.

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.

Please see Resources and Links for additional sources of help.

C.M. & A.B. 16-08-24