Post-traumatic stress disorder

Also called PTSD, Complex PTSD, CPTSD

A memory that has not been filed as past. The body keeps responding as though the danger is now.

What it is

PTSD is not weakness and it is not a failure to move on. It is what happens when a traumatic memory is not processed into ordinary autobiographical memory, so it stays raw and keeps intruding as though it is happening now.

That is why flashbacks feel present rather than remembered, and why the body responds with a full threat reaction to something that ended years ago.

Complex PTSD, now recognised in ICD-11, follows repeated or prolonged trauma, often in childhood, and adds three further difficulties: emotional regulation, a persistently negative self-concept, and difficulty in relationships. A great many people diagnosed with borderline personality disorder fit this description better.

Signs you might notice

Intrusion: flashbacks, nightmares, intrusive images, and intense physical reactions to reminders.

Avoidance of people, places, conversations and thoughts connected to the event.

Hyperarousal: on edge, startling easily, poor sleep, irritability, scanning for threat.

Negative changes in mood and belief: guilt, shame, numbness, a sense of a foreshortened future.

Dissociation: going blank, feeling unreal, losing time.

How it can affect day-to-day life

Avoidance is what keeps it going, and it is entirely rational in the short term.

Trauma is common in the populations social care works with: children in care, people with a learning disability, people who have experienced domestic abuse, and staff themselves. Yet services are frequently designed in ways that re-traumatise: unpredictable staffing, restraint, being asked to repeat the story to each new professional.

Sleep is usually wrecked, which degrades everything else.

Supporting someone well

Give control back wherever possible. Choice, predictability and knowing what happens next are the active ingredients of trauma-informed practice, not a poster in a corridor.

Do not ask for the story. It is not needed for support, and repeating it without a therapeutic frame can make things worse.

Ask "what happened to you" rather than "what is wrong with you", and mean it as a change in stance rather than a phrase.

Ground rather than reassure during a flashback: name the room, the date, five things you can see. Reassurance that it is over does not reach somebody who is currently there.

Ask for trauma-focused CBT or EMDR by name. These are the treatments NICE recommends, and generic counselling is not equivalent.

Handle anniversaries and reminders deliberately.

Fiducia Life lets somebody set out how they want to be approached and what helps in all about me, which means a new member of staff can meet them correctly on day one instead of learning by getting it wrong.

Where to get help

In England, self-refer to NHS Talking Therapies and ask about trauma-focused treatment.

Combat Stress support veterans, and Rape Crisis and Refuge support survivors of sexual and domestic abuse.

Ask for a specialist trauma service if there is complex or childhood trauma, because standard-length therapy is often not the right offer.