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PTSD and complex PTSD

Table of Content

Table of Contents

PTSD, or Post-Traumatic Stress Disorder, is something we often hear about, but what does it really mean? How does an event leave such a lasting impact on some, while others seem to heal and move forward?

What is PTSD?

Officially recognised after the first world war which left soldiers “shell-shocked,” PTSD extends beyond the battlefield, touching the lives of those who have been exposed to actual or threatened death, serious injury, or sexual violence.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), one of the guides healthcare professionals rely on to diagnose mental health conditions, this exposure can take several forms:

  • Directly experiencing the traumatic event, such as being the driver or pedestrian involved in a traffic accident.
  • Witnessing a traumatic event, like being a pedestrian who watched the traffic accident unfold.
  • Learning that a traumatic event has occurred to a loved one, such as receiving a phone call informing you that a family member or friend has been hit by a car.
  • Experiencing repeated or extreme exposure to aversive details of the traumatic event, such as working as a first responder who renders first aid to victims of traffic accidents.

Common symptoms of PTSD include: 

  • Intrusive memories: Recurrent and involuntary distressing memories of the traumatic event.
  • Nightmares: Recurrent distressing dreams in which the content and/or emotions are related to the traumatic event(s).
  • Re-experiencing: Dissociative reactions (e.g., flashbacks) where the individual feels or acts as if the traumatic event(s) were recurring.
  • Psychological distress: Intense or prolonged psychological distress when exposed to internal or external cues that symbolise or resemble an aspect of the traumatic event(s).
  • Physiological reactions: Marked physiological responses to internal or external cues that symbolise or resemble an aspect of the traumatic event(s).

Do I have PTSD?

Not everyone who experiences trauma will develop PTSD—most people do not. In fact, the World Health Organisation (WHO) estimates that while nearly 80% of people will encounter a potentially traumatic event during their lifetime, only 5.6% will go on to develop PTSD. 

The likelihood of developing PTSD can vary depending on the type of trauma. For instance, rates of PTSD are over three times higher (15.3%) among those exposed to violent conflict or war, and the risk is especially high following sexual violence.

In addition to the symptoms mentioned earlier, a diagnosis of PTSD also takes into account whether the following symptoms are present:

  • Avoidance: You persistently avoid or try to avoid distressing memories, thoughts, or feelings related to the traumatic event(s), as well as external reminders (people, places, conversations, activities, objects, situations) that trigger those thoughts and emotions.
  • Negative alterations in cognition: You may struggle to remember key aspects of the traumatic event and find it difficult to see its causes and consequences objectively, even blaming yourself or others for it. You may also develop negative beliefs about yourself, others, or the world.
  • Negative alterations in mood: You may experience persistent negative emotions, such as fear and anxiety, and find it difficult to feel positive emotions. You may lose interest in activities that once mattered to you, feel disconnected or estranged from others, and become disengaged from significant relationships.
  • Hyperarousal and reactivity: You may feel constantly on edge, be easily startled, and have difficulty concentrating or sleeping. Irritability and anger can surface as verbal or physical aggression, and you might engage in reckless or self-destructive behaviours.

More importantly, these disturbances should persist for more than a month and cause significant distress or impairment in social, occupational, or other important areas of functioning.

As PTSD often coexists with other mental health conditions, such as depression and anxiety, and its symptoms may be attributed to medical conditions or the physiological effects of substances like medication or alcohol, it is important to consult a mental health professional for an accurate diagnosis. Only clinical psychologists and psychiatrists are qualified to diagnose PTSD in Singapore.

How is complex PTSD different?

It’s important to note that complex PTSD is recognised as a distinct mental health condition in the International Classification of Diseases, 11th Revision (ICD-11) but not in the DSM-5. While this diagnosis is relatively new, it is generally differentiated from PTSD based on the duration of the trauma and the associated symptoms.

  • Duration: PTSD is typically linked to short-term traumatic events, such as a traffic accident or a natural disaster. In contrast, complex PTSD arises from prolonged or chronic trauma. For instance, a child who endures physical or sexual abuse over time may develop complex PTSD. Although less common, adults exposed to long-term trauma, like soldiers deployed in war-torn regions for extended periods, can also be affected.
  • Symptoms: In addition to the symptoms of PTSD mentioned earlier, individuals with complex PTSD often develop a negative self-concept and struggle with emotion regulation, leading to feelings of guilt, shame, and loneliness. They may also face challenges in their relationships, finding it hard to build and maintain connections with others.

PTSD diagnosis in Singapore

At Intellect Clinic, diagnosing PTSD involves a comprehensive evaluation that typically lasts between 1 to 1.5 hours. Our clinical psychologists may utilise the DSM-5 criteria along with various screening tools, such as the PTSD Checklist for DSM-5 (PCL-5) or the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).

Once a PTSD diagnosis is confirmed, our clinicians collaborate closely with you to create an evidence-based treatment plan tailored to your needs.

PTSD treatment in Singapore 

According to WHO, nearly 4% of the global population has experienced PTSD at some point in their lives and up to 40% of people with PTSD recover within one year. The American Psychological Association recommends several effective treatments for PTSD, including Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR).

Cognitive Behavioural Therapy (CBT)

CBT aims to change unhelpful patterns of thoughts, feelings, and behaviours to lessen the impact of trauma. One specific approach within CBT is Prolonged Exposure (PE), which addresses avoidance symptoms by gradually helping you confront trauma-related triggers until they feel less threatening.

For example, if you experience a persistent fear of driving after a car accident, your counsellor or therapist may guide you through imaginal exposure during sessions. This involves mentally revisiting the traumatic event in a safe environment, all while recognizing it as a memory. Over time, PE can help you understand that, although the trauma was real, it doesn’t mean you are in danger every time you’re in a car.

Eye Movement Desensitisation and Reprocessing (EMDR)

EMDR is another effective therapy for PTSD that works to reduce the emotional charge of traumatic memories through a structured process. In EMDR sessions, you’ll focus on negative memories and beliefs while experiencing bilateral stimulation.

For instance, if you grew up in a violent environment, your counsellor may help you identify a specific memory (e.g., witnessing your parents fight over something you did) and the belief associated with it (e.g., “I’m bad”). As you mentally revisit the experience, they will guide you to focus on an external stimulus, such as moving lights or hand taps. This process engages both sides of your brain, allowing you to process the traumatic memory in a healthier way.

Learn to manage PTSD at Intellect Clinic 

If you’ve experienced trauma and are ready to begin your healing journey, we’re here to support you. Our team of clinical psychologists draw from evidence-based therapies for PTSD recovery, creating personalised treatment plans that cater to your unique needs.

50-minute sessions with our counsellors and clinical psychologists are priced at $160 and $240 (Singapore dollars) respectively, and we offer appointments at our clinics in Marina One, Tanjong Pagar, Woodleigh, and Tembeling.

Reach out to us today for an appointment in the same week. 

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