Post-traumatic stress disorder develops after an event involving actual or threatened death, serious injury or violence — a road accident, an assault, a bombing, a violent bereavement, childhood abuse, or a period of sustained threat. Most people exposed to such events recover without treatment. A substantial minority do not, and for them the symptoms persist and become their own disability.
Islamic Medical Centre assesses and treats post-traumatic stress in Islamabad, including where it is found underneath a substance dependence, which is one of the more common places it is discovered.
What PTSD actually involves
The condition is not simply distressing memories. It is a specific cluster, and it is the combination that identifies it rather than any single element.
- Intrusive memories that arrive unbidden, and flashbacks in which the event is re-experienced as if happening now
- Nightmares, and sleep avoided because of them
- Avoidance of places, people, conversations and reminders connected to the event
- Persistent hypervigilance — scanning for threat, startling easily, unable to sit with the back to a door
- Emotional numbing, detachment from family, and loss of the ability to feel close to anyone
- Irritability and anger disproportionate to the situation
- Guilt, including guilt at having survived or at what was or was not done
Why it is so often missed
Two reasons. The first is that avoidance is a core symptom, so the person does not raise the subject and frequently does not connect their current state to an event years earlier. The second is that what gets presented is the consequence rather than the cause: insomnia, anger, drinking, or a marriage in difficulty.
Assessment therefore asks about trauma directly rather than waiting for it to be volunteered, and asks in a way that does not require the person to give a detailed account before they are ready. A diagnosis can be reached without the patient reliving the event in the first appointment.
Trauma and substance dependence
This combination is common enough that it should be assumed until excluded. Alcohol and sedatives suppress intrusive memories and make sleep possible, which is an entirely understandable reason to use them and a reliable route into dependence. Opioids blunt emotional pain in the same way.
Treating the dependence alone reliably fails here, because withdrawal removes the suppression and returns the intrusive memories and nightmares at full strength to someone who now has nothing to manage them with. Where trauma is present it is treated as part of the plan rather than deferred to some point after recovery.
How trauma is treated
The effective treatments for PTSD are psychological, and they work by processing the memory rather than by avoiding it. This is demanding work and it is done at a pace the patient sets, after a period of stabilisation — nobody begins trauma processing while in acute withdrawal or in crisis.
- Assessment, including risk, substance use and any co-occurring depression
- Stabilisation first: sleep, safety, and management of any acute substance dependence
- Trauma-focused psychological therapy, working through the memory in a structured and paced way
- Techniques for managing flashbacks and hypervigilance in the meantime
- Medication where indicated, particularly for co-occurring depression and for nightmares
- Family work, since the numbing and irritability are frequently what the household experiences
- Follow-up, as improvement continues well past the end of formal sessions
Trauma in children and adolescents
Children present differently. Rather than describing intrusive memories they may show it through repetitive play, regression to earlier behaviour such as bedwetting, refusal to attend school, physical complaints, or a change in mood and conduct that is read as misbehaviour.
Where abuse is disclosed or suspected, the response of the adults around the child affects the outcome substantially. Being believed and supported is associated with better recovery; disbelief, or pressure to keep quiet for the family's reputation, is associated with worse.
What recovery looks like
The aim of treatment is not to erase the memory, which is not possible and would not be desirable. The aim is that the memory becomes something in the past that can be recalled deliberately, rather than something that intrudes and is re-experienced in the present.
Most people improve substantially with treatment. Anniversaries, news coverage and unexpected reminders may still produce difficult periods afterwards, and knowing that in advance prevents an ordinary reaction being misread as relapse.
Frequently Asked Questions
- How soon after an event does PTSD develop?
- Symptoms often begin within weeks, but they can be delayed for months or occasionally years. Most people exposed to a traumatic event recover without treatment; PTSD is diagnosed where the cluster of symptoms persists and interferes with functioning.
- Do I have to describe what happened in detail?
- Not at the first appointment. Assessment can establish what is going on without a detailed account, and trauma processing begins only after a period of stabilisation and at a pace you set.
- Is PTSD only from war or terrorism?
- No. Road accidents, assault, violent bereavement, childhood abuse, medical emergencies and prolonged domestic violence are all common causes, and are seen more often than conflict-related trauma.
- Why do I drink or use to sleep?
- Because alcohol and sedatives suppress intrusive memories and nightmares, which is an understandable short-term solution and a common route into dependence. It is one of the reasons trauma and substance dependence appear together so often, and why both need treating.
- Can PTSD be treated while someone is still using?
- Acute dependence is stabilised first, because trauma processing during withdrawal or crisis is not safe or effective. Both are then treated within one plan rather than the trauma being deferred indefinitely.
- Does medication treat PTSD?
- Psychological therapy is the primary treatment. Medication is useful for co-occurring depression and for nightmares, and can make therapy possible where symptoms are severe, but it is not a substitute for the trauma work itself.
- How do children show trauma?
- Often through repetitive play, regression such as bedwetting, refusal to attend school, physical complaints, or changes in mood and behaviour read as misbehaviour rather than distress.
- Will the memories ever go away?
- The aim is not erasure but change in how the memory is held — something recalled deliberately as past, rather than intruding and re-experienced as present. Most people improve substantially with treatment.