Studies show that 50-70 per cent of doctor visits can be traced to psychological reasons. Employers should give equal weight to supporting their employees with mental health issues and physical complaints.
Post Traumatic Stress Disorder (PTSD) is an anxiety disorder brought on by witnessing or experiencing a traumatic event.
Potential trigger events include:
- A situation in which you genuinely fear for your life
- Seeing people severely injured or killed
- Witnessing a natural disaster such as an earthquake, fire or flooding
- Losing someone close to you in disturbing circumstances.
When your sense of safety is undermined by a traumatic event, it is quite normal for the mind and body to react by going into shock. It is not unusual to have bad dreams and feel fearful in such circumstances. For most people, these symptoms will gradually lessen over time. But our normal responses to trauma can develop into PTSD when the symptoms don’t ease up and the nervous system gets ‘stuck’.
PTSD can develop at any stage in life from early childhood to old age. PTSD arises when the trauma experienced was so distressing that we cannot bear to be reminded of it. Rather than processing the experience into a memory, our brains continue to relate to it as a current problem rather than simply the echo of a past event. Each time we are reminded of the event we experience the trauma as if it were happening all over again. Many people with PTSD repeatedly re-live their ordeals in the form of vivid ‘flashbacks’, nightmares or intrusive thoughts and images. This is particularly likely to happen when exposed to something that reminds them of the original trauma. The anniversary of an event can be enough to trigger symptoms. People with PTSD may also experience emotional numbness, disturbed sleep, depression, anxiety, irritability or outbursts of anger.
Symptoms typically commence within three months of a traumatic event. Once PTSD arises the severity and duration of the illness can vary. Some people recover can within six months, while others will suffer for a much longer time.
PTSD is diagnosed based on the presence of certain signs and symptoms, and a thorough psychological evaluation. To be diagnosed with PTSD, you must meet the criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). PTSD is diagnosed when these symptoms persist for more than one month.
Treatment and Recovery Timeframes
Psychological treatments such as cognitive behavioural therapy (CBT) and eye movement desensitization reprocessing (EMDR) can prove effective in treating PTSD. They do this by helping affected individuals to process a traumatic event into a memory, filing it away in their minds so that they recognise it as a past event.
CBT can help affected individuals recognise certain ways of thinking (cognitive patterns) that are keeping them ‘stuck’.
Using a series of guided eye movements, EMDR can help the malfunctioning part of the brain (the hippocampus) to process distressing memories and flashbacks, so that their influence over an individual’s mind is reduced.
The diagnosis PTSD was first applied to veterans of the Vietnam War, but the problem has been around far longer than that under a variety of other names including Shell Shock, Combat Stress and Soldier’s Heart.
PTSD can be triggered in a moment by a memory, an image, a sound or even smell.
Untreated, PTSD does not get better over time, and can become significantly worse.
The word anxiety describes feelings of unease, worry or fear. It incorporates both the emotions and the physical sensations we can experience when worried or nervous about something.
When sitting an exam or a going for a job interview, for example, it is perfectly natural to worry about how you will perform and what the outcome will be. For a short period of time we might find it harder to sleep or to concentrate. But the effects will normally subside once the stressful situation has passed.
We may find it unpleasant at the time, but anxiety is natural biological reaction to stress. It relates to the so-called ‘fight or flight’ response. The human body has evolved to release hormones, such as adrenalin and cortisol, when a perceived threat arises. These hormones physically prepare us to take on the threat physically (fight) or escape it by running away (flight).
They make us feel more alert, enabling us act faster. They also make our hearts beat faster, pumping blood more quickly to where it is needed. Once we feel the danger has passed, our bodies release other hormones that help our muscles relax. This can sometimes make us feel shaky following a moment of alarm.
The fight or flight response is completely automatic, and something over which we have no conscious control. Although today we rarely face situations that require us to physically fight or flee from danger, our biological responses have yet to adjust to our low-threat environments.
Anxiety becomes a problem when it is disproportionate to whatever is causing it, and when worrying begins to interfere with our everyday lives. We all worry from time to time, but in some cases this worrying can get out of hand and develop into something called generalised anxiety disorder (GAD). This occurs when anxiety becomes persistent (six months or longer) and loses all proportion to its cause. This can involve individuals habitually jumping to the worst possible conclusion (catasprophizing) or worrying about worrying itself.
Affected individuals can experience unpleasant physical and psychological effects over a prolonged period and may experience panic attacks. There is no single cause for anxiety-related conditions, but rather a range of risk factors that can contribute to their development.
- A family history of mental health issues
- Personality traits
- Adverse life experiences
- Current life circumstances/exposure to stressful events
- Physical health problems
- Substance use
Anxiety-related disorders can express themselves in a wide variety of ways, from the generalised feelings of anxiety and stress typical of GAD to unsettlingly specific effects such as compulsive skin picking or pulling out one’s own hair.
So what makes everyday anxieties spiral out of control?
GAD is a disorder in which the sufferer experiences a constant state of high anxiety, often known as chronic worrying. Those affected describe themselves as suffering with free-floating anxiety. No sooner do they resolve one issue than another one seems to pop up.
Anxiety is one of the main symptoms of several conditions, including phobias and post traumatic stress disorder.
It can manifest itself in a number of ways, including:
- Loss of interest in regular everyday acitvities
- Physical pain or rapid heartbeat
- Reluctance to travel or undertake certain tasks for fear of negative outcomes.
What does anxiety feel like?
|Physical Sensations||Psychological sensations|
|Nausea (feeling sick)||Feeling tense, nervous or ‘on edge’|
|Tense muscle and headaches||Sense of dread/fearing the worst|
|Pins and needles||Feeling like the world is speeding up/slowing down|
|Feeling light headed and dizzy||Feeling others perceive your anxiety and are reacting to you differently|
|Faster breathing||Busy thought process|
|Sweating/hot flushes||Dwelling on negative experiences/thinking over situations/rumination|
|Fast thumping irregular heart beat||Feeling restless/unable to concentrate|
|Raised blood pressure||Feeling numb|
|Needing the toilet more or less frequently|
|Experiencing panic attacks|
The symptoms of depression can be complex and vary widely between affected individuals. As can its causes. Depression occasionally occurs for no apparent reason. In many cases the first depressive episode will be triggered by an unwelcome or traumatic event.
As a general rule, depressed individuals will feel sad, hopeless or numb. They may lose interest in things they used to enjoy. As they attempt to cope with their depression, they will also often experience a range of feelings and thoughts which impact on their behaviour. This could lead them to avoid certain activities or situations, to isolate themselves or to engage in self harming behaviours; for example by drinking too much alcohol.
The depression will then give rise to physical symptoms. A vicious circle can become established that leads to weight loss or weight gain (as an individual loses interest in food or seeks to cope by either denying themselves or overindulging in food), sleep deprivation (sometime associated with excessive caffeine intake), low energy levels, loss of motivation and/or problems concentrating.
A range of social symptoms can also arise as a result of the physical and psychological symptoms of depression. These include compromised performance at work, reduced social engagement, neglect of the self, the family or the home.
Occurrence/Frequency of Injury
Depression often comes on gradually. This can make it difficult to notice there is something wrong. Individuals often cope, more or less successfully, with their symptoms, without recognising they have an illness and seeking help. It is often a doctor who will first identify how serious the depression is. Mixed depression and anxiety is the most common mental disorder in Britain, with 9% of Britons meeting the criteria for diagnosis. Somewhere between four and ten percent of people in England will experience depression at some point during their lifetime.
In terms of of severity, depression can be broken down as follows:
- Mild depression: some impact on daily life
- Moderate depression: a significant impact on daily life
- Severe depression: almost impossible to cope with daily life, may result in psychotic symptoms.
Depression can often lead to a cycle of negative thoughts that becomes difficult for the affected individual to challenge. Having initially succumbed to depression, they may then become more depressed about being depressed. The key to recovery is making a conscious effort to break the cycle of depression. But affected individuals need support with recognising an established pattern of negative thinking and replacing it with something more constructive. This can take the form of focusing on positive activities such as regular exercise, developing a routine, setting goals, taking care of oneself, and identifying things that promote a feeling of self-worth. It can also entail identifying and avoiding the negative coping strategies that can make the depression worse, such as smoking and the overconsumption of alcohol or caffeine.
The NHS has developed an Improving Access to Psychological Therapies (IAPT) programme based on NICE guidelines, which aims to make talking therapy available to everyone who needs it.
The NICE guidelines recommend: cognitive behavioural therapy (CBT), mindfulness-based cognitive therapy, behaviour activation, counselling and exercise.
In cases of severe depression, medication combined with a psychological treatment may be the most effective treatment. Antidepressant drugs work on brain chemicals to lift mood. They can take six to eight weeks before taking effect. They don’t cure depression, but can depressed individuals feel able to undertake some course of action that will help them deal with the underlying problems.
- In more than six out of ten cases, sufferers experience their depression as anxiety. Arriving at an accurate diagnosis is the first step to effective treatment
- Alcohol is a depressant. So are marijuana and a host of other recreational drugs. Self-medication will not make an individual better and is far more likely to make their depression worse over time
- Exercise is the easiest and least expensive treatment for depression. Just walking for 30 minutes a day can mitigate and sometimes completely alleviate symptoms
- Depression has the same impact on life expectancy as smoking.
Almost everyone has one or two irrational fears. For most people, these are nothing too much to worry about. But when fears become so severe that they cause acute anxiety and interfere with normal life, we call them phobias.
A phobia is an intense fear of something which in reality poses little or no actual threat. Traumatic events can often trigger the development of specific phobias. Women appear to be slightly more prone than men to this type of phobia. Social phobias, which research suggests may have a hereditary component, occur in equal proportions among men and women.
Signs and Symptoms
The symptoms of a phobia can range from mild feelings of apprehension and anxiety to full-blown panic attacks. Typically, the closer you are to the thing you’re afraid of, the greater your fear will be. Your fear will also be increased if the thing that causes it is hard to escape.
Although phobias are common, they won’t necessarily cause significant distress or disruption to your life. But if avoidance of the object, activity, or situation that triggers your phobia is interfering with your normal functioning, or keeping you from doing things you would otherwise want to do, it’s time to seek help.
- Difficulty breathing
- Racing or pounding heart
- Chest pain or tightness
- Trembling or shaking
- Feeling dizzy or lightheaded
- Churning stomach
- Hot or cold flushes
- Tingling sensations
- Feeling of overwhelming anxiety or panic
- Feeling an intense need to escape
- Feeling ‘unreal’ or detached from yourself
- Fear of losing control or ‘going crazy’
- Feeling like you’re about to die or pass out
- Knowing you’re overreacting, but feeling powerless to control your fear
It is normal and can even be helpful to experience fear in dangerous situations. Fear is a perfectly normal human adaptive response. It triggers our automatic ‘fight or flight’ response, which makes our minds and bodies alert and ready for action, so we can respond quickly to any threat and take steps to protect ourselves.
Treatment and Recovery Timeframes
There is no proven drug treatment for specific phobias, but certain medications may help reduce symptoms of anxiety before a phobic situation arises. A form of cognitive behavioural therapy (CBT) known as ‘exposure therapy’ can also be very helpful in treating phobias. This involves helping patients to become gradually more comfortable with situations that frighten them until they cease to be a problem. Relaxation and breathing techniques can also be helpful.
The good news is that therapy for phobias has a great track record. Not only does it work extremely well, but results can often be achieved very quickly, sometimes in just one to four sessions.
- More than twice as many women as men suffer from specific phobias
- Individuals with a phobia will go to great lengths to avoid a perceived danger which will often little or no threat in real life
- Neuroscience researchers have found that phobias are often linked to the amygdala, a part of the brain which lies behind the pituitary gland. The amygdala can trigger the release of ‘fight or flight’ hormones, which put the mind and body in a highly alert state. Malfunctions of the amygdala and associated brain structures may lie behind many phobias.
- Some example of more unusual phobias include
• Alliumphobia: if you have this phobia you and Dracula have more in common than you may have realised. It’s the fear of garlic
• Deipnophobia: an irrational fear of dinner parties (maybe not so irrational after all)
• Genuphobia: Less of a worry for people living in colder climates, but a nightmare in Bermuda, it’s an uncontrollable fear of knees.
Conversion Disorder is a condition in which psychological stress expresses itself through physical symptoms. The condition was so named to describe a health problem that starts as a mental or emotional crisis – a scary or stressful incident of some kind – and converts itself into a physical problem. Somatoform disorders are marked by persistent physical symptoms that cannot be fully explained by some other medical diagnosis. The exact cause of conversion disorder is unknown, but the part of the brain that controls the muscles and senses may be involved. It may be the brain's initial attempt at reacting to something that seems like a threat.
Occurrence/Frequency of Injury
The immediate cause of conversion disorder can often be a stressful event, accident or situation that leads an affected individual to develop bodily symptoms as symbolic expressions of a longstanding psychological conflict or problem. Conversion disorder symptoms can appear suddenly after a stressful event or trauma, whether physical or psychological. Symptoms of conversion disorder typically affect mobility and/or the senses, for example by compromising an individual’s ability to walk, swallow, see or hear. Conversion disorder symptoms vary in severity. They may come and go, or prove persistent. According to some experts, most people’s symptoms can be alleviated with prompt and appropriate management.
To be diagnosed with conversion disorder, an individual must exhibit symptoms that meet the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. This is used by mental health providers to diagnose mental conditions, and by insurance companies to calculate appropriate reimbursement for treatment.
To be diagnosed with conversion disorder:
- An individual must have one or more symptom they cannot control that affects their movement or their senses, and which cannot be explained by some other neurological or medical condition
- Diagnosis require establishing that symptoms cannot better be accounted for as relating to another mental health problem. Psychological tests should be requested by a mental health specialist before moving to a diagnosis of conversion disorder.
There are no standard tests for conversion disorder. The main objective of any diagnostic process is to rule out any medical or neurological disease.
Treatment and Recovery Timeframes
For many people, the symptoms of conversion disorder reduce without treatment, especially after reassurance from a doctor that their symptoms do not reflect a serious underlying problem, and referral to a mental health professional.
Talking therapy and stress management training may help to reduce symptoms. The affected body part or physical function may require treatment through physical or occupational therapy until the symptoms disappear. For example, a paralyzed arm will need be be exercised to keep the muscles strong.
Clinical descriptions of conversion disorder date back almost 4000 years. The Ancient Egyptians attributed its symptoms in women to a ‘wandering uterus’.
Other terms sometimes used to describe conversion disorder include pseudoneurologic syndrome, hysterical neurosis, and psychogenic disorder.
Amnesia is one of Hollywood’s favourite medical conditions, providing the inspiration for many films over the years. Also known as amnesic syndrome, Amnesia is a deficit in memory caused by brain damage, disease, or as a result of psychological trauma. It can also be caused, on a temporary basis, by the use of various sedatives and hypnotic drugs.
There are two main types of Amnesia: Retrograde amnesia and anterograde amnesia. Retrograde amnesia is the inability to recall information acquired before a particular date, and can last for anything from months to decades.
Anterograde amnesia is the inability to transfer new information from the short term to the long term memory. Affected individuals cannot retain memories for long periods of time.
The two types are not mutually exclusive, and can occur simultaneously in severe cases.
Occurrence/Frequency of Injury
There are three main causes of amnesia:
- Neurological trauma: trauma to the brain can result traumatic amnesia, e.g. stroke
- Traumatic events: some events are so distressing that the mind chooses to blank out memories rather than deal with the resulting stress. Traumatic events are subjective and will differ from person to person.
Physical deficiencies: certain more passive physical issues can also cause amnesia, these include atrophy of the brain due to disease or age,e.g. Alzheimer’s.
The chances of developing amnesia increase if you've experienced:
- Brain surgery, head injury or trauma
- Alcohol abuse
There is no definitive test for amnesia. Diagnosis depends on interpreting the results of a number of different tests. Cognitive tests can help to determine any memory loss or associated reduction in cognitive function. Diagnostics tests such as MRIs and CT scans can reveal physical damage in the brain, while blood tests can show up, disease or nutritional deficiencies.
Treatment and Recovery Timeframes
Treatment for amnesia focuses on techniques to help make up for the memory problem. There is no medication available for treating most types of amnesia.
Treatment techniques include:
- Cognitive therapy and eye movement desensitisation and reprocessing (EMDR): These psychological techniques can help to integrate the two hemispheres of the brain and so improve the ability to recall events. Cognotive therapy can help an individual acquire the tools and strategies they need to improve their thinking, time management, executive functioning, and decision making.
- Memory training: A variety of strategies are available for helping individuals organise information so that it is easier for them to remember.
- Technology: people with amnesia are increasingly using technology to remind them to complete activities.
- Nutrition: Foods high in protein and/or rich in Omega 3 fatty acids can improve access to and retrieval of memory
- Hypnosis: A method called ‘age regression’ can be used to help retrieve lost memories.
Despite what Hollywood might tell you, people suffering from amnesia rarely forget who they are. There is some truth, however, in the idea that people can regain their memories, at least partially, when they are suffering with retrograde amnesia.
If you want to know more about our services or you have a rehabilitation issue to discuss, please get in touch on +44 (0)20 7105 4000