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Post-traumatic stress disorder (PTSD) is a mental health condition triggered by experiencing or witnessing a traumatic event. It can develop after events such as natural disasters, serious accidents, terrorist attacks, war, rape, or other violent personal assaults. At Neuralia TMS, we understand how the symptoms of PTSD can be severe and long-lasting, and affect a person’s daily life.

The DSM-5, published by the American Psychiatric Association, plays a valuable role in the diagnosis of PTSD. It provides standardised criteria used by clinicians to ensure accurate and consistent diagnosis.

According to the DSM-5, PTSD diagnosis requires exposure to a traumatic event and the presence of specific symptoms from four categories: intrusive thoughts, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. The DSM-5 also introduces a subtype for children under age 6 and includes a dissociative subtype.

By using the DSM-5 PTSD criteria, healthcare professionals in Australia can reliably identify PTSD, helping those who need it to receive appropriate treatment and support.

Diagnostic Criteria for PTSD in DSM-5

To be diagnosed with PTSD, an individual needs to meet the following criteria, as laid out in the DSM-5. These criteria are used for adults and children above the age of 6 years – children under 6 fall under a specific subtype of PTSD.

Criterion A: Trauma Exposure

To receive a PTSD diagnosis, a person must have been witness to threatened or actual death, serious injury, or sexual violence. This exposure could occur in one (or more) of the following ways:

• Directly experiencing the traumatic event
• Witnessing the traumatic event as it happens to others
• Learning that the traumatic event happened to a close family member or friend
• Experiencing repeated exposure to details of the traumatic event
• Experiencing a single extreme exposure to details of the traumatic event (for example, first responders collecting human remains)

Criterion B: Intrusion Symptoms

As well as being exposed to the original event, the person must experience one (or more) of the following intrusive symptoms related to the traumatic event:

• Recurrent, involuntary, distressing memories of the specific event
• Recurring dreams of a distressing nature, related to the traumatic event
• Dissociative reactions (for instance, flashbacks) where they feel or act like the traumatic event is happening all over again
• Prolonged or intense psychological distress from cues (internal or external) that symbolise or resemble something about the traumatic event
• Distinct physiological responses to triggers or reminders of the traumatic event

Criterion C: Avoidance

For a PTSD diagnosis, the person must be actively and persistently avoiding anything that stimulates thoughts, feelings, or memories about the event. This may also extend to avoiding people, places, activities, and conversations that may bring up memories of the trauma.

Criterion D: Negative Alterations in Cognition and Mood

Negative shifts in mood and thoughts that began or worsened after the traumatic event must be present for a diagnosis. These are indicated by two (or more) of the following:

• Difficulty or inability to recall an important aspect of the traumatic event
• Constant, prolonged, and exaggerated negative beliefs or expectations (for example, “I’m a bad person” or “Nobody can be trusted”)
• Persistent, distorted ideas about the cause or consequences of the traumatic event that result in the person blaming themselves or others
• A persistent and/or prolonged negative emotional state (such as shame, guilt fear, horror, or anger)
• Noticeably reduced interest or participation in activities they used to enjoy
• Feelings of detachment or estrangement from others
• Constant and prolonged inability to feel or experience positive emotions

Criterion E: Alterations in Arousal and Reactivity

PTSD will also present with noticeable changes in reactivity. Two (or more) signs must be present for a diagnosis. These changes could present as:

• Irritable behaviour and angry outbursts (for no apparent reason) expressed as verbal or physical aggression
• Self-destructive or reckless behaviour
• Hypervigilance bordering on paranoia
• An exaggerated or overactive startle response
• Trouble with ability to focus
• Sleep disturbance (for example, difficulty falling or staying asleep, restless sleep)

Criterion F: Duration of Symptoms

Criteria B, C, D, and E should be present for more than a month. If it’s been less than a month, the condition could be a different stressor-related disorder (like acute stress disorder) rather than PTSD, so duration is an important factor in accurately diagnosing a patient.

Criterion G: Functional Significance

The previous criteria must be causing clinically significant impairment in life or distress to the person experiencing it. If the symptoms aren’t severe enough to affect how the person functions in everyday life, it could be put down to something other than PTSD.

Criterion H: Exclusion of Other Factors

The person in question should have no other medical or cognitive conditions, and shouldn’t be under the influence of drugs or alcohol. There must be nothing else that could account for the symptoms – only then will a qualified healthcare professional be able to diagnose PTSD definitively.

Subtypes and Specifiers in DSM-5 PTSD

Dissociative Subtype

The dissociative subtype of PTSD includes symptoms of depersonalisation and derealisation.

• Depersonalisation is when an individual feels detached from their own bodies or mental processes, as if they are outside observers of themselves and their life.
• Derealisation involves feelings of unreality or detachment from the environment, making it seem false, dreamlike, or distorted.

This subtype is particularly common among people who have experienced severe, chronic trauma, like childhood abuse. Identifying this subtype correctly is important because it can affect treatment approaches.

Delayed Expression

This subtype is characterised by a delay in the onset of symptoms. In these cases, full diagnostic criteria aren’t met until at least 6 months after the event. This delay can occur because people may initially suppress or manage their symptoms through coping mechanisms that eventually become ineffective.

Recognising delayed expression is key to making sure those who develop PTSD later on still receive the appropriate diagnosis and treatment.

PTSD for Children 6 Years and Younger

PTSD in children aged 6 years and younger presents differently than in older children and adults. The DSM-5 outlines specific criteria for this age group, recognising that young children may not be able to express their distress verbally. Symptoms often manifest through play that re-enacts the trauma, changes in behaviour like increased clinginess, and physical symptoms like stomach aches.

Diagnosing PTSD in young children involves careful observation of their play and behaviour patterns, as well as input from parents and caregivers. Early intervention is key for this age group to support healthy development and mitigate any long-term effects of trauma.

Changes from DSM-IV to DSM-5

The APA’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is a significant update from the DSM-IV. It was released in May 2013 and introduced several important changes to the classification and diagnosis of mental disorders. These updates aim to improve diagnostic accuracy, reflect current research, and enhance the clinical utility of the manual.

Structural Changes

One of the notable changes in DSM-5 is the reorganisation of chapters and disorders. Unlike the DSM-IV, which categorised disorders into discrete sections, DSM-5 groups them based on developmental and lifespan considerations.

This new structure begins with diagnoses that typically manifest early in life, like neurodevelopmental disorders, and progresses through those more common in adolescence and adulthood, like anxiety and depressive disorders.

Changes to Specific Disorders

Attention-Deficit/Hyperactivity Disorder (ADHD): The criteria for diagnosing ADHD were adjusted to better account for adult presentations. DSM-5 includes examples to illustrate how symptoms might manifest across different ages and environments. The age of onset criterion was changed from before 7 years of age to before 12 years of age, recognising that symptoms may be more noticeable later in childhood.

Introduction of New Disorders

Disruptive Mood Dysregulation Disorder (DMDD): This new diagnosis aims to address concerns about the potential overdiagnosis and overtreatment of bipolar disorder in children. DMDD is characterised by severe temper outbursts and persistent irritability, which are distinct from the episodic nature of bipolar disorder.

Hoarding Disorder: Previously considered a subtype of Obsessive-Compulsive Disorder (OCD), hoarding is now recognised as a distinct disorder. This change reflects research indicating that hoarding behaviours have different clinical features and treatment responses compared to OCD.

Elimination of Multiaxial System

The DSM-IV used a multiaxial system to provide a comprehensive diagnosis, including clinical syndromes, personality disorders, medical conditions, psychosocial and environmental problems, and overall functioning.

DSM-5 got rid of this system and integrated all relevant information into a single diagnostic record. This change simplifies the diagnostic process and emphasises the importance of considering the whole person rather than categorising issues into separate axes.

Cultural Considerations

DSM-5 places greater emphasis on cultural issues, recognising that cultural context can influence the expression and interpretation of symptoms. It includes a cultural formulation interview to help clinicians understand patients’ cultural backgrounds and how these may impact their mental health.

Prevalence and Impact of PTSD

PTSD is a mental health condition that can affect people of all ages. According to the DSM-5, about 8% of the population will experience PTSD at some point in their lives.

In Australia, it’s estimated that around 11% of the population will suffer from PTSD during their lifetime. This disorder is often seen in people who have experienced or witnessed traumatic events such as natural disasters, serious accidents, terrorist attacks, war/combat, or personal assaults.

PTSD can have a profound impact on daily life. Symptoms include intrusive memories, avoidance behaviours, negative changes in thinking and mood, and alterations in arousal and reactivity. These symptoms can disrupt relationships, work, and social activities.

People with PTSD may also struggle with other mental health issues like depression, anxiety, and substance abuse. Early intervention and support are very important for mitigating the long-term effects of PTSD on individuals and their families.

Treatment and Management

Effective treatment for PTSD involves a combination of therapeutic approaches and, in some cases, medication. According to the DSM-5, trauma-focused psychotherapies are the most recommended treatment. These include cognitive behavioural therapy (CBT), specifically cognitive processing therapy (CPT) and prolonged exposure (PE) therapy. These therapies help people process and reframe their traumatic experiences, reducing the power these memories hold over them.

Eye Movement Desensitisation and Reprocessing (EMDR) is another evidence-based therapy that has shown effectiveness in treating PTSD. This therapy involves recalling distressing events while engaging in bilateral sensory input, such as side-to-side eye movements. This can help reduce the emotional impact of traumatic memories.

Medications like selective serotonin reuptake inhibitors (SSRIs) can also be prescribed to help manage symptoms, especially when psychotherapy alone hasn’t been enough. These medications can alleviate symptoms of depression and anxiety that often accompany PTSD.

Support from family and friends, along with self-care practices like regular exercise, healthy eating, and mindfulness, can also play an important role in the management of PTSD. Access to mental health services and community support groups can provide assistance and much-needed encouragement.

Support and Awareness

PTSD is a prevalent and impactful mental health condition that needs comprehensive and personalised treatment. With the right interventions, people with PTSD can experience significant improvement in their symptoms and overall quality of life.

Increased awareness, early diagnosis, and accessible mental health services are essential for supporting those affected by PTSD in Australia. By providing a supportive environment and encouraging open discussions about mental health, we can help reduce the stigma associated with PTSD and promote better outcomes for those affected by this challenging condition.

If you’re looking for any further information on PTSD or TMS treatments for PTSD, get in touch. Our compassionate team at Neuralia TMS is here to help!

Back to Top: Understanding PTSD in the DSM-5

If your moods fluctuate with the seasons, you might be dealing with seasonal affective disorder (SAD). Seasonal mood swings are somewhat common, based on your likes and dislikes when it comes to weather.

But some people experience symptoms more like mental health conditions in late fall or early winter … Which is more like clinical depression and less like a mild annoyance. The team at Neuralia TMS has put together this article to help you understand seasonal affective disorder and offer guidance on how you can get treatment.

What is Seasonal Affective Disorder (SAD)?

Seasonal affective disorder (SAD) is a type of depression that happens at specific times of the year, usually during the autumn and winter months when daylight hours are shorter. This condition is characterised by a variety of symptoms, including persistent low mood, lack of energy, sleep problems, changes in appetite, and difficulty concentrating.

SAD is more common in regions with long winter nights and limited daylight. In Australia, it may be less prevalent than in northern countries but still affects many people, especially those in the southern regions.

How does SAD Differ from Other Forms of Depression?

SAD isn’t like other forms of depression because of its seasonal pattern. While major depressive disorder (MDD) can occur at any time of the year, SAD symptoms typically show up during the late autumn and winter months and improve with the arrival of spring and summer. This seasonal variation is a key diagnostic feature for SAD.

Interestingly, for most people who have been diagnosed with SAD, the symptoms occur for 2 or more years in a row and are present for around 40% of the year. But that’s not true for everyone, as 40 to 50% of people who are diagnosed can end up skipping the period of depression every other year!

Signs and Symptoms of SAD

The symptoms of seasonal affective disorder can mimic depression or bipolar disorder. You don’t just feel sad (despite its name!). People with SAD experience a range of symptoms that are technically unrelated to the seasons, but are more similar to depression symptoms.

Common Symptoms Across All Types

SAD symptoms may change depending on which type a person has. It affects everyone slightly differently, but there are several common symptoms that people with SAD may experience regardless of the season:

• Persistent sad, anxious, or “empty” mood
• Loss of interest in activities
• Low energy and fatigue
• Difficulty concentrating
• Feelings of hopelessness, worthlessness, or guilt

Winter-Pattern SAD

Winter-pattern SAD, also known as winter depression, begins around late autumn and lasts until the early spring. The symptoms can be severe and debilitating. Here are the specific symptoms often associated with winter-pattern SAD:

• Oversleeping (hypersomnia)
• Overeating resulting in weight gain
• Craving carbohydrates
• Social withdrawal (wanting to “hibernate”)

People with winter-pattern SAD might find it hard to wake up in the morning, and may struggle with feelings of heaviness in their limbs. The craving for carbohydrate-rich foods can lead to weight gain, making their mood and energy levels feel even worse.

Summer-Pattern SAD

Summer-pattern SAD, or summer depression, is less common but can be just as challenging. It usually starts in late spring or early summer and eases up in the autumn. The symptoms are somewhat different from those of winter-pattern SAD, and include:

• Insomnia
• Poor appetite and weight loss
• Agitation and anxiety

Those with summer-pattern SAD may have trouble sleeping due to the increased daylight hours and higher temperatures. The lack of appetite can lead to weight loss, and the constant feeling of agitation can make it hard to relax and enjoy activities.

Causes of Seasonal Affective Disorder

Scientists are still unsure exactly what causes SAD, but it’s thought to be linked to reduced exposure to sunlight, which can affect our bodies in several ways. Here are some of the possibilities related to what causes SAD:

Impact of Lack of Sunlight on Circadian Rhythms

The lack of sunlight during shorter winter days can disrupt your body’s internal clock, or circadian rhythm. This clock regulates sleep-wake cycles, hormone release, and other bodily functions. When it’s dark outside, your body produces more melatonin, a hormone that promotes sleep. In those with SAD, this increase in melatonin can keep you feeling sleepy.

Also, less sunlight means lower levels of serotonin, a neurotransmitter that impacts mood. This combination of increased melatonin and decreased serotonin can lead to symptoms of depression.

Biological Factors

Numerous biological factors contribute to SAD. Genetics play a role, as those with a family history of depression are more susceptible. It’s also thought that people with SAD may have a deficiency in vitamin D, which is partly produced in the skin in response to sunlight. Vitamin D is essential for maintaining mood and overall health, and a deficiency can make depressive symptoms worse.

Environmental Factors

Reduced exposure to natural light, especially in the morning, can be a major cause of this condition. Seasonal affective disorder in Australia can be influenced by the fact that the intensity and duration of sunlight can vary greatly between regions and seasons.

Lifestyle factors also play a part; for example, individuals who spend a lot of time indoors or work in environments without much natural light are at higher risk. Shorter daylight hours during the winter can also limit outdoor activities and social interactions, which are important for mental well-being. In urban areas with tall buildings, light pollution and obstructed natural light can add to the issue.

Who is at Risk of Developing SAD?

Seasonal affective disorder can affect anyone, but certain groups are more likely to experience it. Understanding who’s at risk helps identify and manage the condition early.

Demographic Factors

Several demographic factors influence the likelihood of developing SAD:

• Age: SAD is more common in younger people (onset between 20 and 30 years). The risk decreases with age, but it can still affect older adults.
• Gender: Women are around 4 times more likely to be diagnosed with SAD than men! Research suggests that hormonal differences might play a role in this.
• Family History: Having a close relative with SAD or another type of depression increases the risk.

Geographic Location

The prevalence of SAD varies quite widely by location. People living in higher latitudes, where winter days are shorter and there’s less sunlight, are at greater risk. For example:

• Northern Europe and Canada: Higher rates of SAD are reported in these regions due to long, dark, cold winters.
• Australia: SAD is less common. But while Australia is known for its sunny climate, people in the southern parts, like Tasmania, may experience SAD during the shorter winter days. The variation in sunlight exposure across the country can impact the likelihood of developing SAD.

Pre-Existing Conditions

People with certain health conditions may be more at risk of developing SAD. These pre-existing conditions include:

• Mental Health Disorders: Those with a history of major depressive disorder, bipolar disorder, anxiety, and other mood disorders are more prone to SAD. The seasonal changes can make these conditions worse.
• Sleep Disorders: Problems with sleep, like insomnia or sleep phase disorders, can make a person more vulnerable to SAD. Disrupted sleep patterns affect mood and overall mental health.
• Vitamin D Deficiency: Lack of vitamin D, often due to insufficient sunlight exposure, is linked to SAD. People with low levels of this vitamin may experience more severe symptoms.

How is Seasonal Affective Disorder Diagnosed?

Several steps lead up to a SAD diagnosis. You’ll need to meet with a mental health professional, who’ll go through the following steps with you:

1. Discussion: You’ll need to answer some questions about your symptoms. For seasonal depression to be diagnosed, your symptoms must happen during specific seasons for at least 2 consecutive years.
2. Physical Exam: A thorough physical exam is conducted to rule out other medical conditions that could be causing the symptoms. This helps identify any underlying issues that might mimic SAD symptoms.
3. Lab Tests: Lab tests like complete blood count (CBC) and thyroid function tests are often done. These also help to exclude other health conditions that can cause similar symptoms, such as hypothyroidism or anaemia.
4. Psychological Evaluation: A psychological evaluation is key for diagnosing SAD. This includes detailed questionnaires to assess the severity, frequency, and patterns of symptoms.
5. Seasonal Pattern Assessment Questionnaire (SPAQ): The SPAQ is a widely used self-reporting tool that helps identify the seasonal pattern of depressive episodes. Patients answer questions about their mood, energy levels, sleep patterns, and social activities throughout the year.

Treatment Options for SAD

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) is a non-invasive treatment that has shown promise for treating seasonal affective disorder. TMS involves using magnetic fields to stimulate nerve cells in the brain, specifically targeting areas associated with mood regulation.

Studies have shown that TMS can be effective for people with SAD, particularly if they haven’t responded well to other treatments such as medication or light therapy. Research indicates that TMS can lead to significant improvements in mood and overall functioning for many patients.

Light Therapy

Light therapy involves using a light box that mimics natural sunlight, usually providing 10,000 lux of light. This treatment is typically administered for about 20 to 60 minutes daily, ideally within the first hour of waking up.

Studies have shown that light therapy is effective in up to 85% of diagnosed cases, with an 80% response rate in selected patient populations. This method can significantly reduce symptoms by helping to regulate the body’s sleep-wake cycle and improve mood.

Medications

Medications are another treatment option for SAD, particularly antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline are often prescribed.

Another medication, extended-release bupropion (Wellbutrin XL), may help prevent depressive episodes. It’s important to note that these medications may take several weeks to show their full effects. Patients should work closely with their healthcare providers to monitor their progress and adjust dosages as needed.

Psychotherapy

Psychotherapy, specifically cognitive behavioural therapy (CBT) adapted for SAD (CBT-SAD), can be an effective treatment. CBT-SAD focuses on changing negative thought patterns and behaviours associated with depression.

It includes behavioural activation, which encourages patients to engage in enjoyable activities, improving mood and reducing depressive symptoms. This type of therapy can provide patients with tools to manage their symptoms and prevent future episodes.

Vitamin D Supplements

Vitamin D supplements might be helpful, especially if vitamin D deficiency is a known cause of someone’s SAD. Results have been inconsistent in the studies, but there have been some positive outcomes as well, so it may be worthwhile for some.

Lifestyle Changes

Daily Habits

Making daily lifestyle changes can greatly assist in managing SAD. Engaging in outdoor activities during daylight hours is very helpful. Another hugely beneficial change is establishing a regular sleeping and waking schedule. A regular physical activity and exercise routine is also a must, as exercise can boost mood and energy levels.

Environmental Changes

Creating a brighter and sunnier living space can positively impact those with SAD. Simple changes like opening curtains and using bright lights can make a difference. Dawn simulators, which gradually increase light in the morning to mimic sunrise, can help regulate sleep patterns and improve mood.

Stress Management Techniques

Managing stress effectively makes a huge difference to SAD symptoms. We are all different, so find techniques that work for you! For some people, meditation and practising mindfulness could help. For others, journaling could be a stress-relieving activity.

Engaging in social activities is also important to combat the withdrawal and estrangement often associated with depression. Staying connected with friends and family can give you emotional support and ease feelings of isolation.

Prevention and Minimising the Impact of SAD

Early Intervention Strategies

Seasonal affective disorder can be managed effectively with early intervention. Recognising the symptoms early – persistent low mood, loss of interest in everyday activities, irritability, and feelings of despair – means you can seek help as soon as possible.

Preparing for the Challenging Season

Preparation is key to coping with SAD symptoms. As the days shorten, start increasing your exposure to natural light during the day. Spending time outdoors, even on cloudy days, can help. At home, rearrange spaces to maximise sunlight.

If you are particularly vulnerable to SAD, start light therapy in early autumn to pre-empt the onset of symptoms. Plan a balanced diet rich in omega-3 fatty acids, vitamins B12 and D, and maintain regular exercise routines to support mental well-being. Proactively plan activities to stay connected with friends and family during tougher months.

Potential Complications of Untreated SAD

Impact on Mental Health

Untreated SAD can lead to serious mental health issues. Severe depression can increase the risk of suicidal thoughts and behaviours, while anxiety is also a common complication, worsening feelings of stress and hopelessness. Additionally, chronic sleep disturbances can cause even more severe mood swings and cognitive troubles. With this in mind, seeking early treatment can prevent your symptoms from descending into more dangerous ones.

Effect on Daily Functioning

SAD can severely affect daily functioning. Some may find it challenging to maintain regular work or school attendance, leading to decreased performance and productivity. Social withdrawal is common, as you may feel too exhausted or not interested in participating in activities they once enjoyed.

This isolation can strain personal relationships and create a cycle of loneliness and depression. The physical symptoms of SAD, such as fatigue and changes in appetite, can disrupt normal routines and overall quality of life.

Getting Help for SAD

Professional Resources

Getting professional help is essential to treat SAD and manage it. It won’t just go away on its own, in most cases! General practitioners can do initial assessments and refer you to mental health specialists if needed.

Psychologists and psychiatrists can offer therapies such as CBT and medication management. Light therapy devices are also available through healthcare providers, and they can guide patients on proper usage. In Australia, resources like Beyond Blue and the Black Dog Institute offer information and support services for those affected by SAD.

Support Systems

Building a strong support system can make a big difference in managing SAD. Friends and family play a much more important role than you (or they) realise, by providing emotional support and encouraging positive activities.

Joining support groups, either in-person or online, can connect people with others experiencing similar challenges, fostering a sense of community and shared understanding. Workplace accommodations, such as flexible hours or remote work options, can also help individuals cope with the symptoms of SAD. Community resources, including local mental health organisations and counselling services, are valuable for additional support.

Contact us if you’d like more details on SAD or TMS as a treatment for SAD. Our caring staff at Neuralia TMS are ready to help and answer all your questions.

Back to Top: Seasonal Affective Disorder (SAD): Understanding the Winter Blues

The origins of post-traumatic stress disorder (PTSD) for many people come from trauma. In recent studies, it seems that one of the main influencing factors of PTSD is linked to orthopaedic trauma and fractures specifically. Patients with PTSD also have a higher likelihood of fractures, creating a vicious cycle between PTSD and orthopaedic fracture that can debilitate your sleep, relationships, and overall quality of life.

Neuralia TMS offers transcranial magnetic stimulation (TMS). This non-invasive treatment helps target the parts of the brain that are connected with PTSD systems, which has been found to reduce the stress symptoms associated with PTSD. We’ll be investigating the association between PTSD and fracture trauma symptoms, studies, and treatment so you can understand your options moving forward.

Key Takeaways

• Orthopaedic trauma can impact your psychology, resulting in PTSD and depression.
• Symptoms of PTSD include re-experiencing, avoidance, arousal and reactivity, and cognitions and mood symptoms.
• PTSD fractures are orthopaedic fractures caused by the symptoms associated with PTSD.
• You are 12 to 24% more likely to receive an orthopaedic fracture if you have PTSD, according to contemporary studies.
• TMS can be an effective treatment for PTSD symptoms, especially when coupled with other types of treatment.

What is Post-Traumatic Stress Disorder?

PTSD is a disorder that affects the general health of people who have been involved in a traumatic event. While it’s very natural to feel fear during or after a dangerous event, PTSD is characterised by the continuation of symptoms over time. Most people who experience a range of symptoms after trauma will see their reaction diminish over time, but this isn’t the case for people with PTSD.

How is PTSD Linked to Orthopaedic Trauma and Fracture?

Post-traumatic stress disorder symptoms can increase the risk of fractures in a patient. The incidence of PTSD in fracture patients has been mostly limited to older adults. However, there is a statistically significant association according to a systematic review and meta-analysis of PTSD symptoms and fracture risk in older adults in the Fukushima Prefecture, Japan.

How does Orthopaedic Trauma Impact Your Psychology?

Orthopaedic trauma affects your psychology by causing you physical pain, disrupting your life, and limiting your mobility. Orthopaedic injuries are categorised as physical trauma to your bones, ligaments, joints, and muscles, which heavily contribute to the everyday activities we take for granted. When these injuries interfere with your daily life, it can have a major impact on your psychology, including:

• Frustration and irritability from chronic pain
• Loss of independence and emotional distress from a lack of mobility
• Boredom and financial panic from a disruption to your routine
• Depression from social isolation and chronic pain
• PTSD if a traumatic experience caused the injury

Does Orthopaedic Trauma Lead to PTSD? Studies and Statistics

Orthopaedic trauma and fracture have been directly linked to PTSD, especially if the type of fracture occurred during a violent and traumatic experience. A Journal of Trauma and Injury 2024 study found that orthopaedic trauma patients were highly likely to have signs of PTSD after the event when screened with the Injured Trauma Survivor Screen (ITSS).

Around 40% of orthopaedic trauma patients showed signs of PTSD when screened on average 7.1 days after the event that caused the injury. The most common types of injuries that caused PTSD were gunshot wounds (80%), falls from great heights (30%), and serious motor vehicle collisions (17%).

Common PTSD Symptoms in the Aftermath of Trauma

While PTSD can be difficult to link directly to the physical trauma of orthopaedic patients, several common PTSD symptoms (taken from the National Institute of Mental Health) can be identified, including:

Re-Experiencing Symptoms

• Experiencing flashbacks
• Having recurring memories or dreams related to the event
• Having distressing thoughts
• Experiencing physical signs of stress

Avoidance Symptoms

• Avoidance of places, events, and/or objects that are linked to the traumatic experience
• Staying away from thoughts and/or feelings related to the traumatic experience

Arousal and Reactivity Symptoms

• Easily startled or surprised
• Feeling tense or on edge
• Difficulty concentrating
• Difficulty falling asleep or remaining asleep
• General irritableness and/or angry outbursts
• Reckless and destructive behaviour

Cognition and Mood Symptoms

• Difficulty recalling key details of the traumatic experience
• Negative self-perception
• Exaggerated feelings of blame directed towards oneself or others
• Persistent negative emotions of fear, anger, guilt, and/or shame
• Trouble feeling positive emotions
• Disinterest in previous passions or activities
• Feelings of social isolation

While it may be common for everyone to feel these symptoms at one point or another, to be diagnosed with PTSD you must experience the following for at least 1 month:

• At least one re-experiencing symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms

What Responsibilities do Healthcare Workers have in Recognising PTSD?

It’s the responsibility of healthcare workers to not only address the psychological and physical impact of orthopaedic injuries, but also recognise symptoms as soon as possible. Since PTSD has a major effect on the health status of patients, healthcare workers must assess and analyse for symptoms of PTSD when dealing with fracture patients after traumatic events.

The key step to aiding orthopaedic injury patients who are showing signs of PTSD is to take a multidisciplinary approach that includes trauma counselling, and rehabilitation in the following forms:

• Teaching patients about expected emotional responses to orthopaedic injuries
• Creating strategies to manage pain and anxiety as they recover
• Allowing support from friends and family to help promote psychological well-being
• Approaching patients with an encouraging and understanding attitude

How does PTSD Affect Fractures?

There are several ways that PTSD can contribute to fractures, including:

• PTSD affects our calcium, which is a major component of our bone mineral density and strength.
• Patients with PTSD will often smoke or drink to cope with their symptoms, which leads to accidents and weakens bones.
• Older patients with PTSD are more susceptible to PTSD fractures, particularly spinal injuries.

How Common are PTSD Fractures?

A study of incident fractures in the Danish population in 2018 found that the risk of fractures occurring for people with PTSD was 24%, a statistically significant result for the average population. They concluded that there was an increased fracture risk in people with PTSD, stressing the importance of managing the prevalence of PTSD symptoms.

Similarly, another study in 2021 by BMC Geriatrics followed the correlations between bone fractures and PTSD in patients who experienced the Great East Japan Earthquake. After following older adults with PTSD from this dangerous event (a mean age of 56 years), they found that 12% of adults had fractures that were linked to symptoms associated with PTSD. They concluded that disaster-induced PTSD symptoms and insomnia led to increased fracture risk among older adults.

How to Mitigate PTSD Fractures Using Treatment and Therapy

The best way to reduce the likelihood of fracture sites is to mitigate the incidence of PTSD among patients using treatment and therapy. Alleviating the symptoms of PTSD and improving patient conditions following trauma will reduce fracture risk.

Luckily, the presence of PTSD has been studied for several years and there are currently several treatments that can help you with your diagnosis of PTSD and reduce symptoms, including:

• Cognitive Processing Therapy
• Prolonged Exposure Therapy
• Eye Movement Desensitisation and Reprocessing
• Stress Inoculation Training
• Medications

What are Emerging Therapies to Treat PTSD?

One of the most promising emerging therapies for treating PTSD is TMS. TMS is a non-invasive form of brain stimulation that has been shown to treat the symptoms of depression and PTSD. TMS uses magnetic fields to target specific areas of the brain that create and regulate the symptoms that may arise from severe trauma.

The areas are stimulated, which increases brain activity, encourages new neural connections, and with repeated treatments can stimulate the brain’s neuroplasticity. TMS in Australia has witnessed a surge in popularity, with clinics available in Perth, Melbourne, and Sydney. While the technology surrounding TMS isn’t new, access to Medicare and general affordability means that this type of therapy is now available to more people.

Individuals with PTSD can greatly benefit from TMS, especially if they are searching for a non-invasive treatment for PTSD.

Can I use Multidisciplinary Treatments at the Same Time?

Yes, you can. In fact, you’ll find that often using at least two different types of treatment to manage your PTSD symptoms will reduce stress and fracture risk more effectively than just one.

TMS therapy for PTSD is promising, and there is ongoing research that suggests that TMS has a potential efficacy for treating patients displaying symptoms of PTSD. The best type or combination of treatments for PTSD, as with any psychological trauma, is specific to the patient and employs a multidisciplinary approach to treatment.

Encouraging Proactive Mental Healthcare in Orthopaedic Trauma

Mental healthcare regularly suffers when dealing with a diagnosis and symptoms of PTSD, as well as the resulting increased risk of fractures. While approaches to combat the symptoms that arise from PTSD like depression are effective, they have side effects. Antidepressants, for example, can affect your sexual function and leave you feeling like a zombie.

Faced with these decisions, you can feel overwhelmed while coping with traumatic fractures and symptoms – luckily, there’s good news. Neuralia TMS offers non-invasive treatment that is Medicare & DVA covered for patients suffering from PTSD. Book an initial consultation or phone 6230 3996 to see how Neuralia TMS can help you.

FAQs on PTSD Orthopaedic Trauma and Fractures

Does TMS Treat PTSD?

Yes, TMS can be an effective treatment for PTSD. TMS treatments can be effective at treating a stress psychiatric disorder like PTSD, as well as OCD, Parkinson’s, chronic pain, and tinnitus.

Is TMS Therapy Painful?

No, TMS therapy is not painful. Some patients feel slight scalp discomfort, headache, scalp tingling, or lightheadedness. But generally speaking, these side effects are low to moderate and go away quickly after a session. On the other hand, many patients have commented on how relaxing the experience can be.

We understand that numerous PTSD patients will feel on edge or uncomfortable in sensitive situations, which makes TMS a desirable treatment. Lots of our patients will listen to music, watch shows on Netflix, or chat with our friendly TMS nurses throughout their treatment.

Can TMS be used with Other PTSD Treatments?

Yes, TMS is an excellent complement to other therapeutic approaches to PTSD. Improvement in the psychological stress caused by PTSD among patients is best treated with a comprehensive treatment plan that can involve multiple types of treatments.

Back to Top: Understanding PTSD in the Context of Orthopaedic Trauma and Fractures

Tinnitus, otherwise known as “ringing in the ear”, can last anywhere from a few seconds to a lifetime. Your tinnitus is considered chronic if you’ve been experiencing symptoms for more than 3 months, as outlined by the National Institute of Deafness. However, only a detailed history and physical examination can determine your tinnitus diagnosis. Experiencing tinnitus for long periods of time can be distressing, which is why many turn to Neuralia TMS to help manage their symptoms.

If you believe you are part of the 26.5% of Australia’s working population who experience tinnitus, you may be wondering how long it’ll last, what the cause of tinnitus is, and how you can reduce its impact on your life. We’ve put together this guide to help you traverse your tinnitus symptoms.

Key Takeaways

• Tinnitus can last a few seconds or potentially the rest of your life, depending on the underlying health conditions that caused the symptoms.
• Several conditions can cause tinnitus, including hearing loss, inner or middle ear infections, and certain medical conditions.
• You can recognise tinnitus by its signature buzzing or ringing in the ear.
• Repetitive transcranial magnetic stimulation (rTMS) and other treatments are effective at helping reduce the impact of symptoms of tinnitus on your life.

Will Tinnitus Go Away?

Tinnitus can go away, although this will depend on the type of tinnitus you have and what caused the ringing in your ears. A key indicator that could tell you if your tinnitus may go away is whether your tinnitus is temporary or permanent. While this may seem obvious, telling your physician or audiologist about the frequency of your tinnitus symptoms will go a long way in determining whether the ring or buzz in your ear will go away over time.

What is the Difference Between Temporary and Permanent Tinnitus?

We’ve outlined the key differences between temporary and permanent tinnitus below:

What Causes Tinnitus?

Tinnitus can be caused by age-related hearing loss, an ear infection, as well as certain medical conditions and medication. Here are some common causes of tinnitus:

• Age-related hearing loss
• Noise-induced hearing loss
• Ear infections
• Blockages in the ear canal (earwax)
• Head or neck injuries
• High blood pressure
• TMJ disorders (temporomandibular joint disorders)
• Ménière’s disease
• Ototoxic medications
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Circulatory or vascular disorders

How to Tell If You Have Tinnitus

You can tell if you’re experiencing tinnitus if you’ve noticed the following symptoms.

1. Ringing or Buzzing Sound

   You’ll experience a ringing, buzzing, hissing, roaring, clicking, or even a whooshing noise in one ear or both ears. These sounds can vary in pitch and intensity, but if the sound is not caused by a source that other people can hear, it is a form of tinnitus.

2. Patterned Noise

   The pattern at which you’ll hear tinnitus is just as varied as the sound, but in most cases of tinnitus, the noise will either be constant, intermittent, or pulsating. Pulsatile tinnitus can be heard by other people and usually moves in sync or rhythm with your heartbeat.

3. Hearing Loss

   You may notice a loss of hearing, ear pain, or hearing impairment when experiencing mild or severe tinnitus. If you have had frequent exposure to loud noises while working or during recreational activities, this hearing loss may be more pronounced and coupled with the signature ringing white noise of tinnitus.

4. Decreased Quality of Life

   Many Australians often live with undiagnosed tinnitus, ignoring the symptoms and assuming that it may last only a few days. This can severely impact your quality of life, leading to anxiety, depression, and decreased capacity to work once people come to terms with tinnitus not going away.

When Should You See a Doctor for Tinnitus?

If you notice yourself experiencing these symptoms, especially if they remain persistent or worsen over time, then you should book a consultation to determine if you have tinnitus. Tinnitus is a symptom of an underlying condition, which may originate in your inner ear or brain, and receiving answers to questions about tinnitus can not only help you manage its symptoms but also ease any concerns you may have.

What Should you do if you are Diagnosed with Tinnitus?

If you’ve been diagnosed with tinnitus, it’s important to realise that there are some tinnitus treatment options at your disposal. While there’s no cure for tinnitus, speaking with your primary healthcare physician or audiologist can shed light on which option may be right for you. One of the most well-known, non-invasive options is rTMS, which can help reduce the effects of tinnitus on your everyday life.

Our team at Neuralia TMS provides ample support to help you find the tailored rTMS that suits your schedule and needs. Contact Neuralia TMS today and let us help you take the first step towards a quieter future.

FAQs on How long does Tinnitus Last?

What are signs that tinnitus is going away?

Signs that tinnitus is going away include shorter durations of tinnitus, lower intensity of ringing, and overall reduced ear pressure if it was caused by an ear infection. If you feel your tinnitus symptoms are improving, it’s important to speak with a physician to steer clear of activities that can cause or worsen tinnitus.

Is tinnitus permanent?

Not always; tinnitus can be permanent, but not necessarily. Permanent tinnitus is often caused by long-term exposure to loud noises and certain chronic conditions. To prevent permanent tinnitus, it’s important to use a hearing aid or other ear plugs and protection to limit your exposure to high-decibel noises.

Is there a cure for tinnitus?

No, there is no current cure for tinnitus. If you want to reduce the effect that tinnitus has on your life, there are several management strategies and therapies you can use like sound therapy, cognitive behavioural therapy (CBT), and repetitive transcranial magnetic stimulation (rTMS).

Back to Top: How long does Tinnitus Last?