Post Traumatic Stress Disorder (PTSD) is a clear-cut, specific clinical ‘entity’– a unique mental disorder of anxiety, quite different from all other mental disorders. In every case PTSD has arisen from a momentary sudden and unexpected acute-fear experience during a mentally traumatic event at some time in the recallable-past. The age of onset ranges from four years or so to well over seventy.  PTSD persists indefinitely unless successfully eliminated by specific treatment. 

From case to case there is a wide range of the objective severity of the traumatic events which have given rise to their PTSD – some events may appear trivial to others; some events are horrendous to everyone.

Similarly, there is a wide range of severity of their PTSD – for some it is trivial, for some it is horrendous, for others it can be anywhere in between.

Hence there is ‘PTSD, but not so serious’ and there is ‘PTSD, very serious indeed’. PTSD is never to be underestimated in significance when severe just because in other cases it can be sufficiently mild to be ignored.

(In terms of molecular biology: the cause of PTSD is thought to be an instantaneous ‘epigenetic de-methylation’ of DNA in certain brain cell systems in response to a moment of sudden  and unexpected acute-fear.)

The range of severity of mentally traumatic events giving rise to PTSD and the range of severity of PTSD are described in this website.

Abnormal flashbacks are a constant feature of PTSD: detailed aspects of the moment of sudden and unexpected acute-fear are repeatedly recalled in ‘experiential’ form; they are not just repeatedly and briefly remembered, rather they are repeatedly and briefly re-lived and re-experienced. From case to case there is a wide range of the severity of obtrusiveness of abnormal flashbacks, and of the frequency of abnormal flashbacks. In some cases there have been many experiences of sudden and unexpected acute-fear from one or more mentally traumatic events, resulting in many different abnormal flashbacks.

Everyone, with or without PTSD, has ‘normal memory flashbacks’ – brief memory recalls of past events, both good and bad.  ‘Normal flashbacks’ have no abnormal sensory re-experiencing, though they may create intense sadness, anger, grief and other strong emotions.  Abnormal flashbacks are mostly distinguishable from ‘false memories’.

Abnormal flashbacks of PTSD are described in detail in this website.

From the outset and regardless of its severity PTSD has an associated specific abnormality of vision, Persistent Peripheral Oscillopsia,.  This abnormality of vision may or may not be noticed spontaneously by the individual but is virtually always reported present whenever tested for. Persistent Peripheral Oscillopsia is the Visual State Marker for PTSD.  The test for it has become The Visual Test for PTSD.  The test is quick, simple, reliable and sensitive.  It can be administered by anyone and can even be self-administered.  At any age above six years or so the test allows the presence or absence of PTSD, of any severity, to be speedily confirmed.

Persistent Peripheral Oscillopsia and The Visual Test for PTSD are described in detail in this website.

PTSD has a specific treatment. It is in the form of ‘repeated alternating bilateral sensory stimulation’. Each abnormal flashback is repeatedly evoked voluntarily and exposed to this form of sensory stimulation until no abnormal flashbacks can be re-evoked. The most common technique used is Eye Movement Desensitization and Reprocessing (EMDR).  This specific treatment is effective in eliminating PTSD, of any severity, in approximately 95 per cent of cases.  Regardless of severity, from case to case there is a wide range of responsiveness.  For some the treatment takes only a few seconds to be successful; in others it takes very much longer; in five per cent of cases it is unsuccessful, regardless of the time spent.

Once PTSD has been eliminated and no further abnormal flashbacks can be voluntarily re-evoked, then the memories of the moments of sudden and unexpected acute-fear are in normal form, without re-experiencing.  When vision is retested there is no peripheral oscillopsia. If there is no other source of anxiety, then anxiety returns to prior levels.

The remaining five per cent of cases for whom treatment is ineffective have their anxiety, flashbacks and peripheral oscillopsia persisting as before.  In some cases each symptom remains, and as before, remains hardly at all obtrusive. In other cases each symptom remains, and as before, remains severely obtrusive.

In some cases PTSD is so unobtrusive from the start that it hardly warrants any treatment, and if offered may be refused.

PTSD cannot be eliminated with any medication, with any talking therapy, with the passage of time, or with any other remedy yet known. The severity of its symptoms may be alleviated to a greater or lesser extent with these other treatments.

(In terms of molecular biology: when successful, the elimination of PTSD is thought to have been by gradual ‘epigenetic re-methylation’ of DNA in those certain brain cell systems in response to repeated alternating bilateral sensory stimulation.)

The treatment techniques are described in detail in this website.

Common sense tells us that a momentary sudden and unexpected acute-fear experience during a mentally traumatic event does not always result in PTSD.  In some cases such experiences are ‘brushed off’ at the time or soon thereafter. In some cases experiencing such events exacerbate pre-existing mental disorders.  In some cases experiencing such events give rise to other generic ‘post traumatic stress disorders’ which are not PTSD.  These exacerbations and disorders can arise alone or together with, and remain together with (‘co-morbid’ with) PTSD. These generic ‘ptsd’s’ have features in common with each other and with other mental disorders, but are quite distinct from PTSD. These generic ‘ptsd’s’ do not respond curatively to EMDR-like treatments. They are more likely to respond curatively to medication, to talking therapies, to many other remedies, and or to the passage of time.

There may have been horrendous post traumatic physical consequences of the traumatic event in addition to PTSD, leaving horrendous permanent physical disability, disfigurement, grief…… consequences which do not fade with time and take their toll of persisting mental and physical distress. When there are many co-morbid conditions and disorders the term ‘complex PTSD’ is sometimes used, though we feel unnecessarily – to enable specific treatments it is better to list the specific co-morbidities.

Clinically, when we embark on treating a patient with PTSD we are embarking on treating all co-morbid disorders in addition.

Generic ptsd’s and how they differ from PTSD is described in this website.

For reasons not yet known persons who appear to have inherited the genes for Attention Deficit Hyperactivity Disorder (ADHD) appear to have inherited a significantly increased susceptibility to developing PTSD from a momentary sudden and unexpected acute-fear experience.

The genes for ADHD appear to give rise to a slightly different form of brain.  The ADHD-brain gives a different attentiveness, a slightly different way of thinking and a different spontaneity or impulsivity of action. Approximately one in ten persons worldwide, male and female alike, and ‘aware of it or not, like it or not’, appear to have inherited the genes. There is no genetic or other state marker for ADHD. The ADHD brain is ‘recognised’, not ‘diagnosed’.  Most with the ADHD-brain are unaware of having a somewhat different brain and assume they are the same as everyone else; and vice versa.

For the majority of people with the ADHD-brain it is mostly advantageous, presenting no specific difficulty.  For the minority, having the ADHD-brain is not so advantageous and from time to time their different attentiveness, way of thinking and spontaneity give rise to particular difficulties. From time to time these difficulties can be of such nuisance that they certainly constitute a distinct ‘disorder’. This ‘disorder’ is then ‘diagnosed’, but still called ‘ADHD’. Hence there is ‘ADHD, merely a slightly different brain’ and there is ‘ADHD, a disorder of varying morbidity’. ADHD is never to be overestimated in significance when symptomless just because in other cases it can be significantly disabling, at least for a time.

We find no clinical evidence that PTSD per se is heritable.  Since ADHD is significantly heritable there is at least one ‘susceptibility to the development of PTSD’ which is heritable.

A combination of PTSD and ADHD is to be found not un-commonly in certain people of any age from six years onward.  Surprisingly for us we have found PTSD in about half of the newly-presenting patients with ADHD-related difficulties and we have found ADHD in about half of the newly presenting patients with PTSD.

There is good reason why PTSD, ADHD or a combination of the two may not be clinically obvious, and why treatment may not be needed.  There is a wide spectrum of severity of PTSD and also a wide spectrum of severity of ADHD-related difficulties, giving a wide spectrum of severity of combined PTSD and ADHD-related difficulties.

At the lower ends of the wide spectra some cases present with ADHD and or PTSD having few if any difficulties, and if any difficulties do arise at any time then they appear to be well compensated for.  Neither disorder may need any treatment.

At the upper ends of the wide spectra some cases present with ADHD and or PTSD with extreme difficulties, possibly combined with other horrendous mental and physical consequences of traumatic events.  Despite ADHD and PTSD being treated appropriately and successfully, which is certainly needed, they may remain severely distressed and incapacitated from these other consequences and continue in need of other treatment.

ADHD and its association with PTSD are described in detail in this website.

The ‘evidence base’ for the clinical material given here and in the 2009 article in the international medical journal Traumatology (also available through this website) comes direct from patients. Evidence has been gleaned from Psychiatric and Psychological assessments over a 30 year period. During each assessment, and regardless of presenting complaints, the possible covert presence of PTSD and or ADHD was virtually always considered, and for those aged six years and above the Visual Test for PTSD was virtually always performed.

It appears so often to be the case, alas, that when PTSD and ADHD are not specifically sought they are missed. To further confuse: not all Psychiatrists and Psychologists recognise PTSD or ADHD as disorders, let alone worthy of treatment.

Thomas Sydenham, England’s Father of Clinical Medicine, cajoled in 1666 ‘…no my boy, put those tomes aside…it is at the bedside that you learn about disease…’ William Osler, America’s Doyen of Clinical Medicine, cajoled similarly in 1906 ‘…Listen to the patient. He (or she) is telling you the diagnosis…’  (In the present context of PTSD we are cajoled to listen to the six-year-old too.)

There is a growing body of empirical evidence that indicates PTSD to be a specific clinical entity as described and that in the majority of cases it can be successfully treated.