Posttraumatic stress disorder (PTSD) affects a minority of people exposed to trauma and can be, unless treated, a debilitating and chronic condition. It has been described as disorder of memory, and is associated with unusual and distressing symptoms such as flashbacks. It is not well recognized in general practice however, and often remains untreated for long periods. This is sometimes because the person has developed PTSD to an event that is not obviously traumatic, and it is important to understand what conditions and vulnerabilities make PTSD more likely.
The condition is associated with two alterations to normal memory that may appear contradictory: increased intrusion of vivid, distressing images of the traumatic event together with difficulty in producing a coherent verbal narrative of the event. The former often leads to avoidance and clinicians need to appreciate the role of triggers. Contrary to popular belief, traumatic events can sometimes be completely forgotten and the recovery of unexpected memories sometimes requires careful handling.

Content

The way PTSD is diagnosed has recently changed with the introduction of the 11th edition of the International Classification of Diseases (ICD-11). The diagnosis of PTSD has been greatly simplified and a distinction has been introduced between PTSD and Complex PTSD. Dr. Brewin will outline these changes and the new definition of flashbacks and intrusive memories. He will also present recent research on the kind of events that are associated with ICD-11 PTSD, which are broader than the traditional ones and include some types of experience (harassment, abuse, frightening hallucinations) not traditionally considered traumatic.
Following this, key memory concepts such as intrusive memories, flashbacks, and hotspots will be distinguished, along with a discussion of how much they can be expected to reflect external reality. Research indicates that the origin of these intrusions is related to specific responses occurring during the traumatic event. This webinar will include descriptions of how these intrusions can be triggered by aspects of the clinical environment as well as by the words and actions of the clinician, with the danger of disengagement from treatment. Clinicians must ensure that they help patients to feel in control of their interactions as much as possible. Dr. Brewin will describe the impairments that are often found in traumatic memory, the evidence that traumatic events can be forgotten, and the reasons this may happen. A clinical strategy is described to deal with traumatic memories that are recovered from amnesia, involving the absence of any suggestion and neutrality about to what extent the memories correspond to reality.