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PTSD

 

Post Traumatic Stress Disorder (PTSD)

 

WHAT IS TRAUMA?

Trauma has come to mean the reaction to any catastrophic event that leaves you feeling distress or having difficulties long after the danger is over. It can affect your life and the life of the people around you. Your mood, thinking, behavior, and/or daily activities can change for the worse. Trauma can affect a person at any age (NIMH, 2013). 

The technical definition of “Posttraumatic Stress Disorder” has changed in recent years, as mental-health professionals learn more about this issue.  In the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), used for insurance and other administrative purposes, the definition is more limited.  That definition is limited to specific traumas (actual or threatened death, serious injury, or sexual violence), personally experienced, or experienced via knowledge or experience of the trauma happening to someone in direct contact, or via repeated exposure to secondhand trauma information (not including electronic media, TV, etc. unless part of one’s work).  To fit this definition, specific symptom patterns must have occurred as well.

 


Beyond the above DSM-5 (American Psychiatric Association, 2013) definition, people can experience general trauma in reaction to a number of things, including:


  • War
  • Natural disaster (for example, earthquake, big storm with damage)
  • Medical problems such as injury, serious illness, surgery
  • Violence in the home, school, or workplace
  • Imprisonment
  • Terrorism
  • Physical/ emotional/ sexual abuse
  • Illness/ trauma/ death associated with a person or animal that is meaningful to that person.
  • Building collapse

 

 

 Some people have reported trauma-like problems after exposure to the trauma of others.

 

WHY DO SOME PEOPLE SUFFER AFTER TRAUMA?

A post-traumatic reaction is a normal reaction to abnormal events, although people experiencing the symptoms can feel like they are not their normal selves and overwhelms a person’s ability to cope in their usual ways. 

 

This means that although people have ways of managing or preventing everyday stresses, the traumatic event(s) is/are much harder to cope with in the same ways.  There may be just too much to cope with at one time, or the emotional burden may be too much (for example: uncertainty if a loved one will die of a sudden injury).

 

Trauma Recovery and Fight-Flight Response

One theory of PTSD is that the body’s “fight or flight” response begins to take over any time a memory of the event is cued. In other words, At the time of the traumatic event, an individual’s internal survival instincts kick in; in a moment of crisis, one’s body shuts down to solely focus on survival.

This  response that you were experiencing during the traumatic event can get quickly paired with cues, or things in the environment, that didn’t have any particular meaning before. Then later, when you encounter those cues, you are likely to have another fight- flight reaction. Your nervous system senses the cue, which could be a sight, a sound, smell, or even a time, and then your body reacts as though you are in danger again. Your body won’t learn that these are not, in fact, good danger cues. They don’t tell you very accurately whether you are actually in danger so you may have false alarms going off frequently. After a while you won’t trust your own senses or judgment about what is and isn’t dangerous, and too many situations seem dangerous that are not.

You may start to have thoughts about the dangerousness of the world, particular places, or situations that are based on your reactions rather than the actual realistic danger of those situations. Besides thoughts about dangerousness, many different types of beliefs about ourselves and the world can be affected by traumatic events. (Resick & Monson, 2006).

 


WHAT ARE THE SIGNS THAT SOMEONE IS TRAUMATIZED?

 

Because traumas are different, and people are different, no two people will experience trauma exactly the same way.  But common reactions may include some of these:

 

  • Shock / sense of unreality / emotional numbness
  • Nervousness, and/or being more easily startled / Fear
  • Anger, or more easily angered than before, feeling on edge, fighting with loved ones, angry outbursts; strong emotional reactions
  • Upset / Needing to move around / Body symptoms such as sweating, jitters,

              faster breathing

  • Confusion/ Feeling or being disoriented
  • Sadness / Loss
  • Worry
  • Feelings of regret, blame, or guilt (“if only…”)
  • Wondering how or why the event(s) happened as they did  
  • Changes (either more or less than usual) in sleep, eating, exercise, and/or sexual habits Loss of interest in usual activities and pleasures
  • Nightmares, bad dreams
  • Upsetting memories/ Feeling like the scary event is happening again (aka “Flashbacks”) / Scary thoughts you can’t control, including anniversaries of the event
  • Worries about safety and/or extreme safety-consciousness/watchfulness
  • Problems concentrating, remembering, or learning new information
  • Difficulty making decisions, particularly major ones
  • Being agitated, or feeling distress in one’s body, new body problems such as

            stomach upset or headaches

  • Avoiding things that are reminders of the event(s), refusing to discuss or recall the event(s)
  • Avoiding contact with other people

These reactions to trauma can occur at some time much later than the event itself.

Children who have PTSD may show other types of problems. These can include:

  • Behaving like they did when they were younger, even temporarily refusing to use skills they had already gained, like using the toilet. 
  • Being unable to talk
  • Acting out the trauma event in play
  • Clinging more to parents/caregivers

 

  • Behaving in disruptive, disrespectful, or destructive ways

 

These behaviors should be recognized as a signal of emotional pain in need of support and treatment.

 

HOW COMMON IS PTSD?

 

In the U.S., it is estimated that 8.7% of all people will be diagnosed with PTSD by the time they reach 75 years old, using the most current (DSM-5) definition of PTSD.   An estimated 3.5% of U.S. adults have PTSD during any given 12-month period.  Rates of PTSD are higher among veterans and those who work in jobs with higher exposure to trauma, such as police.  Highest rates are found among survivors of rape, military combat, and captivity, and ethnic or political internment and genocide (American Psychiatric Association, 2013.)

 

Depending on the amount of exposure to a catastrophe a person experiences, it may influence the development and severity of PTSD they develop (Galea, Nandi, & Vlahov, 2005). PTSD can occur at any age, affects both men and women, and prevalent among all ethnic and cultural backgrounds. Symptoms of PTSD can be expressed differently depending on one’s biological, psychological, social, and cultural history.

 

WHAT HELPS THE TRAUMATIZED PERSON RECOVER?

 

Some people will recover from trauma on their own.  Their circumstances and their ways of coping will allow them to bring their lives back into balance.

 

But if you, or someone you know, has had trauma that is not healing, there is help.  Some things can be done by oneself.  These include:  looking after one’s physical health by making an effort to sleep enough, eat well, get enough physical activity, taking time for rest and possibly spiritual/religious reflection, and seeking out the company of supportive people.  For some people, these help the traumatized person heal and recover.

 

When trauma does not heal after some time and effort, it may be helpful to see a psychologist.  Psychologists are often trained to deal specifically with helping people recover from trauma, and can use a variety of psychotherapies to assist.

As always, if you are feeling at risk to hurt yourself or someone else, call 911 and ask for immediate help.  Intensive treatments (including medication and/or hospital care) can help people get past this crisis moment.

 

If the situation is not an emergency, office-based psychotherapy (and sometimes medication) may help.  Treatment might take 6 to 12 weeks. For some people, it takes longer. Treatment is not the same for everyone. What works for you might not work for someone else.  Which one(s) will work best for any one person is still under study, in part because, as we learned above, people experience trauma differently and thus recover from it differently. 

While there is no “gold standard” for treatment of PTSD, the most common forms of “talk” therapy currently in use and with observed treatment effects include a combination of

  • Learning the best way to cope with difficult feelings that works specifically for you. 
  • Reduce anxiety, control fear, and/or manage your anger (for instance, if you have rages that pop up when you don’t expect.).
  • Help make sense of the bad memories.
  • Learn how to shut off painful memories in a healthy way, so you are no longer hurt by them all the time, and learn to identify and control situations, which might “trigger” repeat emotional reactions.
  • Learn how the body and brain react after trauma.  This helps you stop the vicious cycle that impairs sleep, distracts your thoughts, and undermines feelings about yourself and the world around you.
  • Learn to cope using alternatives to drinking alcohol or using non-prescribed drugs.  These ways of handling distress will not help PTSD go away and may even make it worse.
  • Learn to develop balanced and realistic beliefs about the event, yourself, and others.

Your needs and ideas are important in choosing and working on your recovery from trauma.  It’s helpful to talk openly with your psychologist, physician, and support people about your priorities for healing.  

 

For more information:

  1. American Psychological Association

www.apa.org/topics/ptsd/ptsd-awareness.aspx

 

  1. International Society For Traumatic Stress Studies

https://www.istss.org/public-resources.aspx

 

  1. Mayo Clinic

http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/symptoms/con-20022540

 

  1. National Institute of Mental Health:

http://www.nimh.nih.gov/health/publications/ptsd-listing.shtml

 

                                  

Article References:

 

 

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Washington, D.C.: Author.

 

Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD). In Agency for Healthcare Research and Quality (2013). Retrieved From:

http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1436#7338)

 

Gabbay, V., Oatis, M.D., Silva, R.R., & Hirsch, G. (2004). Epidemiological aspects of PTSD in children and adolescents. In Raul R. Silva (Ed.), Posttraumatic Stress Disorder in Children and Adolescents: Handbook (1-17). New York: Norton.

 

Galea, S.,  Nandi, A.  and  Vlahov, D. (2005) The epidemiology of post-traumatic stress disorder after disasters.  Epidemiologic Reviews,  27,  78-91.   DOI: 10.1093/epirev/mxi0003

 

Gradus, J. DSc, MPH .  Epidemiology of PTSD. In U.S Department of Veterans Affair.  Retrieved from http://www.ptsd.va.gov/professional/PTSD-overview/epidemiological-facts-ptsd.asp

 

Post-Traumatic Stress Disorder Among Adults. In National Institute of Mental Health (NIMH).  Retrieved from http://www.nimh.nih.gov/health/statistics/prevalence/post-traumatic-stress-disorder-among-adults.shtml

 

Post-Traumatic Stress Disorder (Easy- to- Read; 2013). In National Institute of Mental Health (NIMH).  Retrieved from http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-easy-to-read/index.shtml

 

Posttraumatic Stress Disorder (PTSD). In National Institute of Mental Health. Retrieved from http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml#pub8

 

Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD).  In U.S. Department of Health and Services. Retrieved from http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=1436#7338

Resick, P. and Monson, C. (2006). Cognitive Processing Therapy Veteran/Military Version. National Center for PTSD Women’s Health Science Division: VA Boston Healthcare System and Boston University.

 

 

 

 

 

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