Post-Traumatic Stress Disorder

Artwork by pup

Abuse is a serious psychological trauma, often involving threat to life, so it's not surprising that many of us struggle with PTSD, the same condition that's experienced by many combat veterans. PTSD is not a weakness, and cannot be overcome by willpower, i.e. sucking it up and pretending you're fine till it passes. It's a mental health condition that needs to be diagnosed and treated by a mental health professional. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) criteria for PTSD include a history of exposure to a traumatic event (that meets specific stipulations), and symptoms of four different types: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Symptoms of each type need to be present for more than one month, causing significant distress or functional impairment (e.g. loss of employment), and cannot be due to medications, substance abuse, or other illnesses. This page lists and illustrates the four types of PTSD symptoms, so that survivors would seek professional help if they need it, and supporters would better understand what their loved one is going through and why they act the way they do.

Trauma

The first recorded cases of PTSD involved Civil War veterans. The condition was called "Soldier's Heart": doctors observed changes in heart rate in their patients and felt that the cause of the condition was physiological. During WWI PTSD was referred to as "Shell Shock", and believed to be caused by shock waves from bomb explosions, causing brain injury. Later on doctors realized that its caused by psychological trauma, not physiological one, and it was renamed to "War Neurosis." In 1952 it was renamed to "Gross Stress Reaction" because the same condition can also be present in people who have never been to war, but experienced other types of trauma. For example: earthquakes, concentration camps, car accidents, kidnappings, gang rapes, child abuse, etc. Currently DSM-V defines stressors that can lead to PTSD as direct exposure to or eyewitnessing of actual or threatened death, serious injury, or sexual violence. It also allows for indirect exposure (e.g. learning that your child was raped, even if you didn't personally witness it), or vicarious traumatization of professionals (e.g. EMTs exposed to dying people every day, though not witnessing the incidents that cause those deaths). However, this doesn't include non-professional exposure such as news or horror movies.

Intrusion

People who suffer from PTSD continuously re-experience the traumatic event, in form of nightmares, intrusive memories, flashbacks, or trigger responses. Flashbacks are dissociative reactions where you're feeling as if the traumatic event is happening again in real time, i.e. not realizing that it's a memory, the event is in the past. Trigger responses are intense psychological and/or physiological reactions to reminders of the traumatic event. For example, a combat veteran might be unable to tolerate fireworks, a car crash survivor might get cold sweat when hearing tires screeching, and someone raped in an elevator might throw up in small spaces like closets. You panic, freeze (or run somewhere, or get physically violent), get tunnel vision, hear your heartbeat in your ears, etc - these symptoms are recurrent and involuntary, and interfere with your daily functioning and overall quality of life. It's not something you choose to do, it's that your brain perceives your immediate environment as a threat to your life, so your basic survival instincts kick in and you just can't control it, the same way people can't control their movements while drowning.

Avoidance

The above intrusive symptoms cause a great deal of discomfort and embarrassment, so we try to block out all thoughts and feelings about the trauma, pretend like it didn't happen or wasn't a big deal, "forgive" our perps, "move on", actually forget key features of the traumatic event, etc. Some of us view it's a sign of strength, health, or wisdom: everyone has unpleasant memories, only weaklings "dwell on past hurts", "wallow in self-pity", etc. However, denying the problem doesn't make it go away. If you're avoiding all reminders of the trauma (people, places, activities, objects, etc), can't think or talk about it - you didn't really "move on". The trauma needs to be addressed, only then you'll stop experiencing these symptoms.

Cognitions and mood

Aside from intrusion symptoms, unprocessed trauma distorts your outlook on life, perception of the world and yourself. You develop inaccurate beliefs, e.g. "I'm a bad person", "I deserve to be hurt", "It's my fault", "The world is a dangerous place", "People aren't trustworthy", "Life is unpredictable", etc. Naturally these beliefs result in persistent feelings of fear, anger, guilt, and/or shame, social withdrawal, and alienation from other people. You lose interest in things that were important to you before the traumatic event (e.g. career, school, relationships, hobbies), and have trouble experiencing positive emotions. Many people with PTSD struggle with suicidal thoughts: it feels like your life is ruined beyond repair.

Arousal and reactivity

The last (but not least) cluster of PTSD symptoms is changes in how you respond to stimuli. People who suffer from PTSD are known for hypervigilance and exaggerated startle response: we constantly screen our environment for potential threats, jump from sudden noises, don't tolerate pranks and surprises well (even positive ones, like gifts or birthday parties). Many of us have trouble falling asleep or staying awake (nightmares certainly don't help with that). Some become irritable and aggressive, having a chip on their shoulder - or self-destructive or reckless, rebelling the fear and shame we're feeling, trying to prove to ourselves and the world that we aren't afraid and/or don't care. This often results in further social isolation, sometimes even in re-victimization, which worsens the condition, creating a snowball effect.

Dissociative subtype of PTSD

The latest, fifth, edition of DSM, published in 2003, recognizes the dissociative subtype of PTSD, where in addition to meeting the above diagnostic criteria for PTSD, the person experiences depersonalization or derealization. Depersonalization means feeling as if you're watching what's happening as an outside observer, rather than experiencing it first-hand. For example, many survivors of child sexual abuse describe it as if they were floating to the ceiling and watching the perpetrator molest a child; sometimes feeling sadness, helplessness, compassion towards the child, anger at the perpetrator - but doing so from the ceiling, as opposed to from the child's perspective. Some people don't recognize themselves in the mirror, during flashbacks or just overall stressful times. Derealization, the other symptom of dissociative subtype of PTSD, means the experience of unreality, distance, or distortion. You feel as if things aren't real, maybe the world is only a figment of your imagination, or maybe it's a stage play, a movie, a computer game, or a dream.

PTSD is a serious and painful condition, recognized as a disability. There's no shame in suffering from it, just like there's no shame in having experienced the trauma that caused it. However, you don't have to live with it, there's help available. Recovery takes time, and is often a matter of degree than complete "cure." The trauma did happen, and will be affecting who you are to some extent, just like any other major life experience, e.g. the country you grew up in or the level of wealth of your parents. However, the symptoms of PTSD can be controlled or greatly lowered, so that they don't interfere with your daily life and aren't costing you jobs, relationships, or happiness. DBT (Dialectical Behavior Therapy) and CBT (Cognitive Behavioral Therapy) are particularly helpful in learning new, better skills to deal with stressors of everyday life. Speaking of the trauma helps process it, i.e. make sense of what happened and how it affected you, in order to gain perspective, reconcile it, and file it as a past event, as opposed to continuing to relieve it day after day. Support groups and journaling are especially helpful with that. Trauma and PTSD are sensitive subjects that not everyone is comfortable discussing at a lunch break at work, so a support network (i.e. friends and family) is important as well. It makes a big difference, when you have people you can reach out for help when you're struggling, whom you can talk to about what happened to you and what you're going through now, who will listen and understand you, or simply sit with you and hold your hand to remind you that you aren't alone.



Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.
~ Mark Twain
This page was last updated on April 9th, 2017
© 2008-2017 Fort Refuge. Please don't reproduce without permission.