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- What is Post-traumatic Stress Disorder?
- Diagnosing Post-traumatic Stress Disorder
- What Causes Post-traumatic Stress Disorder?
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What is Post-traumatic Stress Disorder?
Post-traumatic Stress or PTSD is a disorder that arises sometime after a traumatic event in which the person felt intense fear, helplessness or horror.
Sometimes when someone is exposed to such a horrific event, they are left unable to return to their normal lives unaffected. Symptoms of post traumatic stress disorder include struggling to cope with daily routines, and feeling like they cannot escape the memories or feeling like they are experiencing the event over and over again.
Diagnosing Post-traumatic Stress Disorder
A psychologist, doctor or mental health practitioner will ask a series of questions about your symptoms, as well as the traumatic event that precipitated them. They will ask how you felt during the traumatic event and how you feel about it now. They will ask about the severity of your symptoms and how these are affecting your daily functioning and personal relationships.
While talking about some of these things may be difficult, it is important to seek treatment so that you can once again take control of your life and heal. Some people may experience PTSD-like symptoms a few days after a trauma, however, a diagnosis will only be made if the symptoms of post traumatic stress disorder have persisted for longer than one month.
Who Suffers from PTSD? Is there a Cure?
A relatively small percentage of people who experience severe trauma will develop PTSD, although the nature of the traumatic experience is an extremely important deciding factor. Rape is the foremost trigger, 65% of men and 45.9% women who are raped develop PTSD.
Other common triggers are serious accidents such as car crashes or train wrecks, car hijackings, armed robberies, violent attacks, hostage situations or kidnappings, as well as natural disasters such as earthquakes, tsunamis or floods. Symptoms of post traumatic stress disorder can affect an individual at any age, including during childhood, and tends to affect more women than men.
It usually presents within 3 months of the traumatic experience (although this varies greatly) and can last anywhere between a few months and many years. If left untreated, PTSD can be terribly debilitating. However, there are a number of effective treatments that have been used to help people with PTSD.
Symptoms of Post-Traumatic Stress Disorder
In order for someone to be diagnosed with PTSD, they must have experienced or witnessed an event that involved actual or threatened death, serious injury, or threat to the physical integrity of themselves or others.
The symptoms are grouped into three categories: Re-experiencing the event; numbness and avoidance; and increased arousal.
Re-experiencing the event:
- Recurrent recollections of the event which are often intrusive and distressing. These could be images, thoughts or perceptions
- Recurrent distressing dreams of the event
- Feeling as if the event were re-occurring. This could be through illusions, hallucinations or vivid flashbacks
- Feelings of distress and panic when exposed to something that reminds you of the event. This may be an external cue, such as a person, an image, a smell or a sound, or it could be an internal cue such as a thought or memory
- A physical fear response is common when exposed to these reminders
Avoidance and numbness:
- Efforts are made to avoid thoughts, feelings, or conversations associated with the traumatic event
- Tendency to avoid certain activities, places or people that may remind you of the event
- Inability to remember certain details of the event
- Diminished interest or participation in activities that were previously important or enjoyed
- Feeling detached or estranged from others
- Dulled emotions
- Sense of foreshortened future: no expectations or future plans and goals
- Difficulty falling or staying asleep
- Irritability or outbursts of anger
- Difficulty concentrating
- Easily startled
- The feeling of being constantly on edge
What Causes Post-traumatic Stress Disorder?
The cause of PTSD is clear. A person experiences a trauma which causes great distress and then develops PTSD. What is not clear is why some people develop PTSD while others, also having experienced great trauma, do not.
There are a few factors that tend to contribute to an individual’s susceptibility to the disorder.
- Biological and Psychological Factors – We are complex beings influenced by our genetic pre-dispositions, such as our personalities and inherited traits, as well as the sum of all our life experiences. Some people are genetically more anxious or more prone to depression than others, which increases their risk of developing PTSD after trauma. Also at risk are those people whose life experience has taught them that the world is a dangerous and unstable place (for example people with an unstable childhood or family life, or people that have experienced trauma in the past). Drug and alcohol abuse are also risk factors.
- Social Support – People who receive support from their communities and loved ones tend to be at lower risk for PTSD than those who don’t. This is most notable in victims of rape. Those who have loving support and a community that is outraged by the crime and actively involved in trying to help or prevent future tragedy have a decreased risk of developing PTSD. Those who receive blame, humiliation or whose trauma is not acknowledged have a much higher risk of developing PTSD.
- Personal attitude surrounding the trauma – Studies show that veterans of war who believed that their suffering was for the greater good and those who fought for a greater cause such as their country or religion were less likely to get PTSD. Those who suffered senseless trauma or veterans who were shunned by their home country were more vulnerable to PTSD.
Help for Post-traumatic Stress Disorder
There are effective ways to treat and control the symptoms of post traumatic stress disorder. Symptoms associated with PTSD can affect daily living and should not be ignored. PTSD treatment options include conventional therapy, psychotherapy, or a combination of these approaches.
How is PTSD treated?
A number of drug PTSD treatments are available for the management of PTSD. However, most professionals advise against the prescription of high schedule drugs directly after the traumatic event. Although some sedation may be necessary, drug therapy can actually complicate the clinical picture and may also prevent the person from working through the trauma – leading to worse problems further down the line.
- Anti-anxiety drugs - Benzodiazepines such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin) and diazepam (Valium) create a sedative affect to reduce anxiety associated with PTSD. Remember that many of these drugs are addictive and should not be taken for more than a week or two for temporary relief.
- Anti-depressant drugs – which include fluoxetine (Prozac), paroxetine (Paxil), imipramine (Tofranil), and escitalopram (Lexapro) adjust the neurotransmitter levels in your brain to relieve anxiety and depression.
- Adrenergic agents – such as clonidine (Catapres), propanolol (Inderal) and guanfacine (Tenex) are sometimes used to help with hyperarousal, hallucinations and illusions as well as nightmares commonly associated with PTSD.
Prescription medication needs to be taken with caution as many have serious unwanted side-effects or risk of addiction. As with most psychological conditions, medications work best in conjunction with psychotherapy.
PTSD treatments may also include some form of psychotherapy. Cognitive behavioral therapy, individual psychotherapy, trauma counseling, survivor group therapy and family therapy are some examples of psychotherapies that have been very beneficial to PTSD sufferers.
When to Seek Professional Help
Trauma-like symptoms are a natural physical and emotional reaction after any distressing and traumatic experience. These events threaten our beliefs about safety, and shatter our notions of integrity and trust.
To begin with, these symptoms are adaptive and can be nature’s way of slowly letting the mind grasp the enormity of the situation. It is almost expected that some of these trauma-symptoms will be present for a few days after the event.
It is only when these symptoms persist for longer than a month that a diagnosis of PTSD can be considered. (That is not to say that you need to painfully endure the symptoms for a month before seeking help!)
If you have been suffering these symptoms for more that a few days and feel you are struggling to get your life back in control you should consider seeking professional help. You may be diagnosed with Acute Stress Disorder (essentially PTSD symptoms of less than 1 month duration) and begin a treatment plan that will assist recovery.
Please note that after experiencing any trauma, it is advisable to seek some sort of debriefing or counseling as soon as possible. Early intervention and treatment can make the world of difference to the healing process. It is possible to avoid PTSD by receiving the necessary psychological treatment as soon as you can!
Debriefing or counseling can be facilitated by a psychologist or a lay counselor trained to work with PTSD. You can also telephone a helpline and speak to a counselor. If you do not have access to a professional person, try to find someone you trust and talk to them about what happened and about your feelings.
Keeping the experience to yourself and trying to be ‘brave’ may cause harm in the future, even though it may help you to cope in the short term. Studies have shown that the earlier people talk through their traumatic experiences, the smaller the chance of developing PTSD.
More Information on Post-traumatic Stress Disorder
Other Disorders Related to PTSD
Both Depression and Generalized Anxiety Disorder (GAD) are closely related to PTSD and the symptoms may be very similar. For this reason, diagnosis can be somewhat difficult as a health care professional would have to rule out other similar presenting disorders. Alcohol and drug abuse are also often seen as part of the clinical picture as people with PTSD often try to self medicate to achieve relief.
Can children develop PTSD?
Yes, children can develop PTSD, however, the symptoms may present in slightly different ways. Some symptoms to watch out for are:
- Vivid re-enactment of event through play, drawings or stories
- Post-traumatic play: play that repeats aspect of trauma over and over again and is less imaginative and spontaneous than normal play
- Bad dreams or night terrors
- Fear of dark
- Difficulty falling asleep, or frequently waking up
- Bed wetting
- New fears of things unrelated to the traumatic event, such as monsters
- Separation anxiety
- Irritability or new aggression
- Memory problems and difficulty concentrating
- Regression of learned skills
- Startles easily
Some children find it difficult to talk to their parents about the traumatic event and may say that they are fine. They are also not usually inclined to speak to peers for fear of being different, and so feelings of isolation may result. Children may also lack the vocabulary to put their feelings into words.
For this reason a child psychologist can be crucial in facilitating therapy. Depending on the age of the child, psychologists will use treatment such as play therapy and art therapy to assist children with their feelings and to help them develop coping strategies.
Tips for Coping with PTSD
- Learn about PTSD. It is helpful to understand your symptoms and know what to expect.
- Talk about it. Talking to someone you trust, a close friend, a psychologist or even a support group can be very helpful and make you feel less alone.
- Practice relaxation techniques such as deep breathing exercises, meditation, and yoga.
- Participate in artistic or distracting activities. While this may be the last thing you feel up to, keeping busy and productive will help you gain back your sense of power and will help with your recovery. This can be helpful, but remember, you also need to spend some time actually working through the trauma.
- Avoid substances as a means of coping! Substance abuse only creates a perceived and temporary relief, and often causes more problems.
- Try not to become socially isolated. Sometimes PTSD leaves one feeling very alone, irritable and angry. Understand these feelings as a natural response to the trauma and try not to exclude others from your life. While not everyone can understand what you’ve been through, they can still offer you emotional support and friendship.
- Try not to avoid facing the traumatic event. While this may be a painful process that will take time, avoiding all distressing cues will just prolong the pain and recovery. Furthermore, specific phobias or Obsessive Compulsive behavior may begin (for example, after an armed robbery, a person may develop ritualistic behavior – turning on all house lights at a specific time in the evenings, and re-checking that all the doors are locked). While it is important to take preventative steps, a balanced perspective should be promoted.
- Get involved! Find a support group of others who have been through something similar. You may feel comfort in the fact that you are not alone in your struggles and that there are others who understand what you have been through.
- Exercise. Keeping active will help release some physical and emotional tension while releasing happiness inducing endorphins.
Tips for Friends and Family Dealing with PSTD
- Be patient with the trauma survivor. Allow them to tell you their story and feelings in their own time. When they do talk to you, listen attentively and don’t interrupt.
- Understand that they may be angry and irritable. Continue giving love and support even if they push you away.
- Try not to tell a trauma survivor that you know how they feel, or that they should be lucky to be alive. Try to be sensitive to what they must be feeling but don’t feel compelled to try say something to make it all better.
- Clear up any misconceptions the person may have about the traumatic event. This is especially important when talking with children. Many survivors of trauma feel guilt and a sense of responsibility for what happened.