Post-Traumatic Stress Disorder

Let’s begin with a description of what the experience of Post-Traumatic Stress Disorder (PTSD) might be like for someone affected:

I was raped when I was 19 years old. For a long time, it felt as though someone else had been raped instead of me. I was very aware that it had happened to me, but there was just no feeling it. Then I started having flashbacks. They kind of came over me like a wave. I would be terrified. Suddenly I was reliving my rape. Every instant was startling. I wasn’t aware of anything around me, I was in a bubble, just kind of floating. And it was super scary. Having a flashback can be very frightening. The rape happened the week before Thanksgiving, and I can’t believe the anxiety and fear I feel every year around the anniversary date. It’s as though I’ve seen a werewolf. I can’t relax, can’t sleep, don’t want to be with anyone. I wonder whether I’ll ever be free of this terrible problem.

PTSD develops after a terrifying ordeal that involves physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

PTSD was first brought to public attention in relation to war veterans, but it can result from a variety of traumatic experiences, such as robbery, rape, torture, being kidnapped or held captive, child abuse or incest, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as extreme storms, floods or earthquakes.

People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent. They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult. PTSD symptoms seem to be worse if the event that triggered them was deliberately initiated by another person, as in a rape or a kidnapping.

Unfortunately, most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again.

Who is most at risk?

Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward.

PTSD affects about 7-8 percent of North American adults in their lifetime, but it can occur at any age, including childhood. Women are more likely to develop PTSD than men, and there is some evidence that being at risk to develop the disorder may run in families. PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

While the initial trauma can cause social, familial, school, work, and financial difficulties, further harmful effects may also stem from the symptoms of PTSD. For example, if a person loses their job as a result of a disaster, the additional stressor of unemployment may increase the risk of developing PTSD. Consequently, the therapist should assist the patient in addressing issues that may arise in various life domains, including family and social relationships, living conditions, general health, and academic and occupational performance, and help the patient to consider options that may be available to address such problems (e.g., considering alternative school or work schedules, other vocational options, financial or social supports). Working in collaboration with patients to set realistic and achievable short- and long-term goals can be useful. Patients can increase their sense of self-worth through achieving these goals, thereby reducing the demoralization that worsens or maintains their PTSD. It may also be important to help the patient with PTSD obtain clinical assistance for family problems or for family members who may themselves require psychological support. Finally, patients who have children may need help in assessing and meeting their children’s needs, both during and in the wake of acute episodes.

Not everyone exposed to trauma will develop PTSD. The concept of “psychological resilience” refers to the apparent ability of some people to positively deal with psychosocial and emotional changes after trauma exposure. Some research suggests that resilience against PTSD includes such protections as intellectual and physical toughness, positive motivation, humor, hardiness, positive perceptions of oneself, emotional well-being, hope, life satisfaction, optimism, happiness, trust, feeling in control of one’s actions, spirituality, hope for growth after the trauma, social skills and relationships, feeling connected and supported by others. Some studies also show that optimism can buffer the effects of life stress and enable some individuals to be resilient following trauma.

Treatment of PTSD is described in another column. To learn about the treatment of PTSD, click here.

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