What is post-traumatic stress disorder?
Trauma and PTSD are related to disturbing experiences of an extreme type. Examples include terrorist incident, air-line crash, assault, rape (or other sexual abuse), and natural disaster. Mild trauma may follow on from events like a (non-injurious) car accident, getting trapped in a lift, or personal accident.
Exposure to such incidents produces trauma, which is an upsetting memory linked to the event. Trauma may be accompanied by shock, anxiety and emotional distress.
However, most people with trauma (whether mild or serious) do not develop post-traumatic stress disorder. In the majority of cases the shock will fade between 4-6 weeks, and symptoms of post-traumatic stress disorder may never appear at all. However, some people with trauma find psychotherapy helpful in getting some perspective on the matter, and working through their emotions. This can prevent PTSD from developing (see below).
The symptoms of post-traumatic stress disorder.
Symptoms of PTSD include:
- Flash-backs, in which the traumatic incident is vividly replayed in the mind
- Hyper-vigilance for danger
- Impaired concentration
- Hopeless thinking patterns
- Detachment/Emotional numbness
- Avoidance of activities and sites associated with trauma
If any of these symptoms appear and get worse after 6 weeks following the traumatic incident the individual is classed as having post-traumatic stress disorder. However, only around 20% of people exposed to a traumatic incident develop the disorder. In most cases that do the individual may have:
- Previous unresolved trauma episodes
- A prior history of anxiety and other mental health issues
- Poor resilience
- Poor social support
Some survivors may experience intense guilt if the incident involved children, partners and friends who died, or were seriously injured. Others may experience shame over what they see as a failure to act. These feelings complicate the underlying problem, and intensify the symptoms. In a few cases suicidal thoughts may appear.
It is advisable to seek professional help should PTSD develop. In case of emergency UK telephone helplines can be contacted here. If the case involves sexual assault help is available here. Psychotherapy appointments can be made here.
What causes post-traumatic stress disorder?
Simply put, the cause of the problem lies in the mind and its perceptions about what happened, why it happened, and what this means to the individual. For example (worst case), someone surviving a bomb-blast at a rock concert in which many died may view the event as evidence that the world is a horrifying place, that terrorists are everywhere, and no one is safe. Along with the personal interpretation that she is somehow to blame because a friend died later in hospital; she will never get over what happened; and cannot cope with the aftermath. Thoughts like these trigger states of anxiety, dread and helplessness.
As symptoms appear these confirm the perception that she is headed for break-down. Each flash-back, nightmare, or return of panicky feelings confirms this self-diagnosis, leading to learned helplessness and a downward spiral of mental health problems.
Getting over trauma
Contrast this worst-case scenario with the experience of the majority of people who do not develop post-traumatic stress. Such people will view the trauma in a different way. One important difference is that they view the original incident in context – as a tragic life event rather than as a personal threat. (Note: this does not apply to domestic abuse, in which the survivor will require safe-guarding measures). In this way they normalise their experiences, rather than catastrophising them.
When people are able to view the incident impersonally they are less likely to see the memory of trauma as an existential threat. In that way they are less likely to fuse with it. This, in turn, enables them to move on from the incident, and refocus on the life they had before. Some survivors find that talking about their experiences and emotions helps them to move on. However, research shows that this is not necessary in all cases. What is more important is re-integration with family, friends and community. Social support has been established as the most important factor in recovery from trauma.
Individuals who bounce back quickly from trauma are also high in resilience. As such they will employ a variety of resilience skills in recovery:
- Reaching out for support
- Taking time out
- Keeping to a routine
- Coping mechanisms
- Maintaining focus on purposeful activity in personal, work and family life
- Personal growth: reflecting on what can be learned from terrible experiences
Treatment of post-traumatic stress disorder
Psychotherapy can assist in re-contextualising and normalising the traumatic experience. As well as creating a channel for the discussion of emotions, and mapping a path to recovery. Along the way addressing the catastrophic thoughts that lead from an experience of trauma to PTSD. Leading, in turn to improved resilience and re-orientation to life.
Where the client is overwhelmed by the traumatic memory itself Eye-Movement Desensitisation & Reprocessing (EMDR therapy) is of proven effectiveness in such cases. EMDR is a technique that neutralises painful memories. In the EMDR process random hand signals are used to distract eye-movements as the client recalls the traumatic memory. This interrupts the brain’s attempt to re-process the memory. After several repetitions the link between anxiety and the trauma memory is broken.
For a short video on the EMDR technique click here.