Jane Chugg-White CBT

Post-Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) is often linked to those who have been involved in the armed forces. However; it is important to stress that PTSD can affect anyone who has experienced or witnessed; or learned about a traumatic event. The essential feature according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is 'exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate'. 'The person's response to the event involves intense fear, helplessness, or horror'.   

Traumatic Events can include; but are not limited to events such as; (according to DSM IV)

'Military Combat, Violent personal assault (Sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness.

According to DSM-IV; PTSD is considered Acute if the symptoms have lasted for more than one month, but less than 3 months; (symptoms of less than one months duration are diagnosed as 'Acute Stress Disorder' (according to DSM-IV). It is considered Chronic if the duration of symptoms is 3 months or more.

It is also essential to note that symptoms can be of delayed onset. Delayed onset is considered if the symptoms appear at least 6 months after the traumatic event. However; symptoms can appear many years later. This can happen in cases of adults who have experienced childhood abuse. They may not have experienced any related symptoms of PTSD until much later in adult life. (It is usually triggered by a major or significant event in their lives).

The effects of PTSD are extremely debilitating and include;

  • Flashbacks

A flashback is usually triggered by a reminder of the original traumatic event; (although the person may not necessarily know what the trigger was), and the person feels as if they are re living the traumatic event or an aspect of the traumatic event all over again as if it was happening again in the here and now. The person can lose all sense of here and now reality and they literally re experience the event as if it is happening all over again. Flashbacks are extremely distressing and as a result the person often understandably attempts to avoid any reminders of the traumatic event in order to avoid having a flashback.  

  • Intrusive Images and Feelings

These are also usually triggered by a reminder of the original traumatic event. The person may be engaging in an every day activity but having intrusive images flashing through their mind related to the original traumatic event, or they may have body memories. When a person has a body memory, they re experience sensations and feelings in their body associated to the original trauma. These are extremely common in people who have experienced trauma that has involved violation of the body such as sexual assault and/or sexual abuse. Intrusive thoughts, images and feelings are extremely distressing and the person may attempt to avoid any reminder of the trauma in order to avoid these symptoms.

  • Nightmares

Nightmares directly related to the trauma or of other frightening images and scenarios (not necessarily directly related to the trauma in an obvious sense) are extremely common in people suffering from PTSD.  

  • Avoidance of reminders of the traumatic event; and numbing

People with PTSD will often avoid thinking about the traumatic event, and can also experience a more generalized sense of numbing.  They will often avoid all reminders or triggers of the event. A trigger is any thing that may be a reminder to the original event. Triggers can be obvious and they can be extremely subtle. For example a person who has been in a Road Traffic Accident may avoid travelling in a car or become highly agitated and panicky if they have no option but to do so. A person who has been sexually abused may avoid or have difficulty with sexual relations, and they may avoid newspaper articles, or TV programmes related to sexual abuse. A person who has been involved in a bomb explosion may become highly anxious in, and avoid environments involving loud noise. (These are just a few examples, and each individual will differ in their avoidance behaviours, even if they may have been through a similar trauma).  The examples given relate to more obvious triggers that are being avoided. However; there can be subtle triggers that the person themselves may not necessarily be consciously aware of. Someone may experience a flashback and be at a loss to what the trigger was. This is because triggers can be as subtle as someone's facial expression or the colour of paint on a wall. The person may not obviously associate these with the original trauma, but the brain has remembered them as present at the time of the trauma. Our threat/survival system is highly tuned, and becomes even more so in a person suffering from PTSD. This makes sense, as the brain is attempting to safeguard the person from the trauma ever happening again. It will therefore pick up on the slightest cue that is perceived as danger.

  • A feeling of always being on guard and being easily startled

People with PTSD often have what is termed as an exaggerated startle reflex. This means that they 'jump' easily. A sudden noise will often make a person with PTSD jump. People with PTSD are often extremely hyper-vigilant to noise, or anything out of the ordinary. They often have a feeling of being constantly on guard. They also often like to be able to know where their escape routes are; so they may need to sit near a door, or be able to see the door from the place in which they sitting/standing.      

Well meaning friends and relatives often advise people with PTSD to 'move on' or say things like 'the past is the past; forget it now'  For a person suffering with PTSD this is not possible to do, and the person with PTSD often feels guilt and shame about the fact they are not able to do this.  

A person suffering from PTSD needs professional help and will usually need to receive evidence based trauma focussed treatment in order to recover.

 

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