Understanding Post-traumatic Stress Disorder

A father and son on a weekend fishing trip eagerly set out in their boat on the river early one morning. All is going well until the son, standing too close to the side of the boat while trying to reel in his line, suddenly slips and falls over the side into the deep water of the river below. His father, horrified, jumps in and tries desperately to reach his son, but he is quickly swept out of sight by the river’s swift current. Two hours later, rescuers pull the boy’s lifeless body from the river.

For the next year, the father has nightmares of his son’s tragic fall off the boat and subsequent drowning. He wakes up in a cold sweat night after night, and insomnia is a frequent problem. He no longer goes fishing or camping with his male friends, activities he once really enjoyed. He keeps all his fishing gear packed away, out of sight. He finds it difficult to concentrate on his work, and is often irritable towards his coworkers. He refuses to talk about his son or the event with anyone, and his marriage is on the brink of divorce as he has become increasingly detached from his wife.

Causes of PTSD

This father is experiencing a classic case of the psychiatric disorder known as posttraumatic stress disorder. Commonly referred to as PTSD, it is an anxiety disorder which can develop after you experience an extremely traumatic event. While the event may involve witnessing the unexpected or violent death, threat of death, serious injury or other type of harm to someone else, it may also be a trauma that happens to you personally. PTSD can also develop when you doesn’t actually experience or witness the event first hand, but learn of the trauma happening to a close friend or loved one.

There are many types of situations which could cause a person to develop PTSD. The disorder was first noted by clinicians treating Vietnam War veterans who were exhibiting certain types of symptoms after experiencing the horrors of combat. They observed many of these men having flashbacks in which they suddenly appeared to be reliving events from the war. They also noticed that many of the former soldiers reacted significantly to loud noises, particularly ones such as fireworks or a car backfiring – sounds which closely mimicked gun shots and explosions.

In addition to military combat, other events which may lead to the development of PTSD include things such as:

• Plane crashes
• Natural disasters such as earthquakes, hurricanes, or tornadoes
• Fires
• Car accidents or other serious accidents
• Rape or other types of physical or sexual assault
• Terrorist attacks, such as 9/11
• Being held at gunpoint, e.g., while being robbed
• Being kidnapped
• Being sexually or physically abused as a child
• Being diagnosed with a life-threatening medical condition

Factors in the Development of PTSD

Just because you are exposed to significant trauma doesn’t mean you will develop PTSD. The majority of people will experience some symptoms shortly following the trauma, but these symptoms quickly resolve for some while becoming chronic and emotionally crippling for others. The reasons for this are not completely clear at this time, although there are several factors which may make you more vulnerable to the disorder. These factors include:

• The severity and / or duration of the trauma
• The proximity of the event
• The degree of control you felt over the event
• The amount of help and emotional support you received after the trauma
Other contributing factors include such things as one’s personality, things experienced in childhood, family history, degree of social support in one’s life, and having any kind of mental health disorder prior to the trauma. However, when a trauma is particularly extreme, a person with no predisposing factors can still develop this disorder.

Course of PTSD

PTSD can develop at any age. Children and adults alike develop this disorder. In most cases, the symptoms first begin to show within 3 months of the traumatic event. However, some people do not develop symptoms for several months or even a few years after the trauma.

Approximately one out of every two people who develop PTSD will recover completely within the first 3 months. Some individuals, however, will have chronic symptoms lasting for a year or more after the trauma.

Symptoms of PTSD

There are many different symptoms associated with PTSD. Not everyone experiences the disorder in the same way, and the symptoms can vary over time for a person with PTSD. There are four different types of symptoms which are experienced:
Re-experiencing the trauma in one form or another

People with PTSD find themselves reliving the traumatic event. This will happen in one or more of the following ways:

• Recollecting the event in your mind either in pictures, thoughts, or perceptions
• Having recurring, distressing dreams about the trauma
• Feeling as if the event were actually happening to you again, as in a flashback, hallucination, or illusion
• Experiencing significant emotional distress (e.g. you feel very anxious or sad) when exposed to anything that reminds you of the event
• Experiencing a physical reaction (e.g. your heart starts to race or you break out in a sweat) when exposed to anything that reminds you of the trauma

Persistently avoiding anything which reminds you of the traumatic event and
• You try to avoid thinking about, talking about, or having feelings about anything related to the trauma
• You try to avoid people, places or activities which remind you of the trauma

Decreased responsiveness to people and things – “psychic numbing”
• You lose interest in or stop taking part in activities that used to be important to you
• You are unable to remember important details about the trauma
• You become more detached from others
• You have less ability to experience various emotions
• You perceive your future as cut short in some way – e.g. you don’t expect to live to an old age, get married or ever have children

Persistent, increased arousal which wasn’t present prior to the trauma
• Insomnia
• Angry outbursts or arousal
• Problems with concentration
• Hypervigilence (i.e., increased sensitivity to and / or overreaction to perceived threats)
• Very easily startled

Problems Associated with PTSD

One of the criteria for PTSD is that it significantly impacts important areas of your life, such as your work or your relationships. It is not uncommon for someone with PTSD to begin to have marital problems, end up getting divorced, or lose his or her job.
Other problems associated with PTSD may include struggling with survivor’s guilt, developing phobias related to the trauma, becoming increasingly impulsive, losing your faith, struggling with feelings of hopelessness or despair, and experiencing changes in your personality.

People with PTSD are also more vulnerable to developing other psychiatric disorders including:

• Depression
• Panic disorder
Social anxiety disorder
• Agoraphobia
• Other phobias
• Somatization disorder
• OCD

It is also not uncommon for individuals with PTSD to develop a problem with alcohol or drug abuse. This is often due to an ongoing attempt to self-medicate the challenging symptoms of PTSD.

Treatment for PTSD

Treatment for PTSD can be very effective, and should definitely be sought if you are battling this disorder. Treatment includes various types of psychotherapy, medication and hypnosis.

Psychotherapy

- Cognitive Behavioral Therapy (CBT) - CBT has been shown to be quite effective for PTSD. CBT addresses your maladaptive thoughts and how those thoughts affect your feelings and behavior. With regards to PTSD, the therapy focuses specifically on identifying thoughts about the trauma which are distorted. By challenging the irrational thoughts and underlying beliefs, you can begin to make changes in your thinking which positively impact feelings and behaviors.

- Psychodynamic therapy – Unlike CBT, which focuses on your thoughts, psychodynamic therapy focuses primarily on your unconscious mind. The unconscious plays a significant role in how we react to situations. Painful thoughts, feelings and desires are often stored in your unconscious, and “defense mechanisms” are used to avoid dealing with them. During therapy, these unconscious issues are brought to the conscious level where they can be worked through and resolved.

- EMDR – EMDR stands for “eye movement desensitization and reprocessing”. It was developed in the late 1980s by Dr. Francis Shapiro. EMDR has been very effective for many individuals with PTSD, and for some it works quite quickly. It incorporates principles from several different therapeutic approaches including psychodynamic, interpersonal, cognitive-behavioral, body-centered, and person-centered.

EMDR utilizes rapid eye movement, which our minds use to process things when we are asleep. Trauma disrupts this process. In a nutshell, EMDR works by using eye movement patterns to help you process the painful memories and feelings brought about by the trauma. This processing is what reduces anxiety while bringing about resolution and healing.
- Family therapy – As with most disorders, PTSD not only affects you but those close to you as well. Family therapy can be very beneficial in helping your family understand the challenges you face with PTSD. Since relationships are often significantly impacted by PTSD, family therapy can help facilitate open communication and relational healing.

Medication

While there aren’t medications specifically indicated for PTSD, those which are used for anxiety disorders and depression in general are sometimes used to treat some of the symptoms of PTSD. These are primarily the SSRIs. SSRI stands for selective serotonin reuptake inhibitors. These medications target serotonin, a neurotransmitter in the brain associated with mood. Popular medications in this category include Paxil, Prozac, and Zoloft. It is usually best to use medication in conjunction with therapy rather than alone when treating PTSD.

Hypnosis

While there is quite a bit of anecdotal evidence which suggests the efficacy of hypnosis as a treatment for PTSD, it is not something which has been heavily researched. Hypnosis may positively impact the anxiety symptoms that are part of PTSD. It may also help people with this disorder more effectively process the painful feelings and memories created by the trauma.

PTSD affects men and women of all ages, races, and socio-economic backgrounds. It can be a very painful and disruptive disorder with which to live, but with proper treatment, the intensity of the symptoms can be greatly reduced, if not alleviated altogether.

Posted on February 25th, 2010
Posted in Dual Diagnosis

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