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Compiled by the Scientific & Advisory Board Members of the Depression & Anxiety Support Group, and reviewed by the MRC Research Unit on Anxiety and Stress Disorders
- Case Study
- What Is Post-Traumatic Stress Disorder
- Who Is Affected By Post-Traumatic Stress Disorder
- What Are The Symptoms Of PTSD
- Appearance Of Symptoms And Diagnosis
- Myths And Facts
- Ongoing Research
"I was raped when I was 25 years old. For a long time, I thought and spoke about the, rape solely on an intellectual level, as though it was something that had happened to somebody else. I was very aware all along that it had in fact happened to me, but there was just no feeling about it all. For a while, I just seemed to skid along through life...
I started having flashbacks that would crash over me and leave me bewildered and terrified. Suddenly, through each and every terrifying flashback, I found myself reliving the rape ordeal. Every instant was startling and frightening. I felt like my entire head was moving and shaking, even though I remained perfectly still. I would suddenly feel flushed and my mouth would dry up. As I began to feel that I was being held in suspension, my breathing changed. I was no longer aware of the cushion on the chair I was sitting in, or that my arm was touching a piece of furniture. I felt as if I was trapped in a bubble, floating around inside and feeling frightened. You feel really shaken after a flashback, physically and mentally exhausted.
The rape happened the week before Christmas, and I feel out of sorts around Christmas time. I can't believe the transformation into anxiety and fear.
After seeking help and receiving treatment for Post-Traumatic Stress Disorder, I have been able to pick up the pieces of my life and move on. It has taken some time, but I am feeling in control of my life again."
What is Post-Traumatic Stress Disorder
Also called shell shock, battle figure, accident neurosis and post-rape syndrome, Post Traumatic Stress Disorder (PTSD) is often misunderstood and misdiagnosed, even though the condition presents with very specific symptoms that comprise a definite psychiatric disorder.
A diagnosis of Post Traumatic Stress Disorder is made when the symptoms cause distress and interference in daily life. PTSD is a debilitating condition which follows a traumatic event. Often, people with PTSD are plagued by persistent frightening memories of the traumatic event which set off the condition, and feel emotionally numbed by the ordeal.
This disorder was first brought to the public attention by war veterans following the Korean and Vietnam war, but can result from any number of traumatic incidents, including earthquakes, aircraft crashes, hijackings, domestic violence or violent attacks. The disease can be triggered not only by the experiencing of a traumatic event, but also through the witnessing of a traumatic event such as the mass destruction of an aircraft crash.
Psychiatrists estimate that up to ten percent of the population have been affected by clinically diagnosable PTSD. Still more show only some symptoms of the disorder. While it was once thought to be mostly a disorder of war veterans involved in heavy combat, researchers now know that PTSD can affect anyone who has been involved in a significant traumatic event.
Not all people who have experienced trauma will develop PTSD or require treatment; some recover with the help of family, friends or other support. But many do require professional help to successfully recover from the symptoms that can result from experiencing, witnessing or participating in an overwhelmingly traumatic event.
Although the understanding of PTSD is based primarily on studies of trauma in adults, PTSD can occur in children as well. It is well known that traumatic occurrences - domestic abuse, loss of parents, war and natural disasters - often have a profound impact on the lives of children. Further research is needed in order to establish the special characteristics of the disorder in children that distinguish if from PTSD in adults. For example, it is not clear how the development and resolution of the condition are affected by the type of trauma, age of onset and type of treatment used.
PTSD usually appears within three months of the trauma, but sometimes the condition may surface months or even years later. Doctors categorise PTSD symptoms into three groups; intrusive symptoms, avoidance symptoms and symptoms of hyper-arousal.
Intrusive Symptoms. People sufferings from PTSD may have episodes where the traumatic event "intrudes" into their current life. This occurs by means of sudden, vivid memories accompanied by painful emotions which take over the victim's attention. This re-experiencing of the trauma is a flashback - a recollection so powerful that the individual may feel as if the trauma is actually being experienced all over again. In traumatised children, this re-living of the trauma often occurs in the form of repetitive play.
At times, the re-experiencing occurs in nightmares that appear so real the person wakes up screaming in terror, as if the trauma was being re-enacted in sleep. In young children, distressing dreams of the traumatic event evolve into generalised nightmares of monsters, threats to other people and rescue attempts.
At other times, the re-experience comes as a sudden, painful onslaught of emotions that seemingly have no cause, but are usually linked to the traumatic event. These emotions, often those of grief that bring tears and tight throats, can also be of anger or fear. In such cases, fantasies of revenge may occur. Individuals recount that these experiences occur repeatedly, in much the same way as memories or dreams of the traumatic event would also occur.
Avoidance Symptoms. These symptoms affect a person's relationships with other people, because he or she will avoid close emotional ties with family, friends and colleagues. At first, the person may feel emotionally numbed, with emotions often diminished to the extent that only routine, mechanical activities are completed. When re-experiencing the event later, the individual alternates between the flood of emotions caused by re-experiencing the event and the inability to feel or express emotions. PTSD sufferers will frequently say that they cannot feel emotion, especially towards those closest to them. When emotions are felt, there is often difficulty in expressing them. As the avoidance continues, the person may seem bored, cold or preoccupied. Family members often feel rebuffed by the PTSD sufferer because he or she lacks affection and acts in a mechanical manner.
For children, emotional numbness and diminished interest in significant activities may be difficult to explain to a therapist. For this reason, the reports of parents, teachers and other observers are particularly important.
PTSD sufferers also often avoid situations that may serve as reminders of the traumatic event because the symptoms ,may worsen when emerging in an activity or situation which resembles -even in a very small part - the original trauma. A hijack victim, for example, may find it extremely frightening to drive.
Over time, the person may become so fearful of particular situations that his or her daily life is characterised by attempts to avoid these situations.
hyper-arousal Symptoms. PTSD can cause sufferers to act as if they are continually threatened by the trauma that caused their illness. Sufferers often become irritable, even when not provoked, and may have trouble concentrating or remembering current information. Insomnia (difficulty sleeping) may develop as a result of the irritability. PTSD sufferers may have exaggerated startle reactions - for instance, a war veteran may revert to combat behaviour and dive for cover when the sound of a car backfiring or a string of firecrackers exploding is heard. At times, those with PTSD can suffer panic attacks, resulting from the extreme fear they felt during the traumatic event. During their attack; their throats tighten, while breathing and heart rate increase dramatically, resulting in feelings of nausea and dizziness. Children may exhibit physical symptoms, including stomach and head pains, in addition to the symptoms of increased arousal.
Associated Features. Finally, many suffering with PTSD also attempt to rid themselves of painful re-experiences, loneliness and panic attacks by abusing alcohol or other drugs as a form of self-medication. Substance abuse helps to blunt emotions and allows the traumatic event to be temporarily forgotten. A person with PTSD may show poor control over impulses and may therefore be at risk for suicide.
Related Problems. The inability of PTSD sufferers to resolve grief and anger over the injury or loss brought about by the traumatic episode means that the trauma will continue to control their behaviour without their-being aware of it. Some people also feel guilty because they have survived a disaster while others may not have. With combat veterans or survivors of civilian disasters, the guilt may be worsened if they have witnessed or participated in behaviour that was necessary for survival but unacceptable in contemporary society. Such guilt can deepen depression as the person begins to view him or herself as an unworthy failure.
Symptoms typically appear within a few weeks of the trauma event, but on rare occasions there can be a long gap between the trigger event and the onset of PTSD symptoms. Some people may go months or even years before displaying any of the symptoms associated with PTSD. The disease is diagnosed as PTSD only if the symptoms persist for longer than one month, with symptoms usually appearing within three months of the event. Recovery time can range from six months upwards.
The diagnosis of PTSD may be difficult because both the patient and therapist may overlook a distant episode or event that may have brought on the disorder or catalysed its development. Often a patient may forget the incident or simply fail to tell the therapist about it in the belief that the event is not important. It is therefore essential that a person seeking help for emotional problems informs the therapist about any traumatic experiences. This will enable the therapist to better consider whether the traumatic event in question is related to the patient's current difficulties.
A further confounding factor is the occurrence of other symptoms and diseases together with PTSD. The very nature of the disease results in feelings of depression, anxiety and even social withdrawal, thus carrying with it symptoms of depression, panic disorder and social phobia. Sleep problems, avoidant behaviour and substance abuse associated with PTSD may mimic other psychiatric disorders.
Today psychiatrists and other medical professionals have good success in treating the very real effects of PTSD. Using a variety of treatment methods, they help people who suffer with PTSD to work through their trauma and pain to resolve their expressed grief.
It is important to be gentle on yourself and to give yourself time to heal. Having survived a trauma stresses both the mind and body. A person who has survived a trauma cannot expect to function as they normally do immediately after the trauma and it is not a good time to make important decisions.
One important form of therapy for those with PTSD is cognitive behavioural therapy (CBT). This treatment approach focuses on coping with the PTSD sufferer's painful and intrusive patterns of behaviour by teaching him or her relaxation techniques, and examining (and challenging) his or her mental processes. A therapist using CBT to treat a person with PTSD might, for example, help a patient who is provoked into panic attacks by loud street noises by setting a schedule that gradually exposes the patient to such noises in a controlled setting until he or she becomes "desensitised" and thus is no longer so prone to terror. Using other such techniques, patient and therapist explore the patient's environment to determine what might aggravate the PTSD symptoms and work with the patient to reduce the sensitivity or to teach them new skills for coping.
In addition, therapists may recommend family therapy because the behaviour of the spouse and children may result from and affect the individual suffering from PTSD. Spouses and children often report their loved one doesn't communicate, show affection, or share family life. By working with the family, the therapist can work to bring about change within the family. Its members can learn to recognise and cope with the range of emotions each feels. They do this by learning good communications, parenting and stress management techniques.
Therapy involving discussion groups or support groups is another effective treatment for many suffering from PTSD. This method encourages survivors of similar traumatic events to share their experiences and reactions to them. In doing so, group members help each other realise that many people would have done the same thing and felt the same emotions. That, in turn, helps the individual realise that he or she is not uniquely unworthy or guilty. Over time, individuals change their opinions of themselves and others, and can build a new view of the world and redefine a positive sense of self.
Counselling and debriefing. Trauma counselling is another effective way of coping with the experience. The person may go for individual sessions where he or she can talk through the experience and work through the painful feelings such as anger, sadness and guilt. Ways of coping with the symptoms can be explored. A person seeking help for an emotional problem should always inform the therapist about any traumatic experiences.
Debriefing is a form of crisis intervention which is used when a group of people have been through a traumatic event together. It is a structured group meeting that allows for each group member to vent their feelings and reactions to the event(s). It is not psychotherapy psychological counselling. Debriefing is not a "curative" intervention and does not necessarily prevent reactions from occurring, but it does provide the individual with a framework to contain and understand his/her reaction and to take further action.
Medication can help to control the symptoms of PTSD. Antidepressant medication are particularly helpful in treating the core symptoms of PTSD. The term "antidepressants" is not an appropriate one, as these agents are useful for PTSD even when severe depression is not present. These agents are safe and non-addictive (in contrast to certain other kinds of medication sometimes used to decrease anxiety).
There are several classes of antidepressants that can be used for PTSD. Tricyclics such as amitriptyline and imipramine have proved to be effective for PTSD. Recent research has shown SSRIs to be particularly effective in the treatment for PTSD. Dosages for the treatment of PTSD may sometimes be higher than those used for depression.
It is important to realise that medication will often bring about a reduction in the symptoms of PTSD, but that continued psychotherapy is also often necessary to resolve the emotions and thoughts regarding the traumatic event.
As with the treatment of all anxiety and depression disorders, the most effective treatment for PTSD often revolves a combination of medication and psychotherapy.
Myth PTSD is only seen in people with "weak" characters, who are unable to cope with traumatic events in the same way as everyone else.
Fact PTSD can affect anyone who has experienced trauma, and involves specific chemical changes in the brain, occurring in response to the experience of a traumatic event.
Myth Everybody has been through a frightening experience and must therefore be suffering from one or more symptoms of PTSD as a result.
Fact The specific brain-based stress responses seen in PTSD differ from those observed in normal anxiety. The experience of normal anxiety and PTSD are in fact markedly different.
Myth Stress reactions to trauma exist, but these should not be considered as a serious medical problem.
Fact PTSD is associated with high levels of comorbid mood, anxiety and substance related disorders. In addition, there may be significant impairment in occupational and social functioning.
Extensive research is currently underway into various aspects of PTSD. Studies are The following are recent research findings:
• Some studies show that debriefing people very soon after a catastrophic event may
reduce certain PTSD symptoms. A study of 12 000 school children who survived a
hurricane in Hawaii found that those who received counselling early on were coping
substantially better two years later than those who did not.
• People with PTSD tend to have abnormal levels of key hormones involved in response
to stress. Cortisol levels are lower than normal, while epinephrine and norepinephrine
are higher than normal, Scientists have also discovered that people suffering from
PTSD have alterations in the function of the thyroid and in neurotransmitter activity
involving serotonin and opiates.
• When people are in danger, they produce higher levels of natural opiates, which can
temporarily mask pain. It has been found that PTSD sufferers continue to produce those
higher levels even after the danger has passed; this may lead to the blunted emotions
associated with the condition.
It was previously believed that people who tend to disassociate themselves from trauma were showing a healthy response, but researchers now suspect that such people may in fact be more prone to PTSD.
THE SIX STEPS TOWARDS RECOVERY
STEP 1: Understand the symptoms - they are part of the disease and will eventually pass.
STEP 2: Feelings of guilt are normal - they represent a way of taking back control. Help from a counselor may be beneficial.
STEP 3: Talk about your experience in detail - your thoughts, feelings and fears. Tell people you are close to that you want to talk about it.
STEP 4: Take control of your life as soon as possible. It is not advisable to go for sleep therapy, on leave or on holiday. It is best to face your fears and feelings rather than avoid them.
Exercise (mild aerobic work-outs may help with feelings of depression).
Do what you normally do - if you find this difficult, get the support of family and friends. It is also important not to push yourself to the point of failure, rather take things slowly and gradually.
STEP 5: Understand that you are going through a process -you will get better, but it may take some time.
STEP 6: Help those around you to cope with both their trauma and your trauma. Your family and friends may also be struggling with what you've been through.
There are excellent clinics across the country - please try and get help. You may only need a few sessions with a Therapist or Counselor.