“The mind replays what the heart can’t delete.” –Unknown
Can you imagine how exhausting it would be to go through a terrible trauma, and than relive the memories everyday, over and over again, sometimes for years? Imagine that the painful memories feel inescapable, they are in your thoughts during the day, and your dreams at night. Envision the need to sit with your back to the wall, because you always feel the need to be on alert for danger. Try to grasp feeling anxiety, that is so powerful, sometimes you can’t even focus on simple tasks. Can you even conceptualize how physically, and mentally, exhausted you might become? It’s very difficult, for those who haven’t experienced these feelings, to even truly comprehend that kind of existence. The perspective I am trying to convey, is the experience of an individual living with post-traumatic stress disorder (PTSD). In our current culture, of unceasing random violence and unforeseen tragedies, this disorder can affect anyone.
For a long time, many of our heroic military veterans have struggled with PTSD. Military personnel are exposed to prolonged, horrible, life-threatening experiences, when in combat environments. The tragedies our veterans face are beyond a civilians capacity to fathom. It is not surprising, due to the painful events that a soldier witnesses, the number of soldiers who experience PTSD has always been relatively high. However, would it surprise you to know, that the number of “civilians” experiencing PTSD is increasing as well? What was once considered to be something that affected only our brave veterans, is now becoming more prevalent among “ordinary people”.
In our current society, with the expanding numbers of random mass shootings, terrorism, and other acts of violence, the number of noncombat associated cases of PTSD is increasing. Even people, who were not physically involved in the actual event, can develop symptoms of PTSD. Our advanced technology brings catastrophic scenes of tragedy, and destruction, into our own living rooms, and onto our smart phones. Individuals far removed from the tragedies can be intensely affected by the harrowing images viewed in the media. This is called communal trauma: when people who were not physically at the disaster scenes, identify with the victims, and their personal ideas of being safe, and sheltered, are shattered. The world becomes an unpredictable perilous place, where everyone is vulnerable to tragedy, that can strike without warning. People who have been exposed to trauma in daily life, may not realize what they are experiencing, because many don’t understand that anyone, not just veterans, can experience post-traumatic stress disorder. Anyone who experiences a real, or perceived, threat to one’s safety, or witnesses a similar threat to someone else’s safety, can develop PTSD.
Examples of traumatic events that may precipitate the disorder often include:
- Crimes and random acts of violence and or death (example: mass shootings)
- Witnessing crimes and dangerous situations
- Domestic violence & abuse
- Suicide or other violent death of a loved one
- Childhood traumas (sexual, physical, emotional abuse or neglect)
- Rape and sexual assaults
- Physical assault/violence (to self or loved one)
- Natural disasters
- Being threatened with a weapon
- Serious motor vehicle accidents
- Witnessing violence or death
- Diagnosis of a life threatening illness
- Traumatic death of family member or someone close
- Any other serious risks, or perceived risks, of severe injury or loss of life.
Post-traumatic stress disorder is not an uncommon disorder. Estimates indicate that approximately 9% of the population will develop PTSD at some point in their lifetime (Breslau, Davis, Andreski, et al., 1991). That is 7 to 8 people out of every 100. The probability of developing PTSD depends in part on the nature of the trauma, the number of traumatic events a person has been exposed to, the characteristics of the victim, as well as the strength of a persons coping skills, and their available support systems (NIMH, 2016).
If you, or someone you know, has experienced trauma, it’s a good idea to know the signs and symptoms of PTSD. It is a terrible disorder to live with, and there are treatment options that can greatly improve a persons quality of life. Almost everyone has some stress related reactions (acute stress) after living through a traumatic event. However, if the symptoms last longer than a few months, cause ongoing concern and distress, or affect one’s ability to function in life (problems at work, relationships difficulties, inability to concentrate on daily tasks, isolation, etc…), than it might be beneficial to seek help (American Psychiatric Association, 2000).
Some possible “warning signs” that may indicate post-traumatic stress:
* agitation * tension * hypervigilance
* feeling afraid * feeling jumpy * easily startled
* tension * amnesia * loss of interest in normal activities
* crying a lot * isolation * feeling responsible for outcome
* fatigue * feeling numb * overreacting to minor conflicts
* impatience * lashing out * use of substances to avoid feelings
* risk taking * depression * feelings of “survivor’s guilt”
* anxiety * insomnia * neglecting health or hygiene
* flashbacks * nightmares * avoiding certain people or places
NOTE: This is by no means a complete list. These are examples of some of
the most commonly reported, and troubling, symptoms associated with PTSD.
People with PTSD often feel stressed or afraid, even when they are in no apparent danger.
There are four main features associated with PTSD:
- A persistent re-experiencing of the event: This can come in many forms and can even occur subconsciously (as is often the case with childhood traumas). Some examples of re-experiencing can include: intrusive memories of the trauma; dreams or nightmares about the event; and flashbacks. Flashbacks are defined as a dissociative experience (a type of disconnect from reality). The event is basically “relived”, a person may act out (sometimes aggressively), as if the event is actually reoccurring.
- Avoidance of anything that may trigger memories or feelings associated with the trauma: Certain stimuli, or triggers, may often cause unpleasant emotions and feelings of intense anxiety. Some examples of triggers may include: seeing similar events on the news, or even in dramatic entertainment shows; avoidance of and/or difficulty talking about the event; amnesia (loss of memory); and avoidance of people, places or things that are reminders of the trauma.
- Feeling numb: This can appear as if the person has no emotions, or what is often referred to as a blunted affect. Examples include: feeling detached from others; feeling empty inside; isolation; loss of interest in activities that were once enjoyed; difficulty concentrating; and feelings of depersonalization or derealization. Depersonalization is defined as a perception in which a person does not feel like they are real, the person’s body may feel as though it is not part of the environment, or that their thoughts and feelings are not real. Derealization is defined as a feeling that one’s surroundings are not real.
- Hyper-arousal: This is an exaggerated state of increased alertness, especially to possible danger. Examples of symptoms can include: irritability, exhaustion; paranoia; catastrophizing; insomnia or frequent waking; problems focusing on simple tasks; exaggerated startle response (may jump when touched); and hypervigilance. Hypervigilance is defined as a feeling of being constantly tense and on guard for potential danger.
What causes some people to navigate through trauma, with few residual effects, while others develop post-traumatic stress disorder?
As we said above, PTSD is a psychological disorder that can develop, in certain individuals, after a precipitating traumatic, fearful, or life threatening event. It is completely natural to experience the emotion of fear during a scary occurrence, or potentially life threatening situation. When we are exposed to danger, our body goes into “fight or flight” mode, in which we either fight for our lives, or flee from the danger. This is a natural system ingrained in our psyche to protect us. It triggers our bodies to release certain chemicals, that propel us into a state of heightened awareness and increases our body’s energy levels, to prepare us to handle the threat. This system enables us to, most efficiently, deal with the danger. Sometimes with severe traumatic events, it is hard for the brain to extinguish the “fight or flight” response, after the danger has passed (NIMH, 2016).
We have all probably felt these feelings after a harrowing experience, our heart is racing, we have increased energy, and it takes a few minutes, after the danger has passed, for us to readjust and regain our composure. People go through a range of different emotions, we all deal with the aftermath of a crisis in an individualized manner. Some people will develop “Acute Stress Disorder”, which has similar symptoms to PTSD, and may require professional help, but generally resolves on it’s own in a few weeks. However, some individuals do not recover naturally, and can develop post-traumatic stress disorder, which does not resolve in weeks, but rather can persist for months, years, or even decades (Op den Velde, Hovens, Aarts, et al., 1996). Furthermore, PTSD may not manifest immediately, sometimes the symptoms will begin to appear, inexplicably, later in life.
Research indicates that individuals, who go on to develop PTSD, have complications in the areas of the brain responsible for suppressing fearful memories. There is a particular area of the brain, the prefrontal cortex, that is involved with the ability to suppress fear. Some individuals, when exposed to extreme stress and fear, may develop problems in this area of the brain. Changes in the brain, that have been triggered by stress, and the physical and psychological effects that follow, can be a related to changes in this prefrontal area of the brain. In addition, there may be changes associated with the amygdala, which is a part of the brain that deals with emotions (Milad, Rauch, Pitman, & Quirk, 2006). The amygdala also plays a part in interpreting fearful stimuli. The amygdala is linked to many mental disorders that involve anxiety. Because the disorder is believed to be linked to actual injury in the brain, PTSD is now starting to be viewed as both a psychological and a physical disorder. More research is needed in this area to focus on possible improved treatments (Fonzo, 2017).
How to seek help:
A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. If you are not sure where to start, you could start by asking your family doctor to recommend a mental health care provider. It’s important to find a mental health provider with experience treating PTSD. The most common treatments for PTSD include a combination of talk therapy and medications. However, there are many other treatment options that can be tried. Some people will need to explore different options, to find a treatment regimen, that works for them. People are individuals with different needs, so what works for one, may not work for another. You will also need to find a mental health provider that you feel comfortable with. It is important that you feel a sense of trust, and security, with you doctor. It is okay to change providers, if you don’t feel at ease with a particular health care professional. A good doctor will understand the importance of feeling comfortable with your treatment, and won’t take the change personally. Additionally, other mental health issues such as anxiety, panic disorder, depression, domestic violence, and substance use disorders, may need to be addressed (NIMH, 2016).
If you are having trouble locating a mental health provider you can check the resources on our Helplines & Crisis Hotlines page. You can also check the National Institute of Mental Health’s Help for Mental Illness Website . If you are in an immediate crisis, dial 911, or go to the nearest emergency room, an ER doctor can also provide temporary help and direct you to resources for further treatment (NIMH, 2016).
Caring for yourself is important, you are worth it! Taking the first step towards seeking help, and change, is often scary and hard. Try to focus on the thought that you can get better, and take baby steps towards your goal. Just put one foot in front of the other, one day at a time, looking to far into the future can be daunting. It may take some time, and hard work, but you won’t have to live in fear anymore, and that will be worth the effort.
Comments and discussion are welcomed. I would like to hear your opinions, thoughts, and experiences in the comment section below. Sharing stories of strength and hope brings us together, and we can help each other. Support is essential to mental health!
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed., Text Revision). Washington, DC: Author.
Breslau, N., Davis, G., Andreski, P., & Peterson, E. (1991). Traumatic events and post-traumatic stress disorder in an urban population of young adults. Archives of General Psychology, 48, 218-228.
Fonzo, G. (2017). Selective effects of psychotherapy on frontopolar cortical function in PTSD. American Journal of Psychiatry. Retrieved from https://doi.org/10.1176/appi.ajp.2017.16091073
Milad, M., Rauch, S., Pitman, R., & Quirk, G. (2006). Fear extinction in rats: implications for human brain imaging and anxiety disorders. Biological Psychology: Jul;73(1): p.61-71. DOI: 10.1016/j.biopsycho.2006.01.008
National Institute of Mental Health [NIMH]. (2016). Post-traumatic stress disorder. Retrieved from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Op den Velde, W, Hovens, J., Aarts, P., FreyWouters, E., Falger, P., Van Duijn, H., & De Groen, J. (1996). Prevalence and course of posttraumatic stress disorder in Dutch veterans of the civilian resistance during World War II: An overview. Psychological Reports, 78, 519-529.