PTSD: Trauma and Post Traumatic Stress Disorder

“There is a pain — so utter —

It swallows substance up —

Then covers the Abyss with Trance —

So Memory can step

Around — across — upon it —

As one within a Swoon —

Goes safely — where an open eye —

Would drop Him — Bone by Bone –“

(Emily Dickinson)


This poem is a better definition of trauma than anything you will find in a textbook. What separates a trauma from other negative events is that it is an experience so distressing that to even accept it is often impossible. The mind does all it can to repress the memory or distract itself from it. Every effort is made to avoid anything that is a reminder of the traumatic event; the ultimate fear being that acknowledging the total reality of the trauma will be unbearable and will destroy us.


In most cases though, repression does not defend against the trauma which instead manifests as intrusive memories, nightmares, and debilitating mood and anxiety symptoms. Now, the less eloquent but important DSM (Diagnostic and Statistical Manual of Mental Disorders) definition of trauma


Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

1. Directly experiencing the traumatic event(s).

2. Witnessing, in person, the event(s) as it occurred to others.

3. Learning that the traumatic event(s) occurred to a close family member or close friend.

4. Experiencing repeated or extreme exposure to aversive details of the traumatic events.


Two important things to note here: the first is that it is not just instances of mortal peril but sexual violence too that can be traumatizing. The second is that apart from being the victim of trauma or directly witnessing it, learning of a traumatic incident involving a loved one can also have significant psychological repercussions.


In addition to this, a well-known phenomenon amongst first responders and mental health providers is vicarious traumatization: repeated exposure to traumatic scenes or traumatic recollections can also trigger PTSD (Post-Traumatic Stress Disorder)-like symptoms.


PTSD:

The lifetime prevalence of PTSD is estimated to be between 6-8% of the adult population. The prevalence is almost 10% for women who are three times more likely than men to develop the illness. It is estimated that up to 70% of American adults have experienced a traumatic event at least once in their lifetime and about 20% went on to develop PTSD.

PTSD is an under-diagnosed condition for several reasons. Individuals suffering symptoms tend to rationalize what they are experiencing as a “normal response” to a traumatic event and continue to do so even when months have passed without any relief. Like many other psychiatric disorders, PTSD syndrome is widely misunderstood. Hollywood stereotypes of dramatic flashbacks and violent outbursts often prevail in the popular imagination. The reality is that most people with PTSD tend to have “internalizing” symptoms-that is, symptoms patient experiences subjectively that do not have any obvious “externalizing” manifestations. So how does one recognize symptoms of PTSD within oneself and in others? The best place to start is the typical symptoms which are also the diagnostic criteria outlined by the DSM-5.

Recollection: Recurrent thoughts and/or mental images of the precipitating traumatic event, the event, traumatic nightmares, dissociative reactions, prolonged psychological distress

Hyperarousal:  Hypervigilance (constantly scanning the environment for threats, “watching your back” every time you leave the house), insomnia, irritability, anger, and the use of alcohol and other drugs to calm down.

Avoidance: Initially avoiding people, places, conversations, or movies/shows that remind one of the trauma. This may eventually lead to being reclusive and avoiding all social interaction.

 Mood “affective” disturbance: Fatalistic or extremely pessimistic thoughts, especially about the future, blaming others for one’s problems, feeling disconnected from others/ alienated, and diminished interest in daily routine and hobbies.


PTSD is a serious medical problem that if untreated causes debilitating impairment of social and occupational functioning leading to job loss, marital discord, physical violence, and suicide. While statistics for completed suicide are not available, it is estimated that over one-fourth of individuals with PTSD attempt suicide.

PTSD is treated with both medication and psychotherapy. A combination of medication and therapy has been proven to be more effective than either modality alone. Antidepressants that work on the neurotransmitter Serotonin are considered the gold standard.


These medications are best taken under the supervision of a psychiatrist who has the expertise to titrate doses and monitor for side effects.

While there is a wide range of psychotherapy approaches that can be used to treat PTSD, the two with the best evidence from clinical trials are Trauma-Focused Cognitive Behavioral Therapy and Eye Movement Desensitization and Reprocessing (EMDR). Group therapy and support groups can provide an additional benefit to those who are not getting adequate relief from individual therapy. The experience of listening to others who are going through the same experience and can relate to you helps individuals feel less alone with their emotional pain.


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Texas Behavior Health is a mental health service that offers in-person consultations as well as online counseling. Learning about health conditions by listening to constructive podcasts is at the heart of mental health sayings.
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