Post-traumatic stress disorder (PTSD)

What is Post-traumatic stress disorder (PTSD)?

Post-traumatic stress, also known as shell shock, battle fatigue, accident neurosis, or post-rape syndrome, causes distress and interference in the daily lives of so many people. PTSD is a debilitating condition, which follows a traumatic event or events. People suffering from PTSD are plagued by persistent frightening memories of a traumatic event or events, which sets off the condition.

To use the words of Peter A. Levine: trauma is hell on earth.  Resolved trauma is a gift of the gods

Who is affected by Post-traumatic stress disorder?

It is estimated that up to ten percent of the population have been affected by PTSD. It was once thought to be mostly a disorder of war veterans. PTSD can however affect anyone who has been involved in a significant traumatic event, or what the individual considers to be a trauma.

What are the symptoms of PTSD?

Symptoms of PTSD normally only appear after three months after a traumatic event. The condition can also appear months, even years after a traumatic experience. I had a client whose symptoms only surfaced 30 years after a traumatic experience. He had not experienced any PTSD symptoms for the said period until he got triggered by a cue reminding him of the trauma, even after 30 years of latent PTSD.

The symptoms of post-traumatic stress disorder as described by the DSM 5 are:

Note:  The following criteria apply to adults, adolescents, and children older than 6 years.

A. 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. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental
4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g. first responders collecting human remains; police officers repeatedly exposed to details of child abuse)

Note:  Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work-related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)
2. Recurrent distressing dreams in which the content and/or effect of the dream are related to the traumatic event(s)
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolise or resemble an aspect of the traumatic event(s)
5. Marked physiological reactions to internal or external cues that symbolise or resemble an aspect of the traumatic event(s)

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning, or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs)
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g. I am bad, no one can be trusted, the world is completely dangerous, my whole nervous system is permanently ruined)
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame themselves or others
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g. inability to experience happiness, satisfaction, or loving feelings)

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning, or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

1. Irritable behaviour and angry outbursts (with little or no provocation) are typically expressed as verbal or physical aggression toward people or objects 

2. Hypervigilance

3. Reckless or self-destructive behaviour

4. Exaggerated startle response

5. Problems with concentration

6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)

F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition

An easier explanation and summary of PTSD

People experiencing PTSD may experience a variety of symptoms after trauma in a number of ways. 

• One of the most common characteristics of PTSD is that a traumatic event can be re-experienced in many ways.

This may often include sudden, vivid memories, flashbacks, or dreams accompanied by painful emotions that dominate their attention. This re-experiencing of trauma, or so-called flashback involves a recollection so powerful that the individual may feel as if the trauma is actually happening all over again. These memories can also be triggered when a person is exposed to cues that may remind them of a traumatic incident.

A client of mine, as an example, was in a branch of a well-known chain group of shops, when a robbery took place at the time. He was being held at gunpoint by a man wearing a yellow T-shirt during the robbery. After the robbery, they left the shop with nobody hurt or harmed. After that, he was unable to go to that shop or to enter any other branch of this specific supermarket group.  He started to feel anxious when he saw an advert for the shop on television, radio, or in the press.  He realised that he started to experience physical and psychological distress every time he saw anybody wearing a yellow T-shirt.  He even became anxious, going into intense physical and psychological distress when he watched shooting scenes during certain movies, almost as if it was actually recurring.

These surprises may often return again and again as sudden and painful onslaughts of emotions that seemingly have no cause but are usually linked to one or even more traumatic events. These emotions may often trigger sadness, a tightening of the throat, and anger or fear. In such cases, fantasies of revenge may even reverberate.

• Most people suffering from PTSD may try to avoid these traumatic cues at all cost. They may even avoid intimate relationships with other people, almost as if they can’t connect with others, even spouses, children. If they are able to feel emotions at all, they will find it difficult to express these emotions.

People with PTSD may more than often try to avoid any situations, persons, thoughts, or incidents that may serve as reminders of the specific trauma, since the symptoms may become triggered when exposed to any activity or situation, that resembles – even if only a very small portion – the original trauma.

They may experience psychological or physiological distress when confronted with any cues that resemble any aspect of trauma in the form of anxiety, stress, panic, or uncomfortable emotions, or physical symptoms such as sweatiness, palpitations, shaking, nausea and so many more.

Over time, they might even become so fearful of particular situations, that their daily life is characterised by attempts to avoid these situations. They may not be able to even remember important aspects of the trauma and have a reduced participation in meaningful activities because of the mentioned fear.

• People experiencing PTSD, may experience typical symptoms similar to anxiety such as feelings of irritability, trouble concentrating or remembering short-term information, and insomnia (difficulty sleeping). There is also the excessive startle response in which they will be excessively startled by any loud sounds that may remind them of the trauma. For example, a loud blow that reminds them of a gunshot.

Can you imagine what might happen if these people are repeatedly exposed to these cues? These symptoms will just keep on stacking up and keep worsening.

The more incidents that happen without treatment, the stronger the triggers become and the more difficult it will be to recover. Studies have shown that people who are debriefed immediately, stand a lesser chance of developing PTSD.

• This challenge is worsened by the fact that PTSD does not develop immediately after the trauma. It may develop months, even years after the traumatic incident. It might feel as if nothing has happened and indeed you experience no symptoms. When and if the symptoms eventually do appear – it might feel as if it is coming as a surprise.

• People experiencing PTSD don’t want to talk about it, as part of the attempts to forget about the trauma. Cowboys don’t cry and a glass or two of alcohol will do the job. Some even make jokes in the hope that it will be gone by tomorrow but the imprint in the subconscious mind does not go away.

• We are, however, making use of all different defence mechanisms to protect us against those memories. One of the most commonly used defence mechanisms against PTSD is the so-called We are literally placing a huge concrete block on top of our feelings to ensure that our trauma keeps on staying suppressed. Unfortunately, these suppressed feelings will always push back upwards in the form of trauma, anger, and depression. Since your defence mechanisms keep on pushing it down (repressing it), a battle develops. The anger and trauma keep on pushing upwards and the defence mechanisms keep on pressing downwards. These counter forces, cause anxiety (or stress) in most cases. Stress, literally speaking is when there is pressure from two different directions.

Alcohol is the best treatment to help you relax and suppress the anxiety, to help you get rid of and forget these painful events. It is just a pity that this therapy is short-lived with so many side effects.   Although loneliness can be suppressed with alcohol, it only lasts for a short while.  The use, even abuse of substances may help to blunt emotions and allow the traumatic event to be temporarily forgotten. A person with PTSD may show poor control over impulses and may, therefore, be at risk of committing assault or suicide in an attempt to seize control.

Depression, anxiety, and social withdrawal may co-exist with PTSD.

• It is widely thought, especially by policemen and soldiers, that PTSD only happens to weak The truth is that PTSD can happen to the bravest of us. A chemical reaction in the brain can happen to anyone, no matter how strong or weak we are. It is, in this context, almost like cancer. Cancer can happen to the weak or elderly but it can also happen to a fit and strong rugby player. PTSD does not discriminate. Children as well as Recce’s can develop PTSD.

• It is not a sign of weakness to seek help and it is only the strong who have the guts to recognise a challenge and seek help for it.

Therapy

The good news is that there is therapy available for PTSD. This practice is making use of techniques such as BWRT or hypnosis together with NLP, where it is possible to desensitise such traumas.

Contemporary therapies often involve a disassociated approach, sparing clients confrontation with specific traumatic events. These techniques minimise trauma during the process, surprising clients with the ease of overcoming symptoms without active participation.  Don’t let these ghosts ruin your life.  Grab the available help in front of you with both hands! It is there, a gift for the gods.

Are you experiencing PTSD?  Test yourself

The Impact of Event Scale (IES) is a short set of 15 questions that can measure the amount of distress you associate with a specific event.  The IES was developed in 1979 by Mardi Horowitz, Nancy Wilner, and William Alvarez.

Studies show that the IES is valuable in spotting both trauma and less intense forms of stress.  It will show how big an impact the traumatic event is currently having on you.

Here are the questions and instructions for the Impact of Event Scale.

Below is a list of comments made by people after stressful life events.  Please mark each item, indicating how frequently these comments were true for you during the past seven days.  If they did not occur during the specified time, please mark the not at all column.

Select only one answer per statement: