People suffering from PTSD have an episode where the traumatic event "intrudes" into their current life. This can happen in sudden, vivid memories that are accompanied by painful emotions. Sometimes the trauma is "re-experienced". This is called a flashback -- a recollection that is so strong that the individual thinks he or she is actually experiencing the trauma again or seeing it unfold before their eyes.
At times, the re-experiencing occurs in nightmares.
At times, the re-experience comes as a sudden, painful onslaught of emotions that seem to have no cause. These emotions are often of grief that brings tears, fear or anger. Individuals say these emotional experiences occur repeatedly, much like memories or dreams about the traumatic event.
Another set of symptoms involves what is called avoidance phenomena. This affects the person's relationships with others, because he or she often avoids close emotional ties with family, colleagues and friends. The person feels numb, has diminished emotions and can complete only routine, mechanical activities. When the symptoms of "re-experiencing" occur, people seem to spend their energies on suppressing the flood of emotions. Often, they are incapable of mustering the necessary energy to respond appropriately to their environment: people who suffer PTSD frequently say they can't feel emotions, especially toward those to whom they are closest. As the avoidance continues, the person seems to be bored, cold or preoccupied. Family members often feel the person lacks affection and acts mechanically.
The person with PTSD also avoids situations that are reminders of the traumatic event because the symptoms may worsen when a situation or activity occurs that reminds them of the original trauma. For example, a person who survived a prisoner-of-war camp might overreact to seeing people wearing uniforms. Over time, people can become so fearful of particular situations that their daily lives are ruled by their attempts to avoid them.
Many war veterans avoid accepting responsibility for others because they think they failed in ensuring the safety of people who did not survive the trauma. Some people also feel guilty because they survived while others did not. In combat veterans, this guilt may be worse if they witnessed or participated in behavior that was necessary to survival but unacceptable to society. Such guilt can deepen depression as the person begins to look on him or herself as unworthy, a failure, a person who violated his or her pre-war values.
PTSD sufferers' inability to work out grief and anger over injury or loss during the traumatic event mean the trauma will continue to control their behavior without their being aware of it. Depression is a common product of this inability to resolve painful feelings.
PTSD can cause those who suffer with it to act as if they are threatened by the trauma that caused their syndrome. People with PTSD may become irritable. They may have trouble concentrating or remembering current information, and may develop insomnia. Because of their chronic hyperarousal, many people with PTSD have poor work records, trouble with their bosses and poor relationships with their family and friends.
The persistence of a biological alarm reaction is expressed in exaggerated startle reactions. War veterans may revert to their war behavior, diving for cover when they hear a car backfire or a string of firecrackers exploding. At times, those with PTSD suffer panic attacks, whose symptoms include extreme fear resembling that which they felt during the trauma. They may feel sweaty, have trouble breathing and may notice their heart rate increasing. They may feel dizzy or nauseated.
Many people with PTSD also develop depression and may at times abuse alcohol or other drugs as a "self-medication" to blunt their emotions and forget the trauma. A person with PTSD may also show poor control over his or her impulses, and may be at risk for suicide.
Psychiatrists and other mental health professionals today have effective psychological and pharmacological treatments available for PTSD. These treatments can restore a sense of control and diminish the power of past events over current experience. The sooner people are treated, the more likely they are to recover from a traumatizing experience. Appropriate therapy can help with other chronic trauma-related disorders, too.
Psychiatrists help people with PTSD by helping them to accept that the trauma happened to them, without being overwhelmed by memories of the trauma and without arranging their lives to avoid being reminded of it.
It is important to re-establish a sense of safety and control in the PTSD sufferer's life. This helps him or her to feel strong and secure enough to confront the reality of what has happened.
In people who have been badly traumatized, the support and safety provided by loved ones is critical. Friends and family should resist the urge to tell the traumatized person to "snap out of it", instead allowing time and space for intense grief and mourning. Being able to talk about what happened and getting help with feelings of guilt, self-blame, and rage about the trauma usually is very effective in helping people put the event behind them. Psychiatrists know that loved ones can make a significant difference in the long-term outcome of the traumatized person by being active participants in creating a treatment plan -- helping him or her to communicate and anticipating what he or she needs to restore a sense of equilibrium to his or her life. If treatment is to be effective it is important, too, that the traumatized person feel that he or she is a part of this planning process.
Sleeplessness and other symptoms of hyperarousal may interfere with recovery and increase preoccupation with the traumatizing experience. Psychiatrists have several medications -- including benzodiazepines and the new class of serotonin re-uptake blockers -- that can help people to sleep and to cope with their hyperarousal symptoms. These medications, as part of an integrated treatment plan, can help the traumatized person to avoid the development of long-term psychological problems.
In people whose trauma occurred years or even decades before, the professionals who treat them must pay close attention to the behaviors which the PTSD sufferer has evolved to cope with his or her symptoms. Many people whose trauma happened long ago have suffered in silence with PTSD's symptoms without ever having been able to talk about the trauma or their nightmares, hyperarousal, numbing or irritability. During treatment, being able to talk about what has happened and making the connection between past trauma and current symptoms provides people with the increased sense of control they need to manage their current lives and have meaningful relationships.
Relationships are often a trouble spot for people with PTSD. They often resolve conflicts by withdrawing emotionally or even by becoming physically violent. Therapy can help PTSD sufferers to identify and avoid unhealthy relationships. This is vital to the healing process; only after the feeling of stability and safety is established can the process of uncovering the roots of the trauma begin.
To make progress in easing flashbacks and other painful thoughts and feelings, most PTSD sufferers need to confront what has happened to them, and by repeating this confrontation, learn to accept the trauma as part of their past.
One important form of therapy for those who struggle with post-traumatic stress disorder is cognitive/behavior therapy. This is a form of treatment that focuses on correcting the PTSD sufferer's painful and intrusive patterns of behavior and thought by teaching him or her relaxation techniques, and examining (and challenging) his or her mental processes. A therapist using behavior therapy 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 "desensitized" and thus is no longer so prone to terror. Using other successful techniques, patient and therapist explore the patient's environment to determine what might aggravate the PTSD symptoms and work to reduce sensitivity or to learn new coping skills.
Whether PTSD sufferers are treated by therapists who use cognitive/behavioral treatment or psychodynamic treatment, traumatized people need to identify the triggers for their memories of trauma, as well as identifying those situations in their lives in which they feel out of control and the conditions that need to exist for them to feel safe. Therapists can help people with PTSD to construct ways of coping with the hyperarousal and painful flashbacks that come over them when they are around reminders of the trauma. The trusting relationship between patient and therapist is crucial in establishing this necessary feeling of safety.
Group therapy is also an important part of treatment for PTSD. Trauma often affects people's ability to form relationships. It can profoundly affect their basic assumption that the world is a safe and predictable place, leaving them feeling alienated and distrustful or else anxiously clinging to those closest to them. Group therapy helps people with PTSD to regain trust and a sense of community, and to regain their ability to relate in healthy ways to other people in a controlled setting.
Most PTSD treatment is done on an outpatient basis. However, for people whose symptoms are making it impossible to function or for people who have developed additional symptoms as a result of their PTSD, inpatient treatment is sometimes necessary to create the vital atmosphere of safety in which they can examine their flashbacks, re-enactments of the trauma, and self-destructive behavior. Inpatient treatment is also important for PTSD sufferers who have developed alcohol or other drug problems as a result of their attempts to "self medicate". Occasionally too, inpatient treatment can be very useful in helping a PTSD patient to get past a particularly painful period of their therapy.
The recognition of PTSD as a major health problem in this country is quite recent. Over the past 15 years, research has produced a major explosion of knowledge about the ways people deal with trauma -- what places them at risk for development of long-term problems, and what helps them to cope.
Here are some very common signs and signals of a stress reaction:
PHYSICAL SIGNS:
*Fatigue
*Muscle remors
*Chest Pain
*Difficulty Breathing
*Elevated Blood Pressue
*Rapid Heart Rate
*Thirst
*Visual Difficulties
*Weakness
*Dizziness
*Profuse Sweating
*Chills
*Shock Symptoms
*Fainting
*Trouble Sleeping
COGNITIVE SIGNS:
*Blaming Someone
*Confusion, Disorientation
*Poor Attention
*Poor Decisions
*Heightened or Lowered Alertness
*Hyper-Vigilance
*Poor Concentration
*Memory Problems
*Poor Problem Solving
*Difficulty Identifying Familiar Objects or People
*Loss of Time, Place or Person Orientation
*Disturbed Thinking
*Nightmares or Unwanted Thoughts
*Intrusive Images
EMOTIONAL SIGNS:
*Anxiety
*Insecurity
*Guilt
*Grief
*Denial
*Uncertainty
*Severe Panic
*Shock, Numbed Emotions
*Crying
*Inflexibility
*Fear
*Agitation
*Depression
*Disassociation, Feelings of Unreality
*Apprehension
*Irritability
*Inappropriate Emotional Response
*Intense Anger
*Feeling Overwhelmed
*Loss of Emotional Control
BEHAVIORAL SIGNS:
*Change in Activities
*Chance in Speech Patterns
*Emotional Outbursts
*Suspiciousness
*Withdrawal
*Inablity to Rest
*Erratic Movements
*Change in Sexual Functioning
*Change in Usual Communications
*Hyper-alart to Environment
*Loss or Increase in Appetite
*Alcohol Consumption
*Antisocial Acts
*Non-specific Bodily Complaints
*Startle Reflex Intensified
*Pacing
Trauma survivors spent a lot of time thinking about what they could have done differently. The truth is, they couldn't have done it differently -- the body takes over. And the important thing is not what you did -- it's that you survived.
During a traumatic experience, you adapt adn choose new approaches that are survival-oriented for the situation you're in. The problem comes after the trauma, when those approaches and responses are no longer functional. Recovery involves recognizing what responses are and aren't functional, and getting rid of the ones that hurt you. In effect, traum reprograms your reactions very quickly; recover is a kind of process of "deprogramming".
Some practitioners believe that trauma causes changes in brain chemistry, changes that are helpful in the short term by reducing the level of emotion to something bearable, but that are harmful in the long term because they reinforce the PTSD symptoms.
Crucial to helping someone survive trauma is realizing that you, too, are affected by the trauma, that deciding to help is a big commitment, and that you need helpers, too.
One of the best ways to help a traumatized person is simply to listen compassionately and actively, and make the person aware that you are willing to listen. Reassure the person that there are realistic ways to make it okay, they can survive, that you are willing to help.
DO NOT criticize the person's reaction, minimize the trauma, suggest it was fate or "God's doing", minimize the person's feelings, or say you know exactly how they feel. Do not interfere with actions the person has chosen to take unless they are endangering themselves or others. If you think an action is too extreme, encourage the person to slow down and talk it through.
Healing begins when the survivor realizes that the trauma was real and had real effects on their life, not all of which are adaptive in terms of "ordinary living".
Trauma creates overwhelming fear and leaves behind a feeling that the world is not a safe place. Many practitioners believe recover begins with establishing a safe place, a situation within which the survivor can feel some sense of safety and predictability. This usually involves developing an honesty about adn awareness of the fear. As the fear subsides, the survivor is able to focus on other feelings and symptoms, to recognize them, sear for meaning and decide whether or not to act on them.
In summary, here are ten ways to recognize PTSD. Recognizing these symptoms is the first step toward recovery and finding treatment.
1) Re-experiencing the event through vivid memories or flashbacks.
2) Feeling "emotionally numb".
3) Feeling overwhelmed by what would normally be considered everyday situations, and diminished interest in performing normal tasks or persuing usual interests.
4) Crying uncontrollably.
5) Isolating oneself from family and friends, and avoiding social situations.
6) Relying increasingly on alcohol or drugs to get through the day.
7) Feeling extremely moody, irratable, angry, suspicious or frightened.
8) Having difficulty falling or staying asleep, sleeping too much or experiencing nightmares.
9) Feeling guilty about surviving.
10) Feeling fears and a sense of doom about the future.
