Post traumatic stress disorder (more commonly referred to as PTSD) is both one of the most common and most misunderstood mental disorders in the cultural and contemporary imagination. This is perhaps because PTSD can be caused by so many kinds of trauma, from the trench warfare of World War I to abuse victims.
Reliving the traumatic event
Stimuli can cause a vivid flashback for the sufferer, sometimes divorcing the patient from reality momentarily as the traumatic memories play out. This can obviously become very dangerous depending on what the patient was doing before the stimuli caused the flashback. Said stimuli is usually called a “trigger.” Common triggers include loud noises, news reports, and images and discussions of an event similar to the trauma. Ironically, the 4th of July can be a very hard time for a American soldier with PTSD. The sound and light of fireworks can trigger flashbacks.
Avoiding situations that remind you of the trauma
This is a preemptive way to avoid triggers but it’s also part of the dysfunction. A rape victim may refuse to go to parties or an assault victim may avoid locations that remind them of the assault. This can be crippling for the patient because it puts spaces off limits. Part of PTSD recovery often includes reclaiming these spaces and memories, sometimes through immersion therapy or virtual reality, as illustrated in this video.
Numbness or reclusivity
This is another coping mechanism that when it goes on too long can really hurt a patient. (A little quiet time and rest can be recuperative, but when you are hiding from anxiety for a long period of time the isolation can actually amplify the power of the trauma.) When family and friends of PTSD sufferers talk about personality changes, it’s usually this. The traumatized brain can basically shut off the patient’s ability to love both people and activities they used to enjoy, in some ways out of fear that they will be taken away by another trauma. In some cases, patients block traumatic memories entirely, leaving memory gaps.
Aggression and edginess
It makes complete sense that trauma can lead to paranoia. Patients can feel like they and their loved ones are always in danger. Living in this constant state of anxiety and adrenaline can put major stress on the body and mind, from problems concentrating to sleep issues to bodily pain. Though said pain is often called a somatic complaint, as in psychosomatic or an injury caused by a mental problem rather than a bodily cause, extended exposure to adrenaline and cortisol (the so called “stress hormone”) can cause increased blood pressure, weight gain, and digestive problems.
Shame and hopelessness
Shame is a natural human emotion but PTSD causes extended feelings of worthlessness, all too commonly leading to suicide in patients who aren’t receiving treatment or whose treatment isn’t working. Because the brain is spending so much time in its panic state, it doesn’t get a chance to rationalize shame and put it in perspective. There isn’t enough time to breathe, let alone cope. This is why anti-anxiety and depression meds are used to treat PTSD. The hope is the drugs will break the chemical cycle that’s paralyzing the patient.
Impulsive or self destructive behavior
Consider this the mirror world answer to the numbness symptom. Instead of the PTSD paralyzing the patient, the patient has trouble predicting or caring about the outcomes of their actions. A traumatic event can make the victim feel like they have no control over events, so why should they even try to be careful? They were being careful when the trauma occurred (or conversely in the case that you’re dealing with a daredevil injury, the patient’s belief in their own invincibility can be diagnosed as part of the disorder. PTSD can interfere with the patient’s assessment of reality and risk, and that is why it can be so crippling.)
Diagnosis and Disassociation
Any kind of trauma will usually cause PTSD type symptoms. The diagnosis usually lies in the duration and severity of the symptoms. If a patient finds their work or home life severely impaired for four weeks or more, the DSM-V, the diagnosing manual for mental health professionals, says the patient can be diagnosed. Symptoms may not appear immediately after the trauma, sometimes appearing or returning years afterward the initial event or onset.
Another interesting tidbit to pull from the DSM-V is they advise the doctor to check for disassociative symptoms, i.e. the patient feeling like they are outside themselves or that the world they live in is not real. Feeling like an outside observer of your own life is called depersonalization. Journalists and photographers, as professional observers of sorts, can perhaps sympathize with this problem more than most.
Treatment methods include medication, from pills that treat anxiety, depression, and even anti-psychotics to medical marijuana, and talk therapy, usually CBT or cognitive behavioral therapy, which includes helping the patient confront and understand the traumatic event as well as providing coping strategies for anxiety, depression, and stress brought on by PTSD.Though the disorder is hard to treat, another tragedy is how many victims don’t ever get treatment because of fear or limited access to medical help. (This is far too common for veterans.)
Check out the National Center for PTSD’s site for more information.
And check out this story from This American Life that explores the similarities and differences between PTSD sufferers from a US soldier to a gangland kid.