Whether you are civilian or in the military, traumatic events can change the way you live your daily life or view of the world. Depending of how intense the traumatic event is, the effects can affect people differently, it may last for a short period of time or it can be a long-lasting effect. What is P.T.S.D? It is a disorder that derives from a intense traumatic event, particularly ones that threatened the individuals life. The National Center for Post Traumatic Stress Disorder describes P.T.S.D as “an anxiety disorder that can occur following the experience or witnessing of a traumatic event. A traumatic event is a life-threatening event such as military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault in adult or childhood. Most survivors of trauma return to normal given a little time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time”. People with P.T.S.D experience three different kinds of symptoms.
The first kind of symptoms involves a trigger or reminder of the trauma whilst trying to do something else causing them to become upset. The second type of symptoms these individuals may experience is trying to stay away from places that remind them of the trauma, isolating themselves from society, or feeling numb. The third type of symptom includes things such as feeling the need to be on guard at all times, being easily irritated, or startled easily by loud noises. In addition to the symptoms described above, it is understood that there are biological changes that are associated with P.T.S.D. It’s complicated by the fact that people with this disorder may also develop additional disorders such as depression, drug abuse, memory and cognitive problems, physical and mental health issues, further causing obstacles in their lives that may lead to deterioration of the person’s ability to function in their social or family life, including employment instability, marital and family problems. Considering the biological effect P.T.S.D has, it can affect anyone.
When diagnosing P.T.S.D a doctor may perform a series of test to check for any medical problems that may be causing the symptoms, as well as performing a psychological evaluation in which a discussion of signs and symptoms of the events that led up to them is provided. The National Center for P.T.S.D states that this disorder is included in “Diagnostic and Statistical Manual of Mental Disorders and that all conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.”
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Symptoms for P.T.S.D can last up to months, it can also create distress or functional impairment, many misconceptions of this disorder fall under the category of substance abuse, but in the case of this disorder most times is not due to any medication, substance abuse or other illness. For example, stated in DSM-5 under the National Center for P.T.S.D explains that the individual has had to been exposed to: death, threatened death, actual or serious injury threat, actual or threatened sexual violence, in the following way(s):
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- The traumatic event is persistently re-experienced by the individual, in the following way(s):
- Unwanted upsetting memories
- Nightmares
- Flashbacks
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
- The individual experiences negative thoughts or feelings that began or worsened after the trauma, in the following way(s):
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
- Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):
- Irritability or aggression
- Risky or destructive behavior
- Hypervigilance
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
The causes of post-traumatic stress disorder (P.T.S.D) are not well known or understood. Post-traumatic stress disorder is an anxiety disorder that occurs after being involved in a traumatic event involving harm, or threats of harm to oneself or others. While one could think of the trauma as the cause of P.T.S.D, some people can undergo a trauma and not develop post-traumatic stress disorder. Exposure to trauma causes fear in people’s brains which leads to people anticipating danger where none exists. However, it’s possible for two people can go through the same trauma and only one will develop P.T.S.D. Some people carry other risk factors for P.T.S.D.
Risk factors/characteristics:
- Exposure to previous traumas, particularly as a child
- Pre-existing conditions like anxiety or depression
- Family history of anxiety or depression
- Gender (more women than men develop P.T.S.D)
- The events most likely to cause P.T.S.D are:
- Combat exposure
- Childhood rape
- Childhood neglect and physical abuse
- Physical attack
- Being threatened with a weapon
The treatment of P.T.S.D has been the subject for several systematic review throughout the years, “Guidelines from the World Federation of Societies of Biological Psychiatry, the US Institute of Medicine (IOM), the American Psychiatric Association, the UK National Institute of Clinical Excellence (NICE), the British Association for Psychopharmacology, and the International Psychopharmacology Algorithm Project (IPAP). All of these guidelines acknowledge that there are two distinct approaches that are of proven benefit in PTSD: pharmacological and psychotherapeutic.” (Seedat, S. 2013)
Most treatment guidelines recommend the use of either selective serotonin reuptake inhibitors (SSRIs) or exposure-based, trauma focused cognitive-behavioral therapy (TF-CBT) as first-line therapy. However, US IOM guidelines and the UK NICE guidelines suggest that evidence for the successfulness of pharmacological therapies, namely SSRIs, is at best tentative. However, NICE guidelines, do not recommend drug treatments as a routine first line for adults with PTSD, but rather suggests for the use of TF-CBT. (Seedat, S. 2013)
The selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitor (SNRIs) are the two groups of antidepressants that have been the most carefully studied in placebo-controlled randomised controlled trials (RCTs). Of the SSRIs, paroxetine, sertraline and fluoxetine currently have the best evidence for success. “Paroxetine and sertraline are the only two that US Food and Drug Administration (FDA) suggested for PTSD.” (Seedat, S. 2013)
Drug treatment of PTSD has not been effective in children or adolescents. However, in adults medications have helped relieve some symptoms of P.T.S.D, but given their low effect sizes, medications are not recommended as first-line treatments over exposure and TF-CBT. (Williams, A. A, 2017)
Prolonged Exposure (PE) works by helping you face your fears. “By talking about the details of the trauma and by confronting safe situations that you have been avoiding, you can decrease your symptoms of P.T.S.D and regain more control of your life.” (Williams, A. A, 2017)
In Cognitive Processing Therapy (CPT) teaches you a new way to handle upsetting thoughts. In CPT, you will learn skills that can help you decide whether there are more helpful ways to think about your trauma. (Williams, A. A, 2017) During your session, you will learn how to examine whether the facts support your thought or do not support your thought. You can decide whether or not it makes sense to take a new perspective.
Eye-Movement Desensitization and Reprocessing (EMDR) helps you process the trauma, which can allow you to start to heal. In EMDR, you will pay attention to a back-and-forth movement or sound while calling to mind the upsetting memory. You will do this until the way you experience the memory shifts and becomes less distressing. “Some research shows that the back and forth movement is an important part of treatment, but other research shows the opposite.” (Williams, A. A, 2017)
In Narrative Exposure Therapy (NET) people who have experienced trauma from ongoing war, conflict, and organized violence. This treatment, you would talk through stressful life events in order (from birth to the present day) and put them together into a story.
In Written Narrative Exposure (WET) it involves writing about the trauma during sessions. The therapist gives you instructions on the writing assignment, allows you to complete the writing alone, and then returns at the end of the session to briefly discuss any reactions to the writing assignment.
P.T.S.D. is a serious issue that many think can only happen if you fall into a certain category of people. For instance, a common belief is that it can only happen from events in the military. Though there are many who suffer after serving, There are many other circumstances that can lead to the disorder. There are many labels and misconceptions surrounding P.T.S.D. that need to be addressed and minimized in order to create awareness and understanding. Not everyone who suffers from the disorder has to witness combat, but can develop it from any situation that stimulates one’s body in a negative way, and is encoded into long term memory.
The truth is that many people who suffer from P.T.S.D. have inherited it from rape, abuse, natural disasters, and other traumatic events other than war. Veterans Today reports that 24 million americans suffer from P.T.S.D. in some form. It is a mental disorder that can only be fully understood by the one who suffers from it, as well as those who specialize in treating it. Like a bad joke, those who are uneducated in the manner believe that it can go away by itself one day. However, these damaging events manifest into involuntary psychological responses that need to be treated. There is a misunderstanding that people with Post Traumatic Stress Disorder are weak.
Today reports that people view P.T.S.D. as similar to the stress of losing a job, or going through a divorce, so one should be able to get over it in time if they wanted to. However, this far from the truth. In fact, the American Medical Association (AMA), American Psychiatric Association (APA), Centers for Disease Control (CDC) and the National Institutes of Health (NIH) all recognize P.T.S.D. as a valid and significant disorder. If the public took time to research the disorder, this label could be negated.
Many people feel uncomfortable around those who have P.T.S.D. because they automatically think the sufferer is unstable. According to Veterans Today, Post Traumatic Stress disorder does not always lead to violent behavior, and its symptoms are determined by one’s mental discipline and characteristics. Though there are some who do have threatening outbursts, there are others who primarily have memory problems, problems regarding bodily function, or trouble connecting with others, regardless if the disorder was developed from war or a traumatic event. It is not something that cannot be overcome. Therefore, it is safe to say that sufferers do not have to be feared, as there are many who have a well developed mental state to endure the disorder.
A common misconception of P.T.S.D. is that it is formed immediately after the traumatic event. According to the National Institute of Health, there is no set time that the disorder develops; though it is usual to occur within three months after the event, there are victims who experience P.T.S.D. up to six months after. The way P.T.S.D. is diagnosed, is a month-long observation in which a psychiatrist or psychologist will evaluate a patient to see if they re-experience the event through thought, persistent about trying to avoid bringing up the event (avoidance symptoms) , or experience irritability or physical reactions when thinking of the event (hyperarousal symptoms). P.T.S.D. may result from trauma, but does not develop quickly like trauma, but rather it builds up and develops overtime.
It’s a common belief that P.T.S.D. and panic attacks are the same and the words are interchangeable. In the article, “The differences between panic disorder and P.T.S.D.,” by VeryWellMind, Panic attacks place someone in fear of bodily harm and experience abnormal body functions at any time without warning and generally the cause is unknown, while P.T.S.D. requires people, places, objects, or memory to stimulate an episode. Though some physical symptoms are the same, methods of attempting to avoid another experience are different. People who suffer from panic attacks will do their best to avoid areas or practices and do not know the main cause that triggers the attack, resulting in a phobia of not knowing when the attack will happen next. In P.T.S.D. sufferers, avoiding anything that reminds them of the traumatic event is typical, irritability, anger, and violent tendencies can occur to avoid these stimulants, unlike people who have panic attacks and primarily experience fear. It is good to know the difference between these two disorders, because they both require different medical and psychological treatment.
Many sufferers who recognize they have P.T.S.D. believe that treatment or therapy will not work. However, VA Benefits Blog states that educating sufferers about the psychological effects and their traumatic experience is crucial to helping them cope or even totally eradicate the symptoms. Another effective way to help in the treatment is exposing the suffer to other people who overcame P.T.S.D. and their testimonials. This practice gives them hope for the future and shows them that there are others who went through similar experiences. With proper commitment, recovery is possible, and for some, just functioning effectively with the disorder is satisfying.
P.T.S.D. can occur at any age. Contrary to popular belief, UnbrokenWarriors.org states that it can occur to children and bring about different and more severe symptoms. The National Institute of Mental Health reports that children can experience more severe symptoms than adults, such as night terrors, being unable to speak, obsessively clinging to parents, and negative interactions during “playtime.” The NIMH also reports that older children begin to start showing symptoms similar to adults, but grow up with negative and destructive mindsets that can become permanent unless treated. It is important that parents recognize the disorder in children and treat it early as it can become worse than if it was experienced as an adult. P.T.S.D. is a serious disorder that cannot be taken lightly, and there is no room for assumption, only empathy, motivation and recovery actions.
In today’s society, media has a large impact on how people view culture. Through television and movies, we are faced with the media’s idea on what a culture should look like. Post-traumatic stress disorder (P.T.S.D) is a particular mental condition that appears in the media, particularly in movies and television. Research tells us there is a link between watching news of traumatic events, such as terrorist attacks, and stress symptoms. It could be that watching television of the event makes people worse. It could also be that people who have more severe stress reactions are the ones who choose to watch more television about the event.
However, the media tend to get it wrong on how they portray people on how society would view them. Whoopi Goldberg, a famous actor, talk show host and comedian has P.T.S.D. She developed PTSD after witnessing two planes collide mid air as a child. She had a large fear of planes because of this, and when she was required to get on one she suffered from severe panic attacks. She tries her best to travel by land when she can. She has also come out and said that she undergoes therapy for her disorder. “‘There are people out there who could benefit from therapy but don’t go because they think it’s just for ‘crazy’ people or think all therapists are nuts — because that’s what they see in the media.’” (Tartakovsky, M, 2016)
