Post-Traumatic Stress Disorder
Difficult situations are part of life. We all must cope with tough circumstances, such as bereavement or conflict in our personal and professional relationships, and learn to move on. But sometimes people experience an event which is so unexpected and so shattering that it continues to have a serious effect on them, long after any physical danger involved has passed. Individuals with this kind of experience may suffer flashbacks and nightmares, in which they relive the situation that caused them intense fear and horror. They may become emotionally numb. When this condition persists for over a month, it is diagnosed as Post-Traumatic Stress Disorder (PTSD).
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PTSD is a mental illness. It involves exposure to trauma involving death or the threat of death, serious injury, or sexual violence. Something is traumatic when it is very frightening, overwhelming and causes a lot of distress. Trauma is often unexpected, and many people say that they felt powerless to stop or change the event. Traumatic events may include crimes, natural disasters, accidents, war or conflict, or other threats to life. It could be an event or situation that you experience yourself or something that happens to others, including loved ones. PTSD causes intrusive symptoms such as reexperiencing the traumatic event. Many people have vivid nightmares, flashbacks, or thoughts of the event that seem to come from nowhere. They often avoid things that remind them of the event—for example, someone who was hurt in a car crash might avoid driving. PTSD can make people feel very nervous or ‘on edge’ all the time. Many feel startled very easily, have a hard time concentrating, feel irritable, or have problems sleeping well. They may often feel like something terrible is about to happen, even when they are safe. Some people feel very numb and detached. They may feel like things around them aren’t real, feel disconnected from their body or thoughts, or have a hard time feeling emotions. People also experience a change in their thoughts and mood related to the traumatic event. For some people, alcohol or other drugs can be a way to cope with PTSD.
PTSD is one of several conditions known as an anxiety disorder. This kind of medical disorder affects approximately 1 in 10 people. They are among the most common of mental health problems. Children and adults can develop PTSD. The disorder can become so severe that that the individual finds it difficult to lead a normal life. Fortunately, treatments exist to help people with PTSD bring their lives back into balance.
While most people experience trauma at some point in their life, not all traumatic experiences lead to PTSD. We aren’t sure why trauma causes PTSD in some people but not others, but it’s likely linked to many different factors. This includes the length of time the trauma lasted, the number of other traumatic experiences in a person’s life, their reaction to the event, and the kind of support they received after the event. Some jobs or occupations put people in dangerous situations. Military personnel, first responders (police, firefighters, and paramedics), doctors, and nurses experience higher rates of PTSD than other professions. Trauma is not always a single event in the past. Some trauma, particularly repeated acts like abuse or trauma during wartime, can impact a person’s life far beyond the symptoms of PTSD. Some use other terms like ‘complex PTSD’ to describe these experiences.
The symptoms of PTSD usually begin within 3 months of the traumatic event, though they may surface many years later. The duration of PTSD and the strength of the symptoms vary. For some people, recovery may be achieved in 6 months; for others, it may take much longer.
There are three categories of symptoms. The first involves re-experiencing the event. This is the main characteristic of PTSD and it can happen in different ways. Most commonly the person has powerful, recurrent memories of the event, or recurrent nightmares or flashbacks in which they relive their distressing experience. The anniversary of the triggering event, or situations which remind them of it, can also cause extreme discomfort. Avoidance and emotional numbing are the second category of symptoms. The first occurs when people with PTSD avoid encountering scenarios which may remind them of the trauma. Emotional numbing generally begins very soon after the event. A person with PTSD may withdraw from friends and family, lose interest in activities they previously enjoyed or have difficulty feeling emotions, especially those associated with intimacy. Feelings of extreme guilt are also common.
In rare cases, a person may enter dissociative states, lasting anywhere from a few minutes to several days, during which they believe they are reliving the episode, and behave as if it is happening all over again. The third category of symptoms involves changes in sleeping patterns and increased alertness. Insomnia is common and some people with PTSD have difficulty concentrating and finishing tasks. Increased aggression can also result.
People with PTSD may develop a dependence on drugs or alcohol. They may become depressed. It is not uncommon for another anxiety disorder to be present at the same time as PTSD. As well, dizziness, chest pain, gastrointestinal complaints and immune system problems may be linked to PTSD. These are often treated as self-contained illnesses; the link with PTSD will be revealed only if a patient volunteers information about a traumatic event, or if a doctor investigates a possible link with psychological trauma.
Many people feel a lot of guilt or shame around PTSD because we’re often told that we should just get over difficult experiences. Others may feel embarrassed talking with others. Some people even feel like it’s somehow their own fault. Medication can help with the depression and anxiety often felt by people with PTSD and assist them in establishing regular sleep patterns. Cognitive-behavioural therapy (CBT) and group therapy are generally felt to be more promising treatments for PTSD. CBT teaches you how your thoughts, feelings, and behaviours work together and how to deal with problems and stress. You can also learn skills like relaxation and techniques to bring you back to the present. You can learn and practice many skills in CBT on your own. They’re often performed by therapists experienced in a particular type of trauma, such as rape counsellors. Exposure therapy, in which the patient relives the experience under controlled conditions in order to work through the trauma, can also be beneficial. Support groups can also help. They are a place to share your own experiences and learn from others, and help you connect with people who understand what you’re going through. There may also be support groups for loved ones affected by PTSD. Research into the causes of PTSD and its treatment is ongoing. Determining which treatments work best for which types of trauma is currently under investigation.
When someone is diagnosed with PTSD, loved ones can also experience a lot of difficulties. You may feel guilty or angry about the trauma itself—then, on top of those feelings, experience difficulties around PTSD. You may feel like your loved one is a different person, worry that things will never be normal, or wonder what will happen in the future. Here are some tips to help you cope:
- Start by learning more about PTSD. This can give you a better idea of your loved one’s experiences.
- People who experience PTSD may withdraw from family and friends. Even if your loved one doesn’t want to talk, you can still remind them that you are there to listen when they’re ready.
- Understand that behaviours related to PTSD— like avoiding certain situations or reacting angrily to a minor problem—are not about you. They are about the illness.
- While it’s usually not a good idea to support behaviours that create problems, it’s still important to support your loved one’s overall movement toward wellness. This balance is not always easy, but you need to respect your own boundaries, too.
- Ask what you can do to help, but don’t push unwanted advice.
- Try to put your own feelings into words and encourage your loved one to do the same. It’s easier to solve problems or look at conflicts when you know what’s really going on.
- Take care of your own wellness, and seek support for yourself if you experience difficulties.
- If a loved one’s PTSD is affecting other family members, it may be helpful to seek family counselling. With support, people can recover from PTSD and the effects of trauma. Recovery is good for the entire family, especially for young people who are still learning how to interact with the world. A loved one’s recovery is a chance for everyone to learn the skills that support wellness.