Post-traumatic stress disorder – PTSD – four letters that every therapist can decipher.
The diagnosis “post-traumatic stress disorder” is overly popular in society and is often applied inappropriately, which devalues the meaning of the term itself. Before we talk about PTSD, it’s necessary to define what stress is. The founder of the doctrine of adaptive reactions, G. Sellier, introduced the concepts of eustress and distress. Eustress is a “good” stress, in which the defense reaction proceeds without loss to the body, i.e. painlessly, distress – excessive stress, leading to disorganization of the body, weakening its capabilities. It’s clear that the higher the intensity of the stress impact, the higher the probability of transition from eustress to distress. All people are subjected to stress that sometimes can occur during pleasant times, like playing at lightning roulette or going on a date, but reactions to it can differ.
PTSD is a delayed and/or prolonged response to a stressful event of an exceptionally threatening nature that can cause distress in almost anyone.
What Is “Vietnam Syndrome”?
The study of the disorder began with the wars, when doctors noted similar symptoms in soldiers and veterans. Therefore, the first names for PTSD were “soldier’s heart,” “Vietnam syndrome,” and “Afghan syndrome,” depending on the name of the war in which people were involved. Among the general symptoms stood out: a sense of terror, fear, helplessness, nervous excitability and irritability, detachment and psychological fixation on the event. Later, it was discovered that the character of mental changes was similar in people who have suffered natural disasters, violence and other catastrophes.
In Whom Does PTSD Occur?
The frequency of the disorder in the general population reaches 8%. PTSD can occur in anyone at any age, although it’s thought to be more likely to occur in women, children and the elderly.
After a traumatic experience, most people have an acute stress reaction that has some overlap in symptoms with PTSD. This reaction passes in most cases within a month, but not everyone is so lucky.
At the heart of the disorder is a severe psychological trauma or psychotraumatic situation that is life-threatening or terrifying. Psychotraumatic acts are not always committed against the patient, he or she can be a witness to them (for example, the death of a loved one) or even the perpetrator (for example, combat veterans). These emotions resemble “heavy” food that cannot be digested in the stomach and creates heaviness; accordingly, PTSD can be called a kind of “psychological indigestion.”
The main causes of the disorder are:
- Aggressive assault, threat of death or injury, rape, including blackmail, defenselessness or dependency.
- Prolonged severe illness, death of loved ones.
- Physical or psychological torture.
- Natural and man-made disasters (tsunamis, earthquakes).
- Epidemics, including coronavirus infection.
- Social causes (revolutions, terrorism, mass repressions, genocide, financial and economic crises, forced migration, chronic family violence).
- Military actions.
- Religious, ethnic, cultural conflicts, etc.
Separately, complex or complicated PTSD is a condition caused by a severe chronic situation over several months or years – is singled out. It’s more often observed in those who have experienced trauma in childhood.
Risk factors also include heredity, congenital and acquired psychological features (characteristic, neurophysiological, personal), psychological traumas suffered in the past, social conditions, specific working conditions (rescuers, military, journalists), economic situation.
What a Person Feels When Experiencing PTSD?
Symptoms usually appear within the first few weeks after trauma, but may begin within 6 months and persist for a long time. Description of some of the signs:
- Invasion of memories – the traumatic event is constantly relieved – recurrent illusions, frightening thoughts, nightmares and flashbacks (“flashbacks”) with the presence of physical symptoms when reminded of the event (sweating, numbness of extremities, feeling of weakness, pressure in the throat, itching, chills).
- Attempts are made to avoid stress-inducing stimuli connected with the trauma after the event – the person tries to occupy himself or herself with something and avoids the situations and the people reminding about the event.
- Negative changes in thought activity and mood – the person cannot remember some episodes during the traumatic event, expressed decrease of interest to earlier significant kinds of activity, constant negative emotions, sensation of alienation and detachment from other people and the world.
- Changes in arousal and ability to react – aggressive behavior, sleep disorders, difficulties in concentrating, excessive vigilance, increased reaction to fright.
Symptoms of PTSD can vary in intensity over time.
The clinical picture is usually presented with additional symptoms that are consequences of PTSD. For example, many patients fall into alcohol or drug (as a variant, drug) addiction, from which they cannot get rid for the rest of their lives. Individuals with PTSD often present with somatic and psychosomatic disorders in the form of headaches, arthritis-like pain, stomach ulcers, heart pain, colitis, and respiratory problems. Often the disorder runs in conjunction with depression and suicidal thoughts up to and including suicide attempts.
Post-traumatic stress disorder is a signal that the psyche has failed to cope with a traumatic situation on its own.
Are People With PTSD Dangerous?
For the most part, no. With PTSD, someone can indeed be violent, and some even commit murder. Most tend to distance themselves as much as possible from others, avoid communication, and above all, people with PTSD are dangerous to themselves: the rate of suicide attempts in samples of people with PTSD is eight times higher than in the general population.
Diagnosis of the disorder is made by a therapist. For a statement of diagnosis of PTSD, the patient’s history is carefully studied, and a detailed clinical interview, including relatives and friends, is conducted. The interview uses scales, tests, and questionnaires that assess the patient’s condition and the presence of depression and anxiety.
Types of disorder:
- Acute – symptoms persist for less than three months.
- Chronic – symptoms persist for three months or more.
- Deferred – symptoms occur at least six months after exposure to a stressor ends.
PTSD is distinguished from acute stress disorder and obsessive-compulsive disorder. Symptoms of acute stress disorder appear and disappear within four weeks of psychological trauma. If symptoms persist longer, the diagnosis must be changed to PTSD. The distinction of obsessive-compulsive disorder is obsessive thoughts and rituals unrelated to the specific traumatic event.
Thus, to make a diagnosis of PTSD, symptoms must persist for at least one month after the event and have a negative impact on the victim’s work or personal life.
The nature of the course of the disease is strictly individual. Some people recover in six months, while others have symptoms for much longer. For some people, these conditions become chronic, and the earlier treatment begins, the better the prognosis for recovery. There is also strong evidence that patients benefit from treatment even if symptoms persist for years. In the absence of treatment, growing physical and psychological pain leads to depression, suicidal ideation, and the formation of various addictions.
With PTSD, professional help is needed to assess the person’s condition and select therapy.
In the acute condition, being there for the person, being supportive, and being more attentive before seeking help is necessary. The person has the right to “mourn” and has the opportunity to speak out and cry. However, if after six months, the reactions have not subsided, it’s necessary to call for help.
PTSD therapy includes two key directions: psychotherapeutic and medical.
People don’t often seek psychotherapy, as they don’t want to sink into painful memories that they constantly experience in their dreams or in their dreams, experiencing shame (in the case of rape), guilt (when a person walked past a traffic accident and didn’t call an ambulance). The person believes that “no one will understand” and “they cannot help” and perceives meetings with a psychologist or psychotherapist as a potential threat, another traumatic event.
Despite the painfulness of memories, it’s necessary to relive these events. At the moment of psychotrauma, the body doesn’t understand what is happening and what to do with these events and impressions. Therefore, it’s necessary to relive the situation so that the brain understands what happened and “processes” the information.
Although there are different types of psychotherapy, in all cases it involves talking to a specialist in order to treat the mental disorder. It’s important for anyone who suffers from PTSD to be treated by someone who has experience with the disorder.
First, a trusting relationship is built with the doctor, the patient is told what PTSD is, and is prepared for the need to return to painful traumatic experiences. When talking with a therapist, the person won’t be judged; there is only an unevaluated acceptance of the experience. Each interview is conducted in a safe environment in the absence of contact with the traumatic factor. Therapy is directed at the creation of positive self-perceptions and resources for coping with the experience and adapting to the events that have occurred. A holistic picture is then created from the disparate memories, which has to be accepted and integrated into the personal history. After integration, new orientations, perspectives and goals in life are defined. A course of psychotherapy lasts 6 to 12 weeks or longer.
Body-oriented therapies include techniques such as physical and osteopathy, massage, acupuncture, reflexology, yoga, and meditation. These therapies focus on using body language to treat the mind and are based on sensation work.
Cognitive behavioral therapy (CBT) helps you learn to think differently about your memories, so they become less anxious and more manageable. It usually involves relaxation to help you process the discomfort caused by traumatic events.
The most recommended method of CBT is Shapiro Eye Movement Desensitization and Processing. This therapy involves the patient following the therapist’s finger movement while imagining that they are experiencing a traumatic event. The idea is that the effect of rapid eye movements will be similar to the way our brains process memories and experiences during sleep.
Group psychotherapy helps you feel less alone and isolated, and group members help each other realize that many people would react the same way and experience the same emotions. A “sense of elbow” develops as common problems are shared by group members with each other. Over time in the group, each member’s sense of shame and guilt diminishes, and confidence in progress after therapy increases.
The most often used auxiliary methods in psychotherapy are: hypnosis (suggestion); auto-training (self-hypnosis); relaxation methods (breathing exercises, eye movement techniques, etc.); and treatment with the aid of visual art.
The ultimate goals of therapy:
- To help one better understand the nature of the traumatic event and its effects.
- To help learn and apply relaxation and anger management skills.
- To provide guidance on how to improve sleep quality, diet and how to make exercise a habit.
- To help recognize and control feelings of guilt, shame, and other feelings related to the traumatic event.
- To take steps to correct the reactions of others to their PTSD symptoms.
PTSD in Children and Adolescents
Children generally experience symptoms similar to adults, but there are some manifestations that are more specific to children under the age of 6, such as urinary incontinence, fear of separation or increased anxiety, acting out a scary event in games, and others. Children with PTSD become withdrawn, cranky, irritable, and their academic performance declines.
At the long course of PTSD children considerably lag behind mentally and physically, they have irreversible pathological defamation of character traits. Adolescents tend to develop antisocial, destructive behavior and addictions earlier than adults. Older children and adolescents may feel guilty for not preventing injury or death.
Emergency help for children and adolescents involves making body contact (holding hands, hugging, touching a shoulder or arm), reassuring (“It’s over, I’m with you”), and encouraging (“You helped me a lot”, “You did great”).
Important moments in psychotherapeutic interaction with the child:
- Gradually gaining the child’s trust.
- Rejection of standard procedures before talking about traumatic events.
- Creation of a safe environment during therapy.
With younger children, psychological work can take place in the form of play therapy (games with plasticine, dolls, sand therapy, storytelling, role-playing games); with older children, therapy with the aid of visual art.
Corrective psychotherapy with the family is of great importance for the restoration of a normal psychological condition of the child.
If signs of distress have acquired a persistent character, consult a child therapist.
How Can You Help a Loved One With PTSD?
First, offer emotional support, understanding, encouragement and patience. If the person resists your help, give them time and let them know that you are available to talk and help if they become necessary. Try not to force your loved one to talk about the trauma until he or she is ready for it. Additionally, research information about the upset to better understand what your loved one is going through. Set yourself up for positive thinking: plan family vacations or socializing with friends, encourage his participation. Physical activity and a healthy, balanced diet are important for correcting the condition.
Often, people who have experienced psychotraumatic events, due to the peculiarity of psychological defenses, do not attach serious importance to their symptoms, perceiving it as the norm. If you see that your loved one is not coping, coordinate and plan a joint visit to a specialist.
Relatives of the victim can also seek support. When treating PTSD, it’s important to have those closest to you around to provide support, and it takes a lot of strength to do so.