Post-traumatic Stress Disorder
(PTSD)
by Marleen Norman, LCSW
Post-Traumatic Stress Disorder, once known as "shell shock" and
later
"combat (or battle) fatigue," is now universally recognized as
occurring
as a result of exposure to an extremely traumatic stressor. Not all who
experience
the trauma develop it, but all who develop the disorder have each
suffered
a personal trauma, such as:
- the threat of death
- the threat of, or actual, serious injury to one's self
- witnessing the death or serious injury of another
- learning about the unexpected and/or violent death, serious
injury--or the threat of death or injury--to a significant other.
It can occur at any age, including childhood. Some examples of events
that can precipitate
a post-traumatic stress disorder are:
- war
- natural disasters (e.g., a catastrophic tornado, earthquake)
- rape
- an auto accident involving death and/or severe injury
- being a hostage and/or victim of torture
- being robbed at gunpoint.
Symptoms associated with the disorder usually develop within the first
three
months after the traumatic event, but the symptoms can also be delayed
for
months or even years. The person's response to the event involves
intense fear, helplessness, and/or horror; for children, the response
involves disorganized
and agitated behaviors. To be diagnosed with this disorder, the
symptoms
must last longer than one month, and the symptoms must not be present
before
the traumatic event. To be considered a "chronic" condition, the
symptoms
must last longer than three months. These persistent symptoms include:
- difficulty falling or staying asleep
- irritability or explosive outbursts of anger
- difficulty concentrating
- hyper-vigilance
- an exaggerated startle response
Shortly after the traumatic event, one individual may react by being
afraid to be alone; conversely, another may isolate and become
withdrawn. Individuals with post-traumatic stress disorder experience
intrusive and disturbing memories
of the event in the form of thoughts or images, flashbacks,
dreams/nightmares. Spontaneous recollections of the trauma also can be
"triggered" by
experiences in the here-and-now. At such times, an individual may act
or
feel as if the traumatic event is recurring and is being relived. There
is
always intense psychological distress from internal or external
triggers that
resemble or symbolize the whole, or part, of the event.
With post-traumatic-stress-disorder, there can be a "numbing"
response to the trauma, which may occur soon after the event. Unlike
the individual who has intrusive and vivid memories of the event,
another may be unable to
recall all or important parts of the experience. There may also be a
feeling
of detachment and/or estrangement from others. Often, an individual who
experiences
PTSD will avoid anything associated with, or resembling, the event.
Experiencing intense symptoms and being overwhelmed with memories
(or the
constant fear of suddenly being overwhelmed with memories) can
interfere with
personal relationships and work, and usually prevent enjoyment of
once-pleasurable
activities. Individuals with PTSD find it difficult to express the
emotions
they feel. They also may alternate between feeling flooded by emotion
and
an inability to feel or express any emotion at all.
Not everyone requires treatment for PTSD. If one has relatively good
coping
skills and a reliable support system (friends and/or family), and if
the
stress is acute (a response to a recent event), it is possible for the
symptoms
to resolve within the first month. However, those with PTSD also may
have
experienced earlier losses or chaotic situations, and the current
stress
is compounded by these earlier, unresolved events. Survivor's guilt can
be
another complication. This kind of guilt occurs when one is in the
position
of surviving a catastrophic event that causes loss of life (even if one
is
injured).
The inability to work out grief and anger over injury and loss
(whether due to one or more events) means the trauma can continue to
affect one's feelings
and behavior--often without being aware of it. Severe depression,
anxiety,
and even suicidal thinking can result from the inability to resolve
painful
feelings from a trauma. At such times, it is important to seek help and
find
a therapist who is experienced in working with post-traumatic stress.
Marleen Norman, LCSW, is a psychotherapist in San Francisco. Go
to
her homepage or send an email to: Ms. Norman
National
Insitute of
Mental Health is another site to visit.
Return to our homepage: COLUMBIA
PSYCHOTHERAPY ASSOCIATES
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Changes last made on: Fri 12 Apr 2007 10:14:03