In our daily lives, each of us can have an experience that is overwhelming, frightening, and beyond our control. We may be involved in a car accident, be the victim of an assault or witness an accident. These experiences are more likely to happen to police officers, firefighters, ambulance crews – who are often faced with gruesome scenes. Also, military personnel may be shot or injured by explosions, or see friends killed or injured.
Most people, in time, get over such experiences without needing help. However, for some, traumatic experiences trigger a reaction that can last for many months or even years. This is called Post Traumatic Stress Disorder (PTSD).
How does PTSD start?
PTSD can begin after a traumatic event, meaning anything perceived to put us in danger, life threatening, or the sight of other people being injured or dying. Typical such events may be:
- serious accidents
- war battle
- violent personal attack (sexual assault, physical violence, abuse, robbery)
- hostage situation
- terrorist attack
- war imprisonment
- natural or man-made disasters
- diagnosis of life-threatening illness.
PTSD can even be triggered by hearing of an unexpected injury or violent death of a family member or close friend.
When does PTSD start?
Symptoms of PTSD may appear immediately or with a delay of weeks or months, but usually within 6 months of the traumatic event.
What does PTSD look like?
Many people feel overwhelmed with grief, depressed, anxious, guilty and angry after a traumatic experience. Along with these expected emotional reactions, there are three main types of symptoms:
1. Flashbacks & nightmares
One finds oneself reliving the event over and over again. This can occur either as flashbacks during the day, or as nightmares during sleep. These can be so realistic that one feels like they are reliving the experience all over again. They see the scene in their mind, but can also feel the emotions and physical reactions they had when it happened – fear, sweating, smells, sounds, pain.
These flashbacks can be triggered by ordinary things. For example, if someone had a car accident in the rain, a rainy day can trigger such a reaction.
2. Avoidance & numbness
Reliving the experience can be very disturbing, so one looks for ways to distract oneself. They keep their mind occupied by being involved in a hobby, hard work, solving crosswords or doing puzzles. They avoid places and people that remind them of the traumatic event, and try not to discuss it.
One can manage emotional pain by trying not to feel anything at all – ending up emotionally “numb”. They communicate less with other people, creating difficulties in living together or working together.
3. Alert state
One feels on constant alert, looking for causes of danger. They can’t calm down. This is called “Hypervigilance”. They feel anxious and have difficulty falling asleep. One gives the image of a nervous and irritable person.
- muscle pains
- irregular heartbeats;
- feelings of panic and fear
- alcohol abuse
- use of medicinal substances (including painkillers)
Why are traumatic events so shocking?
They undermine our sense that life is fair, that it is as safe as possible, and that we are protected. A traumatic experience makes it clear that we can lose our lives at any time and moment. PTSD symptoms are part of our normal response to a death that was avoided at the last minute.
Does everyone develop PTSD after a traumatic experience?
No. But almost everyone will have PTSD symptoms for the first month or so. This is because they can help someone cope, and make sense of the experience they’ve been through. This is an “acute stress reaction”. Over the course of a few weeks, most people gradually come to terms with what has happened, and the stress symptoms begin to subside.
Not everyone is so lucky. About 1 in 3 people will find that the symptoms remain, and that they cannot accept what has happened. It’s like the process is “stuck”. PTSD symptoms develop into a problematic condition when they persist for a long time.
What makes PTSD worse?
The more distressing the experience, the more likely it is that PTSD will occur. The most traumatic events:
- are sudden and unexpected
- last for a long time
- occur when one is trapped without being able to escape
- are man-made
- cause many deaths
- cause amputations and loss of limbs.
- involve children
If one is still exposed to stress and uncertainty, it makes it difficult or impossible to improve the symptoms of PTSD.
What about common stress?
Everyone feels stressed from time to time. Unfortunately, the word “stress” is used to describe two rather different things:
· our inner sense of restlessness, the feeling of tension or heaviness
· the problems in our lives that cause these feelings. It can be work, relationships, financial hardship.
Unlike PTSD, these follow us on a daily basis. They are part of our normal, everyday life, but they can cause anxiety, depression, fatigue and headaches. They can also worsen some physical problems, such as stomach ulcers and skin conditions. These are clearly worrisome, but they are not the same as PTSD.
Why does PTSD happen?
We don’t know for sure. There are several possible explanations for why PTSD occurs.
· When someone is scared, they remember situations very clearly. Although it can be painful to recall such memories, it can help one understand what happened, and in the long run, contribute to survival.
· Recalls are like replaying events. They force one to think about what happened so that one is better prepared in case it happens again.
· Remembering a traumatic experience is tiring and painful. Evasion and numbness keep the number of repetitions manageable.
· Being alert means that one can react immediately to any such crisis. This can be seen in earthquake survivors, where aftershocks can follow. It can also give someone the energy they need to respond after an accident or crisis.
But no one wants to spend the rest of their life trying to get over a traumatic experience and all they want is to think about it when they need to – if they find themselves in a similar situation.
Adrenaline is the hormone that the body produces when it is in a state of stress. It “drugs” the body to prepare it for action. When the stress is gone, adrenaline levels should return to normal. In PTSD, vivid memories of the traumatic experience keep adrenaline high. This makes one tense, irritable, and creates difficulty in relaxing and sleeping.
How can one know if they have overcome a traumatic experience?
When they can:
- think about it without it being painful.
- not to feel constantly under threat.
- not to think of it at inappropriate times.
How can I tell if I have PTSD?
Have you experienced a traumatic event like those mentioned at the beginning of this article? If yes, then:
- do you have vivid memories, flashbacks or nightmares?
- do you avoid things that remind you of the event?
- do you feel emotionally numb at times?
- do you feel irritable and constantly tense but can’t see the cause?
- are you eating more than usual, or using more alcohol or drugs than usual?
- do you feel like your mood is out of control?
- do you have difficulty socializing with other people?
- do you need to be constantly busy to cope?
- feeling sad or exhausted?
If it has been less than 6 weeks since the traumatic event and these symptoms are gradually subsiding, this may be part of the normal adjustment process.
If more than 6 weeks have passed since the event and these symptoms do not seem to be subsiding, it is wise to have a discussion with your doctor.
Children and PTSD
PTSD can occur at any age. Younger children may have anxious dreams about the traumatic event, which can later turn into nightmares with monsters. They often relive the traumatic experience in their play. For example, a child involved in a serious car accident may re-enact the accident with their toy cars over and over again.
They may lose interest in things that used to please them. They may have difficulty believing that they will live long enough to grow up. They often complain of stomachaches and headaches.
How can PTSD be treated in everyday life?
What to do:
- carry on with your life as normally as you can.
- return to your daily routine.
- discuss what happened with someone you trust.
- try relaxation exercises.
- go back to your work.
- eat right and exercise regularly.
- return to the scene of the traumatic event.
- spend time with family and friends.
- drive carefully because your attention may be impaired.
- be generally more careful because accidents usually occur with greater frequency during this period.
- see a doctor.
- believe you will get better.
What not to do:
- don’t blame yourself – PTSD symptoms are not a sign of weakness. It is a normal reaction of a normal person to frightening experiences.
- don’t suppress your feelings. If you have developed symptoms of PTSD, do not internalize them because usually the treatment is very effective.
- don’t shy away from discussing it.
- don’t expect the memories to disappear immediately – you may have them for a long time.
- don’t make too many demands on yourself. Try to relax as you adjust to what has happened to you.
- don’t avoid other people.
- don’t drink large amounts of alcohol or coffee and don’t smoke a lot.
- don’t get too tired.
- don’t skip meals.
- find time for a vacation.
What can have a negative impact on recovery?
You may find that others may:
- not give you the chance to discuss it.
- avoid you.
- get angry with you.
- see you as weak.
- accuse you.
These are all ways that people protect themselves from thinking about horrible or scary events. It doesn’t help you because it doesn’t give you the opportunity to discuss what happened to you, which is difficult in itself.
A traumatic event can send you into a state of trance that makes the situation seem fake and confusing. It’s harder to deal with such situations if you can’t remember what happened, if you can’t put it into words, or if you can’t give a logical explanation.
For friends, relatives & colleagues
What to do:
- try to point out any changes in behavior – poor work performance, sick leave, tardiness, minor accidents.
- observe behaviors of anger, irritability, depression, lack of interest, impaired concentration.
- take time with someone who has had a traumatic experience to allow them to tell their story.
- show interest by asking general questions.
- let them talk, without interrupting their flow, or interjecting your own experiences.
What not to do:
- don’t pretend you know how they feel – you don’t.
- don’t tell them they’re lucky to be alive – they don’t feel lucky at all.
- don’t downplay their experiences – “it couldn’t have been that bad…”
- don’t suggest to them that all they need to do is forget about it and move on.
People who have repeatedly experienced:
- severe neglect or abuse in childhood or as an adult;
- severe and repeated violence as adults, such as torture or imprisonment
they may have similar reactions. This is called complex PTSD.
It may begin weeks or months after the traumatic event, but may take years to recognize.
Traumatic events affect a child’s development – the younger the age, the greater the damage. Some children react with defensive or aggressive behavior. Others cut themselves off from what’s going on around them and grow up with a sense of shame and guilt instead of being confident and feeling good about themselves.
Adults who have been abused or tortured repeatedly develop a similar feeling of detachment from others, and a lack of trust in the world and people.
In addition to many of the symptoms of PTSD described above, you may also experience:
- Feeling of shame and guilt.
- Numbness, lack of consciousness in the body.
- Weakness of pleasure.
- Trying to control emotions, using drugs, alcohol, self-injury.
- Cut off from what is happening around (Disconnect).
- Appearance of physical symptoms caused by mental pain.
- Inability to verbalize feelings.
- Desire to self-destruct.
- Risky and impulsive behavior.
It is worse if:
- it occurs at a young age – the younger the age, the worse the trauma
- it is caused by a parent or other caregiver
- the traumatic experience is severe
- the traumatic experience lasts a long time
- there is isolation · there is still contact with the person who caused it, and/or there are security threats.