Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that can develop after experiencing or witnessing a major trauma.
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There are many different types of symptoms that someone can have after a trauma, but PTSD symptoms fall into 3 categories:
Reliving or re-experiencing the trauma
Attempts to avoid thoughts, situations, or people that are reminders of the trauma
Increased anxiety or arousal, including being constantly on guard for danger, and being easily startled
People with PTSD will have at least one or more symptoms of each of these categories.
John is a 54-year-old man who witnessed his grandson die in an automobile accident. A semi-truck trailer crashed into the car John was driving. His grandson was a passenger in the front seat. Although John had some minor injuries after the accident, his grandson died at the scene. Before the accident, John ran a successful small business and was very close to his family.
Since the accident 8 months ago, John has been having flashbacks, or very vivid images, of the crash; these flashbacks will sometimes cause him to dissociate, that is, he will lose track of where he is and feel like he is back at the scene of the accident. He is very scared of these flashbacks, and worries that it is a sign that he is going "crazy". He tries to avoid anything that reminds him of the crash, and will avoid looking at pictures of his grandson, going to his grave site, or talking about him with friends and family.
John also seems to be using work as a way of avoiding thinking about the accident. His wife is very concerned, because he is working over 10 hours a day and has started going in to work most weekends. However, when he is at work, he is constantly distracted and has difficulty concentrating. He also finds it hard to make important decisions. Several of his employees have told him that they are worried about the changes they have seen in him.
John has started drinking every day when he gets home. He does this to try to stop the memories and to lessen his feelings of anxiety. He feels angry and irritable much of the time. Although he is worried that he is pushing his family and friends away, he says that he often feels numb. He says that he has not felt positive feelings of love, joy, or sexual arousal for quite some time. He has not been able to drive by the place where the accident took place, and he will not take any passengers in his car. He is also extremely nervous when driving alone, and as a result tries to use public transit as much as possible, despite the inconvenience. John has difficulty remembering certain parts of the accident, even though he did not lose consciousness or hit his head. Recently, he has been thinking that life is not worth living this way, even though he never thought he would consider taking his own life. He does not want to hurt his family.
Sharon is a 23-year-old single woman who lives with her older sister. She left university two years ago after being raped while out on a date with a male student she met through class. Since being assaulted, she has experienced a variety of symptoms that have not gone away with time. She has unwanted memories of her trauma whenever she sees a man who looks like the person who assaulted her. She often has nightmares about the rape, and sometimes they are so upsetting that she is not able to fall back asleep without leaving the lights on or taking an extra sleeping pill. She has also had several panic attacks when thinking about the rape, and avoids watching movies that may show a rape scene. She has not been able to talk about the assault with her family doctor, even though she is afraid that she may have been exposed to a sexually transmitted disease. She has never told any friends or family about it either, because she is scared that they won't believe her or that they will think badly of her.
Sharon has been unable to go back to university, because she fears that she might see the man who raped her. She also worries that she won't be able to pay attention in class and do her homework because she now has a very hard time concentrating. Sharon says that she no longer feels any enjoyment when she is with her friends and family. She has let all of her hobbies go, including quitting the soccer team and not reading her favourite books anymore. She says that she feels cut off from everyone around her, and she doubts that she will ever be able to be intimate with a man again. This is especially upsetting to her, because she is afraid that this means she will never be able to start a family, and having children some day has always been very important to her.
When Sharon is out in public, she is constantly on guard, especially if men are around. She is finding it difficult to keep a job, and she lives with her sister because she no longer feels safe living on her own. Recently, she got very angry at her sister when she brought some male friends over to their apartment. Sharon's relationship with her sister is now quite tense.
There is no one type of trauma that can lead to PTSD. Rather, there are several different kinds of traumatic situations that can do this, all of which have certain common elements:
The trauma was life threatening or it led to an actual or potentially serious injury
The individual reacted to the trauma with intense fear, helplessness, or horror.
You can develop PTSD if you have been directly involved in a serious traumatic event, or if you witnessed a traumatic event. Some common traumas that can lead to PTSD include:
Being in, or seeing, a serious car accident
Being sexually assaulted/raped
Experiencing long-term sexual or physical abuse
Undergoing major surgery (bone marrow transplant, extensive hospitalization, severe burns)
Experiencing or witnessing natural disasters (earthquakes, hurricanes, floods, fire)
Experiencing torture, a terrorist attack, or being a prisoner of war
Experiencing or witnessing a violent crime (kidnapping, physical assault, assault or murder of a loved one)
Being involved in a war or witnessing violence or death during wartime
In order to receive a diagnosis of PTSD, you need to be currently experiencing at least one symptom from each of the following three categories.
1. Symptoms of reliving or "re-experiencing" the trauma
Upsetting memories about the event. This usually involves having vivid images about the trauma come up again and again even when you do not want to have them. For example, if you were physically attacked, you might keep remembering your attacker's face. Or, if you were in a car accident, you might have strong memories about the sound of the crash or a vivid picture of blood all over yourself or someone else involved.
Nightmares about the trauma. People with PTSD will often have very vivid nightmares of either the trauma or themes surrounding the trauma. For example, if you were in a car accident, you might have frequent nightmares about being in the accident yourself, or about other people being involved in accidents. Some people with PTSD who were assaulted will have nightmares of being chased, and the person chasing them in the dream might not be the person who assaulted them.
Acting as if the trauma were happening again ("reliving the trauma"). This is also called "dissociation", where an individual loses touch with the present, and feels as if they are living through the trauma again. Some people with this symptom might speak and act as if they are physically in the traumatic situation, whereas others might appear to simply stare off into space for a period of time. Some people with PTSD will also have "flashbacks", which are very vivid images of the trauma they experienced. Flashbacks can seem very real, and some people describe it as a picture or movie that they can see clearly in their minds.
Anxiety or distress when reminded of the trauma. Some people with PTSD become extremely upset or feel very anxious whenever they are confronted with a person, place, situation, or conversation that reminds them of the trauma. This can include becoming very upset when hearing tires squeal if you were in a car accident, or feeling anxious when watching violence on TV if you were assaulted.
Why do I have flashbacks and upsetting intrusive thoughts? When you live through a traumatic experience, your mind processes and stores the memory a little differently than it stores regular experiences. Sensory information about the trauma, that is, smells, sights, sounds, tastes, and the feel of things, is given high priority in the mind, and is remembered as something threatening. Once this happens, whenever you are faced with a touch, a taste, a smell, a feel, or a sight that reminds you of your trauma, the memory (and the feeling of threat) comes back up and you might have vivid memories or flashbacks about the trauma. This is just the way the mind works. It is not dangerous or a sign that you are going crazy.
2. Symptoms of avoidance
Avoiding reminders of the trauma. Many people with PTSD will try very hard to avoid anything that is associated with, or reminds them of, the traumatic event they experienced. Reminders can include:
Circumstances (e.g., the actual date of the event, clothes worn, place where the event occurred, etc.)
Things associated with the trauma (e.g. being in a car if the trauma was a car accident)
General signs of danger (e.g. TV shows about violence, news programs, police or fire department sirens, fire alarms, etc.)
Avoiding thoughts, feelings, or memories related to the trauma. Although many people with PTSD will avoid any reminders of their traumatic experience, it is also common for people to avoid even thinking about what happened. For example, you might avoid talking to anyone about the trauma, and if you have thoughts or memories about what happened, you might try to push them out of your head.
Not able to recall parts of the trauma. It is not uncommon for people who have lived through a trauma to have difficulty remembering parts of it, or the entire trauma, or to be confused about the timeline of events.
Reduced interest in previously enjoyed activities. For example, after a trauma, you might stop wanting to spend time with friends and family, or you might stop all activities that you used to enjoy (such as sports or hobbies).
Feeling detached/estranged from others. People with this symptom describe feeling cut off from others, even though they might have family and/or friends around them.
Feeling numb/unable to experience feelings. Some people with PTSD will say that they generally feel numb, and don't experience loving feelings anymore (such as love, joy, or happiness). People with this symptom might have a hard time even describing how they feel, and are not able to recognize when they are happy, sad, or angry.
- Feeling of foreshortened future. It is not uncommon for people with PTSD to say that they have a feeling of "impending doom"; that is, they say that they don't expect to live long, that something bad is likely to happen again soon, or that they feel hopeless about the future.
3. Symptoms of increased anxiety or "hyperarousal"
Sleep difficulties. Some people with PTSD will have trouble falling asleep or staying asleep. This often happens when you feel quite anxious throughout the day.
Anger outbursts or irritability. It is not uncommon for people with PTSD to feel more irritable and angry. If you have this symptom, you might find yourself snapping at people, or getting extremely angry in a situation that reminds you of your trauma. For example, if you were in a car accident, and while driving someone cuts you off, you might get very angry and even yell or act inappropriately.
Concentration difficulties. Many people with PTSD report that they have a hard time paying attention or concentrating while completing daily tasks. This is often the result of being very anxious; it is not a sign that there is something wrong with your memory.
Hypervigilance. Often, people with PTSD feel as if they are "on guard" or "on alert" all the time. People with this symptom will be very easily startled, and will jump at the slightest sound (for example, the telephone ringing, someone tapping you on the shoulder).
KEEP IN MIND: Although most people with PTSD will develop symptoms within three months of the traumatic event, some people don't notice any symptoms until years after it occurred. A major increase in stress, or exposure to a reminder of the trauma, can trigger symptoms to appear months or years later.
As you probably noticed, there are many symptoms of PTSD, and very few people have all of them. Also, it is normal to experience times of greater anxiety in your life, particularly when you are under a lot of stress. Some of the symptoms of PTSD, such as sleep or concentration problems, for example, are also seen in other anxiety disorders. So how do you know if you might have PTSD? Here are two tips that might be helpful:
Tip #1: If you have at least one symptom in each of the 3 categories, and your symptoms only started after a traumatic event, then you might have PTSD. If your anxiety symptoms were already present before the trauma, then it is probably not PTSD.
Tip #2: It is normal to feel more anxious right after a trauma. But over time, these anxious feelings will settle down. Remember: not everyone who lives through a trauma will develop PTSD. But if your symptoms have been present for over one month, and you find that they are interfering significantly in your life, then you might have PTSD.
Many adults with PTSD have strong feelings of shame, guilt, or despair about what happened. It is also not uncommon to have increased feelings of hostility or anger, this is sometimes directed towards entire groups of people (for example, you might find yourself being very angry and suspicious of men if you were raped, or you might get extremely angry at drivers who speed if you were in a serious car accident).
Because living through a trauma can be such a life-changing experience, some adults with PTSD find that their relationships with others are different after a trauma. For instance, you might have difficulty maintaining a romantic relationship or trusting other people and their intentions following a sexual assault, or you might have some sexual or intimacy problems.
REMEMBER: Adults with PTSD can sometimes feel like they are "going crazy" or are "broken" following a trauma. But it is important to keep in mind that PTSD is a treatable anxiety disorder. No matter how bad you feel or how hopeless it seems, there is help for PTSD.
Several studies have shown that a majority of people will likely experience at least one traumatic event in their lives; but many of them will NOT develop PTSD.
The chance of developing PTSD goes up if the trauma was very severe, chronic (that is, lasted a long time), or you were physically close to the event, that is, if the trauma happened right next to you or in front of you.
Certain traumas are more likely to lead to PTSD than others. For example, you are more likely to develop PTSD if the trauma you experienced was a rape/sexual assault, combat exposure, or childhood neglect/physical abuse.
If you develop PTSD symptoms within one month of a traumatic event, this is called acute PTSD. If you don't develop any symptoms until at least six months after the trauma, this is called delayed onset PTSD.
Adults with PTSD can have other problems as well, including depression, drug and alcohol abuse, or other anxiety problems (for example, panic disorder, social anxiety).
Click here for Self-Help Strategies for PTSD
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