Post Traumatic Stress Disorder (PTSD): What Is It?
As a former serviceman, I have served with and latterly worked to a very positive conclusion with those whose lives are overwhelmed by events of the past.
One single unexpected event can shatter people’s sense of predictability and invulnerability, it profoundly alter their embedded coping skills, their relationships, and the way they perceive and interact with the world.
The diagnostic criteria for Post Traumatic Stress Disorder (PTSD) are 1) exposure to a traumatic event(s) in which the person witnessed or experienced or were confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, and 2) the person’s response involved intense fear, helplessness or horror DSM IV p. 427-28). Gradual Onset Traumatic Stress Disorder can be caused by repeated exposure to “sub-critical incidents” such as child abuse, traffic fatalities, rapes and personal assaults.
That said, not all people who have been exposed to trauma are “traumatized.” Why?
Back In 1998, Pynoos and Nader proposed a theory to assist in explaining why people have different reactions to the same event. They theorised that people are at greater risk of being negatively impacted by traumatic events if any of the following are present:
They have experienced other traumatic events within the preceding 6 months,
They were already stressed out or depressed at the time of the event,
The situation occurred close to their home or somewhere they considered safe,
The victims bear a similarity to a family member or friend and
They have little or no social support.
It has been argued that service personnel, the children of addicts and abuse victims experience traumatic events or threats to their safety on an almost daily basis. Being abused, not knowing when or if parents will come home, repeatedly seeing adults and children in the worst of situations and environments starts to take its toll.
The public likes to see and want idealistic service personnel, those who joined the services to change the world and protect begin to feel like nothing they do makes a difference, they cannot even keep their own space safe (criteria 3). This is especially problematic for those who live in or near their work area and often leads to frustration and burnout (criteria 2). Children start to feel that the whole world is uncontrollable and unsafe.
Although things are improving it is still not totally accepted within the services for men and women to discuss the impact of situations on them. Often fielded away with anger, humour Sarcasm is only a short-lived relief for what many personnel may dream about at night. As their condition worsens, they may withdraw, being fearful of seeking help or support for in fear of judgment in their ability to “do their job” or it might become an obstacle for future promotions. Several studies in recent years have shown that Post Traumatic Stress Disorder (PTSD) is among the most common psychiatric disorders.
Another thing that distinguishes people who develop PTSD from those who are just temporarily overwhelmed is that people who develop PTSD become “stuck” on the trauma, they keep re-living it in thoughts, feelings, or images. It is this intrusive repetitive thinking, rather than the trauma itself that is responsible for what we call PTSD.
Traumatized individuals begin living their lives around ways of avoiding the trauma. This avoidance may take many different forms: keeping away from reminders, calling in sick to work, drugs or alcohol that numb awareness of distress. A sense of futility, hyperarousal, and other trauma-related changes may permanently change how people deal with stress, alter their self-concept and interfere with their view of the world and what should be a safe and predictable place.
One of the core issues in trauma is the fact that memories of what has happened cannot be integrated into the general experience. The lack of people’s ability to make this “fit” into their expectations, or the way they think about the world in a way that makes sense keeps the experience stored in the mind on a sensory level. When they encounter smells, sounds, sights, or other sensory stimuli that remind them of the primary event, it may trigger a similar response to what the person originally had: physical sensations (such as panic attacks), visual images (such as flashbacks and nightmares), obsessive ruminations, or behavioural reenactments of elements of the trauma.
The goal of any treatment plan is to find a way in which they can acknowledge the reality of what has happened and then integrate it into their understanding of the world without having to re-experience the trauma time and time again. To be able to tell their story, comfortably.