What is PTSD – Post-Traumatic Stress Disorder?
By Gail-Elaine Tinker MS, LPC Psychotherapist
Mary (not a real person) grew up in a chaotic household fraught with violence and addiction. Despite this experience, she has grown to have a functional life; higher education, relationship, children, career, nice home, friends, and hobbies. One tragic day, Mary is involved in a multiple vehicle highway accident where there were grave injuries and fatalities. Mary survives with minor, but painful injuries. Within a month, Mary is expected to return to work and to perform her functions as partner and parent; this is what she does. Unfortunately, Mary has become withdrawn, irritable, suffers from a lack of concentration, and bouts of insomnia. Mary silently dwells on details of her accident and experiences frequent nightmares of auto accidents. Mary becomes obsessed about traffic safety issues and legislation and becomes fearful of her children’s safety in traveling. Mary has been using alternate routes to avoid the highway where her accident happened. Mary’s work performance is called into question due to her symptoms, so she visits her doctor, who prescribes sleep medication to help her with her sleeplessness. Nearly a year later, Mary is demoted after several key mistakes in her job. Mary’s marriage is in trouble due to her irritability, fears, numbness, withdrawal, and obsessive focus. Mary has been having frequent ‘girls’ night out,’ where she takes a cab home in an inebriated state. The couple attempts to attend marriage counseling to save their family. The counselor picks up on Mary’s past and recent trauma and strongly suggests that Mary receive counseling of her own to address these issues. Mary is diagnosed with PTSD.
Post-Traumatic Stress is a mental health issue following the witness or experience of a life-threatening event. Surviving a car accident, natural or man-made disaster, an auto or industrial accident, violence, or sexual assault or chronic abuse are the usual ways in which normal people are exposed to traumatic events.
While it is normal to feel on edge, have trouble sleeping, feel upset or guilty immediately after a traumatic event and in the months after. It is understandable that people would have difficulty resuming work, school, and socializing after such an experience. Most people experience a degree of fear, anxiety and life-stress following a traumatic event, but not everyone does. The point is, that if you are having trouble in daily life many months after the trauma, you may have PTSD.
Who develops PTSD involves factors which are beyond any person’s control. It is never a sign of weakness; it can happen to anyone. However, there are some circumstances which predispose individuals to a PTSD response. For example, having survived a previous trauma, a chronic, intense, long-standing trauma, becoming injured as a result of the trauma, and what happens next as a result of the traumatic event.
PTSD symptoms usually start soon after the traumatic event, but sometimes they may not appear until months or years later. They can also come and go over a period of years. While there are common factors in which we define PTSD, each person experiences the symptoms in their own way. One way to determine PTSD is by asking how many months and how intensely does the survivor exhibit distress because of a traumatic act. Below is a list of some of the experiences which characterize PTSD. Not all of these symptoms must be experienced to meet the standard; remember each person may be entirely different.
- Reliving the event repeatedly in a compulsive manner
- Remembering the event in such a way that you ‘return to the situation’
- Nightmares and trouble sleeping
- Feeling ‘hyper’ after the event and beyond
- Avoiding people, places, and situations which trigger memories
- Free-floating anxiety and social anxiety
- Negative sense that the world is an unsafe place
- Undue fear for family or friends’ safety
- Relationship issues and fear of intimacy
- Expressed irritability and/or anger
- Frequently startled in daily life
- Unhealthy behaviors or addictions
- Urge to control everything in one’s life
- Desire to withdraw and/or run away
- Risky behaviors
- Experiencing guilt, shame and/or lack of trust
- Lack of interest in activities you once enjoyed
- Emotional numbness
- Feelings of despair or hopelessness
- Trouble concentrating and performing work duties
- Symptoms of chronic pain and frequent illness
- Becoming emotionally overwhelmed on a frequent basis
- Triggered to re-experience life traumas before the traumatic event
- Having symptoms which impact the survivor across all areas of life
Can anyone recover from PTSD? Yes, in some ways. Traumatic means life-altering, so your life may never be what it once was, but it can be good again. Trauma treatment can be a lengthy and exhausting process for survivor and family. Some people recover from symptoms completely, but many can only expect fewer symptoms and in a less intense manner after treatment. Trauma tends to impact all areas of the survivor’s life, so there are many areas in which to recover.
How we treat PTSD varies and is customizable to each individual. Generally, psychotherapy and medication are used in tandem to begin the healing process.
Trauma-Informed Psychotherapy, including cognitive processing helps you to understand how the trauma has changed you. A modality called Prolonged Exposure helps a person feel a sense of control after having the survivor talk about the events until the memories lack the power they once had. Returning to people, places, and situations which have been avoided due to PTSD helps a person by exposing the memories and de-sensitizing to the pain. Other methods include EMDR, a means of focusing on sound, eye or hand movement while you talk about the experience to help your brain ‘rewire’ around the memories. Hypnosis can be effective in re-teaching relaxation and promoting subconscious improvement of symptoms. Transformative therapies, such as, art, music, movement, Gestalt, and psychodrama can be effective in helping a survivor to regain health.
Medications are not a ‘silver bullet’ in PTSD treatment, however, many anti-depressants can be helpful. It is important to mention that addictive compounds and self-medicating can worsen the experience of the survivor in the long run. Many doctors will prescribe anti-anxiety medications to assist the daily suffering, which can be helpful only in the short-term.
How will Mary proceed, now that she has a PTSD diagnosis? Mary’s treatment with her trauma-informed therapist includes cognitive processing the recent and past traumatic events. Mary sees her doctor to attain an antidepressant, they make a co-joint goal to wean her from the sleeping medication as she progresses in therapy. Mary does well in therapy and feels more like her old self and enjoys more family activities. Her husband becomes better informed about how Mary expresses her PTSD. Mary’s therapist suggests a weekend retreat which involves psychodrama. Mary is awed by the power of the technique and realizes the connection between her childhood and her present fears and obsessions. Her therapy includes hypnotherapy and mindfulness training, which helps Mary to re-learn how to relax and to sleep more fitfully. Mary sees value in taking a yoga class and is delighted by the change she feels within. Mary can return to intimacy with her partner after a few sessions of marriage counseling, which improves their communication styles.
Mary knows she will be forever changed by the accident, but can experience gratitude over guilt when facing her feelings. She feels far less guilty for surviving her childhood issues and knows her own children are safe, breaking the cycle of trauma. She is sleeping well, independent of sleeping medication, needing only to use self-hypnosis for her occasional sleeplessness. Her marriage and work performance are returning to previous levels of satisfaction. Mary has a positive performance review and hopes to join an important team project at work. Because her yoga and meditation practice help her moods, she feels capable of the challenge.
Mary has become a successful trauma survivor and is enjoying the best possible outcome for her issues. The hope is that Mary will continue to progress to a point where trauma is a minor part of her story. PTSD is a serious, but treatable condition. Not everyone will have the success that Mary has, but the potential is higher if they obtain appropriate physical and psychological treatment for the way their traumatic event has impacted their lives.
Gail-Elaine Tinker MS, LPC is a licensed psychotherapist located in Bethlehem, PA who works with survivors of trauma.
