PTSD – THE NORMAL RESPONSE TO AN ABNORMAL EVENT
WHAT IS PTSD?
Post Traumatic Stress Disorder or PTSD is one of the anxiety disorders that can be experienced by anyone. It is experienced by almost everyone who has experienced some type of severe psychic or physical trauma. That trauma may have occurred in childhood with symptoms appearing decades after the original traumatic event. Or it may occur during their adult years.
Psychic trauma occurs whenever we feel that our very lives are threatened. In some cases, that is exactly what has happened. For example, a near-death experience from a terrible auto accident, a physical assault, or a war trauma where massive physical injuries have occurred. Other times, we have experienced a moment when we thought our life would end-a near plane crash, having a gun muzzle put to our head, being told as a child that we would be killed if we told the “secret”. Even experiencing a threat to another person\’s life can produce the kind of psychic trauma that results in PTSD. For example, a child being told that her mother will be killed if she tells the “secret” or being a witness to a violent crime.
The most important fact to remember is that the high intensity, very distressing symptoms that accompany PTSD are a NORMAL response to a very ABNORMAL event.
Our bodies respond to trauma immediately in one way, but then days, weeks, and even years after a trauma, they respond in a different way.
During the immediate response, our brain instantaneously prepares our bodies to fight or flee. Stress hormones are released that close down blood vessels in the skin and internal cavity and send blood coursing to the large muscles and the brain. Heart and breathing rate increase dramatically. The way we perceive the world around us changes. In children, the trauma of molest or other maltreatment can be so severe that the brain simple shuts down and dissociates. This lead to what we describe as out-of-body experiences. The memory of the incident can be lost for years, sometimes forever.
During the delayed response hours, days, weeks or years later, the body becomes over-reactive in another way. Senses are heightened. Our startle response goes into hyper drive. Symptoms of depression and anxiety leave us fighting tears and feeling panicky. Our sleep is interrupted or fitful, our appetite disrupted. Vivid memories of the traumatic event intrude into our waking hours. We can have full flashback experiences where the event is relived. Nightmares dominate our sleep. This delayed response usually begins several days after the traumatic event. But as we found with our Viet Nam vets and with victims of molestation, it can also occur decades later.
There can be triggers in our current lives that precipitate PTSD symptoms from an event long ago and far away. An example from my own life illustrates this. I was in my mid Thirties, working as a psychologist in a community mental health program in the Midwest. I had gone to a school in the suburbs to present the results of some psychological testing. The moment I entered the school building where I was to give the report, I started having a full-blown panic episode, my heart racing, and my palms sweaty. I knew it wasn\’t related to the current situation because I had given dozens of such reports before. When I left the building two hours later, I could still feel the anxiety, was near tears, and had a pervasive sense of dread. As I came to the street corner near where I had parked, I looked up and saw the names of the two intersecting streets. I suddenly realized, for the first time, where I was. I was at the very elementary school I had attended in the second grade. It has been a traumatic year for me. My mother had been seriously injured in a household accident, and I had been sent back to live with my father, whom I scarcely knew. I recall how mean the teachers had been compared to my prior teachers, even using rulers to slap my hands. My body, twenty-eight years later, remembered the trauma of that year, even though I did not consciously recognize the school at all. Body memories are indelible.
HOW DO WE TREAT PTSD?
So how do we get rid of these indelible body memories from traumatic events? In the best-case scenario, these memories simply fade over time. The acute symptoms last anywhere from a few weeks to a few months after the initial event. This is true largely when the trauma occurs in adulthood. Reassurance and supportive counseling, such as services provided for the victims of crime, a few days or weeks off from work if concentration is too disrupted, family support, and measures such as self-defense training if one was the victim of an assault, are useful in this recovery period. In some cases, the person needs to be transferred to a new job or relocate their residence to get away from the painful memories.
It is important, however, not to retreat too far. “Getting back on the horse” has some merits in terms of not becoming phobic and having your life closed down due to fears related to and even unrelated to the original trauma. I would never recommend, however, getting back on a “bad” horse. Re-traumatizing ourselves by staying in a battering relationship, for example, is not a good thing.
Another psychological technique, called EMDR, has been shown to be effective as a therapeutic intervention. Its efficacy has been shown both for victims of past childhood trauma as well as for those experiencing recent trauma in adulthood. EMDR stands for Eye Movement Desensitization and Reprocessing. Imagine for a moment that the trauma has affected the memories in one isolated region of the brain. The memories reverberating within this area and intensified by current triggers, are unable to be soothed or healed by the rest of the adult functioning part of the brain. Using bilateral stimulation (side to side eye movement or other forms of bilateral stimulation), that isolated part of the brain is put in contact with the adult reasoning, creative, solution-finding part of the brain and the memories are desensitized and reprocessed in a healthy manner. For more information about this therapeutic technique, go to http://www.emdr.com/
NEXT MONTH: OBSESSIVE-COMPULSIVE DISORDER (OCD)