WHAT IS POST TRAUMATIC STRESS DISORDER (PTSD)?
All humans are endowed with a biological and psychological stress response system. Our genetic “Fight or Flight” response is designed for crisis management. This life-saving response causes the body to release stress hormones to fight or get out of harm’s way (flight). It also automatically pumps the heart faster, directing blood, as a resource, to muscles and other areas, Many are able to move on with life after traumatic events, but for some this response lingers and the body is unable to return to normal state. IT IS NOT A SIGN OF WEAKNESS.
IS PTSD SYNONYMOUS WITH ANXIETY?
Yes, PTSD is classified as an anxiety disorder. Anxiety is classically defined as a sense of worry, fear, uneasiness, apprehension or nervousness. PTSD has specific symptoms.
ALTHOUGH COMMONLY LINKED WITH THOSE SERVING IN THE MILITARY, WHAT ARE SOME OTHER TYPES OF TRAUMA WHICH COMMONLY CAUSE PTSD?
This condition is not limited to combat veterans. It can occur in anyone who has been exposed to a traumatic threat or upsetting event(s). It can occur at any age. Examples include: military combat, domestic violence, sexual assault/abuse, abandonment, death of a loved one, natural disasters, community violence, poverty or medical issues.
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WHAT CLASSIFIES SOMETHING AS A “TRAUMA”? CAN YOU EXPERIENCE A TRAUMA INDIRECTLY AND STILL BE AFFECTED?
Trauma refers to any event that threatens the life, integrity or sense of safety of an individual or loved one. Exposure to trauma creates stress which can cause emotional, mental or physical symptoms. The stress may be immediate, short-lived or chronic.
While we do not fully understand who will develop this disorder, but there are certain risk factors which make an individual more likely to have struggles: exposure to prior trauma, poor social supports and lack of resilience. It can be direct or indirect. Indirect trauma can be experienced by those who deal with or work with trauma victims.
HOW IS A TYPICAL REACTION TO TRAUMA DIFFERENT FROM PTSD?
Not all people exposed to traumatic events will develop this disorder. The range of responses is varied. Most will have no residual problems. It is common to have nightmares/flashbacks for the first few weeks after exposure. While most people will recall the fear experienced during the trauma, PTSD can actually make the person feel as they are experiencing or re-living the event. 50-70% of all people will experience at least one traumatic experience in their lifetime (American Psychiatric Association) of those about 20% will develop the disorder.
PTSD becomes an emotional and mental disorder when, after exposure to a traumatic event, the individual begins to experience difficulties with the management of daily activities. For examples: struggles with work performance, and relationship problems.
WHAT ARE THE SYMPTOMS OF PTSD?
- These are often thoughts, mental images or memories which are involuntary, and not under the control of the individual.
- They may present as unpleasant, frightening thoughts
- These experiences are often a great source of stress for the person.
- These intrusions can present as nightmares or flashbacks.
- There may be a tendency to stay away from places, persons or situations which may serve as a reminder of the traumatic event.
- Avoidance of thoughts related to the traumatic event.
THOUGHTS AND EMOTIONS:
- Trouble recalling details of the event
- Negative thoughts.
- The person may experience a host of emotions: guilt, numbness, depressed/sad/ irritable mood, concentration problems.
- Loss of interest
- The person may be predisposed to experience life as an out-of-body experience, called derealization; where the person describes living life in a dream-like unreal state. Another explanation is that they may experience life as if they were observing from above.
- Hypervigilance – an enhanced state of stimulation to sensory input (sight, sound, taste, smell and touch)
- Easily startled
- Angry outbursts or irritability
- Sleep problems
WHAT IMPACT DOES LONG-TERM TRAUMA HAVE ON THE BODY AND BRAIN?
Everyone responds differently:
- Persistent fearful, hyper-aroused states can wear down the brains neuron pathways, leading to chemical imbalances and other conditions such as depression.
- Certain areas of the brain show heightened activity in trauma survivors.
- Trauma can lead to problems with brain development in children.
- May leave an individual to experience harmless situations as scary or threatening
- Brain changes may not be permanent and may improve over time with psychotherapy and supportive/stable environment.
- More likely to suffer stroke
- Greater risk of heart disease
- Greater risk of dying from heart attack
- More likely to suffer from chronic Fatigue Syndrome, Irritable bowel syndrome and Fibromyalgia
- Increase risk of adult cancer
HOW COMMON IS PTSD? DOES IT AFFECT MEN OR WOMEN MORE?
Very common in adults over 18. Common in teens and children. Rare under the age of 5.
- It is not limited to military veterans
- In the U.S., about 8 million people experience PTSD (Veterans’s Administration)
- 7 out of every 100 people will have PTSD in their lifetime.
- 10 of every 100 women and 4 or every 100 men.
- It can occur in victims, as well as those who witness a traumatic event
- Studies show that adverse childhood experiences are not only common, but that most adults have experienced two or more traumatic events during childhood.
WHAT SHOULD YOU DO AFTER EXPERIENCING A TRAUMA?
Turn to natural supports, such as family and friends to process and talk about what happened
- Consult with clergy
- Join a support group – often being around people who have similar experiences is grounding and normalizes the person’s emotions
- Healthy and positive coping strategies: meditation, yoga
- Distractions: arts/cultural experiences, music, exercise
- Practice mindfulness: grounding experiences to guide the person’s thoughts back to the present moment – uses the body’s senses such as touching a fabric, breathing deeply, sniffing a strong scent
- AVOID: drugs and alcohol to cope with overwhelming feelings
HOW DO YOU PROVIDE HELP FOR OTHERS?
Provide a calm, safe environment:
- Minimize fighting or raised voices
- Give support and reassurance: remind the person that they are safe now
- Create a safety plan if the trauma is related to domestic violence
- Provide support and assistance when facing non-dangerous situations to help them learn how to approach it
- Encourage use of healthy coping skills: deep breathing and relaxation, distraction (such as music)
HOW DO YOU KNOW WHEN TO SEEK TREATMENT?
Symptoms of this disorder typically begin within three months after exposure to the traumatic event. On occasion, the symptoms may not begin until years later.
- If symptoms and emotions have not returned to normal after one month
- If coping skills and distractions have not reduced the symptoms or emotions after one month
- Discuss with primary care physician and seek mental health referral when needed
WHAT ARE THE TREATMENT OPTIONS?
- Cognitive-Behavioral Therapy (CBT) – helps the person recognize negative or damaging thoughts and teaches how to replace them with positive and helpful ones.
- Eye Movement Desensitization and Reprocessing (EMDR)– newer treatment which focuses on exposure to the traumatic event by different stimuli, such as eye movement.
- Exposure Therapy – Helps the person to safely face fears related to the trauma and teaches ways to cope.
- Imagery Rehearsal Therapy (IRT) – newer treatment to reduce intensity and frequency of nightmares.
- Help Yourself: find educational programs
IS PTSD CURABLE?
PTSD is certainly treatable. For many it can be cured. For others symptoms can reappear intermittently throughout life, but may not present with the same intensity or frequency.
IS THERE A SUPPORT GROUP FOR FAMILY MEMBERS WHO ARE DEALING WITH PTSD?
Contact various organizations for internet assistance and referrals:
American Psychiatric Association – www.psychiatry.org/
American Psychological Association – www.apa.org/
Black Psychiatrist of America – www.bpaincpsych.org/
National Alliance on Mental Illness – www.nami.org
Veteran’s Administration National Center for PTSD – www.ptsd.va.gov/
It’s important to recognize that caregivers can become traumatized and my need assistance as well
ARE THERE PROGRAMS AVAILABLE TO HELP CAREGIVERS WITH EXPENSES?
Caregiver support networks: VA 855-260-3274
The National Alliance on Mental Illness (NAMI): 800-273-8255
WHAT QUESTIONS AND TESTS SHOULD A PERSON ASK THEIR DOCTOR IF THEY BELIEVE THEY’RE SUFFERING FROM PTSD?
- What are the symptoms of PTSD?
- Who can get PTSD?
- Is PTSD treatable? Can is go away on its own?
- How will I know if I am better?
- I think I may have PTSD. What should I do?
- Will my health insurance cover the cost of treatment?
- Are there organizations which provide assistance?
IS PTSD OFTEN MISDIAGNOSED?
A: Yes. It can be misdiagnosed for:
- Mood disorder, such as depression
- Personality disorders
- Malingering (faking for secondary gain)
Dr. Dodd is a board-certified psychiatrist who specializes in forensic psychiatry, trauma informed treatment and women’s issues.She is the Chairperson of the state’s forensic board which provides oversight and management of patients found Not Guilty by Reason of Insanity. She also provides expert witness testimony for the state’s legal system. In addition, Dr. Dodd practices general psychiatry as the Medical Director of Huron Valley Consultation Center and lectures doctors in training about various topics in general and forensic psychiatry.
Dr. Dodd attended is a graduate of Howard University. She received her medical degree from the University of Michigan Medical School and was a Gaughn fellow in forensic psychiatry at Harvard University.
Dr. Dodd answers your “Text Tom” questions on the next page.