Weeks, months or even years following a traumatic experience, many victims make statements like: “I just can’t get over it!” “I can’t stop thinking about it.” “I feel numb, like I’m behind a glass wall, cut off from everyone”. “Will I ever feel safe again?” These thoughts also reflect typical aspects or symptoms of Post Traumatic Stress Disorder (PTSD). What generally constitutes a traumatic event? It is typically a sudden, unexpected, and/or uncontrollable event that involves actual or threatened harm to oneself or others. Such events include, but are not limited to, motor vehicle or work accidents, interpersonal violence, natural disasters, even sudden severe illness or medical procedures. When a person witnesses or experiences a traumatic event, she or he may react with feelings of intense fear, helplessness, or horror.
PTSD is a complex disorder; many factors contribute to its development, or lack of development, following exposure to a traumatic event. People perceive and react to events differently; and will therefore not all experience an incident as traumatic. And among those who do experience an event as traumatic, there are differences in who develops PTSD. So, for example, among colleagues who go through a crisis together, some will go on to develop PTSD while others won’t. It is often difficult for those not experiencing the symptoms of PTSD to understand why another person continues to be so troubled or distressed by the event. Factors that seem to account for these differences include previous exposure to trauma, coping ability, pre-existing conditions such as depression or anxiety, and available social support.
The major symptoms of PTSD may be grouped into three categories – re-experiencing, avoidance and arousal. Re-experiencing includes intrusive, upsetting memories, dreams and flashbacks of the trauma. People often feel “as if it’s still happening”. There is an intense quality to the memory that distinguishes it from ordinary memories and the sounds, images, smells, physical sensations associated with the traumatic event may be re-experienced repeatedly. To avoid triggering such painful or distressing flashbacks and memories, people will avoid places, activities or people associated with the traumatic event. People may avoid feelings too; they report feeling numb, detached from others, or disinterested in their usual activities. Arousal symptoms include irritability, anger, sleep difficulties, impaired concentration, anxiety that something bad is about to happen (hypervigilance) and an exaggerated startle response (being “jumpy”).
In the first days or weeks following a traumatic experience, a person may experience an acute stress reaction, including a sense of numbing or feeling “dazed”, avoidance of things that are reminders of the trauma, re-experiencing the trauma (e.g., nightmares or dreams), and symptoms of anxiety and arousal such as sleep or concentration difficulties. If symptoms persist beyond four weeks, a diagnosis of PTSD may be warranted. However, the beginning of PTSD symptoms can be delayed. A person may experience a trauma but not experience symptoms until months or years later – sometimes triggered by something that is a reminder of the trauma, or by another traumatic event. This may be confusing, both for affected individuals, and those who interact with them. Well-meaning friends, family and colleagues may encourage them to “snap out of it”, “get over it”, or “shake it off”. People struggling with PTSD are likely to be saying such things to themselves as well. As symptoms persist, they may become frustrated, ashamed, or depressed.
By identifying the symptoms of PTSD individuals can be assisted to understand that their reaction is not a sign of weakness or failure, but a complex psychological reaction that can be treated by medical and psychological means. A variety of effective treatment strategies can be provided through counseling and medical support.
Briere, J & Scott, C (2005). Principles of Trauma Therapy
Cash, A. (2006). Posttraumatic Stress Disorder, John Wiley & Sons.