The Trinity Pages
The Trinity Pages

Post Traumatic Stress Disorder

Post Traumatic Stress Disorder, also known as PTSD, is an acquired mental condition and psychological injury that is manifested following a psychologically distressing event outside the range of usual human experience. This disorder presumes that the person experienced a traumatic event or events involving actual or threatened death or injury to themselves or others, and where they felt fear, helplessness, or horror. Symptoms of PTSD may be delayed, or may become evident at any time following the original trauma(s), including years after the fact.

In recent years, another pattern related to traumatic psychological injury has been gaining recognition. Proposed by Harvard University's Dr. Judith Herman and generally known as Complex Post Traumatic Stress Disorder (C-PTSD), some experts feel this is a better way of describing the patterns and symptoms classified as Borderline Personality Disorder (BPD). C-PTSD is seen in people who have been subjected to protracted exposure to prolonged social and/or interpersonal trauma with lack or loss of control, disempowerment, and in the context of either captivity or entrapment, i.e. the lack of a viable escape route for the victim.

The symptoms of PTSD include intrusions, such as flashbacks or nightmares, avoidance, where the person tries to reduce exposure to people or things that might bring on their intrusive symptoms, and hyperarousal, that is, signs of increased arousal, such as hypervigilance or jumpiness.

In practical terms, symptoms of PTSD can include any combination of the following:

  • Recurring nightmares about the event(s), including possibly intrusive memory flashbacks which may come in the form of strong emotion, audio memory, or visual memory, or a combination of these.
  • Difficulty sleeping or changes in appetite.
  • Feelings of anxiety and fear, especially when exposed to events or situations reminiscent of the trauma(s).
  • Jumpiness, edginess, exaggerated startle reflex, or becoming overly alert.
  • Depression, sadness, and lack of energy. Spontaneous crying. Sense of despair and hopelessness.
  • Memory problems, including difficulty in remembering aspects of the trauma(s).
  • Feeling "scattered" or "off center", and unable to focus on work or daily activities. Difficulty making decisions or carrying out plans.
  • Irritability, aggitation, or feelings of anger and resentment.
  • Feeling emotionally "numb," withdrawn, disconnected, or different from others.
  • Oveprotectiveness of loved ones, or fear for the safety of loved ones.
  • Not being able to face certain aspects of the trauma, and avoiding activities, places, or even people that remind you of the event(s).

A difference between C-PTSD and PTSD has been suggested. C-PTSD better describes the pervasive negative impact of chronic repetitive trauma than does PTSD alone, and PTSD descriptions fail to capture some of the core characteristics of C-PTSD. These characteristics include captivity, psychological fragmentation, the loss of a sense of safety, trust, and self-worth, the tendency to be revictimized, and, most importantly, the loss of a coherent sense of self. It is this loss of a coherent sense of self, and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD.

Symptoms of C-PTSD include:

  • Attachment - "problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to otherís emotional states, and lack of empathy"
  • Biology - "sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems"
  • Affect or emotional regulation - "poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes"
  • Dissociation - "amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events"
  • Behavioural control - "problems with impulse control, aggression, pathological self-soothing, and sleep problems"
  • Cognition - "difficulty regulating attention, problems with a variety of "executive functions" such as planning, judgement, initiation, use of materials, and self- monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with "cause-effect" thinking, and language developmental problems such as a gap between receptive and expressive communication abilities."
  • Self-concept -"fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self".

Post Traumatic Stress Disorder is officially classed as an anxiety disorder, but, according to David Baldwin, it has been argued that PTSD is more closely akin to dissociation. As a personal observation, the flashbacks I have experienced have a very definite dissociative quality to them; I am actually partly re-experiencing the trauma, and not just remembering it, giving the flashback an otherworldly, out of control "feel" to it.

It's also a misnomer that Post Traumatic Stress Disorder is something that only soldiers or survivors of sudden servere misfortune get. It is true that combat veterans are known to develop PTSD, but victims and survivors of any and all kinds of trauma can and do develop PTSD, including those who have experienced natural disasters, assault, plane crashes, car accidents, and many other sorts of traumatic events. Child abuse survivors are almost certain to live with symptoms of this disorder, as do survivors of domestic violence and political upheavals such as civil war or revolutions. PTSD is associated with trauma where the victim felt helpless, overwhelmingly afraid, and experienced the threat of death or injury to themselves or others, as already mentioned. It is in no way limited to soldiers and combat veterans. Unfortunately, many people suffering from this disorder go undiagnosed for a long time (or possibly forever) because they lack a specific "traumatic event" and therefore doctors and other health care professionals miss the symptoms and fail to diagnose the condition.

Sometimes, PTSD symptoms don't show up in any significant way for years after the original trauma(s). It's not known how or why this happens, but it's fairly well-documented in psychological research on the subject of trauma. I've also heard of "delayed" PTSD being given as a defense in court (presumably on a "temporary insanity" or "reduced capacity" plea), but I don't know how effective it was as a defense (I know a lot about psych issues that I've researched, but I know very little about legal precedent and other matters of law; if anyone has specifics, I'd be interested in hearing about it).

Treatment of PTSD tends to focus on anxiety reduction and stress coping techniques. Self-hypnosis can be helpful, as can learned relaxation exercises. In many cases, cognitive psychotherapy is helpful, as the trauma survivor brings the trauma out in a therapy setting, discusses it and how they dealt with it, and learns new ways to react to the traumatic memories. Drug therapy can be helpful if there are notable depressive symptoms, panic attacks, or debilitating stress symptoms.

On a personal note, I suffered from just about all of the symptoms listed above for PTSD and fit the diagnostic pattern for C-PTSD, although the condition went undiagnosed for a very long time (and I never got a C-PTSD diagnosis because I was going through recovery before anyone had really started to identify it; I did once get the suggested diagnosis of Borderline Personality Disorder (BPD), however). My post-traumatic symptoms were sometimes less intrusive and sometimes very noticible, and I experienced them for as long as I can remember. I had nightmares regularly from childhood, was known for being excessively jumpy and easily startled, and I was depressed, irritable, moody, and often angry, alternating with being weepy and feeling hopeless and desperate. I definitely lacked a sense of self-worth and my sense of self was highly fragmented and disordered.

When in the worst and most difficult part of my recovery, when the memories were returning like a hail storm, demanding to be dealt with, I was extremely unbalanced, extremely moody, fearful to the point of debilitating panic attacks, and I most certainly isolated myself and practiced various avoidance techniques in a vain attempt to keep from having any more flashbacks or nightmares "triggered". My entire personality structure, such as it was, was falling apart, and I was profoundly unstable as a result. To put it very mildly, I was a nervous wreck.

These days it's a different story, and I only have a few lingering wisps of the psychological injury syndrome that once plagued me and made me and everyone around me miserable. I now cope quite effectively. I still have my days when I'm moody or off-balance, to be sure, but I've healed significantly and I can usually deal with life in a generally healthy way. During the course of my treatment, I was treated with medication (for the mood swings; once the moods were stable and external circumstances less stressful, I was taken off the medication), with coginitive therapy, and by learning effective stress management and coping skills. The point is, I had an extreme case of C-PTSD/PTSD, with just about every symptom known, and yet, with time and the right kind of help and support, I have healed and lead a productive, responsible, often enjoyable life.... Others with Post Traumatic Stress Disorder can do the same thing. It is possible to heal, and the prognosis for PTSD is excellent, if you just seek the treatment and help.

On the other hand, left untreated, PTSD has a high link with alcoholism, drug addiction, poor job performance, and any number of other self-destructive and unhealthy behaviors. It can wreak havoc with relationships, with work, with pursuit of leisure, with just about every aspect of a person's life and mental health. If you have symptoms such as those listed, if what you read sort of rings a bell, or if you see someone you love in this description, please get help. You don't have to be hypervigilant and moody and ready to jump out of your own skin. You don't have to be irritable all the time, or depressed, or suffer from nightmares and flashbacks. There is effective help available. Don't suffer needlessly; there is hope.

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