Post Traumatic Stress Disorder PTSD What Is It

Post Traumatic Stress Disorder PTSD What Is It

Over the​ past decade,​ as​ I have worked with cops,​ firfighters,​ abuse victims and children of​ addicts,​ I have learned that there are many causes for PTSD. it​ has also affirmed my belief that PTSD is​ real and harmful,​ not only to​ those who have it,​ but also to​ those around them. it​ impacts the​ way we act,​ react,​ our motivation and our capacity to​ feel--well,​ anything.

Terrifying experiences that shatter people's sense of​ predictability and invulnerability can profoundly alter their coping skills,​ relationships and the​ way they perceive and interact with the​ world. the​ criteria for Post Traumatic Stress Disorder (PTSD) are 1) exposure to​ a​ traumatic event(s) in​ which the​ person witnessed or​ experienced or​ were confronted with an​ event or​ events that involved actual or​ threatened death or​ serious injury,​ or​ a​ threat to​ the​ physical integrity of​ self or​ others,​ and 2) the​ person’s response involved intense fear,​ helplessness or​ horror DSM IV p. 427-28). Gradual Onset Traumatic Stress Disorder can be caused by repeated exposure to​ “sub-critical incidents” such as​ child abuse,​ traffic fatalities,​ rapes and personal assaults.

Nevertheless,​ not all people exposed to​ trauma are “traumatized.” Why? in​ 1998,​ Pynoos and Nader proposed a​ theory to​ assist in​ explaining why people have different reactions to​ the​ same event. They asserted that people are at​ greater risk of​ being negatively impacted by traumatic events if​ any of​ the​ following are present: 1) they have experienced other traumatic events within the​ preceding 6 months,​ 2) they were already stressed out or​ depressed at​ the​ time of​ the​ event,​ 3) the​ situation occurred close to​ their home or​ somewhere they considered safe,​ 4) the​ victims bear a​ similarity to​ a​ family member or​ friend and 5) they have little social support.

It has been argued that officers,​ emergency service personnel,​ children of​ addicts and abuse victims experience traumatic events or​ threats to​ their safety on​ an​ almost daily basis. Being abused,​ not knowing when or​ if​ your parents will come home,​ repeatedly seeing children murdered,​ people burned in​ car fires and devastated victims starts to​ take its toll. People like idealistic officers who joined the​ force to​ change the​ world and protect the​ innocent begin to​ feel like nothing they do makes a​ difference,​ they cannot even keep their zone safe (criteria 3). This is​ especially problematic for officers who live in​ or​ near their work zone and often leads to​ frustration and burnout (criteria 2). Children start to​ feel that the​ whole world is​ uncontrollable and unsafe.

It is​ still not totally accepted within the​ law enforcement community for officers to​ discuss the​ impact of​ situations on​ them. Anger,​ humor and sarcasm are but a​ brief outlet for what many officers dream about at​ night. as​ their condition worsens,​ many officers withdraw,​ because they are fearful of​ seeking help or​ support for fear it​ is​ a​ one way ticket to​ a​ fitness for duty evaluation or​ will get out and be an​ obstacle for future promotions. Several studies in​ recent years have shown that Post Traumatic Stress Disorder (PTSD) is​ among the​ most common of​ psychiatric disorders.

Another thing that distinguishes people who develop PTSD from those who are just temporarily overwhelmed is​ that people who develop PTSD become "stuck" on​ the​ trauma,​ keep re-living it​ in​ thoughts,​ feelings,​ or​ images. it​ is​ this intrusive reliving,​ rather than the​ trauma itself that many believe is​ responsible for what we call PTSD. For example,​ I have worked with officers who have responded to​ child abuse calls and had a​ child of​ their own who was a​ similar age (criteria 4). in​ the​ course of​ daily life children get hurt and have bad dreams. as​ parents they have seen looks of​ pain and fright on​ their kids faces. This makes it​ just that much easier to​ envision the​ looks of​ terror and agony on​ the​ face of​ the​ child as​ their parent beat them. Sometimes this visualization gets corrupted and officers suddenly they start to​ see their child in​ their mental re-enactment of​ the​ trauma,​ obviously a​ much more powerful memory. These officers are much more likely to​ be “traumatized” by the​ incident and potentially get “stuck.”

Traumatized individuals begin organizing their lives around avoiding the​ trauma. Avoidance may take many different forms: keeping away from reminders,​ calling in​ sick to​ work,​ or​ ingesting drugs or​ alcohol that numb awareness of​ distress. the​ sense of​ futility,​ hyperarousal,​ and other trauma-related changes may permanently change how people deal with stress,​ alter thier self-concept and interfere with their view of​ the​ world as​ a​ basically safe and predictable place. in​ the​ example above,​ these people often became even more overprotective of​ their children,​ suspicious of​ others,​ and had difficulty sleeping,​ because every time they close their eyes they see the​ child.

One of​ the​ core issues in​ trauma is​ the​ fact that memories of​ what has happened cannot be integrated into one's general experience. the​ lack of​ people’s ability to​ make this “fit” into their expectations or​ the​ way they think about the​ world in​ a​ way that makes sense keeps the​ experience stored in​ the​ mind on​ a​ sensory level. When people encounter smells,​ sounds or​ other sensory stimuli that remind them of​ the​ event,​ it​ may trigger a​ similar response to​ what the​ person originally had: physical sensations (such as​ panic attacks),​ visual images (such as​ flashbacks and nightmares),​ obsessive ruminations,​ or​ behavioral reenactments of​ elements of​ the​ trauma. in​ the​ example above,​ sensory triggers that triggered some of​ the​ officers memories were certain cries,​ hearing or​ seeing a​ parent spank their child,​ returning to​ the​ same neighborhood for other calls and,​ of​ course,​ television shows or​ news reports that involved descriptions of​ abuse.

The goal of​ treatment is​ find a​ way in​ which people can acknowledge the​ reality of​ what has happened and somehow integrate it​ into their understanding of​ the​ world without having to​ re-experience the​ trauma all over again. to​ be able to​ tell their story,​ if​ you​ will.

The Symptoms of​ PTSD

Regardless of​ the​ origin of​ the​ terror,​ the​ brain reacts to​ overwhelming,​ threatening,​ and uncontrollable experiences with conditioned emotional responses. For example,​ rape victims may respond to​ conditioned stimuli,​ such as​ the​ approach by an​ unknown man,​ as​ if​ they were about to​ be raped again,​ and experience panic.

Remembrance and intrusion of​ the​ trauma is​ expressed on​ many different levels,​ ranging from flashbacks,​ feelings,​ physical sensations,​ nightmares,​ and interpersonal re-enactments. Interpersonal re-enactments can be especially problematic for the​ officer leading to​ over-reaction in​ situations that remind the​ officer of​ previous experiences in​ which she or​ he has felt helpless. For example,​ in​ the​ child abuse example above,​ officers may be much more physically and verbally aggressive toward alleged perpetrators and their reports tend to​ be much more negative and subjective.

Hyperarousal. While people with PTSD tend to​ deal with their environment by reducing their range of​ emotions or​ numbing,​ their bodies continue to​ react to​ certain physical and emotional stimuli as​ if​ there were a​ continuing threat. This arousal is​ supposed to​ alert the​ person to​ potential danger,​ but seems to​ loose that function in​ traumatized people. This is​ sort of​ like when rookie officers start and a​ hot call is​ toned out,​ they usually have an​ adrenaline rush. After two or​ three years,​ the​ tones hardly have any impact on​ them. Since traumatized people are always “keyed up” they often do not pay any attention to​ that feeling which is​ supposed to​ warn them of​ impending danger.

Numbing of​ responsiveness. Aware of​ their difficulties in​ controlling their emotions,​ traumatized people seem to​ spend their energies on​ avoiding distress. in​ addition,​ they lose pleasure in​ things that previously gave them a​ sense of​ satisfaction. They may feel "dead to​ the​ world". This emotional numbing may be expressed as​ depression,​ and lack of​ motivation,​ or​ as​ physical reactions. After being traumatized,​ many people stop feeling pleasure from involvement in​ activities,​ and they feel that they just "go through the​ motions" of​ everyday living. Emotional numbness also gets in​ the​ way of​ resolving the​ trauma in​ therapy.

Intense emotional reactions and sleep problems. Traumatized people go immediately from incident to​ reaction without being able to​ first figure out what makes them so upset. They tend to​ experience intense fear,​ anxiety,​ anger and panic in​ response to​ even minor stimuli. This makes them either overreact and intimidate others,​ or​ to​ shut down and freeze. Both adults and children with such hyperarousal will experience sleep problems,​ because they are unable to​ settle down enough to​ go to​ sleep,​ and because they are afraid of​ having nightmares. Many traumatized people report dream-interruption insomnia: they wake themselves up as​ soon as​ they start having a​ dream,​ for fear that this dream will turn into a​ trauma-related nightmare. They also are liable to​ exhibit hypervigilance,​ exaggerated startle response and restlessness.

Learning difficulties. Being “keyed-up” interferes with the​ capacity to​ concentrate and to​ learn from experience. Traumatized people often have trouble remembering ordinary events. it​ is​ helpful to​ always write things down for them. Often “keyed-up” and having difficulty paying attention,​ they may display symptoms of​ attention deficit disorder.

After a​ trauma,​ people often regress to​ earlier modes of​ coping with stress. in​ adults,​ it​ is​ expressed in​ excessive dependence and in​ a​ loss of​ capacity to​ make thoughtful,​ independent decisions. in​ officers,​ this is​ often noticed because they suddenly begin making a​ lot of​ poor decisions,​ their reports lose quality and detail and they are unable to​ focus. in​ children they may begin wetting their bed,​ having fears of​ monsters or​ having temper tantrums.

Aggression against self and others: Both adults and children who have been traumatized are likely to​ turn their aggression against others or​ themselves. Due to​ their persistent anxiety,​ traumatized people are almost always “stressed out,​” so it​ does not take much to​ them set off. This aggression may take many forms ranging from fighting to​ excessive exercise or​ obsession about something---anything to​ keep them from thinking about the​ trauma.

Psychosomatic reactions. Chronic anxiety and emotional numbing also get in​ the​ way of​ learning to​ identify and discuss internal states and wishes. May traumatized people report a​ high frequency of​ headaches,​ back and neck aches,​ gastro-intestinal problems etceteras. Since the​ stress is​ being held inside,​ the​ body begins to​ become distressed.


After a​ trauma,​ people realize the​ limited scope of​ their safety,​ power and control in​ the​ world,​ and life can never be exactly the​ same. the​ traumatic experience becomes part of​ a​ person's life. Sorting out exactly what happened and sharing one’s reactions with others can make a​ great deal of​ difference a​ person’s recovery. Putting the​ reactions and thoughts related to​ the​ trauma into words is​ essential in​ the​ resolution of​ post traumatic reactions. This should,​ however,​ be done with a​ professional specializing in​ PTSD due to​ the​ wide range of​ reactions people have when they start confronting and integrating the​ memories of​ the​ trauma.

Failure to​ approach trauma related material gradually is​ likely to​ make things worse. Often,​ talking about the​ trauma is​ not enough: trauma survivors need to​ take some action that symbolizes triumph over helplessness and despair. the​ Holocaust Memorial in​ Jerusalem and the​ Vietnam Memorial in​ Washington,​ DC,​ are good examples of​ symbols for survivors to​ mourn the​ dead and establish the​ historical and cultural meaning of​ the​ traumatic events. There are several events for survivors of​ traumas that officers can also take part in. These events remind survivors of​ the​ fact that there are others who have shared similar experiences. Other symbolic actions may take the​ form of​ writing a​ book,​ taking political action or​ helping other victims.

PTSD is​ real,​ and can be resolved with time,​ patience and compassion.

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