For Those Who've Been Affected by PTSD: Everything You're Experiencing Makes Sense Given a Senseless Situation
Posttraumatic Stress Disorder (PTSD) occurs in people who have endured a trauma. PTSD is a reaction; it’s complex, it’s debilitating, takes away one’s identity, and can be misunderstood by not only the survivor, but also the people in their lives. I have worked for almost 10 years with individuals struggling with PTSD. I’ve sat with and treated our amazing Vietnam, Desert Storm & OEF/OIF Veterans, courageous women who have been sexually assaulted, kidnapped and tortured, resilient men who have been sexually assaulted, our heroic first responders witnessing constant tragedy, childhood abuse/neglect survivors, survivors of loved ones who have been murdered, incredibly brave parents who have watched their children take their last breath, individuals who have accidentally taken the life of someone else. Why am I disclosing this? Because regardless of how different each of these incredible individuals’ stories are, they all have one thing very much in common - their bravery of internal and external struggles through their journey of recovery.
If this is you or someone close to you whom has been affected by PTSD and trauma, know that you are not alone. This blog is going to be the first of a series explaining what the condition is, how it manifests in others differently, and ultimately with the hope of serving to educate and validate those who have been affected.
First, the definition of an actual trauma: a situation in which you observed or personally experienced involving an actual or threatened death, a serious injury or sexual violation. It’s also considered a trauma if you learned that a traumatic event occurred to a close family member or close friend.
Just because you endured a trauma, does NOT mean you will develop PTSD. Most folks will experience some PTSD-like symptoms immediately after the event and notice the symptoms go away on their own (Acute Stress Disorder, which a lesser/temporary form of PTSD) and some folks never experience symptoms at all. However, for those individuals who notice their symptoms sticking around for more than one month, THIS is when a diagnosis of PTSD can be considered. So let’s talk about those symptoms. They are placed into four categories:
1) Re-experiencing: Your brain and body attempt to try to make sense of the trauma by re-experiencing the event through:
- nightmares - can be the literal event or themes of the event. Many patients I work with experience more nightmares in the very early morning of their sleep (More REM, thus more dreaming, occurs during this time).
- intrusive memories - spontaneous and very strong, vivid, emotionally distressing memories of the event. People can actually experience the memories through their senses (hearing the voice, smelling the scent, tasting the blood, etc). I call the hallucinations “trauma congruent”. You are not going crazy. Your brain is just trying to process.
- flashbacks - it literally feels like the actual trauma is happening again. People will lose sense of reality and of their surroundings and can act out the trauma. Despite what is thought in society, flashbacks are quite rare, as what most people are describing as flashbacks, they are actually experiencing intrusive memories instead.
2) Hyperarousal: Your body is physically feeling the effects of what happened to you, as well as reacting to the symptoms themselves (i.e. you physically react by being on edge as a result of having a nightmare). Your Fight-Flight-Freeze system is more active and more sensitive than the non-trauma survivor:
- sleep difficulties: I typically see that the “magic” number is only about 4 hours of sleep. This also can include acting out those nightmares or being very reactive if woken up by someone (spouse accidentally gets hit when trying to wake up the survivor during his dream).
- hyper vigilance: finding yourself constantly looking over your shoulder, scanning your environment to assess any potential threats, overly checking locks, windows, needing your back to the wall so that you can have full view of what is around you, sitting in the back and/or close to the exit in a public location, and yes, you’ve identified where all the exits are even before you sat down.
- irritability/aggression: finding yourself getting mad over even the smallest things. If you’re not sleeping well and if you’re constantly on edge and feel as if the world is a constant threat to you because of what happened, it’s a lot easier for you to become angry or blow up because you’re already pretty high on that arousal meter scale. (On an arousal scale of 0-10, folks with PTSD or anxiety walk around life at around a “5” because of their overactive Fight-Flight-Freeze system, versus people without PTSD or anxiety who live at a “2”). Also, you didn’t blow up at your spouse for not doing the dishes. You blew up at them because the situation subconsciously made you feel how you did when the trauma happened to you years ago - “I was neglected because I wasn’t important enough.”
- concentration difficulties: of course you can’t concentrate for shit - you’re not sleeping, always on edge, dealing with upsetting memories and nightmares. Also, keep in mind that if you’re not concentrating, you’re not going to remember what you aren't paying attention to! So relax, this is not early onset Dementia. You have a lot going on in your head.
- easily startled: being overly jumpy to sounds or being touched. Again, this makes sense given the fact that your body is physically still trying to protect you by being on edge and hypervigilant. PTSD is an extremely physiological condition that needs a physical outlet.
3) Negative Cognitions & Mood: as a result of what you endured, your core belief system and emotions about self, others, and the world change. (Especially around control, power, safety, intimacy, trust, and esteem):
- inability to remember aspects of the event: I’ve tend to notice that it works either two ways; it’s either crystal clear in every detail for a person, or, they really have no ability to remember parts of it. As our trauma work progresses, it’s quite common for my patients to remember details or parts of it that their brain wasn't allowing them to remember before. As frightening as this can be, it’s actually a good thing, because your brain and body are ready to process through it.
- guilting and/or shaming yourself: in the attempt to try to make sense of what and why the trauma happened, to attempt finding control, many survivors will do this at the expense of blaming themselves for what happened. “If only I had done __ differently”, “I should have known __”, “if I had left earlier __ wouldn’t have happened…” are very common beliefs my patients get stuck with. It’s a lot easier to take the blame for something than to sit with the unknown.
- anhedonia: finding yourself not being able to experience joy or pleasure in doing the things you used to enjoy. This too makes sense. If you are constantly being triggered, feeling unsafe and threatened in your environment, tired, on edge, of course you wont find joy in the things you once did! You wont enjoy the big crowds of people at the parties, concerts and festivals you once loved. It’s just too much.
- feeling detached from others: you feel different. Misunderstood, scared to be judged. Don't want to lose more people or get hurt. So you push away, and isolate. One of the worst things you can do. Social support is the strongest protective factor!
4) Avoidance - the “Big A”, as I call this cluster. Engaging in avoidance is THE BIGGEST FACTOR IN MAINTAINING PTSD:
- Avoiding places, people, or situations that remind you of the event: when you expose yourself to something that reminds you of what happened, it feels awful. You’re triggered so become anxious, panic, feel angry, fearful and it’s a paralyzing feeling and people around you don’t understand this. However, there’s a difference between avoiding something that is bad for you (the assailant or a burning house) versus avoiding neutral things (the park where the rape happened, the song that was playing while you were involved in the accident). More on this topic in a separate blog, because this need for “corrective experiences” is huge for your recovery.
- Avoiding talking or thinking about what happened: same as above, you try to avoid what makes you feel bad. However, this prevents you from recovering or your brain and body being able to process through the trauma.
When I explain to my patients what PTSD is and all the symptoms that come with it, it can be both daunting, triggering, but also validating that they finally have names and categories for what they have been struggling with internally. It’s a lonely and frightening place for someone to carry this with them, often times not even realizing that “this” is actually a thing that makes sense. Be compassionate with yourself, know that there is hope, and I look forward to continuing writing more about what you are understandably experiencing and how to start coping.