Post Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is an extreme stress response to a traumatic event that threatens your safety or makes you feel helpless. The symptoms of PTSD present as a psychiatric condition that can develop following any traumatic, life-threatening, or highly unsafe, catastrophic life experience. Recognition of this condition increased significantly following the Viet Nam war, due to U.S. veterans developing disturbing psychological symptoms and impaired functioning upon their return home from war.
Symptoms that must be present for the diagnosis of PTSD, according to the DSM-IV, are as follows:
- The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.
- The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior).
- The characteristic symptoms resulting from the exposure to the extreme trauma include persistent re-experiencing of the traumatic event, persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, and persistent symptoms of increased arousal. Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event and to avoid activities, situation, or people who arouse recollections of it. This avoidance of reminders may include amnesia for an important aspect of the traumatic event. Diminished responsiveness to the external world, referred to as “psychic numbing” or “emotional anesthesia,” usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities, of feeling detached or estranged from other people, or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness, and sexuality). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span).
- The full symptom picture must be present for more than 1 month, and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
In layman’s terms, one suffering with PTSD, may experience recurrent flashbacks or intrusive recollections of the event they experienced, or nightmares of the event and have difficulty sleeping; intense hyperarousal – startling easily, feeling jittery, distressed and anxious, scanning the environment and having a hard time relaxing; avoiding the scene of the event or anything or anyone that may remind them of the event. In avoiding the event, there may be an unconscious or conscious blocking out of certain memories. Consequently the repressed memories and emotions around the traumatic event may create some feelings of detachment and estrangement in their life and relationships, anhedonia – loss of interest in previously pleasurable activities, anxiety, difficulty focusing, anger outbursts and depression, as well as isolation and a generalized disruption of functioning in relationships and in work or school. In severe cases, the individual with PTSD may experience significant dissociation, whereupon they feel and act as if they are re-experiencing the actual event in that moment, and this may last from a matter of seconds to hours or days.
The trauma may be so severe to the individual’s psyche that severe psychological disorganization and disequilibrium occurs, and the aforementioned psychic numbing, avoidance of the event, blocking of memories and repression of feelings are defenses that the psyche implements as a sort of survival mechanism.
Causes of PTSD were first founded in the traumas and horrors that war veterans experienced, such as witnessing the death of a comrade, losing a limb, facing death a in a war, or experiencing torture as a prisoner of war. Once PTSD became more prevalent and understood post 1980, further causes became defined, including the following: being of a victim of rape, robbery, or other violent assault; witnessing or being involved in a life threatening incident; being kidnapped, taken hostage, experiencing a terrorist attack, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. Pervasive and chronic childhood abuse, emotional, physical, and/or sexual, can also be contributing factors to the development of PTSD. When a child is exposed to an unsafe home environment where their physical and/or emotional safety is threatened, this can have long lasting effects on their mental wellbeing and emotional health. Furthermore, when a young child is exposed to a chaotic, abusive and dangerous home environment, their basic neural circuitry can be altered due to the high levels of stress hormone that are constantly being released by the brain as the child is still developing. This can lead to a permanently increased level of psychological and physiological arousal which when combined with a lack of safety, trust and stability, along with the constant violations of abuse or neglect, often leaves a child with an internalized sense of badness, emotional and cognitive distortions and disorganization, and little ability to regulate their emotions or internal world, leaving them vulnerable to impulsive and self-destructive behaviors, particularly alcohol and drug abuse as a means of self-medication. The world typically becomes an unsafe place for these individuals and further traumas often occur through maladaptive coping behaviors, and these traumatic themes may ultimately be expressed in PTSD with acute onset or delayed onset of symptoms. The symptoms in young children may look different than that of adults. A child that is being abused may have frightening dreams or nightmares but with no specific content. They may also manifest problems in school, failing grades, withdrawal or isolation, separation anxiety, clinginess and neediness, or conversely rebellion. In adolescence and young adulthood, there may be a frequency of eating disorders, alcohol and drug abuse, sexual acting out, teen pregnancy, or criminal and antisocial behavior. The Watershed can help in any and all of these areas, call us today, 1-800-861-1768.
Substance abuse problems are commonly experienced by those who have experienced trauma, and there is a complex relationship between trauma/PTSD and addiction.
Alcohol and drug abuse typically become a means for self-medicating and for dampening the anxiety and hyperarousal individuals with PTSD experience.
Other psychiatric conditions that may co-occur with PTSD involve
- Depression, Depressed Mood
- Anxiety, Social Phobia, Panic Disorder
- Mood Disorders (eg. Bipolar Disorder)
- Personality Disorder (eg. Borderline Personality Disorder)
- Sleep Disorders (eg. Insomnia)
Overall, research demonstrates that for traumatic events to be less traumatic or for trauma to begin to be resolved, it is essential that there be support and emotional attunement to the individual in order for processing and relief to begin to occur. Traumatic events tend to become more traumatizing when there is no containment, attunement or support for the individual, thereby leaving them with no means to make sense of what is happening to them or to get relief from crisis.
Treatment for PTSD involves intensive individual therapy and may require residential treatment at a drug and alcohol rehab or dual diagnosis rehab due to the high co-occurrence of PTSD and addiction. It is critical that an individual dealing with this dual diagnosis stabilize in a safe, supervised and structured environment where all elements of their diagnoses and underlying issues can be addressed intensively through the therapy, groups, meetings, and one to one attention with doctors that an individual can receive in rehab.
Specific therapeutic treatments for PTSD involve relieving symptoms by recalling and processing the trauma that has been experienced, once the individual is stable enough to do so (this must be assessed by qualified mental health professional). This involves cognitive-behavioral therapy (CBT) techniques that focus on: exploring thoughts and feelings about the trauma, working through feelings of guilt, shame and mistrust, learning how to cope with and control intrusive memories, and addressing problems PTSD has caused in life and relationships. More specifically, CBT may also focus on cognitive restructuring, where distorted and irrational thoughts about the traumatic event are identified and challenged with the goal being to redefine them and restructure the individual’s cognitions and self-beliefs in a more accurate and balanced way.
Exposure therapy has also been found as an effective treatment method for PTSD and involves the individual gradually exposing themselves, with the support and guidance of their therapist, to thoughts, feelings, and situations that remind them of the trauma. The process may begin with focusing on a memory that is mildly distressing but manageable, then the exposure will work towards facing the memories that are significantly distressing, as the individual builds their coping skills and emotional tolerance. The goal is that as the individuals re-experience these memories in a safe environment, they will start to feel less intense and overwhelming, and the memories may begin to be reprocessed and stored in such a way that they have a less disturbing impact.
Finally, EMDR (Eye Movement Desensitization and Reprocessing) is a well known and potentially effective treatment approach for PTSD. EMDR incorporates elements of cognitive-behavioral therapy with eye movements or other forms of left-right brain stimulation, such as finger movements or sounds. For example, in EMDR therapy an individual may talk about a traumatic event while following their therapist’s finger back and forth with their eyes. These movements are thought to work by releasing elements of the traumatic memory which are stuck in active parts of the brain’s information processing system, as during times of extreme stress the brain is unable to process and break down these pieces of information allowing them to then be stored in the appropriate memory center of the brain. Instead, the traumatic pieces of information are left in parts of the brain where they retain the level of intensity that occurred at the time of the trauma. EMDR assists the individual in accessing these fragments of the trauma whereby they can then be integrated into a less disturbing memory.
For additional information on the private dual diagnosis programs and other drug treatment programs at The Watershed, please visit our main Drug Treatment page, and our main Dual Diagnosis page. For immediate assistance call The Watershed anytime at 1-800-861-1768.