Posttraumatic Stress Disorder and its Pecularities
Shell shock, battle fatigue, gross stress reaction, soldier’s heart all names that the trauma and stressor-related disorder Posttraumatic Stress Disorder has been called, and the commonality of these monikers hint at its prevalence in our history. Though no longer considered to be merely a combat veteran’s disorder, it is still most often seen depicted in mainstream media as a World War I or II soldier back at home hearing the rumble of gunfire, jumping when someone approaches them from behind, or unable to control hand tremors as they attempt to complete a simple task. These portrayals, while they can be accurate, do not show the full picture of what PTSD is and whom it affects.
PTSD can occur in any individual despite gender, age, ethnicity, or background, and can stem from a multitude of distressing events, including a natural disaster, a terrorist attack, or a violent personal assault, such as rape or abuse. PTSD symptoms are not fixed, but rather on a scale, and can vary in severity. A key signifier of PTSD is repetition in unwanted memories, upsetting dreams, avoidance of triggering circumstances and reminders of the traumatic experience, negative thoughts, and even flashbacks so life-like that the person feels like they are reliving the event. Hyper-arousal is evident and can be observed through paranoia and hypervigilance, which is an exaggerated state of alertness. The person’s daily life can be greatly affected and will display avoidance in many areas of their life, including withdrawal from family and friends, and loss of interest in activities that they once enjoyed. These symptoms may last for months or even years but are certainly prolonged and recurring. The person may not complain of specific symptoms, as they may be misattributing these symptoms to other disorders such as generalized anxiety disorder or depression; oftentimes these other disorders or generic ailments are noticed sooner than the “big picture diagnosis of PTSD.
PTSD is a highly treatable disorder and some people will find that PTSD can lessen or disappear over time, even without treatment. However, most people who are in distress due to a traumatic event would benefit from a professional’s help. Not everyone who experiences a traumatic experience will develop PTSD – it is not a given. Most people experience at least one traumatic event during their lifetime, however only around 14% of those exposed to traumatic events develop PTSD (Yehuda, 1999). Research is still emerging as to why some individuals are at a higher risk of developing chronic PTSD while others show more resilience to the disorder.
Diagnosis is typically obtained through a physical exam and a psychological evaluation that includes symptoms and the level of intensity of said symptoms. Subjection to a distressing event is a requirement for diagnosis but does not have to be first-hand. An example of the second-hand experience of a trauma would be hearing about a violent death of a close friend you were not there for the event itself, but hearing the details would cause distress. Another occurrence is when a person is repeatedly exposed to alarming circumstances, perhaps through their job, such as social workers knowing the specifics of child abuse cases.
Several different risk factors may be in play at developing PTSD after a traumatic event, including the type of event that it was and possible predisposing characteristics including sex and personality traits. The severity of the traumatic event, as well as whether the person viewed their life to be in danger, seem to be a strong predictors for vulnerability to PTSD development, with “torture and [violent personal assault] associated with the highest rates of chronic PTSD, whereas lower magnitude events such as motor vehicle accidents and life-threatening illness were associated with lower rates of trauma. (Kessler, Sonnega, Bomet, Hughes, Nelson, Breslau).
Surprisingly, some factors that one would assume would be strong indicators of PTSD development (history of abuse or previous trauma, the intentionality of the event if it was caused by another person, or having the availability of a mental health professional after the event), in fact, did not have a strong bearing. In some studies, debriefing after a trauma could even be associated with increased vulnerability in the individual and could hinder the natural recovery process. (Rose, Bisson, Churchill, Wessely, 2002)
Women more likely than men to develop PTSD (Voges and Romney, 2003). A possibility for the higher rate of women versus men with PTSD is that while women are less likely to be victims of violent assault, they are at a higher risk of sexual assault (such as rape). One could propose the idea that sexual assault is more alarming to the mind-body connection and requires different coping skills than if the assault were, say, being mugged. While this may be a factor, other research has shown that women are more vulnerable to PTSD no matter what kind of assault it is. (Breslau, Chilcoat, Kessler, Peterson, Lucia, 1999) While there is no conclusive reasoning for this yet, it’s suggested that women are overall more vulnerable in attitude than men, though what exactly that vulnerability stems from is unclear and needs further research.
Coping skills can play a major role in the resilience of individuals after a traumatic event. The responsibility, whether we place the blame on someone else or ourselves, for a traumatic event has been studied and it has shown that those who accepted responsibility for the trauma exhibited fewer symptoms of PTSD. (Hickling, Blanchard, Buckley, Taylor, 1999) This could be viewed as those people who accept responsibility feel a stronger sense of control over the situation and can utilize other emotion-coping and problem-solving adaptive strategies to “move on. Of course, this would only be applicable in situations where the individual does truly have some control over the situation and self-blame would not be beneficial for an individual who experienced trauma at the hands of another. External locus of control, in contrast, could increase the risk of development of PTSD due to the person turning to more maladaptive coping strategies like avoidance.
When we speak about resilience, we are defining this term as ability to maintain a state of normal equilibrium in the face of extremely unfavorable circumstances. (Ayesha S. Ahmed, 2007) When we think of a resilient individual, we think of someone who is emotionally intelligent and does not let adversity stop them from their goals. Several factors may promote resilience in such an individual, including coping skills, personal and religious beliefs, and personality traits. Resilient individuals and their neurobiology may be able to distinguish dangerous situations versus every day situations that would not require hypervigilance or fight-or-flight reactions.