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PTSD affects many people who
have been exposed to violent events such as rape, domestic violence, child
abuse, war, accidents, natural disasters and political torture. Estimates
state that up to one to three percent of the population have clinically
diagnosable PTSD. Researchers state that PTSD can result from many types
of trauma, particularly those that include a threat to life.
Although our present knowledge of post-traumatic stress disorder is based on studies of trauma in adults, PTSD also occurs in children. It is known that traumatic experiences--sexual or physical abuse, loss of parents, the disaster of war--often have a profound effect on the lives of children. In addition to PTSD symptoms, children may develop learning disabilities and problems with attention and memory. They may become anxious or clinging, and may also abuse themselves or others. The symptoms of PTSD may initially seem to be part of a normal response to an overwhelming experience. Only if those symptoms persist beyond three months do we speak of them being part of a disorder. Sometimes the disorder surfaces months or even years later. Psychiatrists categorize PTSD's symptoms in three categories: intrusive symptoms, avoidant symptoms, and symptoms of hyperarousal. Intrusive Symptoms Sometimes, this re-experiencing occurs in nightmares. In young children, distressing dreams of the traumatic event may evolve into generalized nightmares of monsters, of rescuing others or of threats to self or others. At times, the flashback comes as a sudden, painful onslaught of emotions that seem to have no cause. These emotions are often of grief that brings tears, fear or anger. Individuals say these emotional experiences occur repeatedly, much like memories or dreams about the traumatic event. Symptoms of Avoidance Emotional numbness and diminished interest in significant activities may be difficult concepts to explain to a therapist. This is especially true for children. For this reason, the reports of family members, friends, parents, teachers and other observers are particularly important. The person with PTSD also avoids situations that are reminders of the traumatic event because the symptoms may worsen when a situation or activity occurs that reminds them of the original trauma. For example, a person who survived a prisoner-of-war camp might overreact to seeing people wearing uniforms. Over time, people can become so fearful of particular situations that their daily lives are ruled by their attempts to avoid them. Others avoid accepting responsibility for others because they think they failed in ensuring the safety of people who did not survive the trauma. Some people also feel guilty because they survived a trauma while others--particularly friends or family--did not. This guilt may be worse if they witnessed or participated in behavior that was necessary to survival but unacceptable to society. Such guilt can deepen depression as the person begins to look on him or herself as unworthy, a failure, a person who violated his or her pre-disaster values. Children suffering from PTSD may show a marked change in orientation toward the future. A child may, for example, not expect to marry or have a career. Or he or she may exhibit "omen formation," the belief in an ability to predict future untoward events. PTSD sufferers' inability to work out grief and anger over injury or loss during the traumatic event mean the trauma will continue to control their behavior without their being aware of it. Depression is a common product of this inability to resolve painful feelings. Symptoms of Hyperarousal The persistence of a biological alarm reaction is expressed in exaggerated startle reactions. War veterans may revert to their war behavior, diving for cover when they hear a car backfire or a string of firecrackers exploding. At times, those with PTSD suffer panic attacks, whose symptoms include extreme fear resembling that which they felt during the trauma. They may feel sweaty, have trouble breathing and may notice their heart rate increasing. They may feel dizzy or nauseated. Many traumatized children and adults may have physical symptoms, such as stomachaches and headaches, in addition to symptoms of increased arousal. Other Associated Features Psychiatrists and other therapists have effective psychological and pharmacological treatments available for PTSD. These treatments can restore a sense of control and diminish the power of past events over current experience. The sooner people are treated, the more likely they are to recover from a traumatizing experience. Psychiatrists and therapists help people with PTSD to accept that the trauma happened to them, without being overwhelmed by memories of the trauma and without arranging their lives to avoid being reminded of it. It is important to re-establish a sense of safety and control in the PTSD sufferer's life. This helps him or her to feel strong and secure enough to confront the reality of what has happened. In people who have been badly traumatized, the support and safety provided by loved ones is critical. Friends and family should resist the urge to tell the traumatized person to "get over it," or "Put it behind you," instead allowing time and space for intense grief and mourning. Being able to talk about what happened and getting help with feelings of guilt, self-blame, and rage about the trauma usually is very effective in helping people put the event behind them. Therapists know that loved ones can make a significant difference in the long-term outcome of the traumatized person by being active participants in creating a treatment plan - helping him or her to communicate and anticipating what he or she needs to restore a sense of safety and control to his or her life. If treatment is to be effective it is important, too, that the traumatized person feel that he or she is a part of this planning process. Sleeplessness and other symptoms of hyperarousal may interfere with recovery and increase preoccupation with the traumatizing experience. Psychiatrists have several medications--including benzodiazepines and the new class of serotonin re-uptake blockers--that can help people to sleep and to cope with their hyperarousal symptoms. These medications, as part of an integrated treatment plan, can help the traumatized person to avoid the development of long-term psychological problems. In people whose trauma occurred years or even decades before, the professionals who treat them must pay close attention to the behaviors--often deeply entrenched--which the PTSD sufferer has evolved to cope with his or her symptoms. Many people whose trauma happened long ago have suffered in silence with PTSD's symptoms without ever having been able to talk about the trauma or their nightmares, hyperarousal, numbing, or irritability. During treatment, being able to talk about what has happened and making the connection between past trauma and current symptoms provides people with the increased sense of control they need to manage their current lives and have meaningful relationships. Relationships are often a trouble spot for people with PTSD. They often resolve conflicts by withdrawing emotionally or even by becoming physically violent. Therapy can help PTSD sufferers to identify and avoid unhealthy relationships. This is vital to the healing process; only after the feeling of stability and safety is established can the process of uncovering the roots of the trauma begin. To make progress in easing flashbacks and other painful thoughts and feelings, most PTSD sufferers need to confront what has happened to them, and by repeating this confrontation, learn to accept the trauma as part of their past. Psychiatrists and other therapists use several techniques to help with this process. One important form of therapy for those who struggle with post-traumatic stress disorder is cognitive/behavior therapy. This is a form of treatment that focuses on correcting the PTSD sufferer's painful and intrusive patterns of behavior and thought by teaching him or her relaxation techniques, and examining (and challenging) his or her beliefs and thinking. A therapist using behavior therapy to treat a person with PTSD might, for example, help a patient who is provoked into panic attacks by loud street noises by setting a schedule that gradually exposes the patient to such noises in a controlled setting until he or she becomes "desensitized" and thus is no longer so prone to terror. Using other such techniques, patient and therapist explore the patient's environment to determine what might aggravate the PTSD symptoms and work to reduce sensitivity or to learn new coping skills. Therapists also treat cases of PTSD by using psychodynamic psychotherapy. Post-traumatic stress disorder results, in part, from the difference between the individual's personal values or view of the world and the reality that he or she witnessed or lived during the traumatic event. Psychodynamic psychotherapy, then, focuses on helping the individual examine personal values and how behavior and experience during the traumatic event violated them. The goal is resolution of the conscious and unconscious conflicts that were thus created. In addition, the individual works to build self-esteem and self-control, develops a good and reasonable sense of personal accountability and renews a sense of integrity and personal pride. Whether PTSD sufferers are treated by therapists who use cognitive/behavioral treatment or psychodynamic treatment, traumatized people need to identify the triggers for their memories of trauma, as well as identifying those situations in their lives in which they feel out of control and the conditions that need to exist for them to feel safe. Therapists can help people with PTSD to construct ways of coping with the hyperarousal and painful flashbacks that come over them when they are around reminders of the trauma. The trusting relationship between patient and therapist is crucial in establishing this necessary feeling of safety. Medications can help in this process also. Group therapy can be an important part of treatment for PTSD. Trauma often affects people's ability to form relationships--especially such traumas as rape or domestic violence. It can profoundly affect their basic assumption that the world is a safe and predictable place, leaving them feeling alienated and distrustful, or else anxiously clinging to those closest to them. Group therapy helps people with PTSD to regain trust and a sense of community, and to regain their ability to relate in healthy ways to other people in a controlled setting.
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