It is not the event that determines whether something is traumatic to someone but, the individual’s experience of the event.
What does Trauma mean?
Trauma is the Greek word (Tραύμα) for to pierce, or to wound. It is a severe emotional shock caused by an extremely upsetting experience that affects the physiology of the body and the central nervous system.
Why do people get traumatised?
In order to successfully negotiate a traumatic event, we must respond in one of two ways: Either resist and overcome the threat (‘Fight’), or avoid and get away from the threat (‘Flight’). Furthermore, if we are unable to exercise either of these two options; we enter a third state, common to all animals, we “Freeze”. Unlike our animal friends, this frozen state of heightened autonomic arousal may become chronic over time. Animals in the wild literally “shake off” the threat, but we humans, with our complex brains, get stuck in frozen patterns of distress.
In PTSD and Panic Disorder, for example, we see automatic and persistent symptoms of hypervigilance, fatigue, anxiety, sleep disturbance, social withdrawal, addictive behaviour, depression, numbing, et cetera, that are chronic and unreleased over time.
What is Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD)?
Symptoms of Acute Stress Disorder (ASD)
For some trauma survivors, acute stress reactions are severe enough to meet DSM-IV (Diagnostic and Statistical Manual, Fourth Edition) criteria for Acute Stress Disorder (ASD).
A growing body of evidence suggests that there are specific stress symptoms that may occur almost immediately following a traumatic event that may predict the development of PTSD. The observation of acute stress reactions in these and other studies of natural and human-caused disasters led to the formation of the Acute Stress Disorder (ASD) diagnosis in the Diagnostic and Statistical Manual of Mental Disorders. Fourth edition (DSM IV Edition).
Acute Stress Disorder is conceptually similar to PTSD and shares many of the same symptoms. Diagnostic criteria include dissociative (emotional numbness, feeling “unreal” or disconnected from emotions or the environment), intrusive, avoidance, and arousal symptoms.
To meet a diagnosis of ASD, symptoms must occur between 2 days and 4 weeks after a traumatic experience. After four weeks, a PTSD diagnosis should be considered
Post-Traumatic Stress Disorder (PTSD)
In our everyday lives, any of us can have an experience that is overwhelming, frightening, and beyond our control. We could find ourselves in a car crash, the victim of an assault, or see an accident. Police, fire brigade or ambulance workers are more likely to have such experiences; They often have to deal with horrifying scenes.
Soldiers may be shot or blown up and see friends killed or injured.
Most people, in time, get over experiences like this without needing help. In some people, though, traumatic experiences set off a reaction that can last for many months or years. This is called, Post-Traumatic Stress Disorder or PTSD for short.
What are the symptoms of PTSD?
There are four main types of PTSD symptoms. A diagnosis of PTSD requires the presence of all categories of symptomatic responses:
- re-experiencing the trauma: flashbacks, nightmares, intrusive memories and exaggerated emotional and physical reactions to triggers that remind the person of the trauma.
- emotional numbing: feeling detached, lack of emotions (especially positive ones), loss of interest in activities.
- avoidance: avoiding activities, people, or places that remind the person of the trauma.
- increased arousal: difficulty sleeping and concentrating, irritability, hypervigilance (being on guard), and exaggerated startle response.
How does PTSD start?
PTSD can start after any traumatic event. A traumatic event is one where we can see that we are in danger, our life is threatened, or where we see other people dying or being injured.
How PTSD is commonly treated?
Psychotherapy
Because PTSD has so strongly affected the brain itself, treatment often takes longer and progresses more slowly than with other types of anxiety disorders, and is most effective with a specialist in trauma recovery.
It is most important to feel comfortable and safe with the therapist, so there is no additional fear or anxiety about the treatment itself. Depending on the extent of the symptoms, it may be more effective to see the therapist several times a week, if possible.
Psychotherapy may include relaxation techniques (deep breathing, muscle relaxation, positive imagery, meditation, prayer, etc). There are documented instances where relaxation was counterproductive triggering rather than relieving symptom.
Cognitive-Behavioural Therapy (CBT)
Often including exploring personal history as well as history of the event, challenging beliefs and thoughts that lead to distress. Learning to recognise and manage “triggering” episodes, and exposure or de-sensitisation (gradual re-introduction to the event that caused the trauma).
In my experience, the sooner trauma therapy begins, the more favourable the outcome will be however, the longer we leave it, the more complex the process will be
By Dr Vasilios Silivistris
