For this week’s Mental Health Monday, I’m going to discuss PTSD and its components.
Please note, this is solely for the purposes of writing, and is NOT intended for medical advice or treatment.
So what is PTSD (Post-Traumatic Stress Disorder)?
It is classified as an anxiety disorder. Technically, the person must have a constellation of symptoms for at least 30 days to qualify for the diagnosis. Some people recover, some go on to have a chronic course, lasting months to years. Symptoms can recur several years later as well, with a period of remission between.
An event must be perceived as life threatening or potentially life threatening to qualify as traumatic. Immediately, that lends a LOT of subjectivity. What’s life threatening to me may be different for you. That being said, I’m sure we can all pretty much agree on the biggies–combat, rape, assault, natural disasters, terrorism, abuse (sexual, neglect, physical, emotional, verbal, whether as an adult or child).
The traumatic event can either be one “biggie,” or it can be the accumulation of “smaller” events over a prolonged period of time (such as child abuse or domestic violence).
Classic symptoms include:
Hypervigilence: The person doesn’t trust others. They may feel uncomfortable in exposed places (malls, crowded places, being around strangers). They will frequently make sure their back is to a wall (so it’s not exposed). They’ll keep an eye on the exits and make sure they can get to one fast if needed. They’ll also show a “startle” response, where they jump at a loud, sudden sound. Some people jump when the phone rings, for example.
Avoidance: This is pretty much self explanatory. The person will avoid triggers and things associated with the trauma. This can include movies, locations, people, even certain subjects of discussion for fear it will lead to symptoms. This, by the way, makes PTSD difficult to treat in some instances, because the very thing bringing a person to treatment, is the thing they want to avoid discussing.
What’s important to know is the brain remembers details about a traumatic event that the sufferer may not consciously recall. Furthermore, an otherwise innocuous stimuli may be paired with the event and become “dangerous.” If, for example, a person’s attacker wore a blue jacket, then the person may experience an anxiety response when confronted with a blue article of clothing. The jacket itself is benign, but the brain “remembers” it as a threat via association.
Another example would be a soldier in Iraq who has returned home and every time he goes under an overpass, he searches for IEDs (Improvised Explosive Devices) tucked under the framework.
Which leads me to my next point. For a soldier in Iraq, being hypervigilent is conducive to survival. It makes her good at her job. BUT, when she returned to civilian life, her sensitive attunement to stimuli in the environment does not return to baseline. That is NOT conducive to living in a non-war zone.
That’s what PTSD is. A state of “hyper arousal” that is above baseline. It’s like drinking 16 cups of coffee and maintaining that level of tension and awareness ALL THE TIME.
Finally, I’d like to discuss another cardinal symptom of PTSD.
Flashbacks and nightmares: If someone is presented with a “trigger” (like a blue jacket), they may experience a flashback. Flashbacks can be mild (where the person is able to recognize it as a flashback and they can control it) or they can be severe, where the person actually feels like they’re reliving the event in real time.
Final tidbit: The person who suffers from PTSD is at higher risk of misusing drugs and overusing alcohol. Substance abuse and dependence as a co-morbid diagnosis is therefore common and an important aspect to address.
As always, if you have any mental health questions for your writing, don’t hesitate to ask! Be sure to check out Lydia’s blog for Medical Monday.