For this week’s Mental Health Monday, I’m going to discuss PTSD and its components. Blogger and writer Amie Borst prompted the idea. Thanks, Amie! Be sure to check out her blog here.
Please note, this post 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.
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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 and Sarah Fine’s The Strangest Situation!
Author Laura Diamond--Lucid Dreamer 
Wonderful summary, Laura! I think it’s also important for people to know that just because there’s been a trauma, you can’t assume a person has PTSD or will develop it. I see this mistake in my work, where the vast majority of our clients have been through some sort of traumatic life experience. Many of them have symptoms, but the majority of them do not meet critieria for PTSD (though they might meet criteria for some other disorder, like depression). The mistake comes when clinicians automatically ascribe trauma as the cause of every maladaptive behavior, which keeps them from looking further. It can stymy good treatment (you’ve probably witnessed this before!) PTSD is never something to overlook, but also not something to assume. Great post!
This is so great. Both of my last two stories had heroes with PTSD. This disorder was interesting to research, especially since my brother suffered from it for a short time after deploying to Afghan during the first push after 9/11. Thanks, Laura!
As a former addictions therapist, I saw a lot of self-medicating (drugs, alcohol) as a result of PTSD. PTSD as always intrigued me. Probably because of its close relation to what I studied in grad school (adult addictions). I’ve written a few characters who suffer from this disorder.
Thanks for this post! 🙂
This doesn’t sound fun to live with at all, especially the avoidance element. It has to be tough living day to day. I wonder if family or friend interaction helps or hinders someone suffering from PTSD.
You musta read my mind. I was researching survivors guilt last night and came up with PTSD. Thanks, this is great.
The definition of ‘traumatic’ is fascinating. People’s emotional range seems to vary so much. I used to think when certain people in my life had emotional meltdowns, they were in danger of harming themselves, because I couldn’t imagine having that sort of response to the stimuli in question without being at the edge of reason. Eventually I learned—we are all different. Put us in the crucible–like being a soldier in Iraq–and the range of reaction must be difficult to classify. You professionals must have incredibly honed compassion and empathy to do that! Your post made me think about how important it is, in writing, to develop characters fully so their strong or quirky behaviors and reactions make sense to readers. Thanks!
I think my mom has undiagnosed PTSD left over from World War 2. All of the behaviors that you described here sound like things I have observed in her. She’s native Japanese and lived through the bombing of Tokyo, and they just didn’t have medical care to treat people back then as they do now. I think that people have just always viewed her as being kind of quirky when it came to avoidance and just figured it was part of her personality. But in the last five years or so, I started to think that it probably isn’t (looking back on her life). Thing is…it does no good to bring it up now at the end of her life with the fact that she’s schizophrenic, has dementia, and all sorts of other mental issues. Having PTSD would be just a drop in the pond of mental problems.
HI, Laura,
How are you? It’s been ages, but I finally made it back to visit your blog.
Interesting post today. My latest novel has a character under constant abuse from is alcoholic father.
He doesn’t have this disorder, but he does battle with anxiety and panic attacks when pushed to the edge.
It’s amazing how the human mind protects itself or reacts to such traumas in life.
Great post, Laura. I witnessed PTSD up close and personal, thanks to my years in Rwanda after the genocide. It’s amazing, too, how many physical symptoms can stem from the mind trying to protect itself.
Sometimes it shocking how horrible an effect PTSD can have on people.
Great, informative post!
Fascinating and sad. The brain does strange things to protect itself.
Great post!
One of my MC is a survivor of sexual and physical abuse by her alcoholic father. I’m having troubles integrating the PTSD so that she is not a total wimp, or promiscuous.
An excellent post Laura. Thanks for the info.
………dhole
When did the term PTSD come into regular use? I don’t recall ever hearing it before the 80s. I am writing a novel that takes place in the mid-60s and the main character is suffering from this, but would it have been called this back then?
Lee
A Faraway View
Great question, Lee! I’ll address it next Monday, ‘kay?
thank you, thank you, thank you!! great post about PTSD! and you’ve helped my research so much! working on a story with an MC struggling with this very thing, so it’s really put it in perspective for me!
[…] 30, 2012 by lbdiamond Last week, I discussed the symptoms of PTSD. Arlee Bird (writer and blogger–Tossing It Out) had a great follow up question. When did the […]