Ptsd: Why Does It Happen How Survivors Can Heal
Neuroscience, Self DevelopmentRobyn E. Brickel, M.A., LMFT
A traumatic event is something no one is prepared to deal with. You may feel your mind and body are in a state of shock from the experience. You may have nightmares, feel jumpy, or find yourself re-playing the event in your mind. You may even feel disconnected from the world around you. What happened was traumatic, and any person would feel shaken up. This is natural and human.
For people who have enough resilience, the intense state of alarm will go away over time. They can sort out their thoughts and feelings, process what happened, and move on. It may take days or weeks, but the symptoms gradually decrease.
With post-traumatic stress disorder the feelings dont go away. People with PTSD dont experience getting a little bit better every day. In fact, trying to cope with the after-effects of severe trauma can be very difficult. New brain research and the hard work of survivors provide important insights for treatment and hope.
What Are The Symptoms Associated With Ptsd
Its possible to develop PTSD symptoms in the days or even hours after a traumatic experience, however, in many cases the symptoms dont appear for several months or possibly years after the incident itself. Although PTSD can develop differently in each sufferer, there are four separate clusters of symptoms:
Intrusive and recurrent reminders of the traumatic experience these include nightmares, flashbacks and distressing thoughts. Sufferers may experience strong physical and emotional reactions to any reminder of the incident. These reactions may include heart palpitations, uncontrollable shaking or panic attacks.
- Avoidance of anything that is a reminder of the traumatic experience this includes thoughts, situations, places and people associated with those negative memories. Avoidance may include withdrawal from family and friends or a loss of interest in previously enjoyable activities.
- Negative mood and thought changes these may include exaggerated negative beliefs about the world and ongoing feelings of shame, guilt or fear. Sufferers may struggle to experience any positive emotions.
- Feeling on guard permanently this involves being emotionally reactive and jumpy, with irritability, reckless behavior, anger, trouble concentrating, hypervigilance and difficulty sleeping all being commonplace.
- A minimum of one re-experiencing symptom
- A minimum of one avoidance symptom,
- A minimum of two reactivity and arousal symptoms
- A minimum of two mood and cognition symptoms.
Why Do Some People Develop Delayed Ptsd
Post-traumatic stress disorder is a potentially debilitating response to life-threatening events that occurs in a significant minority of adults and children. Established guidelines prevent doctors from diagnosing PTSD until 30 days after a traumatic event. However, some people develop a delayed form of the disorder and dont display any symptoms for a number of months after the opening of this diagnostic window. In a study published in August 2013 in the journal JAMA Psychiatry, an Australian research team investigated the potential causes for delayed PTSD. This team concluded that people with delayed symptoms have certain backgrounds that distinguish them from people who experience the effects of post-traumatic stress relatively rapidly.
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Who Is At Risk For Post
You can develop PTSD at any age. Many risk factors play a part in whether you will develop PTSD. They include
- Your sex women are more likely to develop PTSD
- Having had trauma in childhood
- Feeling horror, helplessness, or extreme fear
- Going through a traumatic event that lasts a long time
- Having little or no social support after the event
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
- Having a history of mental illness or substance use
Diagnostic And Statistical Manual
PTSD was classified as an anxiety disorder in the DSM-IV, but has since been reclassified as a “trauma- and stressor-related disorder” in the DSM-5. The DSM-5 diagnostic criteria for PTSD include four symptom clusters: re-experiencing, avoidance, negative alterations in cognition/mood, and alterations in arousal and reactivity.
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Support Is Important For Recovery
Many people experience some of the symptoms of PTSD in the first two weeks after a traumatic event, but most recover on their own or with the help of family and friends. For this reason, formal treatment for PTSD does not usually start for at least two or more weeks after a traumatic experience.
It is important during the first few days and weeks after a traumatic event to get whatever help is needed. This may include accessing information, people and resources that can help you to recover. Support from family and friends may be all that is needed. Otherwise, a doctor is the best place to start to get further help.
Why Does Ptsd Only Affect Some People
We know that some groups of people are more likely to have PTSD than others, such as victims of sexual assault and war veterans. But, not every person who has been sexually assaulted has PTSD, and not every war veteran has violent flashbacks. So why are only some people affected by this condition?
Some research suggests that PTSD occurs when chemicals in the brain are disrupted by an extreme stress response. As an example, high levels of adrenaline may cause memories from the event to remain powerful and real to the person. Also, trauma at a younger age may cause the brain to be hyperactive, resulting in more extreme reactions to stress.
Here are some of the risk factors that may make one person more likely than another to develop PTSD:
- Previous history or family history of mental illness
- History of substance abuse
- Suffering an injury during the attack
- Seeing someone injured or killed
- Seeing a dead body
- Additional stress on top of the event, such as losing a loved one
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What Makes A Brain Resilient
After observing MRI scans of 31 Dutch male veterans with PTSD, 25 veterans without PTSD, and 25 average civilians during their resting states, we discovered some significant findings. First off, all veterans showed a weaker connection in motor control areas, and areas involved in self-reflection compared to average civilians. However, veterans without PTSD had a stronger connection between brain areas that deal with attention than their counterparts who were diagnosed with PTSD. Being able to control your attentional focus may be a protective factor against developing PTSD and may be an effective strategy to cope with traumatic experiences.
These results may potentially reflect the neurobiology of resilience. Prior studies have shown that there are differences between the brains of those with PTSD and those without, specifically in the brain region behind the forehead . In our study, we also found these differences to be apparent. Additionally, we noticed increased connectivity in these medial prefrontal regions for those without PTSD, indicating that there is more information flowing between these brain areas. This means that better functioning control regionsareas that regulate emotional responsesmay signify stronger brain resilience and ultimately, greater ability to adapt to trauma.
Impact Of Ptsd On Relationships And Day
PTSD can affect a persons ability to work, perform day-to-day activities or relate to their family and friends. A person with PTSD can often seem disinterested or distant as they try not to think or feel in order to block out painful memories. They may stop them from participating in family life or ignore offers of help. This can lead to loved ones feeling shut out.
It is important to remember that these behaviours are part of the problem. People with PTSD need the support of family and friends, but may not think that they need help.
It is not unusual for people with PTSD to experience other mental health problems at the same time. In fact, up to 80 per cent of people who have long-standing PTSD develop additional problems – most commonly depression, anxiety, and alcohol or othersubstance misuse. These may have developed directly in response to the traumatic event or have developed sometime after the onset of PTSD.
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Do Autistic People Have A Higher Risk Of Being Exposed To Trauma
It seems so.
Research shows that trauma is a pretty common part of life around 68 percent of teens will have been exposed to a potentially traumatic event by the time they’re 16. Only a modest one percent of them will go on to be diagnosed with post-traumatic stress disorder, but get this: the risk of developing PTSD rises with each exposure to trauma. A full 50 percent of young people who lived through more than one trauma were found to end up with PTSD.
Research shows that autistic people:
- Have a higher risk of being bullied by their typically-developing peers.
- Are more likely to be physically abused, including by caregivers.
- Fall victim to sexual abuse more often.
All these things could fall under “trauma”, as defined by the fifth edition of the diagnostic and statistical manual of mental disorders “exposure to actual or threatened death, serious injury, or sexual violence”. Research also indicates, however, that autistic people may experience other things as traumatic, including “social insults and degradation, sensory overstimulation, abrupt changes in known routines”. Not all these things would necessarily be considered traumatic under the DSM-5, but they can result in the same symptoms PTSD causes. For all intents and purposes, they can, then, lead to PTSD.
What Can I Do To Help Myself
It is important to know that, although it may take some time, you can get better with treatment. Here are some things you can do to help yourself:
- Talk with your health care provider about treatment options, and follow your treatment plan.
- Engage in exercise, mindfulness, or other activities that help reduce stress.
- Try to maintain routines for meals, exercise, and sleep.
- Set realistic goals and do what you can as you are able.
- Spend time with trusted friends or relatives, and tell them about things that may trigger symptoms.
- Expect your symptoms to improve gradually, not immediately.
- Avoid use of alcohol or drugs.
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Ptsd In Children And Teenagers
Older children and teenagers experience similar problems to adults when they develop PTSD. Younger children can express distress in a different way. For example, they may re-live the traumatic event through repetitive play rather than having unwanted memories of the event during the day. Many children have frightening dreams without recognisable content rather than nightmares that replay the traumatic event. Children may also lose interest in play, become socially withdrawn, or have extreme temper tantrums.
About one third of children who experience a traumatic event will develop PTSD.
Other problems that can develop alongside PTSD include anxiety or depression, defiant behaviour, attention deficit hyperactivity disorder, and in teenagers and young adults, suicidal thoughts and alcohol or drug use.
What Are The Treatments For Post
The main treatments for PTSD are talk therapy, medicines, or both. PTSD affects people differently, so a treatment that works for one person may not work for another. If you have PTSD, you need to work with a mental health professional to find the best treatment for your symptoms.
- Talk therapy, or psychotherapy, which can teach you about your symptoms. You will learn how to identify what triggers them and how to manage them. There are different types of talk therapy for PTSD.
- Medicines can help with the symptoms of PTSD. Antidepressants may help control symptoms such as sadness, worry, anger, and feeling numb inside. Other medicines can help with sleep problems and nightmares.
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What Can I Do If I Am Not Happy With My Treatment
If you are not happy with your treatment you can:
- talk to your doctor about your treatment options,
- ask for a second opinion,
- ask a relative, friend or advocate to help you speak your doctor,
- contact Patient Advice and Liaison Service , or
- make a complaint.
There is more information about these options below.
Treatment options
You should first speak to your doctor about your treatment. Explain why you are not happy with it. You could ask what other treatments you could try.
Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you are not given this treatment, ask your doctor to explain why it is not suitable for you.
Second opinion
A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.
You dont have a legal right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.
Advocacy
An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.
There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like.
You can find out more about:
Why Do Some People Develop Ptsd And Other People Do Not
Not everyone who lives through a dangerous event develops PTSDmany factors play a part. Some of these factors are present before the trauma others become important during and after a traumatic event.
Risk factors that may increase the likelihood of developing of PTSD include:
- Exposure to dangerous events or traumas
- Getting hurt or seeing people hurt or killed
- Childhood trauma
- Feeling horror, helplessness, or extreme fear
- Having little or no social support after the event
- Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
- Having a personal history or family history of mental illness or substance use
Resilience factors that may reduce the likelihood of developing PTSD include:
- Seeking out support from friends, family, or support groups
- Learning to feel okay with ones actions in response to a traumatic event
- Having a coping strategy for getting through and learning from a traumatic event
- Being prepared and able to respond to upsetting events as they occur, despite feeling fear
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What Is The Cause Of Ptsd
PTSD has several names including combat stress and shell shock. It occurs after experiencing a life-threatening event or severe trauma. Although it is most commonly associated with wear veterans, it can affect anyone who has had a traumatic experience, for example those who have experienced sexuality, race or gender-related violence or harassment from their peers.
It is quite normal for the body and mind to go into shock after a traumatic event, however, if the nervous system becomes stuck it becomes PTSD. There are two reflexive, automatic ways that the nervous system can respond to a stressful event:
- Mobilization this is also known as the flight or fight response. It occurs when you have to survive a dangerous situation or defend yourself. The heart begins to pound more quickly, blood pressure goes up, the muscles tighten, and all of this causes your reaction speed and strength to increase. Once the danger is gone, the nervous system begins to calm the body back down, lowering blood pressure and heart rate and, eventually, normal balance is restored.
- Immobilization this occurs if youve become too stressed in a specific situation. Even though that danger has gone, you become stuck with the nervous system unable to go back to its normal balanced state. This is known as post traumatic stress disorder or PTSD.
To recover from PTSD you have to transition from the emotional and mental warzone that youre living in and allow the nervous system to become unstuck.
Some Brains Are More Susceptible To Ptsd After Trauma Than Others
Everyone experiences trauma, but in some brains, PTSD arises where others aren’t at as much risk
Exposure to trauma is a common human experience approximately 70% of us go through at least one traumatic event during our lifetimes. Many go on to recover from the trauma, which gets stored away as a bad memory.
However, in a subset of people, trauma persists in their minds and infiltrates their daily lives. They experience intrusive thoughts, such as reliving the experience through flashbacks.” They tend to avoid anything related to the event, and have changes in mood and in their physical and emotional reactions to everyday occurrences. Eventually, people who experience these symptoms may be diagnosed with post-traumatic stress disorder , a chronic condition in which people continue to experience problems after a traumatic event.
…different factors work together in tipping the balance towards risk of developing PTSD
PTSD is very prevalent, affecting between 7-10% of the population in the US. However, not everyone who has experienced trauma goes on to develop PTSD or other stress disorders. Whats different between people who do and do not develop PTSD?
Photo by Edwin Andrade on Unsplash
…due to their heightened stress responses, the group of low-freezing animals became susceptible to developing PTSD-like behaviors.
A brain scan highlighting the location of the amygdala
NIMH
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Why Do Some People Develop Ptsd And Others Dont Even After The Same Traumatic Event
Human beings are incredibly resilient. They can bounce back and recover from stresses well. But sometimes our unique makeups can make an event overwhelming. Of all the people who will experience a traumatic event, only about 15% will have a lasting and harmful impact after it. Not all of these responses would be post-traumatic stress disorder. Why some people develop the disorder and others dont is complex and has to do with many factors that are as unique and difficult to figure out as people are. Factors may include how weve faced other challenging or dangerous events in the past, our lifetime of learning how to react to these kinds of events, and our emotional styles.