PTSD, or Post-Traumatic Stress Disorder, is a term we use a lot these days in the media, in social science classrooms, and certainly in therapy sessions. In a world beset by so many changes and so much instability, it's no wonder—America's endless wars abroad and the millions of troops and family members affected by them are a case in point. Since many existing and prospective therapy patients (often, accurately) come to me requesting treatment for PTSD, I'm going to devote a series of blog posts to exploring each of the five main elements of the disorder, as laid out in the manual clinicians like me use to diagnose people—the Diagnostic and Statistical Manual of Mental Disorders, or DSM. Here, I'll just provide a bit of an overview of what PTSD is.
When I was a clinical social work intern at the Veterans Affairs (VA) PTSD Outpatient Clinic, a therapist I worked with gave a presentation to a group of veterans explaining what PTSD really means, and I liked her simple and clear approach. She seemed to help the veterans in attendance feel as though their experiences weren't strange or abnormal, given what they'd been through with combat, accidents, and sexual assault. The framework she used involved the acronym TIANA, like the woman's name. Here's how she broke down PTSD's features:
T – Traumatic event, or an experience involving actual or threatened death, serious injury, or sexual violence. This can include something that happened directly to you, something you witnessed, or certain traumatic events you learned about or encountered through your work.
I – Intrusive memories, which means thinking about the traumatic event when you don't want to. Intrusive memories could mean exactly what they describe—you're at work and you find yourself thinking of a particularly bad 911 call you responded to as an EMT, and some of the images (or even just the feelings you had then) will not leave you, no matter what you do to distract yourself or try to focus on your job. Intrusive memories can also take the form of flashbacks or nightmares.
A – Avoidance, which is when you stay away from things or experiences that remind you in some way of the traumatic event. For example, if you were hurt by an IED blast in a crowded market, you may only go grocery shopping at midnight, when few people are in the store. If your ex-boyfriend was physically or sexually abusive, you might avoid men altogether, even to the point of not looking for a job or leaving your home. Avoidance can also involve trying not to think or talk about what happened, sometimes without even realizing that you're doing it.
N – Negative thoughts and emotions are another feature of PTSD that can include symptoms of depression, emotional numbness, difficulty remembering important parts of the traumatic event, or a more specific pattern of thinking or feeling, like not trusting anyone because you were severely bullied or assaulted as a kid, or thinking bad things are your fault all the time because you weren't able to save your patient in the ER.
A – Anger, sleep disruptions, an exaggerated startle reflex, and hypervigilance belong to the same group of symptoms that involve feeling jumpy or on edge because of what happened to you. People with PTSD may go from 0 to 100 in a moment when someone says something that triggers them (more on triggers later). They may react more intensely to things that just irritate others, like loud noises or someone cutting them off on the highway. With PTSD, you might find yourself unable to fall or stay asleep because of this sense of being on edge. Your body's stress-response system, which involves chemicals like adrenaline and cortisol, may remain activated even when you're not in danger. You may just be easily startled, or watchful for danger when you don't really need to be, or when the probability of something happening is low. I've spoken to many people who feel they should always face the door in a restaurant or doctor's office in the event that someone enters with a weapon.
T-I-A-N-A. TIANA. Most people who experience a traumatic event do not develop PTSD, although many experience some symptoms of traumatic stress afterward. In fact, according to the World Health Organization, about 5.6% of people exposed to potentially traumatic events develop PTSD at some point in their lives, although the risk is much higher following certain kinds of trauma. We're not entirely sure why some people develop PTSD and others don't. Definitely, if you do go through something hard, it can help to talk about it with a psychologist, social worker, or other helping professional, like a psychiatrist, or even just with a friend or loved one who will listen without judging you or giving you advice. Talking can sometimes help you process—or make sense of—the event and its effects on you. But even this isn't a surefire way to prevent PTSD, and some people who do everything they can still develop symptoms.
The good news is that PTSD is very treatable through various kinds of therapy, such as EMDR, certain kinds of exposure therapy that teach you to gradually approach traumatic memories and triggers, and cognitive processing therapy, which helps you examine how trauma has affected your beliefs about yourself and the world. Many people experience substantial relief from symptoms, and some recover fully, as they learn to more easily tell the difference between what happened in the past and what is going on in their lives now.
Sometimes, recovery also involves something we call post-traumatic growth, or developing a deeper or fuller view of the world, other people, and your purpose in life based on what you've been through. For instance, maybe you go through a period of feeling lonely because you don't trust anyone, but in the process of recovering from PTSD, you understand what friendship means to you, and how important it is. Or, if you're one of those people who struggles with self-blame, maybe you realize that you don't control most unfortunate events that happen to your loved ones, but you do have a role in some of the relationship difficulties that you go through. And you can change what you do to make your relationships deeper and more peaceful.
If there is one thing that you take from this article, I hope that it's that there are many ways PTSD shows up, and you're almost certainly not alone if you're experiencing some or all of these types of symptoms. Also, the condition is not necessarily something that you need to live with for the rest of your life, and effective treatment is available. And strangely, even though most of us do not choose to go through trauma, the experience of recovery can sometimes end up enhancing your life.
Stay tuned for the next five posts, when I go into a bit more detail about what each of the symptoms categories can look like, and offer a few tips on ways to cope.
