Through movies most of us are familiar with the stereotypic” Vietnam Vet”, who years after “Nam” is living his life as if he were still in the hell of war. The backfiring of a car causes him to drop to the ground ready to fire as if ambushed. He thrashes in the early hours, a tangle of sweat and sheets reliving the horrors of war in his sleep. He has a permanent slight tremor in his trigger finger and he is prone to unexpected explosions of anger. He regularly drinks himself to oblivion to stop the memories erupting in his mind. When most us think Post Traumatic Stress Disorder this is what we think of.
So influenced are we by the pairing of the Vietnam Vet with PTSD that there is a public conception that PTSD only occurs if someone has been in a combat situation. But, this is not the situation. PTSD is a group of symptoms may trouble anyone who has experienced a traumatic event or a number of traumatic events. A traumatic event could be a natural disaster, such as flood or bushfire. It could be an act of violence perpetrated against someone, like an assault or serious threat by another person to their life, such as in domestic violence or violence in other contexts. It could be sexual assault or sexual abuse. It could be something horrific that was witnessed. It could occur in the line of one’s work or in their private lives. In essence, a traumatic event can come in multiple forms and shows no discrimination across age, gender, cultural background, religion or nationality. Most importantly, for PTSD the trauma is exposure to actual or threatened death, serious injury, or sexual violence. The trauma my happen to someone directly, or the person may have witnessed the trauma, learned about a traumatic event to a close family member or friend or it may be that the person experiences repeated or extreme exposure to horrific details of traumatic events through work, being in a war torn country or in a family situation.
I mentioned that PTSD is a group of symptoms. This group of symptoms forms four clusters. These cluster are:
- Intrusive thoughts. As the name suggests, people who have PTSD are greatly troubled by memories or fragments of memory of the traumatic event(s) popping (intruding) into their thinking. This might be in the form of dreams. It might be the experience of memory fragments coming to mind for no apparent reason. It might be that for the person the memories that arise are so compelling the person feels like they are back in the traumatic scenario. It might also be that certain body sensations, sights or smells set off strong feelings connected to the traumatic event. The intrusion could be a sense or a feeling and does not necessarily have to be a vivid remembered scene.
- Negative thoughts about oneself and /or others and/or the world that emerged with the traumatic event. It is very common for people with PTSD to blame and hold themselves accountable in some sort of way for what occurred. Many hold the belief that they brought the event on themselves in some sort of way and deserved what happened. Sometimes people who have PTSD have strong hostility and rage toward those who they associate with the trauma. It is not uncommon as well for those who have PTSD to believe that the world in general is unsafe and they are constantly under threat of another catastrophic event.
- Arousal and reactivity. Often those with PTSD feel like they are on alert 24/7. They are always on edge and at the ready for something bad to happen. They may be irritable and have angry outbursts, have trouble concentrating, startle easily and/or have trouble with sleep.
- Avoidance of things that are a reminder of or associated with the traumatic event. People with PTSD may try all kinds of things to not think about or be reminded of the traumatic event. They may have ways of pushing the thoughts away through being super busy and never being idle. They may distract themselves and engage their mind to avoid intrusive thoughts and feelings through such things as gaming, pornography, drug and/or alcohol addiction, fantasy or some other interest. Those with PTSD may also go to great lengths of stay clear of places, people or things connected with the traumatic event.
Treatment of Post Traumatic Stress Disorder (PTSD)
Recent treatment guidelines published by the American Psychological Association and Veterans Affairs / Department of Defence (USA) strongly recommend one of the following three treatments for PTSD: Cognitive Processing Therapy, Prolonged Exposure or trauma-focused CBT. These recommendations are on the basis of the research evidence in support of these interventions. It is also recommended that one of these interventions be the first line of intervention for PTSD.