Post-Traumatic Stress Disorder
Peter was in a work accident six months ago. He doesn’t remember what happened, but he fell from a six stories rooftop. After he fell he lost consciousness and was admitted to the ICU. At first, Peter thought he was going to die, but his body slowly healed and recovered. It took a couple of months before he could go back to work. Now that he’s back to work, he has terrifying nightmares; sometimes he dreams about the fall on the construction site, other times it is about tornadoes. He also finds it hard to do his work. His heart races in the elevator and he gets all sweaty while working on the upper floors. He is also more irritable and lost his temper about nuance things his co-worker did. Peter feels lonely and struggles to connect with his wife and daughter. “They just don’t get it,” he thought. He has not been intimate with his wife for almost five weeks, they used to have good sex. When his wife encouraged him to see a therapist, he got extremely upset and refused to talk about it.
Peter has a mental health condition called PTSD which is common among people who experienced life-threatening incidents. This blog explains the symptoms of PTSD.
When does PTSD start?
Trauma symptoms usually develop within three months after the traumatic incident and can last between months to years. According to the DSM, half of the adults recover within three months. PTSD is diagnosed if symptoms last longer than one month.
Who gets diagnosed with PTSD?
Adults, teens, and children (older than one year) can develop trauma symptoms. These symptoms look different in children younger than six years and are not discussed in this blog.
People are more vulnerable to develop PTSD if they
experienced multiple traumas in their life
experience ongoing stress (financial difficulties, surgeries, job loss, or ongoing court cases related to the traumatic incident)
has a poor support network
has an existing mental health disorder such as bipolar, depression, or anxiety
experience long-lasting physical pain because of the trauma
Criteria A for PTSD
Experiencing a traumatic incident(s)
The DSM—5 is specific about which incidents cause PTSD. If your trauma does not fit these criteria, you might feel invalidated, but keep in mind this is the criteria for a PTSD diagnosis, and it does not define trauma. The trauma experiences not mentioned here can be distressing with persistent symptoms, leading to other mental health conditions such as depression or anxiety. Continue to seek support even if the traumatic event is not mentioned here.
Traumatic incidents according to the DSM-5
If one experienced or witnessed, or learned about a loved one who experienced any of these traumatic incidents below.
Exposure to a life-threatening incident
Serious injury
Sexual violation
First responders e.g firefighters who are exposed to these events continually can also develop PTSD. For example, a police officer is exposed to details of sexual abuse.
Examples of traumatic incidents
Attempted rape, rape, non-consensual penetration
Construction worker falling from a ten-story building
A co-worker witnessing the fall
The construction workers’ wife learning about the details of the fall
The paramedic assisting on the accident site and attending to the construction worker’s wounds.
Criteria B for PTSD
Intrusion symptoms
If you have PTSD, you might experience one or more of the following intrusive symptoms:
Distressing memories of the traumatic event
Distressing dreams. These dreams can be related to a traumatic event or a different scenario, but the underlying feelings are similar. For example, Peter dreamed about tornadoes with an underlying tone of anxiety and powerlessness. He also felt anxiety and powerlessness during the traumatic incident.
Flashbacks, when the person feels as if they are re-living the event. This might be short or long moments in time, and the person might feel as if they are pulled back into the memory as it is happening to them again at the moment.
Severe stress when you are reminded of the event. For example, Peter was irritable (lost his temper) and anxious (heart racing) when he was reminded of the incident.
Physical reactions when reminded o the incident. For example, Peter was sweaty and had a racing heart in the elevator. The elevator reminded him of heights and the fall.
Criteria C for PTSD
Avoiding reminders of the trauma
If you have PTSD, you might experience one or both of the following symptoms:
Avoiding memories, thoughts, or feelings related to the traumatic incident. For example, Peter did not want to talk about the incident or therapy.
Avoiding external reminders of the incident that lead to distressing memories, feelings, or thoughts. For example, Peter preferred to take the elevator instead of the stairs, because the stairs reminded him of the incident.
Criteria D for PTSD
Changes in mood and unhelpful thought patterns
If you have PTSD, you might experience two or more of the following symptoms:
Memory problems. For example, struggling to remember parts of the incident or the chronological order it happened.
Unhelpful beliefs about yourself or the world. For instance, Peter believed no one understands him or “get it”. Other examples of unhelpful beliefs are “The world is unsafe” or “I am permanently broken because of the trauma”.
Self-blame. Blaming yourself for the incident even though it was not your fault. For instance, Peter blames himself for the incident because he should have “known” the safety equipment is faulty. Even though he double-checked the equipment, there was no way he could have known the equipment is faulty.
Persistent changes in mood. For example, feeling heavy and dark feelings such as, anger, sadness, shame, anxiety, and hopelessness.
Lost interest in activities you used to enjoy. For example, Peter lost interest in sex. Other examples, loss of interest in family gatherings, sport, reading, DIY projects, art activities.
Feeling lonely and disconnected from others. For example, Peter felt disconnected from his family.
Struggling to feel lighter feelings such as joy, peace, satisfaction, and love.
Criteria E for PTSD
Increased arousal
If you have PTSD, you might experience two or more of the following symptoms:
Anger outbursts and irritable behavior and feeling “on the edge”. For example, Peter lost his temper over nuances.
Self-harm and reckless behavior. For example, driving too fast, cutting, unsafe sex, overspending.
Hypervigilance. Being over alert, constantly checking your surroundings for possible danger. For instance, going to the grocery store in a relatively safe area and constantly looking over your shoulder to see if someone is following you.
Exaggerated startle response. A startle response is a natural and unconscious behavior to danger. It is closely linked to the flight, fight and freeze response. After trauma, these responses are easily “activated” and lead to an exaggerated response when something unexpected happens. For instance, Peter would get a startle response when his wife talked to him and he was not aware of her presence in the room.
Difficulty concentration. Struggling to focus on one thing, or to complete tasks. For example, Peter found it difficult to complete his tasks at work.
Sleeping difficulties. For instance, struggling to fall asleep, stay asleep, or not getting good quality sleep.
Other criteria for PTSD
Symptoms have to be present for more than one month.
These symptoms affect your ability to work and to have meaningful connections with others.
These symptoms are not caused by depression, anxiety, drugs, or any other medical condition.
After the various altercations with coworkers and his wife, Peter decided to go for therapy. The trauma therapist discussed various treatments with him and collaboratively they decided to do CPT, which help him to stop avoiding the trauma. Peter learned how his thoughts are related to his feelings and he was able to change unhelpful thought patterns. After a few sessions, Peter’s PTSD score dropped and he connected more with his family, he was able to complete tasks and was less irritable.
This blog discussed the five main categories of PTSD which are
Experiencing a traumatic incident
Intrusion symptoms
Avoiding reminders of the trauma
Changes in mood and unhelpful thought patterns
Increased arousal
Information on this website is provided for information purposes only and is not intended as a substitute for the advice provided by a mental health therapist or other healthcare professional. No information offered here should be interpreted as a diagnosis of any disorder, nor an attempt to treat or prevent or cure any disease or condition. Names, characters, places, and incidents on this website are for illustrative purposes only. Any resemblance to actual events or locales or persons, living or dead, is entirely coincidental.
