Post Traumatic Stress Disorder

A new medical condition emerged in the aftermath of the Vietnam War and the women's movement. It was known as Post Traumatic Stress Disorder, or PTSD. To understand PTSD and its impact, one has to first establish a definition for trauma.

Two definitions are emerging from researchers studying PTSD. The first defines trauma as overwhelming life experience, an event or events that overwhelm an individual's psychological or biological coping mechanisms. Examples are combat, domestic violence or sexual assault. A newer definition relates to the sudden loss of loved ones. In this definition, trauma is defined as the abrupt cessation of emotional bonds. This could be a result of bereavement, or it could be caused by abrupt removal from an environment where one has formed strong emotional bonds, such as ties to family members.

Diagnosing PTSD — Herman's Model

PTSD is a combination of physiological and psychological effects that develop in the aftermath of traumatic events. Different researchers use different models to define the effects of PTSD. Judith Lewis Herman, a Harvard researcher and author of Trauma & Recovery, cites hyperarousal as the cardinal indicator. Hyperarousal is a high level of arousal that occurs when the nervous system has become deregulated. The person startles easily, reacts intensely, and has trouble resting. This is, in fact, the symptom that drives many trauma survivors into attempts to control the effects of hyperarousal through drugs or alcohol. Survivors are most likely to abuse depressants of the central nervous system as they try to calm down. Often they use alcohol, opioids or tranquilizers such as Valium to achieve this effect.

These attempts at self-medication can easily develop into substance abuse. Unfortunately, drug use does not address the root of the problem the traumatic experienceand substance abuse gradually creates a host of new problems for the sufferer.

Another indicator from Herman's model is what she refers to as constriction, the process of limiting one's world. This is when the individual becomes disconnected, isolated and avoids things that remind him/her of the trauma. Constriction can also take the form of alterations in consciousness or feeling. Survivors can become physically numb or mentally "spaced out" in the aftermath, or when confronted with reminders of the traumatic experience.

Herman's third indicator is intrusion, a referral to intrusive thoughts, memories or recurrent dreams that constantly bring the memory of the trauma back into the life of the survivor. These intrusions can also take the form of visual images or body memories that are not connected to a sequential memory of events.

Diagnosisng PTSD — APA Model

The American Psychological Association defines trauma by two elements: an actual or threatened death or injury to oneself or another; and a response that involves fear, horror or helplessness. The APA defines PTSD as the traumatic event re-experiened in one or more of the following ways:

  • recurrent or intrusive memories;
  • recurrent dreams;
  • feeling that the event is recurring (i.e. flashbacks);
  • intense distress at exposure to cues that symbolize the event; and/or
  • psychological reactivity upon exposure to those cues.

The APA also defines the PTSD sufferer as displaying three or more of the following:

  • persistent avoidance of stimuli associated with the trauma;
  • efforts to avoid thoughts feelings associated with the trauma;
  • efforts to avoid places people and activities associated with the trauma;
  • inability to recall important aspects of the trauma;
  • diminished interest;
  • feelings of detachment and estrangement;
  • restricted range of affect (emotional range);
  • a sense of a fore-shortened future demonstrated by living provisionally, i.e. recklessness about actions or finances that indicates a poor sense of the future;
  • persistent symptoms of increased arousal;
  • difficulty sleeping, irritability, difficulty concentrating, hypervision; and an exaggerated startle response.

To qualify as PTSD, by APA criteria, these symptoms must last more than one month and cause clinically significant distress or impairment in social occupational or other areas of functioning.

Trauma survivors need to address the source of their trauma in order to overcome the symptoms that result from it. You're not ill and it's not your fault. But you do have to work to overcome the effects and we urge survivors to find other survivors so you can help each other to overcome these problems.