Post-traumatic stress disorder — more than just nightmares, by Dr. Susanne Fogger


June is PTSD Awareness Month. PTSD is a life-disrupting syndrome that is often linked to Veterans and the trauma related to combat experiences. However, the human response to trauma is not exclusively a combat disorder, and PTSD affects people from all walks of life. Trauma can stem from violent relationships, accidents or even experiences with medical care. Experiencing PTSD can have a profound effect on individuals, and we all need to be aware of risk and protective factors for recovery and prevention.

The American Psychiatric Association’s Diagnostic and Statistical Manual 5th Edition recognizes that PTSD is separate from anxiety disorders. PTSD is defined as an ongoing disruptive response to trauma that lasts more than 30 days. Initially, the stress response is related to heightened senses, and over a prolonged period, continually elevated levels of norepinephrine (a neurohormone related to adrenaline, the flight or fight hormone) result in insomnia, irritability and mood changes, as well as an inability to enjoy the things one used to. Individuals with PTSD may also re-experience trauma or feel numb and disconnected from reality.

Realistic flashbacks can contribute to the person feeling like they are losing their mind. In addition, repeated exposure to trauma, such as in combat or as a first responder, increases the risk of developing PTSD. PTSD rates for first responders are about 10 percent compared to the 1.3-3.5 percent of the general population, and those not directly involved in the initial trauma can get PTSD when dealing with trauma victims.

Unexpected sensations may retrigger traumatic experiences, as well. For example, a smell can trigger traumatic memories, as the olfactory nerve is directly tied into the emotional system of the brain. Driving near the site of an accident might also resurface memories. To avoid this, the person may avoid any situations that remind them of the event. Other symptoms include frequent nightmares, survivor guilt, depression and anxiety, which can be overwhelming and unremitting. Sometimes, individuals with PTSD use alcohol and other mind-altering substances to become numb to these thoughts and feelings.

For some, suicidal thoughts may become more prevalent, as they view suicide as an acceptable alternative to living with untreated PTSD. Erroneous thinking may drive the person to conclude their family may be better off without them. While not all individuals with PTSD become suicidal, having untreated PTSD does increase the risk for suicide. It is also important to know that each person’s PTSD experience is unique. Some people have PTSD symptoms over a prolonged period, so the PTSD becomes chronic and ongoing. Others may have short-lived PTSD which resolves on its own. Further, not all people develop PTSD immediately after the trauma, and some may experience the symptoms of PTSD years later after times of stress and distress.

Considering PTSD is a brain disease, what makes a person vulnerable to develop PTSD in the first place? Researchers have explored the histories of people who have developed PTSD and found several risk factors increasing the likelihood of development.

  • Early childhood experiences: Any form of abuse and neglect in childhood increases the risk along with poor interpersonal relationships and inflexible thinking.
  • Psychiatric illness such as major depressive disorder, anxiety or substance use disorder.
  • Maturation level: Younger and/or less emotionally skilled individuals face an increased risk. Developmental periods such as late adolescence and early adulthood increase the vulnerability to develop PTSD.
  • Genetics: Those with family histories of mental illness such as depression, PTSD, and suicide have a higher risk for PTSD.
  • Gender: Women, while less likely to be exposed to trauma, have a higher likelihood of development of PTSD when exposed.
  • Race and ethnicity: Rates of PTSD are highest in those who are African American, intermediate in those who are white or Hispanic and the lowest rate among Asians. Knowing the risk factors for PTSD can guide development of prevention strategies.

While not all factors are modifiable, we can promote a strengthening of factors that act as an emotional life preserver to decrease risk for PTSD. This life preserver is called resilience, a dynamic process that helps people recover from traumatic life events. Resilience is the ability to regain balance after a heavy stressor, a way of responding to events that allow for self-repair and resumption of life. The military has been teaching methods of mental flexibility through mindfulness training, as well as other skills, with the hope that this will decrease the toll of repeat exposure to trauma. First responders with frequent exposure to traumatic accidents and interpersonal violence may benefit from such training. Having a sense of self and one’s moral calling is considered protective, as is being able to consider situations with a degree of flexibility. Those who can adapt this fluid thinking are less likely to develop PTSD.

While this is a simplistic view of a complex issue, providing tools to manage thinking and levels of stress may help individuals be more resilient when exposed to horrific trauma. This skill can be beneficial on multiple levels, even if a person is never exposed to trauma.

Another valuable tool is treating mental illness early and well. Increased awareness of treating children and adolescents for anxiety and depression can help decrease their risk of development of PTSD if exposed. Treatment works best with the patient’s active participation in the process. Therapy may include commitment from the patient to increase exercising such as walking or gentle yoga, as well as both medication and therapy.

So, what can you do to assist someone who is struggling with PTSD? The first step is to recognize that their behavior is not about you. Being supportive means accepting the person as they are and not expecting them to “just get over it.” Don’t give up if your offers for activities are turned down — keep asking anyway. Be trustworthy, which means do what you say you are going to do, when you are going to do it. Encourage the person to seek help for depression, anxiety and substance use as untreated issues make the PTSD worse. Finally, work on developing your own resilience by practicing activities which increase your emotional flexibility.

This is the third blog post in Dr. Susanne Fogger’s ongoing blog series. For the first installment, on addiction, click here. For the second installment, on mental health, click here.


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