We all depend on patterns, whether it is navigating traffic, playing a sport, or recognizing a familiar situation. They help us deal with the world around us in a more efficient way. They help us to not be constantly having to take in every fragment of information around us to understand what is happening.
Patterns allow our brains to see order in the world around us and find rules that we can use to make predictions. Instead of trying to absorb information in unrelated bits, we can use the pattern to make sense of what is going on around us.
This great ability to decipher our complex world can also be harmful, especially if we have experienced a traumatic event. It could be intentional harm, a traumatic accident, or the horrors of war. Then, our brain is at risk of seeing patterns which may remind us, or trigger in us, the feelings we had during the actual traumatic event.
June is National Post-Traumatic Stress Disorder (PTSD) Awareness Month and is intended to raise public awareness about PTSD-related issues, reduce the stigma associated with PTSD, and help ensure that those suffering from the invisible wounds of trauma experiences receive proper treatment.
There are estimated to be about 8 million people in the United States with PTSD.
What is PTSD?
The core issue of PTSD seems to be a problem or malfunction in how trauma is remembered. PTSD is common; between 5% and 10% of us will experience this. PTSD may develop at least one month after a traumatic event. Before then, many therapists consider the reaction to be an “acute stress event,” sometime diagnosed as an acute stress disorder. Not everyone with this will go on to develop PTSD, but approximately half will. If your symptoms last longer than a month, it is important to be evaluated for PTSD. It may develop at least one month after a qualifying traumatic event, specifically an event that involves the threat of death or harm to physical integrity. This is common across all ages and groups.
This malfunction in how the brain is remembering past trauma leads to several potential mental health symptoms. Not everyone who goes through a traumatic event will develop PTSD. There is much research going on as to which of us are more susceptible to the repetitive thinking, or ruminating, that can cause PTSD.
It is common in patients seeing their primary care provider but unfortunately is often undetected. Women are twice as likely to receive a diagnosis compared to men. You do not have to have been in the military. People inside and outside the military have traumatic experiences.
What kind of trauma has been linked to PTSD?
Important to know although about one-half of adults have had traumatic experiences, less than 10% develop PTSD. The kinds of trauma which have been linked to PTSD:
- Sexual relationship violence – more than 30% of victims of sexual relationship violence have experienced PTSD.
- Interpersonal traumatic experiences – like the unexpected death or another traumatic event of a loved one, or the life-threatening illness of a child.
- Interpersonal violence – this includes childhood physical abuse or witnessing interpersonal violence, physical assault, or being threatened by violence.
- Participation in organized violence – this would include combat exposure, witnessing death/serious injury, accidentally or purposefully caused death or serious injury.
- Other life-threatening traumatic events – like a life-threatening motor vehicle collision, a natural disaster, and other.
What are the symptoms?
Intrusive thoughts, avoiding things which remind you of the trauma, and depressed or anxious mood are the more common symptoms. These symptoms can lead to considerable problems at home, work, or your relationships. PTSD symptoms:
- Intrusion symptoms – “re-experiencing,” unwanted thoughts, flashbacks.
- Avoidance symptoms – avoiding activities, people or situations which remind people of the trauma.
- Depressed mood, seeing the world as a frightful place, inability to connect with others.
- Being agitated or “on-edge,” especially when it has started after experiencing a traumatic event.
- Difficulty sleeping, disturbing nightmares.
Since there are other behavioral health disorders which overlap with PTSD, it is important that your provider help you sort this out. It is important for providers to ask their patients about past trauma, especially when there are anxiety or mood symptoms.
Treatment can involve a combination of medications and psychotherapy, but psychotherapy overall may have the greatest benefit. Psychotherapy is the preferred initial treatment for PTSD and should be offered to all patients. Trauma-focused psychotherapies have been shown to be very effective compared to just medication or “non-trauma” therapy. Trauma-focused psychotherapy centers around the experience of past traumatic events to aid in the processing of the events and changing beliefs about the past trauma. These beliefs about the past trauma are often causing great distress and are not helpful. Medication is available to support the treatment and can be quite helpful. In addition, for those suffering with disturbing nightmares, your provider may also be able to help.
What are risk factors for PTSD?
There is increasing emphasis being placed on identifying factors that explain individual differences in responses to trauma. Some of us are more resilient. Are there genetic factors, childhood experiences, or other stressful lifetime events which make us vulnerable?
Many of these events are common, resulting in many affected individuals. An analysis from a survey of a large, representative community-based sample in 24 countries estimated the conditional probability of PTSD for 29 types of traumatic events. The risk factors identified include:
- History of trauma exposure prior to the index traumatic event.
- Less education
- Lower socioeconomic status
- Childhood adversity (including childhood trauma/abuse)
- Personal and family psychiatric history
- Poor social support
- Physical injury (including traumatic brain injury) as part of the traumatic event
A common theme in many of the surveys has demonstrated a higher incidence of PTSD when the trauma was intentional rather than un-intentional.
Finally, if you, a loved one, or a friend are suffering from any of these symptoms, the good news is there are effective ways to treat. Please reach out.