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Post-traumatic stress disorder (PTSD) is a type of anxiety disorder that usually develops after directly participating in or witnessing traumatic events.
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What is PTSD?
Of course, feeling fear in the face of a potentially dangerous situation is quite normal.
In fact, this fear is necessary for our survival. It causes reactions in the body that are aimed at saving our lives if there is a threat. The fight or flight response is natural and necessary to protect us. Most people experience a range of symptoms after traumatic events and usually recover shortly after the event. However, for some people these symptoms do not improve. They may feel scared and stressed, and may have flashbacks from the traumatic event even in normal situations. It is when these symptoms persist and begin to interfere with daily life that PTSD can be diagnosed.
Post-traumatic stress disorder is thought to affect one in three people with a traumatic experience. It is not yet clear why some people develop this condition and others do not. PTSD may develop immediately after experiencing a traumatic event or may appear weeks, months, or even years later.
Can PTSD affect children?
- It's possible. For children under 5 years of age, until they have realized the fact of their mortality, the factors causing PTSD are somewhat different: separation from parents, abuse, and feelings of helplessness. As you grow older, the risk factors are the same as for adults, but one more is added – the reaction of the parents ,” the psychotherapist emphasizes.
“It’s very important for children.” If the parent remains calm, confident, and conveys to the child a sense of control over the situation, then the child endures the traumatic situation more easily. But panic and brokenness of parents can cause the development of a disorder in children, even if nothing threatened them personally. This does not mean that parents should not give in to their feelings. This means that adults need to support themselves with resources and give the child as much confidence and stability as they can at the moment.
Is it a symptom of PTSD if children play protest games?
No. Rather, it is a defensive reaction of the psyche, the psychotherapist emphasizes:
— A game is a way to integrate new unfamiliar phenomena into your world. If the game does not cross the boundaries: children do not cause injuries to each other, do not get stuck in one role, this is normal and there is no need to worry. You can talk and explain reality to children at their level of understanding.
Can law enforcement officers have PTSD?
Yes. PTSD does not only occur in military personnel involved in military operations. Civil conflicts are the same psychotraumatic situation.
“In psychology there is a term “aggressor syndrome,” explains Evgenia Tochitskaya. — Most people experience trauma from causing physical harm and killing their own kind. A very small percentage of people are calm about violence against another person. Therefore, law enforcement officers are specially trained to be able to do this if necessary, and are taught to cope with it.
One of the ways, for example, objectification is when people are called objects, replaced with abstract terms like: “sheep”, “herd”, “territory clearing operation”. The experience of Ukraine shows that security forces from Berkut have turned and continue to turn to specialists for help to cope with PTSD. The situation is complicated by the fact that law enforcement officers often have to hide symptoms, because, firstly, they are ashamed to reveal it in front of their colleagues, and secondly, the diagnosis threatens them with dismissal.
The literature describes another risk factor for PTSD in security forces: often after military or civil conflicts, there is a radical public revaluation of their role, as a result of which they are deprived of social support and are ostracized.
How long does it take for PTSD to develop after trauma?
The period of development of the disorder is from one month to six months. But there can also be delayed PTSD, when it manifests itself several years later, provoked by some kind of trigger. Therefore, the sooner you contact a specialist, the better, the doctor emphasizes. But there's a problem:
— Most traumatized people do not seek help because of fear. This is the fear of legal consequences, the fear of plunging back into these experiences, the fear and shame of condemnation, the fear of misunderstanding.
It is normal to be afraid and ashamed in such situations. But I want to emphasize: post-traumatic stress disorder is an adequate response of the psyche. This, so to speak, is a normal human reaction to an abnormal situation.
Can a GP diagnose PTSD?
Theoretically, yes, but in practice, due to workload and insufficient data, the general practitioner may not give due importance to these symptoms. Therefore, it is better to immediately contact a psychologist, psychotherapist, and in case of serious manifestations (hallucinations, delusional thoughts) - a psychiatrist, the expert advises. This can be done anonymously.
Symptoms of PTSD
In most cases, PTSD symptoms develop within the first month after the event. Although in some cases, symptoms may be delayed for months or years.
Symptoms may also vary from person to person. Some will experience long periods of minor, less noticeable symptoms, followed by periods when they are more severe. Others will have ongoing, severe symptoms that affect their daily life.
While the specific symptoms of PTSD vary from person to person, there are common symptoms associated with PTSD that generally fall into the following categories.
Re-experiencing
The most common symptom of PTSD. Reexperiencing is when a person re-experiences the triggering event. Re-experiencing typically occurs in the form of vivid memories, nightmares, repetitive and disturbing thoughts or sensations, and physical sensations such as pain, sweating, and nausea.
Some people may constantly experience negative thoughts about the event, asking themselves over and over again questions: “Why did this happen to me? How can I stop this?
These repeated questions can prevent them from finding inner peace and coping with the event, often leading to feelings of guilt or shame.
Avoidance and emotional numbness or numbness
Another key symptom of PTSD is an active attempt to avoid any reminders of the trauma. This may mean avoiding certain people or places that remind you of the event, or talking to anyone about the event and everything associated with it.
People with PTSD often ignore memories, repressing them by distracting themselves with other things, such as work.
Other people may try to cope by trying to disconnect from it completely. Not feeling anything sometimes seems like the easier option. This is called emotional numbness. Emotional numbness can cause a person to feel isolated and withdrawn, losing pleasure in things they once enjoyed.
Hyperactivity
PTSD can lead to increased feelings of anxiety and difficulty relaxing. People can be constantly on the lookout for danger and threat. This is known as hyperactivity.
Hyperactivity can lead to increased irritability, trouble sleeping, anger, and difficulty concentrating.
Other problems
PTSD can have a detrimental effect on a person's life. In addition to the symptoms above, people with PTSD may have other symptoms associated with the condition, such as:
- Other mental health problems including anxiety, depression or phobias.
- Physical symptoms including headaches, chest pain, abdominal pain and dizziness.
- Self-destructive or destructive behavior, including drug or alcohol abuse.
Without the right knowledge and support, living with PTSD can become a very lonely experience. In some cases, this can lead to a breakdown in relationships with loved ones and work-related problems.
If you are experiencing problems with PTSD or are worried about a loved one, it is important to seek help early. There are quite a few help centers available for those suffering from PTSD, and while we know it's not easy to seek help, it will make it much easier than going through it alone.
Kinds
The effects of post-traumatic stress disorder depend on what type it is. There are four types of disorders:
- heavy appearance;
- asthenic;
- dysphoric;
- somatoformat.
The severe form is accompanied by causeless anxiety, constant worries; patients have disturbed sleep, insomnia, nightmares at night, and panic attacks. During communication with people, the condition stabilizes, the patient easily makes contact, and is interested in communication.
The asthenic appearance is accompanied by lethargy, bad mood, and indifference to everything that surrounds a person. The patient oppresses himself because he believes that he cannot return to normal life. Apathy leads to the fact that a person begins to lose physical shape, reaching the point where it is difficult for him to get out of bed. Patients prefer daytime sleep and quickly agree to treatment.
Dysphoric appearance is a complex form, manifested by aggression, resentment, anxiety, and distrust of others. Such people like to conflict, are difficult to treat, and in rare cases voluntarily agree to treatment.
The somatoform type is accompanied not only by a psychological disorder, but also by other symptoms, for example, patients complain of pain in the heart and abdomen, and headaches. The complexity of this type is that the symptoms do not appear immediately; they can make themselves felt six months after the incident. If desired, the patient himself may wish to see a doctor.
What are the causes of PTSD?
PTSD can affect anyone. An anxiety disorder can develop after a frightening, life-threatening or disturbing event or after a prolonged traumatic experience.
Types of events that can lead to PTSD include:
- serious road accidents
- violent acts
- long-term drug or substance abuse
- hostilities
- terrorism
- natural disasters
- witnessing a violent death or unexpected injury or death of a loved one
What is PTSD?
When we talk about PTSD, we mean that a person has experienced one or more traumatic events that have deeply affected their psyche. These events are so different from all previous experience or caused such great suffering that the person responded to them with a violent negative reaction. The normal psyche in such a situation naturally strives to alleviate discomfort: a person who has experienced such a reaction radically changes his attitude towards the world around him so that life becomes at least a little easier.
Who's in danger?
Although it is unclear why some people may develop this condition and others do not, there are certain factors that can affect your chances of developing PTSD. If you have a history of depression or anxiety, you may be more likely to develop PTSD after an accident, according to research.
Other risk factors include lack of social support before or after the traumatic event, childhood trauma, or additional stress after the event (death of a loved one, job loss, etc.).
PTSD can also affect children. They generally experience symptoms similar to adults, but there are some symptoms that are more specific to children, such as bedwetting, separation anxiety, or increased anxiety when they are away from adults or reenacting an event through play.
Risk factors for PTSD
Is reading news about traumatic events a risk factor for PTSD?
No. According to current criteria, reading negative news cannot cause PTSD. This process is more likely to provoke anxiety and depressive disorders, panic attacks, explains Evgenia Tochitskaya. Therefore, experts advise in the current situation to limit the flow of information: to keep abreast of current news, but not to be immersed in their flow for hours and days.
Who is especially at risk?
Gender and age are not critical for the occurrence of PTSD. The social factor is more significant, the expert explains:
— If a person after a trauma does not receive support, is rejected by society, remains alone, continues to live under threat, if the perpetrators are not punished, if justice is not restored, these are serious risk factors for the development of PTSD.
“You are safe”, “justice exists”, “we love you even more” - these are the words and feelings that a person who has experienced trauma needs.
Very often, people with PTSD feel excluded from their immediate society and say the following characteristic phrase: “My loved ones have not experienced what I have experienced, they will never understand me.” And indeed it is. But we can say in response: “Yes, we have not experienced this and will not fully understand, but we can be there and empathize with you,” and this is very important support.
Treatment of PTSD
The main treatments for PTSD are medication and psychotherapy (talk therapy). Of course, everyone is different and how PTSD affects people will differ, so the treatment that works for one person may not be for you.
Watchful waiting or active surveillance is an approach that may be suggested if you have been experiencing symptoms for less than four weeks or the symptoms are relatively mild. It involves self-monitoring, where you monitor your feelings and symptoms to see if the situation is improving. This approach is suggested before you are offered any treatment. This should include a follow-up appointment within one month of your initial consultation.
Traumatic events and experiences can be very difficult in themselves. Talking about how you feel and seeking professional help can be a very effective way to treat PTSD. PTSD can also be treated many years after the triggering event, meaning it is never too late to seek help.
Psychotherapy for PTSD
Currently, experts recommend two types of psychotherapeutic treatment.
Trauma-focused cognitive behavioral therapy is a form of cognitive behavioral therapy specifically adapted for PTSD. It is a therapy that focuses on what we think and how those thoughts affect our behavior. It aims to teach you the skills needed to overcome difficult situations. It is recommended to have 8 to 12 one-hour sessions at least once a week.
Eye movement desensitization and reprocessing is a procedure that focuses on rapid eye movements while remembering your experiences. The idea is that the effect of rapid eye movements will be similar to the way our brain processes memories and experiences during sleep. The method was specifically created to treat people with severe traumatic memories, including post-traumatic stress disorder.
If you are unhappy with your treatment or think it is not working, it is important to tell your doctor or therapist. They should offer you another course of treatment or a follow-up appointment to discuss your expectations of the therapy and why you think it didn't work.
Sometimes the first therapist you see isn't the right fit for you, and that's okay. Everything takes time, so if you are not happy with the treatment, speak up.
Drug treatment
Medications for PTSD are not usually prescribed as treatment. You may be offered medication if you are depressed, have trouble sleeping due to post-traumatic stress disorder, or are unable or unwilling to undergo psychotherapy. If you are offered medication, it is usually an antidepressant. Although PTSD is not the same as depression, they have been found to help.
Forms of PTSD
Depending on the predominance of the group of symptoms, the disorder proceeds according to different scenarios.
Its anxious type is accompanied by a feeling of constant, unmotivated anxiety, up to and including panic attacks. Emotionally, such people become unstable and are systematically accompanied by nightmares.
Our Max is a typical anxious type. As his disorder worsened and he began to fear for his daughter's safety, images of her abuse began to appear before his eyes. Attention became unstable, he lost orientation in space and in his personality. While driving a car, I suddenly lost the ability to control it. He couldn't control even the most basic things. The man stopped communicating with friends, his career went downhill.
According to another scenario, a person experiences severe apathy and loss of strength . He cannot motivate himself to action; he spends the entire day motionless in bed. Such an individual is indifferent to both himself and others, his state is depressed.
The dysphoric type of disorder is aggression and irritability towards loved ones, often unconscious. This form of PTSD often accompanies soldiers returning from hot spots. They are suspicious and distrustful, do not want to accept outside help, unlike asthenic patients who willingly agree to therapy. The fighters themselves often say that attacks of aggression frighten them, too. They draw attention to their conflict and inability to compromise, demand complete submission and lose control over themselves. Some personally ask their wives to lock themselves with their children in another room in order to protect themselves from uncontrollable aggression.
The somatoform variant of the disorder is characterized by unpleasant sensations in the body, and usually accompanies a delayed form of the disease. Worrying symptoms include headaches and migraines, tachycardia and heart pain, digestive disorders, tremors of the limbs, as well as dry skin or excessive sweating. Such symptoms are usually confusing in making a correct diagnosis.
How can hypnotherapy help with PTSD?
Some people find hypnotherapy to be a useful tool for treating PTSD. Hypnotherapy, especially when combined with eye movement desensitization and reprocessing, is believed to be an effective way to treat unpleasant memories of trauma.
Trauma can cause a person to lose their own inner sense of security. Thus, the faster emotions begin to be controlled, the faster a person will recover. Hypnotherapy can help you cope with trauma and learn to regain a sense of control and normalcy in your life.
Hypnotherapy aims to access your unconscious mind and change negative experiences.
In most cases, PTSD symptoms develop within the first month after the event. Although in some cases, symptoms may be delayed for months or years.
Kuznetsov Denis Vladimirovichpsychologist of the highest category, hypnotherapist, medical psychologist -
HypnoLIFE
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When to see a doctor
When experiencing severe trauma, complex stressful situations, large-scale events and disasters, violence and other emotional situations, you need to make an appointment with a psychotherapist. JSC “Medicine” (academician Roitberg’s clinic) employs qualified specialists and psychotherapists with extensive experience. Our multidisciplinary medical center also employs experienced neurologists. JSC "Medicine" (clinic of academician Roitberg) is located in the center of Moscow, at 2nd Tverskoy-Yamskaya lane 10, not far from the metro stations Chekhovskaya, Mayakovskaya, Belorusskaya, Novoslobodskaya, Tverskaya.
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Treatment methods
The picture of a person’s mental state and behavior, which is called post-traumatic stress syndrome, describes a certain way of existing in this world. The traditional approach - providing patients with PTS with the opportunity to participate in various kinds of adaptation programs - does not solve the problem, since the main focus of all these programs is not the desire to help a person get rid of a psychological problem, but an attempt to bring his changed ideas about the surrounding reality to the norms accepted in a given society.
Unfortunately, many doctors forget the fact that true physical and mental health is not about conforming to social norms and standards, but about coming to terms with yourself and the real facts of your life. If today the circumstances of life are greatly influenced by exciting memories, behavior, way of thinking and feelings inherited from the past, it is very important to honestly admit their existence, even if it seems “abnormal” to someone.
Based on materials from the World of Psychology website
Diagnostics
- Clinical criteria
Clinical diagnosis is based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
To meet diagnostic criteria, patients must have been directly or indirectly exposed to a traumatic event, and in addition they must have experienced symptoms from each of the following categories for a period of ≥ 1 month:
Symptoms of distortion (≥ 1 of the following symptoms):
- Recurrent, involuntary, intrusive disturbing memories
- Recurrent disturbing dreams (such as nightmares) about the event
- The patient acts or feels as if the event is happening again; these can be different sensations, from flashbacks to a complete loss of awareness of the surrounding reality
- Intense psychological or physiological discomfort when reminded of the traumatic event (eg, sounds similar to what the patient heard during the event, or the anniversary of the event)
Avoidance symptoms (≥ 1 of the following):
- avoiding thoughts, feelings, or memories associated with the event;
- avoiding activities, places, conversations, or people that trigger memories of the event;
Negative effects on cognition and mood (≥ 2 of the following symptoms):
- Loss of memory about important components of the event (dissociative amnesia);
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world in general
- Persistent distorted thoughts about the cause or consequences of the injury, leading to blaming oneself or others
- Persistent negative emotional state (eg, fear, horror, anger, guilt, shame)
- Significant decrease in interest or participation in important events
- Feeling disconnected or alienated from other people;
- Persistent inability to experience positive emotions (eg, happiness, satisfaction, feelings of love)
Altered level of consciousness and reactivity (≥ 2 of the following symptoms):
- difficulty sleeping;
- irritability or angry outbursts;
- Unreasonable behavior or self-aggression
- Problems with concentration
- increased start reflex;
- hypervigilance
In addition, the manifestations must cause significant discomfort or significantly impair social or occupational functioning, and must not be associated with the physiological effects of psychoactive substances or other disease.
