Trauma and Post traumatic stress disorder
Trauma can be described as an abrupt shift in physical experience that elicits similar shifts in mental experience. In other words, a sudden and unexpected threat to the physical body will result in a sudden shift in mental processing. This shift tends to be of a dissociative nature and is seen as an adaptive response that protects the person from the physical trauma, distancing them from pain and fear.
Unfortunately, in some cases, this response may also prevent the
natural processing of the event by dissociating the memories so effectively that they remain out of conscious awareness.
Traumatic events that do not pose a physical threat to the body are referred to as stress responses. However, they can also result in dissociative experiences similar to those encountered in physical trauma resulting in the same maladaptive response.
Responses to trauma can generally be expressed in two ways:
Normal Acute Stress Reactions
These are immediate and brief responses to intense stressors that typically last from a few hours and up to 4 weeks. The core symptoms are anxiety and depression.
Anxiety is the result of experiencing a threatening situation and depression is the result of a loss. Quite often both symptoms will appear at the same time, as the threatening situation will often involve some kind of loss (e.g. a road accident in which a companion is killed).
Other symptoms will include:
- Feelings of being dazed
- Lack of concentration
Coping strategies are also part of the acute stress reaction and include avoidance and denial.
This is the most frequent coping strategy and is characterised by the patient avoiding talking or thinking about the event. The patient will not confront anything that reminds them of the event.
Experienced as a belief that the event hasn't happened or as an amnesia for the event itself.
Both avoidance and denial will recede as the anxiety and depression are worked through. This allows for the appropriate processing of the event (reintegration of the dissociated memories) that will lead to an adaptive resolution.
Unfortunately if the coping strategies and defence mechanisms are maintained for too long a period they may become maladaptive and prevent the working through of the traumatic material. This can then result in a condition known as Post-Traumatic Stress Disorder.
Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) can be characterised as an intense, prolonged (sometimes delayed) and abnormal response to stressful and traumatic situations.
PTSD tends to be the result of natural disaster (earthquakes, flooding etc.) and man-made disasters (major fires, war, accidents, rape, abuse, assault etc.). It is thought that personal predisposition plays an important role in the development of PTSD. Epidemiological studies have shown that not everyone exposed to a particular stressor will develop PTSD.
It has been estimated that approximately 1.0% to 2.6% of the population suffer from PTSD.
- Persistent anxiety
- Poor concentration
- Difficulty in recalling stressful events at will
- Intensive intrusive imagery (flashbacks)
- Recurring distressing dreams
- Avoidance of reminders of the event
- Inability to feel emotion (numbness)
- Diminished interest in activity
Dissociative symptoms (depersonalisation and derealisation) also play an important role in the symptomology.
PTSD can occur at any age and the duration of symptomology is variable with most cases resolving within a few months but some persisting for years. The disorder may begin very soon after the precipitating event but can manifest itself several months and, in some cases, several years later.
Patients suffering from PTSD may develop maladaptive coping strategies that can include persistent aggressive behaviour, excessive use of alcohol or drugs, deliberate self-harm, and suicide.
Diagnostic and statistical manual criteria (DSM)