Post-traumatic Stress Disorder (PTSD):

Symptoms, Types and Treatment

Traumatic experiences can produce feelings of anxiety, depression, despair, hopelessness, reoccurring anger, self-blame, guilt, and shame, as well as sexual dysfunction, compulsive or aggressive behaviors, sleep disorders, and concentration problems.

Post-traumatic stress disorder (PTSD) is a medically recognized disorder that occurs in normal individuals under extremely stressful conditions. Its symptoms affect people from all walks of life, including soldiers, victims of natural disasters or serious accidents. PTSD can affect people who provide emergency services for others. Some individuals who survive a traumatic event are affected so strongly by the experience that they are unable to live normal lives.

What are the symptoms of PTSD?

There are four main types of PTSD symptoms. A diagnosis of PTSD requires the presence of all categories of symptomatic responses:

• Re-experiencing the trauma: flashbacks, nightmares, intrusive memories and exaggerated emotional and physical reactions to triggers that remind the person of the trauma.
• Emotional numbing: feeling detached, lack of emotions (especially positive ones), loss of interest in activities
• Avoidance: avoiding activities, people, or places that remind the person of the trauma
• Increased arousal: difficulty sleeping and concentrating, irritability, hypervigilance (being on guard), and exaggerated startle response.

How do animal studies help us understand PTSD and its symptoms?

There is increasing evidence that the symptoms of PTSD are abnormal responses to stress. According to trauma authority Dr. Peter Levine, traumatic symptoms are not caused by the dangerous event itself. These symptoms arise when residual energy from the event is not discharged from the body, but remains trapped in the nervous system where it can wreak havoc on our bodies and minds.

Levine observes that wild prey animals, though threatened routinely, are rarely traumatized. Animals in the wild utilize innate mechanisms to regulate and discharge the high levels of energy arousal associated with defensive survival behaviors. These mechanisms provide animals with a built-in ''immunity'' to trauma that enables them to return to normal in the aftermath of highly ''charged'' life-threatening experiences.

Although humans are born with virtually the same regulatory mechanisms as animals, the function of these instinctive systems is often overridden or inhibited. This restraint prevents the complete discharge of survival energies, and does not allow the nervous system to regain its equilibrium. From this perspective:

• ‘Traumatic panic anxiety�?symptom occurs where normally varied and active defensive responses have been unsuccessful �?when a situation, perceived as both dangerous and inescapable, results in a profound failure of innate defenses.
• Un-discharged “survival energy�?remains “stuck�?in the body and the nervous system �?sympathetic and parasympathetic responses are concurrently activated, like brake and accelerator, working against each other.
• Symptoms of trauma result from the body's attempt to ''manage'' and contain this unused energy.
• Healing the symptoms of PTSD is accomplished by normalizing defense responses �?by progressively re-establishing the pre-traumatic defensive and orienting responses that were in execution just prior to the initiation of immobility.

In summary, when the normal defensive resources fail to resolve the situation, terror- panic, rage and freezing occur. These emotional anxiety states are evoked when the feelings of danger-orientation and preparedness to flee are blocked or inhibited. It is this “thwarting�?that results in freezing and anxiety-panic symptoms associated with PTSD.

What are the consequences of PTSD?

PTSD can have severe and long lasting effects on people's lives. Examples of outcomes of PTSD are:

Consequences of PTSD
Physiological outcomes	neurobiological changes (alterations in brainwave activity, in size of brain structures, and in functioning of processes such as memory and fear response) psychophysiological changes (hyper-arousal of the sympathetic nervous system, increased startle, sleep disturbances, increased neurohormonal changes that result in heightened stress and increased depression) physical complaints that are often treated symptomatically, rather than as indications of PTSD (headaches, stomach or digestive problems, immune system problems, asthma or breathing problems, dizziness, chest pain, chronic pain or fibromyalgia)
Psychological outcomes	depression (major depressive episodes, or pervasive depression) other anxiety disorders (such as phobias, panic, and social anxiety) conduct disorders dissociation ("splitting off" from the present, and into parts of the self) eating disorders
Social outcomes	interpersonal problems low self esteem alcohol and substance use employment problems homelessness trouble with the law
Self-destructive behaviors	substance abuse suicidal attempts risky sexual behaviors leading to unplanned pregnancy or STDs, including HIV reckless driving self-injury

What is Complex PTSD?

Prolonged, extreme traumatic circumstances �?such as childhood sexual abuse, prisoner of war camps, or long-term domestic violence �?can cause a form of PTSD called Complex PTSD. As in PTSD, ordinary, healthy persons under severe circumstances can experience changes in how they adapt to stress and how they view themselves. A mental health diagnosis called Borderline Personality Disorder is also highly indicative of a history of trauma, and is increasingly viewed as a type of Complex PTSD.

Possible symptoms of Complex PTSD are:

• severe behavioral difficulties (such as alcohol/drug abuse, aggression, eating disorders)
• difficulty in controlling intense emotions (such as anger, panic, or depression)
• other mental difficulties (such as amnesia or dissociation �?a serious condition called Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, which is characterized by "splitting off" parts of oneself).

Why do some people have stronger reactions than others to similar situations?

Anyone exposed to a severely traumatic experience is likely to have symptoms of post-traumatic stress. However, one person's symptoms may appear soon after the event, while another's may not surface for several months or maybe even for years. One person may have relatively minor difficulty adjusting and returning to a fairly normal state, with mild and occasional flare-ups, while another might be debilitated for years to come. Even if two people are exposed to the same situation at the same time, they will have different levels of reaction.

While there is no scientific way to predict or measure the potential effect of a traumatic event on different people, certain variables seem to have the most impact:

• the extent to which the event was unexpected, uncontrollable, and inescapable
• perceived extent of threat or danger, suffering, upset, terror, and fear
• source of the trauma (human-caused is generally more difficult than event of nature)
• sexual victimization, especially when a sense of betrayal is involved
• actual or perceived responsibility
• prior vulnerability factors (such as genetics, early onset and extent of childhood trauma)
• negative social environment (shame, guilt, stigmatization)
• lack of appropriate social or emotional support
• concurrent stressful life events

How is PTSD diagnosed?

A diagnosis of PTSD is made when symptoms in the main clusters (re-experiencing, numbing, avoidance, and arousal) are present for an extended period and are interfering with normal life. The first step in getting treatment is getting a diagnosis. This can be difficult for a number of reasons:

• symptoms may occur months or years after the traumatic event and may not be recognized as being related to the trauma
• beliefs that people "should be able to get over it" or "shouldn't have such a reaction" or "should solve their own problems" may delay treatment being sought
• guilt, blame, embarrassment or pain may interfere with a person seeking help
• avoidance of anything associated with the trauma may result in an inability to recognize the need for treatment

How is PTSD commonly treated?

Symptoms of PTSD are commonly treated by:

Psychotherapy

Because PTSD has so strongly affected the brain itself, treatment often takes longer and progresses more slowly than with other types of anxiety disorders, and is most effective with a specialist in trauma recovery. It is most important to feel comfortable and safe with the therapist, so there is no additional fear or anxiety about the treatment itself. Depending on the extent of the symptoms, it may be more effective to see the therapist several times a week, if possible.

• Cognitive-Behavioral Therapy (CBT), often including exploring personal history as well as history of the event, challenging beliefs and thoughts that lead to distress, learning to recognize and manage "triggering" episodes, and exposure or desensitization (gradual re-introduction to the event that caused the trauma)
• Psychotherapy may include relaxation techniques (deep breathing, muscle relaxation, positive imagery, meditation, neurofeedback, prayer, etc.) There are documented instances where relaxation was counterproductive—triggering rather than relieving symptoms.
• Psychotherapy may take place in a group setting.

Medications

• anti-anxiety medications or anti-depressants to calm anxiety and stabilize mood while other self-care tools are learned

• used most frequently in conjunction with standard psychotherapies

There are also newer effective approaches to healing PTSD that integrate cognitive, emotional and sensory motor experience.

What therapies treat PTSD symptoms by integrating cognitive, emotional and sensory/motor experience?

Noted trauma authority and author Bessel van der Kolk has written, "... re-living trauma often occurs in the form of physical sensations that precipitate emotions of terror and helplessness. Learning how to manage and release these physical sensations from trauma-based emotions is an essential aspect of the effective treatment of PTSD.�?

There are now a number of schools of what has come to be known a somatic psychotherapy which utilize cognitive, emotional and sensory/motor experience to treat PTSD. These include:

• EMDR therapy combines a somatic therapeutic approach with eye movements or other forms of rhythmical stimulation, such as hand taps or sounds that stimulate and integrate the left and right hemispheres of the brain.

• Somatic experiencing is a therapy developed by Peter Levine that incorporates observations of how animals treat themselves following traumatic events and focuses on restoring normality to the stress response. According to Levine, the symptoms of trauma result from highly activated incomplete biological response to threat. Wild animals have the ability to “shake off�?this excess energy. By enabling humans to do the same, trauma can be healed