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Posttraumatic Stress Disorder (PTSD) and War-Related StressInformation for Veterans and their Families |
Common Symptoms of PTSD
PTSD is characterised by three main groups of problems. They can be classified under the headings of intrusive, avoidant and arousal symptoms.
Intrusive Symptoms
Memories, images, smells, sounds, and feelings of the traumatic event can "intrude" into the lives of individuals with PTSD. Sufferers may remain so captured by the memory of past horror that they have difficulty paying attent-ion to the present. People with PTSD report frequent, distressing memories of the event that they wish they did not have. They may have nightmares of the event or other frightening themes. Movement, excessive sweating, and sometimes even acting out the dream while still asleep may accompany these nightmares. They sometimes feel as though the events were happening again; this is referred to as "flashbacks", or "reliving" the event. They may become distressed, or experience physical signs such as sweating, heart racing, and muscle tension when things happen which remind them of the incident. Overall, these "intrusive" symptoms cause intense distress and can result in other emotions such as grief, guilt, fear or anger.
Intrusive Symptoms of PTSD:
- Distressing memories or images of the incident
- Nightmares of the event or other frightening themes
- Flashbacks (reliving the event)
- Becoming upset when reminded of the incident
- Physical symptoms, such as sweating, heart racing, or muscle tension when reminded of the event
Avoidance Symptoms
Memories and reminders of traumatic events are very unpleasant and usually lead to considerable distress. Therefore, people with PTSD often avoid situations, people, or events that may remind them of the trauma. They often try not to think about, or talk about, what happened, and attempt to cut themselves off from the painful feelings associated with the memories. In their attempts to do this, they often withdraw from family, friends, and society in general, and begin to do less and less. This may help them to shut out the painful memories, but it can also lead to a feeling of not belonging to the rest of society and no longer taking part in activities they used to enjoy. In this way the person can become "numb" to their surroundings and not experience normal everyday emotions such as love and joy, even towards those close to them. Such reactions can lead to depression, feelings of isolation and problems within the family. They can also lead to severe problems with motivation – people with PTSD often find it hard to make decisions and get themselves going. They may have difficulty making the effort to help themselves or even to do things that they would previously have found enjoyable or easy. This can be very hard for family and friends, who often think that the sufferer is just being lazy or difficult.
Avoidance and Numbing Symptoms of PTSD:
- Trying to avoid any reminders of the trauma, such as thoughts, feelings, conversations, activities, places and people
- Gaps in memory – forgetting parts of the experience
- Losing interest in normal activities
- Feeling cut-off or detached from loved ones
- Feeling flat or numb
- Difficulty imagining a future
Arousal Symptomss
Often people who have experienced a trauma have been confronted with their own mortality. Their assumptions and beliefs that the world is safe and fair, that other people are basically good, and that "it won’t happen to me", may be shattered by the experience. After the event, these people often see danger everywhere and become "tuned in" to threat. As a consequence, they may become jumpy, on edge, and feel constantly on guard. This can lead to being overly alert or watchful and to having problems concentrating (for example, not able to read a book for long, getting only a small amount of work completed in a few hours, easily distracted). Disturbed sleep is very common.
Anger is often a central feature in PTSD, with sufferers feeling irritable and prone to angry outbursts with themselves, others around them, and the world in general. Many veterans feel let down, abandoned, and judged by others. They may have a sense of betrayal about the way they were treated by a range of people on their return to Australia or about things that have happened since. These feelings of betrayal often result in bitterness and anger. Some people only express their anger verbally (which can still be very damaging). Others become physically aggressive and violent to property or people, even to those who are closest to them. Often veterans feel unable to control their anger. The power of their anger may be frightening for them and they often feel considerable remorse afterwards. Such symptoms frequently cause major problems at work, as well as with family and friends.
Arousal Symptoms of PTSD:
- Sleep disturbance
- Anger and irritability
- Concentration problems
- Constantly on the look-out for signs of danger
- Jumpy, easily startled
Why Do Traumatic Stress Reactions Develop?
It is important to understand where the signs and symptoms of PTSD come from. One of the leading clinicians in the area, Mardi Horowitz, described trauma as an experience that is, by its very nature, overwhelming. It contains a mass of new information that is hard to accept or understand. It doesn’t fit with our view of the world or ourselves – the way we think things are or should be. Human beings have a natural tendency to try and make sense of things that happen around them. When people experience a trauma, the event keeps coming back into their mind in an attempt to make sense of what happened. This is a natural way of trying to deal with, or come to terms with, difficult experiences and seems to work well for many stressful life events. However, due to the high level of distress associated with memories of more severe trauma, the thoughts and feelings tend to be pushed away to protect the person from this distress. The result is that, whilst the memory may go away for a while, the need for it to be dealt with has not been addressed and it keeps coming back. The movement backward and forward from intrusive thoughts and feelings about the trauma to avoidance and numbing can then continue almost indefinitely unless the cycle is addressed in some way.
Throughout this, alternating between short bursts of painful memories and periods of avoidance and numbing, the sense of feeling keyed-up persists. The traumatised person has been through an event that potentially threatened their life, or the life of someone else, so the mind and body stay on alert to make sure that it won’t miss any sign in the future that such an event may recur. It is safer to get it wrong by overestimating potential threat than to risk the possibility of missing any future threat. The persistent activation of this threat detection system, however, leaves the traumatised person feeling keyed-up or on edge much of the time. In addition, the threat detection system is so sensitive that it is constantly going off when there is no danger, in a way that interferes with the person’s capacity to live a normal and happy life.
A similar explanation exists with regard to anger. Anger was useful in battle or other situations of threat. It hypes us up and promotes our survival – it may often be an adaptive way to respond to a life threatening situation and certainly better than being immobilised with fear. Again, however, it is no longer useful for our survival once the danger has passed. In fact, as we all know, it starts to cause serious problems in our day to day lives.
Traumatic stress reactions are therefore sensible and adaptive both as part of survival during the trauma and in attempts to come to terms with the trauma afterward. Once we recognise where these symptoms come from, it is easier to understand the typical traumatic stress reactions. The difficult part is letting go of aspects of these reactions that have ceased to provide benefit and are primarily interfering with the traumatised person’s quality of life.