#MentalHealthMonday: Understanding Post-Traumatic Stress Disorder

Post-traumatic Stress Disorder was previously associated solely

with war veterans who experienced ‘shell shock’ from their time spent in combat. However, Post-traumatic Stress Disorder (PTSD) is a mental illness that develops after a traumatic event – whether it was experienced firsthand, witnessed, learned of, or through repeated or extreme exposure as a first responder. Our natural reaction to perceived frightening or dangerous situations is to fight or flight, activating the sympathetic nervous system to trigger an acute stress response (resulting in increased levels of hormones including adrenaline and cortisol, producing a rapid heart rate and higher blood pressure) which prepares the body to leave the environment or to face the threat, protecting it from harm. Reactions to trauma are varied, but symptoms will typically subside on average in one month. With PTSD, it is as if the nervous system becomes stuck and the feelings of stress and fear continue when one is safe, enduring:

Re-Experiencing the Event

Flashbacks
Bad dreams
Frightening thoughts
Intense mental and/or physical distress when thinking about the event

Alienation and detachment

Trouble remembering key features of the traumatic event
Negative thoughts about oneself or the world
Distorted feelings like guilt or blame
Loss of interest in enjoyable activities

Changing Routine

Staying away from places, events, or objects that serve a reminder of traumatic event
Avoiding thoughts or feelings related to the traumatic event
Emotional numbness
Resisting remembering or talking about the traumatic event

Constant State of Stress and Anger

Being easily startled
Feeling tense or on edge
Having difficulty sleeping
Irritability, recklessness, and angry outbursts

To be diagnosed (by a medical professional such as a psychiatrist or psychologist), adults must experience

At least one intrusion symptom
At least one avoidance symptom
At least two arousal and reactivity symptoms
At least two cognition and mood symptoms

for at least one month with interference to daily life such as in work or relationships. The symptoms usually appear within three months of the traumatic event but may show up years afterwards.

In children (less than 6 years old), symptoms often present

themselves differently and may look like:

Wetting the bed despite being potty trained
Being unusually clingy with a parent or other adult
Acting out the scary event during playtime
Forgetting how or being unable to talk
Having nightmares and trouble sleeping
Acquiring new phobias and anxieties that seem unrelated to the trauma
Experiencing aches and pains without an apparent cause

Include but are not limited to:

Natural disasters (fires, floods, tornados, etc.)
Military combat
Childhood abuse and neglect
Violence, injury, or death
Accidents (car crashes, work injuries, burns, etc.)
Rape or sexual assault
Serious illness
Torture
Childbirth experiences (pregnancy complications, loss of child)

Though about one third of Canadians report experiencing a traumatic event, 1 in 10 Canadians may develop Post-traumatic Stress Disorder at some point in their lives. The likelihood of this occurring increases when:

A history of mental illness and substance use problems exists
Additional stressors are experienced after the event
Feelings of helplessness, extreme fear, shame, or responsibility are present
There is insufficient social support
Trauma has been previously experienced or is ongoing

Treatment

Everyone has a unique experience, and the type and length of treatment will differ for every individual. It is a gradual, ongoing process, but early intervention can prevent symptoms from worsening.

Medication

Unfortunately there is no medicine available to specifically treat Post-traumatic Stress Disorder, so medications are used to manage some of the challenging symptoms of depression, anxiety, and sleep difficulties. Medications are best used in combination with psychotherapy. Some of the more popular prescriptions are antidepressants (selective serotonin reuptake inhibitors like Setraline and serotonin-norepinephrine reuptake inhibitors like Venlafaxine).

Psychotherapy

Trauma-Focused Cognitive Behavioural Therapy is one type of therapy used that can provide education about trauma, practice relaxation and anger management skills, learn how to identify and deal with feelings of guilt and shame, help process the event, and facing reminders of the trauma in a safe space while changing thought patterns and behaviour responses. Forming a trauma narrative allows people to make sense of their experiences and can be cathartic.

Self-Help

A traumatic event cannot be altered or undone, but lifestyle adjustments can be made moving forward. Consuming a balanced diet, avoiding alcohol and drugs, getting regular sleep, and exercising can prevent some of the physical health issues that are associated with Posttraumatic Stress Disorder like cardiovascular disease and arthritis. Other protective and coping strategies include spending time in nature and joining a support group or having reliable friends and family to lean on.