Post traumatic stress disorder: how to recognize it

First brought to public attention in the United States following problems reported by Vietnam War veterans, post-traumatic stress disorder can affect people of all ages, from children to adults. It can also occur in individuals not directly affected by the traumatic circumstances, such as witnesses, rescuers or family members of victims.

Symptoms are typically as follows:

• feelings of fear, terror and horror
• feeling helpless
• impression of reliving the event in the form of disturbing images, intrusive memories and repeated flashbacks, as well as recurring nightmares; In rare cases there are dissociative disorders due to which the subject seems to live the traumatic experience for the first time
• persistent avoidance of stimuli associated with the event, which remind or symbolize it (for example certain places or people) and which lead to feelings of stress, psychological discomfort or typical physiological reactions (if the trauma occurred in an alley, for example, the person may present sudden sweating when forced to walk one)
• intentional efforts to avoid thoughts related to trauma that, in some cases, can lead to the inability to remember an important aspect of the event (psychogenic amnesia)
• less general reactivity, i.e. emotional detachment with respect to one’s affective and intimate life and loss of interest in previously appreciated activities, with consequent estrangement and reduction of social life
• state of hypervigilance, which implies an alteration of the sleep cycle, which becomes short and disturbed, and excessive alarm responses
• difficulty concentrating
• personality alteration and irritability, associated with the fear of a sudden increase in one’s aggression and losing control, resulting in violent or self-destructive behavior.

In relation to the above, symptoms of depression and anxiety, which can be severe to disabling, are commonly associated with post-traumatic stress disorder. The subject, in particular, may experience a significant drop in mood, failing to feel positive emotions and developing negative thoughts and reactions about himself and others. A distorted perception of the facts can also arise, which leads the victim to take the blame for what happened and can result in panic attacks.

Other related effects are impulsive behavior, memory deficit, headache and dizziness.

Typically, these manifestations occur in the period immediately following the trauma, but the most intense emotional experiences, such as the impression of reliving the incident (similar to those of acute stress disorder), can continue for a few months, if not even years.

In children, however, specific symptoms such as agitation, inattention and distraction may develop, as well as stomach pains and headaches. The child may refuse to talk about the trauma suffered, but that does not mean that he cannot remember the negative experiences experienced. In fact, agonizing dreams or nightmares often occur.

The loss of emotions and interest is hardly reported directly by the little ones, and must therefore be interpreted by the adult through the observation of their behavior; For example, there may be a loss of developmental skills, such as personal cleanliness or language.

Finally, children may seem “pessimistic” towards the future, coming to believe that they can “predict” unpleasant or inauspicious events.

Importantly, regardless of the age of the subject, the diagnosis is usually not made if the disorder lasts less than one month and that, in most cases, the symptoms of PTSD are transient.

Causes of Post Traumatic Stress Disorder

The causes of post-traumatic stress disorder are situations that include a direct threat to life or health. Those who suffer from it may be directly or indirectly involved in the event in question. As already highlighted, in fact, PTSD can appear as a result of a traumatizing event that has affected the subject in the first person, but also close relatives and friends or even strangers.

The ways in which trauma can be related are, in summary, four:

• experience a traumatic event directly
• witness a traumatic event that affects third parties
• learn about traumatic events that have affected loved ones
• listen to the detailed account of traumatic episodes that have affected third parties.

Some of the most common eventualities that can lead to PTSD are:

• situations of danger to the physical integrity of the person, such as serious road accidents and accidents at work
• assaults, kidnappings, thefts, which can threaten the physical and mental safety of the victim or cause his death
• sudden destruction and loss of one’s home
• natural disasters, such as floods and earthquakes
• accidental or deliberate man-made disasters, such as plane crashes, structural failures (collapses of buildings, bridges, dams, etc.), serious fires, bombings and terrorist attacks
• prolonged exposure to acts of violence, episodes of abandonment and degradation.

The trauma can be experienced alone or together with other people. In the case of professions at risk (such as first aid personnel, military corps, police and carabinieri corps, firefighters, etc.) exposure to tragic events is more likely and, consequently, the onset of post-traumatic stress disorders.

In any case, these are events outside the usual experiences, such as bereavement, chronic diseases or financial problems. In fact, although this type of event can cause psychological distress, in most cases the symptoms subside spontaneously with the passage of time, until they disappear completely.

How to deal with post-traumatic stress disorder

After recognizing the onset of symptoms in the weeks following the traumatic event, the first step to deal with this type of disorder is to seek support from a doctor, who can redirect the person to the most appropriate therapy. Acting promptly, at this stage, is important to positively influence the outcome of treatment.

Contrary to what usually happens in the presence of a psychological or cognitive problem, the diagnosis of post-traumatic stress disorder is welcomed by the subjects concerned as confirmation of their condition of discomfort. The patient, through the support of a professional, will then be able to establish the most effective treatment, which in some cases may also include pharmacological support.

The first and most important form of support is certainly psychotherapy. Following a clinical interview, the psychotherapist can foresee different strategies for processing the trauma, such as:

• hypnosis
• Autogenic training
• Active imagination
• behavioral therapy
• Group therapies
• psychodrama.

All these techniques involve accompanying the patient towards the acceptance of their emotions, their experience and what is frightening and incomprehensible, in order to abandon dangerous or self-injurious behaviors.

Over the years, EMDR (Eye Movement Desensitization and Reprocessing), a form of therapy based on visual and sensory stimuli, developed specifically to respond to PTSD, has also become increasingly popular. Paths based solely on the word, in fact, are often not entirely effective. The functioning of EMDR is based on the fact that eye movements can induce neurological effects and on the psychology of the patient, going to act on the memory of the event and neutralizing the consequences.

It is important, in any case, that the most correct form of treatment is personalized and studied on the specific case, after analyzing the different aspects; If, for example, the person is still experiencing the traumatic context from which the symptoms derive (mobbing, domestic violence, etc.), rehabilitation work must include the removal of the causes of stress as a first step.

It is also to be considered fundamental the support of family members and the circle of people in close contact with the subject, who must assist and support him throughout the course of care.