Posttraumatic Stress

Because of the strong association of posttraumatic stress with the Viet Nam war, most people think of Posttraumatic Stress Disorder (PTSD) as a wartime-related illness. However, there are a far greater number of traumatic events in people's experiences than just those associated with war. Childhood sexual, physical, or emotional abuse can also result in PTSD. It is not an "all or nothing" phenomena.

What is PTSD all about, anyway?

When we experience a traumatic event that is just "too much" for us, our mind can take over and put the memory far back in a corner, away from our ready access to it. In fact, any highly threatening experience can cause an individual to react by blocking out its memory. This can happen for one event or a series of events over time. It is a defense mechanism to keep us from becoming more overwhelmed by the experience than we can stand at that moment.

However, all is not well. The memory is still there...somewhere. It has gone "underground" in our psychological make-up, and it can affect us in profound ways. We may tend to avoid situations that remind us of the original event, though we may not know why. We may have nightmares. We may be unable to form romantic or sexual relationships, or be unable to participate in activities that are important to us.

This blocking of the memory may not be complete. Small or large fragments may bubble up in our minds at times, and we may become "numbed out" or go into panic. Some people are feel somewhat emotionally numb on a routine basis. Problems with alcohol or drugs may develop in an attempt to hold these disturbing memories at a distance.

Sexual abuse is an experience that can cause this phenomena to occur. Abuse like this is a highly threatening experience, especially for children. Their bodies and their emotional make-ups are violated, and they have no way of coping with the feelings that result. Many children block out these memories. Though there has been much controversy in recent years about the accuracy of memories that are recalled years later, there is no doubt in the minds of most therapists that the memories have some sort of very real basis.

When memories are recalled, they are often recalled as suddenly as they were put away years before. In fact, in some cases it's as if a motion picture were stopped...and then started up again...picking up the original scene as if no time has passed.

When this occurs the body often reacts by restarting its original response to the trauma also. Blood may rush to the scene of a previous wound, hot and cold sensations may occur, and physical pain may be experienced. The emotions and sensations of the original experience may be recalled in a "flashback" during which the person feels that the original event is actually happening at the moment.

Of course, no one wants to reexperience trauma such as this. However, there are ways in which the life-limiting effects of posttraumatic stress can be addressed while minimizing the likelihood of excessive disturbances. The pain of not recovering from trauma can ultimately be much worse than the process of its resolution.

Treatment must be guided gently to promote the increasing stability thoughts and feelings: support networks need to be developed, and skills in working with feelings must be taught. A client has the right to direct the speed at which their concerns are addressed...no one should be forced to address any past memory. Sometimes an individual needs help to stabilize all of the crises in his or her life before actually beginning to work of the trauma itself. A bit of good work at the beginning can make a world of difference down the line.

What are the accepted elements of posttraumatic stress?

Self-diagnosis is not a good idea for most medical or psychological situations. However, the following is presented to offer you an understanding of the "official" diagnostic description of PTSD by the American Psychiatric Association's Diagnostic and Statistics Manual-IV. If you have concerns about yourself, then you should consult a professional. PTSD is serious and you should receivement treatment by someone trained to offer it. Here are the diagnostic criteria...

1. The person has been exposed to a trauma during which:

the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others,

and

the person felt intense fear, helplessness, or horror. In children this may be expressed by disorganized or agitated behavior.

2. The traumatic event is persistently reexperienced in at least one of the following ways:

repeated and intrusive distressing memories of the event, including images, thoughts, or perceptions. In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

repeated distressing dreams of the event. In children there may be frightening dreams without recognizable content.

acting or feeling as if the traumatic event were recurring (a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes--including those that occur on awakening or when intoxicated). In young children, trauma-specific reenactment may occur.

intense psychological distress at exposure to things that remind one of the event.

a physiological reaction to exposure to things that remind one of the traumatic event.

3. Persistent avoidance of things that remind one of the trauma and numbing of general responsiveness, as indicated by at least three of the following:

efforts to avoid thoughts, feelings, or conversations associated with the trauma

efforts to avoid activities, places, or people that arouse memories of the trauma

inability to recall an important aspect of the trauma

markedly diminished interest or participation in significant activities

feeling of detachment or estrangement from others

restricted range of emotion (e.g., unable to have loving feelings).

sense of foreshortened future (e.g., does not expect ot have a career, marriage, children, or a normal life span).

4. Persistent symptoms of increased arousal as indicated by at least two of the following:

difficulty falling or staying asleep

irritability or outbursts of anger

difficulty concentrating

hypervigilance

exaggerated startle response

5. Duration of symptoms is more than one month

What's on the horizon for PTSD treatment?

Eye Movement Desentization and Reprocessing (EMDR) is a treatment that has gained quite a bit of attention during the last several years. It involves using deliberate eye movements of both eyes to facilitate the review and reprocessing of troublesome memories. The strengths of EMDR include the ability to reprocess memories that are otherwise overwhelming--at a rate that is much quicker than other treatment means. There are a number of elements included in successful EMDR treatment, including the use of imagry techniques to distance oneself from the remembered trauma, the careful selection of positive (but reasonable) thoughts to replace alarming/negative ones, and the use of an imagined "safe place" if the memory becomes too threatening,

I have been trained in this process and find it to be a surprisingly effective way to make progress at a rate that is often much faster (and less stressful) than traditional therapy.

For More Information

National Center for PTSD
The EMDR home page
American Psychiatric Assn. online pamplet on PTSD (For a list of all

of their online pamphlets, click here)
Sidhran Foundation and Press
David Baldwin's Trauma Information Pages

David C. Bissette, Psy.D. Alexandria, VA 202-596-6036