I guess knowing you have a disorder is something. I mean, knowing that you are not alone in what you are experiencing; knowing that what
you are experiencing is real and not imagined; knowing that—all things being relative—you
are still normal.
As soon as it was physically possible, I went right back
to where it happened, choosing to face down
my fears—we have nothing to fear but fear itself, right?— rather than to avoid them.
So determined was I to get back on the horse, figuratively speaking, that I remember getting angry when others raised eyebrows about my return to work. If you need more time ...
Panic, cold sweats, flashes of color and pain.
It's the constant peripheral fear that's the worst: fear of another
accident (my euphemism), fear of forever being labelled as the girl who that happened to, fear of being judged as incapable or even worse, fear of people thinking that what happened was in some way my fault. Fear, and a sense of life interrupted, of things I could do before that I would never be able to do
again.
"So long as the organism is in perfect order it responds accurately to the agents that prompt it, but the moment that there is some derangement in any individual, his self-preservative power is impaired. Everybody understands, of course, that if one becomes deaf, has his eyesight weakened, or his limbs injured, the chances for his continued existence are lessened." Nikola Tesla, My Inventions
Written in so
matter-of-fact a manner by the genius, the words, like many things Tesla said and did
resonated very strongly with me. I lingered. I dwelt. Though in truth, these words, written in the context in which they were written would have probably gone unremarked by me had I not been reading them in a post-accident state of mind.
Are the chances of my continued existence now lessened?
I remember sometime
later—later being a few months after the accident—sitting across from the
Ministry approved physician and answering his questions exactly how I thought they should
be answered, all smiles and positivity—whilst having no idea why I was inclined
to do so:
Any nightmares, or difficulty
sleeping? Nope.
Changes in behaviour? Irritability?
Nope. No more than usual.
Flashbacks? Nope.
Difficulty concentrating? Nope.
Exaggerated startle
response? Me? Nope, none whatsoever, heck, I’m even back at work, what
more proof do you need that I’m doing fine, yup, I'm doing just fine.
And now, after some life changes, the discovery of something new to be passionate about, and of course, the altered perspective granted by the passage of time, I have found my own contentment. In fact, I'm now more contented than I think I've ever been. The accident has left me forever changed yes, but it's not all negative. For instance, I am now (after much introspection) far more comfortable in my skin than I would have thought possible before the accident; my priorities have assumed a new order; and things that frazzled, frustrated and angered me before now just slide off my back.
The experience, accident, trauma, attack, has, through the process of healing given me a new perspective on life; an appreciation for nature and authenticity, and the preciousness of time.
That said, I don’t think the sense of an imminent ambush will ever go away. And as such, I’ll probably never stop looking over my shoulder, nor will I cease to scream (and I mean scream) when people brush hurriedly past me on the sidewalk, looking back at me like I’m Crazy Joe Davola, clown suit and all.
And I will probably continue to cry way too easily at acts of kindness and in the presence of beauty (true beauty). But I can laugh and love and appreciate things in a way I never could before. And I have managed to compress all the negative things into something I can manage, which in and of itself is perhaps something of an accomplishment.
American Museum of Natural History via YouTube
- Post-traumatic Stress Disorder (PTSD) is classified as a trauma and stress related disorder. [10]
- PTSD may develop after a person is exposed to one or more traumatic events, such as major stress, sexual assault, terrorism, or other threats on a person's life. [10]
- An estimated 7% of the general population suffer from PTSD. [11]
- Most people having experienced a traumatizing event will not develop PTSD. [15]
- People who experience assault-based trauma are more likely to develop PTSD, as opposed to people who experience non-assault based trauma such as witnessing trauma, accidents, and fire events. [16]
- Children are less likely to experience PTSD after trauma than adults, especially if they are under ten years of age. [15]
- In the typical case, the individual with PTSD persistently avoids all thoughts and emotions, and discussion of the stressor event and may experience amnesia for it.
- However, the event is commonly relived by the individual through intrusive, recurrent recollections, flashbacks, and nightmares. [1]
SYMPTOMS
According to the Mayo Clinic Website, PTSD symptoms are generally grouped into 4 types: [12]
INTRUSIVE MEMORIES
- Recurrent, unwanted distressing memories of the traumatic event
- Reliving the traumatic event as if it were happening again (flashbacks)
- Upsetting dreams about the traumatic event
- Severe emotional distress or physical reactions to something that reminds you of the event
AVOIDANCE
- Trying to avoid thinking or talking about the traumatic event
- Avoiding places, activities or people that remind you of the traumatic event
NEGATIVE CHANGES IN THINKING & MOOD
- Negative feelings about yourself or other people
- Inability to experience positive emotions
- Feeling emotionally numb
- Lack of interest in activities you once enjoyed
- Hopelessness about the future
- Memory problems, including not remembering important aspects of the traumatic event
- Difficulty maintaining close relationships
CHANGES IN EMOTIONAL REACTIONS (AROUSAL SYMPTOMS)
- Irritability, angry outbursts or aggressive behavior
- Always being on guard for danger
- Overwhelming guilt or shame
- Self-destructive behavior
- Trouble concentrating
- Trouble sleeping
- Being easily startled or frightened
DIAGNOSIS
- Standardized screening tools such as the Trauma Screening Questionnaire [13] and the PTSD Symptom Scale [14] can be used to detect possible symptoms of post-traumatic stress disorder and help determine if a formal diagnostic assessment is necessary.
The following is a summary [10] of the diagnostic criteria
for PTSD as stipulated in the International
Statistical Classification of Diseases and Related Health Problems 10
(ICD-10): [38]
- Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.
- Persistent remembering or "reliving" the stressor by intrusive flash backs, vivid memories, recurring dreams, or by experiencing distress when exposed to circumstances resembling or associated with the stressor.
- Actual or preferred avoidance of circumstances resembling or associated with the stressor (not present before exposure to the stressor).
Either (1) or (2):
- Inability to recall, either partially or completely, some important aspects of the period of exposure to the stressor.
- Persistent symptoms of increased psychological sensitivity and arousal (not present before exposure to the stressor) shown by any two of the following:
- Difficulty in falling or staying asleep
- Irritability or outbursts of anger
- Difficulty in concentrating
- Hyper-vigilance
- Exaggerated startle response
CAUSES
The cause of PTSD may
be a complex combination of several factors, including: [12]
- Inherited mental health risks, such as an increased risk of anxiety and depression.
- Inherited aspects of your personality (temperament).
- Family and twin studies have found that risk for PTSD is associated with an underlying genetic vulnerability, and that more than 30% of the variance associated with PTSD is related to a heritable component. [1][2][3]
- Life experiences, including the amount and severity of trauma you have gone through since early childhood.
- The way your body regulates the release of stress hormones.
- Studies have indicated that people suffering from PTSD have chronically low levels of serotonin, which contributes to commonly associated behavioral symptoms such as anxiety, irritability, aggression, suicidal tendencies, and impulsivity. [5][41]
- Having a shorter version of the serotonin transporter gene may increase the risk for PTSD. This same gene variant has been shown to increase activation of the amygdala (responsible for emotional regulation). [42][43]
- Although PTSD has been associated with lower basal cortisol levels, [4] and enhanced negative feedback suppression of the *hypothalamic-pituitary-adrenal axis (HPA axis) by dexamethasone (corticosteroid), significant discrepancies remain among reports on the relationship between cortisol levels and PTSD. [3][6][8][9]
*The HPA axis is a complex set of direct influences and feedback interactions among three endocrine glands: the hypothalamus, the pituitary gland, and the adrenal glands. [7]
NEUROLOGICAL CHANGES CAUSED BY THE PSYCHOLOGICAL EXPERIENCE OF TRAUMA [40]
Regions of the brain associated with stress and post-traumatic stress disorder include: the prefrontal cortex, amygdala, and hippocampus. [39]
 |
| Image Credit: National Institute of Mental Health |
- In some individuals with PTSD the amygdala enlarges.
- Situations that remind an individual suffering from PTSD of the traumatic event or events can trigger excessive release of stress hormones and over-activation of the amygdala which further augments stress hormone release. The result is severe emotional distress - racing thoughts, anger, and hyper-vigilance. [11]
- Functional neuroimaging studies of post-traumatic stress disorder Hughes et al. (2011)
HIPPOCAMPUS
- Twin studies suggest that memory dysfunction is both a pre-existing risk factor for the development of PTSD as well as a consequence of the disorder.
- Studies have shown that in some individuals suffering from PTSD, the hippocampus (responsible for memory and experience assimilation) actually shrinks in volume. [17][18][31]
- Functional imaging studies have demonstrated abnormal cerebral blood flow to the hippocampus [19][20] during declarative memory tasks (memories that can be consciously recalled such as facts and knowledge).
- Post-traumatic stress disorder and declarative memory functioning: a review Samuelson et al. (2011) [31]
- These same studies found that childhood sexual abuse survivors with PTSD showed decreased left hippocampal blood flow during emotional word retrieval versus neutral word retrieval. (As compared to healthy individual unexposed to trauma.) [20]
- However, researchers have not been able to consistently demonstrate a correlation between declarative memory performance and hippocampal function.
- The pattern of memory impairments in PTSD demonstrates that the disorder is less associated with problems in memory retention, a process mediated by the hippocampus, and more associated with problems in acquisition and learning, processes more associated with prefrontal system dysfunction. [21]
- Magnetic resonance imaging (MRI) studies have reported decreased frontal cortex volume in individuals with PTSD [22-24] and decreased volume in medial prefrontal regions. [25-28]
- Post-traumatic stress disorder and declarative memory functioning: a review Samuelson et al. (2011) [31]
- Post-traumatic stress disorder: The role of medial prefrontal cortex and amygdala Koenigs et al. (2009)
- Functional imaging studies have revealed an under-activation of the frontal cortex during paired-associate learning tasks in patients with PTSD. [29]
- Particularly in children, findings of frontal dysfunction are more robust than findings of hippocampal dysfunction. [22,23, 30]
MILITARY COMBAT AND
MENTAL HEALTH
The National Bureau of
Economic Research 2011 study, The Psychological Costs of War: Military Combat and Mental Health, found that:
[32][33]
- Military personnel serving in combat were 12.1% more likely to receive a PTSD diagnosis than their active-duty counterparts in non-combat zones.
- Those serving more than 12 months in a combat zone were 14.3% more likely to be diagnosed with PTSD than those who served less than one year.
- Experiencing an enemy firefight was associated with a 10.4% increase in the likelihood of suicidal thoughts and an 18.3% increase in the probability of PTSD.
- For troops who believed they had killed someone there was a 12% increase in the probability of suicidal thoughts and a 22.2% increase in the likelihood of PTSD, compared to rates for service members who did not believe they had killed another person.
- Being wounded or injured in combat was associated with a 23.9% increase in the likelihood of a PTSD diagnosis.
TREATMENT
- SSRIs (selective serotonin reuptake inhibitors) are considered to be a first-line drug treatment for PTSD. [36][37]
- Cognitive behavioral therapy (CBT) seeks to change the way a trauma victim feels and acts by changing the patterns of thinking or behavior, or both, responsible for negative emotions.
- CBT has been proven to be an effective treatment for PTSD and is currently considered the standard of care for PTSD by the United States Department of Defense.[34]
- Eye movement desensitization and reprocessing is a form of psychotherapy based on the theory that eye movement can be used to facilitate emotional processing of memories. [35]
- Exposure Therapy (re-imaging events in a safe environment), Group Therapy, Art Therapy, Play Therapy for children and Therapy dogs are other ways individuals may try to manage the symptoms of PTSD. [10]
 |
| A therapy dog trained to help combat veterans with conditions like PTSD |
 |
| Art therapy project created by a U.S. Marine with PTSD |
UPDATES/RELATED
Virtual training makes veterans with PTSD nine times more likely to nab a job / PsyPost / July 12, 2015
***
FIN
AND JUST BECAUSE ... LAUGHTER IS AN IMPORTANT PART OF ANY HEALING ...
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ADDITIONAL
RESOURCES
IMAGE
CREDITS
"The Scream" by Edvard Munch -
WebMuseum at ibiblioPage: http://www.ibiblio.org/wm/paint/auth/munch/Image URL:
http://www.ibiblio.org/wm/paint/auth/munch/munch.scream.jpg. Licensed under
Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:The_Scream.jpg#/media/File:The_Scream.jpg
"HPA Axis Diagram (Brian M Sweis
2012)" by BrianMSweis - Own work. Licensed under CC BY-SA 3.0 via
Wikimedia Commons -
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"ProjectROVER Assistance Dog
(12122659685)" by National Institute for Occupational Safety and Health
(NIOSH) from USA - ProjectROVER Assistance Dog. Licensed under Public Domain
via Wikimedia Commons -
http://commons.wikimedia.org/wiki/File:ProjectROVER_Assistance_Dog_(12122659685).jpg#/media/File:ProjectROVER_Assistance_Dog_(12122659685).jpg
"USMC-120503-M-9426J-001" by Cpl.
Andrew Johnston - This Image was released by the United States Marine Corps
with the ID 120503-M-9426J-001 (next).This tag does not indicate the copyright
status of the attached work. A normal copyright tag is still required. See
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