From trauma to post-traumatic stress disorder

More than one-third of Germans report having experienced a traumatic event at least once. In the U.S., it’s even more than half, and in war-torn regions, it’s up to 100 percent. These figures illustrate how many people have had to experience not only events with physical, but above all deep psychological injuries. Often, after some time, those affected manage to process and cope with what they have experienced, but sometimes there are not enough resources available for this and the experiences weigh too heavily – in which case post-traumatic stress disorder (PTSD) develops

When do we speak of a trauma?

Trauma describes an experience that has such a threatening and catastrophic dimension that it exceeds the individual’s ability to cope. Examples of such traumas are:

• Serious accidents
• Natural disasters
• Sexual, physical or emotional abuse
• Acts of violence
• War, imprisonment, terrorist attacks
• Sudden death of a loved one
• Life-threatening illnesses

A distinction is made between trauma that lasts a short time and trauma that lasts longer or is repetitive, as well as whether the trauma happens “by accident” or was deliberately triggered by human force. Those affected experience great fear and horror, combined with helplessness and a shaking of their self-image and view of the world. Immediately afterwards, almost all people experience stressful memories, feelings of guilt or circles of thought about how the situation could have been prevented. Especially traumas that were deliberately caused by people or that lasted longer and were repeated often result in more serious consequences. It is not uncommon for adaptation processes to arise in which those affected try to make the experiences more bearable mentally, emotionally or on the behavioral level. If severe traumatization is already experienced in childhood or adolescence, the entire development can be permanently damaged

Does trauma resemble PTSD?

As bad as trauma can be, fortunately not all people develop post-traumatic stress disorder. In most cases, the increased startle response and avoidance of situations related to the experience diminishes within days or weeks. There are several risk and protective factors that influence coping. Age, for example, is one such risk factor, and children, adolescents and older people in particular have fewer coping resources. Also, previous trauma, stressful childhood experiences, and mental illness, as well as post-traumatic lack of social support, can promote the development of PTSD. Similarly, some occupational groups, such as police officers, soldiers or paramedics, have an increased risk of trauma because they have to deal with stressful events more frequently. On the other hand, it can have a protective effect if those affected have experienced a degree of agency during the trauma and have been able to talk about it following the experience

Importantly, an estimated ten to twenty percent of individuals who experience trauma develop PTSD. Those affected by sexual abuse, other violent crimes, traffic accidents involving personal injury, and life-threatening illnesses are most likely to develop PTSD.

This is how post-traumatic stress disorder manifests itself

The symptoms of PTSD do not usually manifest themselves immediately after a traumatic experience. They usually develop further after the initial acute stress reaction, manifesting themselves and then often appearing months to years later. The following characteristics are ultimately indicative of post-traumatic stress disorder:

• Re-experiencing
• Avoidance
• Negative cognitions and mood
• Overexcitement

Involuntary re-experiencing of the trauma

Spontaneous memories or nightmares of the traumatic experience can overwhelm those affected and are experienced as uncontrollable. While for some people only fractions of the memories come up, others suffer so-called flashbacks – a hallucination-like return to the experience. It is not uncommon for people to react to key stimuli of the trauma, such as smoke in the case of fire victims or screams in the case of witnesses to accidents, with physical stimuli such as shortness of breath, rapid heartbeat or sweating

Avoidance of triggers

It is typical for sufferers to avoid certain memories, situations or people that remind them of what they have experienced. Avoidance can be conscious or unconscious. Those involved in a traffic accident, for example, often avoid public transportation or driving, and victims of violent crimes often no longer leave their homes without accompaniment

Negative changes in cognitions and mood

Enjoyment of life is often massively impaired by PTSD. Affected individuals often lose interest in any activities and withdraw from social life. They stop making active plans for the future and harbor exaggerated negative beliefs or expectations. Many sufferers are either no longer able to feel anything or have strong negative emotions such as anger, sadness or loneliness

Overexcitement

Individuals suffering from PTSD have an increased perception of current threats and tension, which not infrequently leads to outbursts of anger, problems concentrating, or increased vigilance. Even reading a book or watching a movie may become impossible as attention span is shortened. Self-destructive behavior and sleep disturbances are also a common result

Basically, the symptoms of post-traumatic stress disorder vary greatly and can quickly resemble conditions such as depression or anxiety disorders. It is therefore important to first rule out these clinical pictures

Digression: What happens in the brain?

Scientists are continuing their research into the processes that take place in the brain during PTSD. Current studies suggest that the brain stores traumatic experiences incorrectly, preventing successful processing. To this end, the areas responsible for emotion processing are presumably reduced in size and the concentration of certain neurotransmitters is altered. Consequently, there is a dysregulation of the so-called stress axis (hypothalamus-pituitary axis). Accordingly, sufferers of PTSD suffer from an ongoing stress response of the body. In addition, there are a number of findings that relate to the autonomic nervous system and postulate an imbalance of the activating (sympathetic) and relaxing (parasympathetic) parts

Effective therapy methods

If a post-traumatic stress disorder has first developed from a trauma, it is important to treat it early and with professional support. The longer PTSD remains untreated, the greater the likelihood that it will lead to serious stress in the private and professional environment. The following psychotherapeutic procedures have proven to be particularly effective:

Cognitive behavioral therapy: the goal here is to let the trauma become part of normal memory and to gain distance from it. Here, stressful memories are revisited and subsequently reprocessed. Patients learn strategies to deal with their unpleasant thoughts and feelings and to restore their quality of life

Eye Movement Desensitization and Reprocessing (EMDR): EMDR targets neural pathways in the brain. The patient is guided by the therapist to make jerky horizontal eye movements while recalling the traumatic experience. Bilateral stimulation activates and synchronizes both hemispheres of the brain in relation to a traumatic event. Traumatic experiences are thought to be embedded in incompletely integrated memory networks

Prolonged Exposure Therapy (PE): Here, too, the patient is asked to put himself back into the traumatic situation and relive the trauma with all its negative feelings. In this process, the therapy conversation is recorded and patients have the task of listening to the recording again as often as possible. The goal is for the emotional reactions, which are violent at the beginning, to become less so and thus reduce the PTSD symptomatology

Narrative Exposure Therapy (NET): This form of therapy focuses on the patient’s entire life story. Unprocessed traumas are dealt with in the course of this with imaginary exposure. The goal is to create a habituation to the fear reactions and to integrate the traumas into the patient’s own life history

Furthermore, there are a number of other treatment methods for post-traumatic stress disorder, which illustrates the wide range of actions and thus a realistic chance of recovery. In addition to this, treatment can be supplemented by occupational therapy, art therapy, music therapy, and body and movement therapy.

Categories: Trauma