Post-traumatic stress disorder
We have all heard stories of horrifying situations or catastrophic events. Today, we can even experience these disasters ourselves by way of television and radio broadcasts, newspaper stories and Internet sites. As a result, do we risk falling victim to post-traumatic stress disorder (PTSD) one day? Fortunately, the answer is no.
Health professionals have agreed to develop a set of criteria to enable the diagnosis of post-traumatic stress disorder. First and foremost, individuals must have experienced, witnessed, or been confronted by one or more traumatic events, during which their physical security (or that of others) was threatened with actual or potential death or serious injury, to which the individual reacted with intense fear, horror or helplessness.
A number of events can generate the level of trauma capable of triggering PTSD. These may include natural disasters (floods, tornadoes, earthquakes, etc.), serious accidents (automobile/plane crashes, explosions, fire, etc.), deliberate acts of aggression (assaults, armed robbery, rape, hostage-taking, war, etc.), the sudden death of a loved one, the onset of a potentially fatal disease, and death threats.
PTSD may negatively impact normal functioning and many areas of an individual’s personal, domestic and social life. The need to avoid all threatening situations may lead to severe limitations on daily and social activities. For example, imagine a group of individuals who were victimized by a terrorist attack in the subway, or witnessed such an event. At the outset, one can easily assume they will henceforth refuse to take the subway, the bus, or any other public transit, to eliminate the possibility of ever being involved in such a dangerous situation again. However, any sound that reminds them of the explosion (loud music or an air horn, for example) may also trigger major anxiety symptoms. As a result, they may stop listening to the radio or watching television or may have to quickly change channels/radio stations every time an image or sound that recalls the event is broadcast.
The characteristic signs of post-traumatic stress disorder include:
- In nearly all cases, the traumatic incident awakens a strong feeling of intense fear, horror and helplessness.
- The traumatic event is persistently relived through nightmares and flashbacks, intrusive thoughts that cause distress (anxiety, depression).
- Avoidant behaviours, including expending effort to avoid thinking about the trauma, or avoidance of given situations or locations that might reawaken painful memories. Conversely, the individual may be totally unable to remember the incident.
- A feeling of emotional numbness and detachment from others; or the inability to feel certain emotions such as tenderness or sexual desire.
- Hyperactivity, which may present as trouble with concentration and sleep; or a state of nervous agitation characterized by a near-constant state of alertness or irritability.
These disruptions may cause clinically-significant distress or impairment in social and occupational function.
Family life may be affected; this can lead to major conflicts as other family members do not understand the behaviours or attitudes of the PTSD sufferer.
Symptoms usually manifest within the first three months following the trauma, but it may take several months or even years before symptoms appear.
Classified as an anxiety disorder, post-traumatic stress disorder differs from other such disorders due to its origin, i.e. the traumatic trigger.
The severity and duration of such incident, as well as the exposed individual’s physical proximity to danger, are risk factors in the development of PTSD. As we learned from the earliest reported cases, men experience PTSD as a result of war; for women, the most common traumas are physical and sexual assaults. It is also known that mental illness antecedents may increase an individual’s vulnerability to the onset of PTSD.
Any individual who has already experienced an episode of PTSD remains at-risk and may, in the right conditions, see a recurrence in symptoms. Occasionally, the consequences of PTSD may include depression, anxiety disorders, or substance abuse. This recourse to alcohol or drugs may be interpreted as an attempt on the part of the PTSD sufferer to alleviate distress or numb the pervasive fear of threat.
Who is at risk?
Being victimized or present during a traumatic incident does not, in and of itself, imply the development of PTSD, and it is difficult to accurately predict who will be affected. Individuals may be repeatedly exposed to horrific events and never develop PTSD, while others will develop the disorder after a single such exposure. Symptoms may also appear several years following the trauma as a result of the individual experiencing a new incident which recalls the previous one; due to an individual’s higher inherent vulnerability; or perhaps after hearing of a similar incident experienced by someone else. Thus, PTSD may remain latent and may not manifest for many years, and then suddenly appear much later in a context which is seemingly unrelated to the previous trauma.
We cannot predict which mechanisms will trigger PTSD in a specific individual, although a number of theories and hypotheses may be found in the literature. It would appear that the nature of the incident is not the sole determining factor in predicting the intensity of an individual’s reaction to trauma; rather, it would also depend on the perceived threat to the individual’s physical safety and the subjective interpretation made by that individual. It is also believed that the uncontrollable and unpredictable nature of this type of incident may play a part in the onset of post-traumatic stress disorder.
Thus, watching disasters on television or hearing testimonials from rape victims on the radio would not normally trigger PTSD, unless the individual had previously experienced a similar trauma and had expended considerable effort to put it out of mind.
It is important to remember that we are all vulnerable to PTSD, and that it is preferable to talk about traumatic events rather than force ourselves to forget them. It is also worth noting than children may also suffer from PTSD. Their symptoms typically present within some repetitive games and in their dreams, which may incorporate a number of elements from the traumatic incident. These games and dreams are normal and will gradually diminish over time. Finally, it is important to be patient and tolerant of PTSD sufferers, and to encourage them to consult a health professional should their symptoms persist or begin to interfere with daily activities.
Some studies claim that at some point in their lives, between 8-10% of the general population experience an episode of post-traumatic stress.
Prevention and care
If you have been victimized by a traumatic incident:
Recognizing and accepting a wide range of reactions, even when they are painful, likely constitutes the healthiest attitude in attempting to quickly overcome a trauma.
It is important not to isolate yourself after a trauma; secure the presence of a trusted loved one who is willing and able to listen to you.
Pay particular attention to your body. You may notice that your immunity against disease has lowered, as well as the onset of minor ailments. Do not ignore these signs.
Engage in planned leisure activities such as hot baths, physical activity, relaxation, outings and hobbies.
Avoid consuming alcohol or drugs after the traumatic incident.
If the trauma was experienced by a group of people, it may be helpful to join a support group to give voice to your reactions and realize that you are not alone.
If you do not feel better after a few days, consult a professional: your physician, the CLSC or a psychologist.
If a loved one has been victimized by a traumatic incident:
You can help your loved one by paying more attention to expressed feelings and reactions than to the traumatic incident itself.
Encourage loved ones to talk about the incident at their own pace. Support their emotional reactions and withhold judgment.
Remember that stress is a normal reaction to an abnormal event, even when you do not fully understand these reactions.
Demonstrate patience and compassion.
Considering the cumulative effects of stress, try to lessen other concurrent concerns your loved one may be experiencing.
Encourage loved ones to plan leisure activities.
- Encourage them to consult a healthcare professional if symptoms persist.
The clinician’s role is to offer patients an opportunity to open up about their experience, and to provide information on therapeutic options including both psychotherapy and drug therapy. It is important to fully explain the condition to patients and to remind them that this is a normal reaction to trauma. It has been shown that response to treatment improves when therapeutic intervention rapidly follows a diagnosis of PTSD.
Sleep disturbances are often a gateway to seeking medical attention. Sedatives and hypnotics may be prescribed in the short term. The primary treatment may comprise antidepressants, as they are safe, effective, and contribute to lessening the various PTSD symptoms by lowering anxiety levels and facilitating sleep, which may enable patients to discontinue the use of sedatives. Finally, several other drug classes may be used if the patient presents with severe symptoms. These drug therapies are provided by specialized health care teams.
The most frequently recommended psychotherapeutic approaches for the treatment of post-traumatic stress disorder include behavioural therapy, cognitive therapy and cognitive-behavioural therapy. Numerous studies have confirmed the effectiveness of these therapies in treating PTSD.
Behavioural therapy seeks to adjust patient attitudes by reducing avoidant behaviours and providing strategies for lessening anxiety symptoms.
Cognitive therapy targets changes in erroneous or dysfunctional cognitive function (thoughts, ideas, expectations and interpretations) with regard to the consequences of trauma.
Cognitive-behavioural therapy may be composed of desensitization, a technique involving gradual exposure to elements related to the specific traumatic incident, in order to analyze behaviours and thoughts, learn new behaviours and replace undesirable thoughts and emotions by more appropriate ones.
Over the past few years, a psychotherapeutic approach known as Eye Movement Desensitization and Reprocessing (EMDR) therapy has been recognized for its effectiveness in the treatment of PTSD. EMDR is essentially a technique focussed on desensitization and the reprocessing of information (memories, pictures) through eye movements, similar to the effect of watching a swinging pendulum during hypnosis. According to researchers, under certain conditions, eye movements would enable a lessening of the distress associated with painful memories.
Although a specific individual may show improvement with drug therapy or psychotherapy alone, the latter has been scientifically proven to be the most effective treatment for PTSD. Current studies focus both on assessing proven pharmacological and psychological treatments and on the development of new approaches to further refine these treatments. These studies also seek to identify specific indicators likely to help improve response to treatment predictions.
Douglas Mental Health Universitary
Free evaluation of post-traumatic stress
(514) 761-6631 poste 3430
Trauma Studies Centre (TSC) - Hôpital Louis-H Lafontaine
Ordre des psychologues du Québec (Quebec’s Psychologists Order)
(514) 738-1881 ou 1-888-731-9420
Revivre (Association for people suffering from anxiety, bipolar disorder or depression)
ligne d’écoute : (514) 738-4873 ou 1.866.REVIVRE
La Clé des Champs (Peer network for people living with an anxiety disorders)
Phobies-Zéro : (Help groups for youth and adults suffering from anxiety disorders – all around Quebec)
Ligne d’écoute et de soutien : (514) 276-3105 ou 1-866-0002
Psychotherapy services for victims of post-traumatic stress disorder
(514) 272-3326 ou 1-888-272-1896
Association québécoise de prévention du suicide (Suicide prevention)
24 heures/ jour, 7 jours/7 partout au Québec
1-866 APPELLE (277-3553)
Consult our complete Mental Health Resources Directory.