When we think of post traumatic stress disorder or PTSD, we imagine the trauma faced by war veterans. However, PTSD is far more common than it is acknowledged to be.
Trauma is defined as an intense stress due to a significant physical or psychological event which would be perceived as disturbing for most people. A sudden traumatic event causes acute stress response of varying degree, which depends on the person’s biological state, and the reaction is determined by their stress coping abilities.
For some people, the same incident may have massive long-term impact whereas for others, it may produce short-term stress reaction also called acute stress reaction.
Clinically, PTSD is diagnosed after exposure to an intensely-stressful event like experiencing or witnessing a death, serious injury or sexual violence, when the person displays the following symptoms:
1. Recurrent, involuntary, intrusive, and distressing memories, dreams, or flashbacks of the traumatic event.
2. Persistently avoiding memories, thoughts, and/or the place where the trauma took place.
3. Negative mood state, beliefs, or doubts that begin or worsen after the incident. They are often associated with feelings of fear, horror, anger, guilt, or shame or feelings of detachment or inability to feel positive emotions.
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4. Behavioural problems like irritability, angry outbursts, recklessness or hyper vigilance.
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Gargi was travelling with her friends when the college bus met with an accident and toppled over. Many students were seriously injured and about five died on the spot.
Gargi had suffered only minor injuries and was out of the hospital after just one day. But, she started having disturbed sleep soon after. She came back home from the hostel, but when the time came for her to return—she started experiencing severe gastric distress like nausea, vomiting and abdominal pain.
Her physical examination and tests showed no significant anomaly so she was sent back home. Her sleep continued to be disturbed, she started having nightmares of the accident, and would often have palpitations and sweating even while awake.
She avoided looking at buses and would not travel in a bus. She would often have anxiety even if a speeding car went by while she stood still on the road. She became irritable and had difficulty in concentration.
For a month, she found one excuse or the other to avoid going to the hostel. And when forced, she burst out in tears saying she could not go back to her college because it scared her, even though she knew there was nothing wrong there.
Gargi was diagnosed with PTSD after being referred to a psychiatrist and was suggested counselling and medication. It took her 3 months to restart her education and live a normal life.
Such incidents seem trivial to many, especially if the person involved seems to have remained unharmed physically. But the psychological impact and exposure to pain and death act as powerful triggers for stress chemicals.
Similar symptoms are noticed in vulnerable individuals who are witness to major calamities or significant violence. The mental toll such events take are hardly visible externally, but keep on eroding self trust and confidence eventually causing a more permanent effect on personality.
Here are some PTSD symptoms to look out for:
1. Loss of interest in otherwise enjoyable activities, social withdrawal and avoidance
2. Excessive anxiety at minor incidents, news items, or avoiding any distressing conversation or news
3. Inability to enjoy pleasurable activities
4. Anger, irritability or mood swings
5. Stubborn or obsessive reaction to routine scenarios
6. Sleep and appetite disturbance
7. Non-specific physical complaints but definite diagnosis or cause
8. Preoccupation with traumatic event or generalisation of event-related experience
9. Alcohol or drug abuse
10. Deterioration in performance
Once the signs or symptoms of a psychological issue are noticed, it is imperative to seek professional help. Trauma de-briefing is usually carried out in cases of significant apparent traumas of unnatural intensity. It’s usually a mode of primary prevention after a traumatic event to avoid development of PTSD. In some cases, it’s used after the symptoms have started as well to halt the progression.
A psychiatric evaluation to identify vulnerability factors along with clinical assessment is required to formulate an individualised treatment plan to avoid long-term complications. Medicines are helpful in reducing anxiety and mood symptoms so that psychotherapy can be carried out smoothly.
Family and supportive counselling is very important as different people react differently to same events. If many individuals in a family have faced the same event, the tendency to disregard severe reactions of vulnerable individuals is common and comparisons tend to complicate the prognosis. Family counselling also helps in identifying support mechanisms within the family group and a cooperative environment helps in faster resolution.
Avoiding blame games and balancing personal and social aspects of the problem the nascent to treatment and management of complex problems like PTSD