Intrusive Symptoms
Often people suffering from PTSD have an episode where the traumatic event "intrudes" into their current life. This can happen in sudden, vivid memories that are accompanied by painful emotions. Sometimes the trauma is "re-experienced." This is called a flashback_a recollection that is so strong that the individual thinks he or she is actually experiencing the trauma again or seeing it unfold before his or her eyes. In traumatized children, this reliving of the trauma often occurs in the form of repetitive play.
At times, the re-experiencing occurs in nightmares. In young children, distressing dreams of the traumatic event may evolve into generalized nightmares of monsters, of rescuing others or of threats to self or others.
At times, the re-experience comes as a sudden, painful onslaught of emotions that seem to have no cause. These emotions are often of grief that brings tears, fear or anger. Individuals say these emotional experiences occur repeatedly, much like memories or dreams about the traumatic event.
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Information Thread: PTSD
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by Butterfly Faerie » Tue May 16, 2006 3:51 am
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by Butterfly Faerie » Tue May 16, 2006 3:52 am
Symptoms of Avoidance
Another set of symptoms involves what is called avoidance phenomena. This affects the person's relationships with others, because he or she often avoids close emotional ties with family, colleagues and friends. The person feels numb, has diminished emotions and can complete only routine, mechanical activities. When the symptoms of "re-experiencing" occur, people seem to spend their energies on suppressing the flood of emotions. Often, they are incapable of mustering the necessary energy to respond appropriately to their environment: people who suffer post-traumatic stress disorder frequently say they can't feel emotions, especially toward those to whom they are closest. As the avoidance continues, the person seems to be bored, cold or preoccupied. Family members often feel rebuffed by the person because he or she lacks affection and acts mechanically.
Emotional numbness and diminished interest in significant activities may be difficult concepts to explain to a therapist. This is especially true for children. For this reason, the reports of family members, friends, parents,teachers and other observers are particularly important.
The person with PTSD also avoids situations that are reminders of the traumatic event because the symptoms may worsen when a situation or activity occurs that reminds them of the original trauma. For example, aperson who survived a prisoner-of-war camp might overreact to seeing people wearing uniforms. Over time, people can become so fearful of particular situations that their daily lives are ruled by their attempts to avoid them.
Others--many war veterans, for example--avoid accepting responsibility for others because they think they failed in ensuring the safety of people who did not survive the trauma. Some people also feel guilty because they survived a disaster while others--particularly friends or family--did not. In combat veterans or with survivors of civilian disasters, this guilt may be worse if they witnessed or participated in behavior that was necessary to survival but unacceptable to society. Such guilt can deepen depression as the person begins to look on him or herself as unworthy, a failure, a person who violated his or her pre-disaster values. Children suffering from PTSD may show a marked change in orientation toward the future. A child may, for example, not expect to marry or have a career. Or he or she may exhibit "omen formation," the belief in an ability to predict future untoward events.
PTSD sufferers' inability to work out grief and anger over injury or loss during the traumatic event mean the trauma will continue to control their behavior without their being aware of it. Depression is a common product of this inability to resolve painful feelings.
Another set of symptoms involves what is called avoidance phenomena. This affects the person's relationships with others, because he or she often avoids close emotional ties with family, colleagues and friends. The person feels numb, has diminished emotions and can complete only routine, mechanical activities. When the symptoms of "re-experiencing" occur, people seem to spend their energies on suppressing the flood of emotions. Often, they are incapable of mustering the necessary energy to respond appropriately to their environment: people who suffer post-traumatic stress disorder frequently say they can't feel emotions, especially toward those to whom they are closest. As the avoidance continues, the person seems to be bored, cold or preoccupied. Family members often feel rebuffed by the person because he or she lacks affection and acts mechanically.
Emotional numbness and diminished interest in significant activities may be difficult concepts to explain to a therapist. This is especially true for children. For this reason, the reports of family members, friends, parents,teachers and other observers are particularly important.
The person with PTSD also avoids situations that are reminders of the traumatic event because the symptoms may worsen when a situation or activity occurs that reminds them of the original trauma. For example, aperson who survived a prisoner-of-war camp might overreact to seeing people wearing uniforms. Over time, people can become so fearful of particular situations that their daily lives are ruled by their attempts to avoid them.
Others--many war veterans, for example--avoid accepting responsibility for others because they think they failed in ensuring the safety of people who did not survive the trauma. Some people also feel guilty because they survived a disaster while others--particularly friends or family--did not. In combat veterans or with survivors of civilian disasters, this guilt may be worse if they witnessed or participated in behavior that was necessary to survival but unacceptable to society. Such guilt can deepen depression as the person begins to look on him or herself as unworthy, a failure, a person who violated his or her pre-disaster values. Children suffering from PTSD may show a marked change in orientation toward the future. A child may, for example, not expect to marry or have a career. Or he or she may exhibit "omen formation," the belief in an ability to predict future untoward events.
PTSD sufferers' inability to work out grief and anger over injury or loss during the traumatic event mean the trauma will continue to control their behavior without their being aware of it. Depression is a common product of this inability to resolve painful feelings.
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by Butterfly Faerie » Tue May 16, 2006 3:52 am
Symptoms of Hyperarousal
PTSD can cause those who suffer with it to act as if they are threatened by the trauma that caused their illness. People with PTSD may become irritable. They may have trouble concentrating or remembering current information, and may develop insomnia. Because of their chronic hyperarousal, many people with PTSD have poor work records, trouble with their bosses and poor relationships with their family and friends.
The persistence of a biological alarm reaction is expressed in exaggerated startle reactions. War veterans may revert to their war behavior, diving for cover when they hear a car backfire or a string of firecrackers exploding.At times, those with PTSD suffer panic attacks, whose symptoms include extreme fear resembling that which they felt during the trauma. They may feel sweaty, have trouble breathing and may notice their heart rate increasing. They may feel dizzy or nauseated. Many traumatized children and adults may have physical symptoms, such as stomachaches and headaches, in addition to symptoms of increased arousal.
Other Associated Features
Many people with PTSD also develop depression and may at times abuse alcohol or other drugs as a "self-medication" to blunt their emotions and forget the trauma. A person with PTSD may also show poor control over his or her impulses, and may be at risk for suicide.
PTSD can cause those who suffer with it to act as if they are threatened by the trauma that caused their illness. People with PTSD may become irritable. They may have trouble concentrating or remembering current information, and may develop insomnia. Because of their chronic hyperarousal, many people with PTSD have poor work records, trouble with their bosses and poor relationships with their family and friends.
The persistence of a biological alarm reaction is expressed in exaggerated startle reactions. War veterans may revert to their war behavior, diving for cover when they hear a car backfire or a string of firecrackers exploding.At times, those with PTSD suffer panic attacks, whose symptoms include extreme fear resembling that which they felt during the trauma. They may feel sweaty, have trouble breathing and may notice their heart rate increasing. They may feel dizzy or nauseated. Many traumatized children and adults may have physical symptoms, such as stomachaches and headaches, in addition to symptoms of increased arousal.
Other Associated Features
Many people with PTSD also develop depression and may at times abuse alcohol or other drugs as a "self-medication" to blunt their emotions and forget the trauma. A person with PTSD may also show poor control over his or her impulses, and may be at risk for suicide.
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by Butterfly Faerie » Tue May 16, 2006 3:56 am
PTSD & Secondary Wounding
As important to the healing process as other people are, it's an unfortunate truth that often people do more harm than good. Strangers who don't understand your situation can be unintentionally cruel, but so can those who should know better: family, friends, and helping professionals. Instead of being supported, you have been made to feel ashamed of having been a part of the traumatic event in the first place, of your reactions to the event, or the symptoms you have developed as a result, or even for asking for help.
You may have heard, for example, "You weren't hurt enough to be entitled to benefits, " or "It happened years ago. You should be over it by now." Such attitudes exist even in the most obvious and horrendous cases of victimization.
Secondary wounding occurs when the people, the institutions, caregivers, and others to whom the survivor turns for emotional, legal, financial, medical, or other assistance respond in one of the following ways:
Disbelief:
Commonly, people will deny or disbelieve the trauma survivor's account of the trauma. Or they will minimize or discount the magnitude of the event(s), its meaning to the victim, its impact on the victim s life.
Blaming the Victim:
On some level, people may blame the victim for the traumatic event, thereby increasing the victim's sense of self-blame and low self-esteem.
Stigmatization:
Stigmatization occurs when others judge the victim negatively for normal reactions to the traumatic event or for any long-term symptoms he or she may suffer. These judgments can take the following forms:
• Ridicule of, or condescension toward, the survivor
• Misinterpretation of the survivor's psychological distress, as a sign of deep psychological problems or moral or mental deficiency or otherwise giving the survivor's PTSD symptoms negative labels.
• An implication or outright statement that the survivor's symptoms reflect his or her desire for financial gain, attention, or unwarranted sympathy.
• Punishment of the victim, rather than the offender, or in other ways depriving the victim of justice.
Denial of Assistance:
Trauma survivors are sometimes denied promised or unexpected services on the basis that they do not need or are not entitled to such services or compensation.
Causes of Secondary Wounding
In essence, secondary wounding occurs because people who have never been hurt or traumatized have difficulty understanding and being patient with people who have been hurt. Secondary wounding also occurs because people who have never been confronted human tragedy are sometimes unable to comprehend the lives of those in occupations that involve dealing with human suffering or mass casualties on a daily basis.
In addition, some people simply are not strong enough to accept the negatives in life. They prefer to ignore the fact that sadness, injustice and loss are just as much a part of life as joy and goodness. When such individuals confront a trauma survivor, they may reject, depreciate or ridicule the survivor because that individual represents the parts of life they have chosen to deny.
On the other hand, it also happens that trauma survivors are rejected or disparaged by other survivors those who have chosen to deny or repress their own trauma and have not yet dealt with their loses or anger. When trauma survivors who are not dealing with their traumatic pasts see someone who is obviously suffering emotionally or physically, they may need to block out that person in order to leave their own denial system intact.
The following sections give a brief run-down of some of the common causes of secondary wounding.
Ignorance:
Some secondary wounding stems from sheer ignorance. Especially in the past, there were few, if any, courses on PTSD available to medical, legal, and mental health professionals. Today such courses are available in many locations; however, they are not a required part of the training in any of those fields.
Burnout:
Another cause of secondary wounding is that many helping professionals are themselves suffering from some form of PTSD or burnout. As a result of having worked for years with survivors, they (like those survivors) are emotionally depleted. They may also, like many survivors, feel unappreciated and unrecognized by the general public and by those in their workplace.
Just World" Philosophy:
Another hurdle victims face is the prevalence and persistence of the "just world" philosophy. According to this philosophy, people get what they deserve and deserve what they get. The basic assumption of the "just world" philosophy is that if you are sufficiently careful, intelligent, moral, or competent, you can avoid misfortune. Thus people who suffer trauma are somehow to blame for their misfortune. Even if the victims aren't directly blamed, they are seen as causing their own victimization by being inherently weak or ineffectual.
Excerpts from I Can't Get Over It - A Handbook for Trauma Survivors by Aphrodite Matsakis, Ph.D.
As important to the healing process as other people are, it's an unfortunate truth that often people do more harm than good. Strangers who don't understand your situation can be unintentionally cruel, but so can those who should know better: family, friends, and helping professionals. Instead of being supported, you have been made to feel ashamed of having been a part of the traumatic event in the first place, of your reactions to the event, or the symptoms you have developed as a result, or even for asking for help.
You may have heard, for example, "You weren't hurt enough to be entitled to benefits, " or "It happened years ago. You should be over it by now." Such attitudes exist even in the most obvious and horrendous cases of victimization.
Secondary wounding occurs when the people, the institutions, caregivers, and others to whom the survivor turns for emotional, legal, financial, medical, or other assistance respond in one of the following ways:
Disbelief:
Commonly, people will deny or disbelieve the trauma survivor's account of the trauma. Or they will minimize or discount the magnitude of the event(s), its meaning to the victim, its impact on the victim s life.
Blaming the Victim:
On some level, people may blame the victim for the traumatic event, thereby increasing the victim's sense of self-blame and low self-esteem.
Stigmatization:
Stigmatization occurs when others judge the victim negatively for normal reactions to the traumatic event or for any long-term symptoms he or she may suffer. These judgments can take the following forms:
• Ridicule of, or condescension toward, the survivor
• Misinterpretation of the survivor's psychological distress, as a sign of deep psychological problems or moral or mental deficiency or otherwise giving the survivor's PTSD symptoms negative labels.
• An implication or outright statement that the survivor's symptoms reflect his or her desire for financial gain, attention, or unwarranted sympathy.
• Punishment of the victim, rather than the offender, or in other ways depriving the victim of justice.
Denial of Assistance:
Trauma survivors are sometimes denied promised or unexpected services on the basis that they do not need or are not entitled to such services or compensation.
Causes of Secondary Wounding
In essence, secondary wounding occurs because people who have never been hurt or traumatized have difficulty understanding and being patient with people who have been hurt. Secondary wounding also occurs because people who have never been confronted human tragedy are sometimes unable to comprehend the lives of those in occupations that involve dealing with human suffering or mass casualties on a daily basis.
In addition, some people simply are not strong enough to accept the negatives in life. They prefer to ignore the fact that sadness, injustice and loss are just as much a part of life as joy and goodness. When such individuals confront a trauma survivor, they may reject, depreciate or ridicule the survivor because that individual represents the parts of life they have chosen to deny.
On the other hand, it also happens that trauma survivors are rejected or disparaged by other survivors those who have chosen to deny or repress their own trauma and have not yet dealt with their loses or anger. When trauma survivors who are not dealing with their traumatic pasts see someone who is obviously suffering emotionally or physically, they may need to block out that person in order to leave their own denial system intact.
The following sections give a brief run-down of some of the common causes of secondary wounding.
Ignorance:
Some secondary wounding stems from sheer ignorance. Especially in the past, there were few, if any, courses on PTSD available to medical, legal, and mental health professionals. Today such courses are available in many locations; however, they are not a required part of the training in any of those fields.
Burnout:
Another cause of secondary wounding is that many helping professionals are themselves suffering from some form of PTSD or burnout. As a result of having worked for years with survivors, they (like those survivors) are emotionally depleted. They may also, like many survivors, feel unappreciated and unrecognized by the general public and by those in their workplace.
Just World" Philosophy:
Another hurdle victims face is the prevalence and persistence of the "just world" philosophy. According to this philosophy, people get what they deserve and deserve what they get. The basic assumption of the "just world" philosophy is that if you are sufficiently careful, intelligent, moral, or competent, you can avoid misfortune. Thus people who suffer trauma are somehow to blame for their misfortune. Even if the victims aren't directly blamed, they are seen as causing their own victimization by being inherently weak or ineffectual.
Excerpts from I Can't Get Over It - A Handbook for Trauma Survivors by Aphrodite Matsakis, Ph.D.
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by Butterfly Faerie » Tue May 16, 2006 3:57 am
Disasters occur commonly, and affect individuals as well as their communities. They may be human-made, caused by deliberate intention, as with terrorism, civil unrest, and war experiences, or caused by people through mishap or neglect, such as a work accident or an apartment fire. In addition disasters may be caused by nature, including earthquakes, floods, wildfires, hurricanes, or tornadoes.
Often large numbers of people are affected and they share their experience of trauma and traumatic loss. Many losses may occur after a disaster, including loss of loved ones, coworkers, neighbors, and pets, and loss of homes, workplaces, schools, houses of worship, possessions, and communities. Survivors may also lose their routine way of living and working, going to school, and being with others. Some may lose their confidence in the future.
Some disasters, such as terrorism, continue over a long period. These may create an on-going insecurity and exposure to danger or threat of danger, which may make it more difficult for some people to function in their lives.
After a disaster, it is normal to experience a number of stress reactions that may continue for a significant period. And after the sudden, traumatic loss caused by disasters, it is normal for grieving and mourning to be uneven, more intensely felt, and extended over time. In all disasters, the experience of safety, security, and predictability in the world is challenged, and a sense of uncertainty becomes a part of life.
What can I expect after experiencing a disaster?
Most child, adolescent, adult, and older adult survivors experience some of the following normal stress responses to varying degrees. They may last for many months after the disaster has ended, and even longer. Normal stress reactions include:
Emotional (feeling) reactions: feelings of shock, disbelief, anxiety, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, betrayal, depression, emotional numbness (difficulty having feelings, including those of love and intimacy, or taking interest and pleasure in day-to-day activities)
Cognitive (thinking) reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, repeated imagery, self-blame
Physical (bodily) reactions: tension, fatigue, edginess, difficulty sleeping, nightmares, being startled easily, racing heartbeat, nausea, aches and pains, worsening health conditions, change in appetite, change in sex drive
Interpersonal reactions: neediness; dependency; distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling in friendships marriages, family, or other relationships.
Spiritual (meaning) reactions: wondering why, why me, where was God; feeling as if life is not worth living, loss of hope.
What factors increase the risk of lasting vulnerability?
During or after massive disasters, many survivors may be directly exposed to or witness things that may make them particularly vulnerable to serious stress reactions.
Disaster stress may revive memories or experiences of earlier trauma, as well as possibly intensifying pre-existing social, economic, spiritual, psychological, or medical problems. While trauma reactions can become lasting problems, the shared experience of disasters and people's resiliency can provide support. Being aware of risk factors is important. They include:
Loss of family, neighborhood, or community
Life-threatening danger or physical harm (especially to children)
Exposure to horrible death, bodily injury, or bodies
Extreme environmental or human violence or destruction
Loss of home or valued possessions
Loss of communication with or support from important people in one's life
Intense emotional demands
Extreme fatigue, weather exposure, hunger, or sleep deprivation
Extended exposure to danger, loss, emotional/physical strain
Exposure to toxic contamination (such as gas, fumes, chemicals, radioactivity, or biological agents)
Studies show that some individuals are more vulnerable to serious stress reactions and lasting difficulty, including those whose histories include:
Other traumatic experiences (such as severe accidents, abuse, assault, combat, immigrant and refugee experiences, rescue work)
Chronic medical illness or psychological problems
Chronic poverty, homelessness, unemployment, or discrimination
Recent or earlier major life stressors or emotional strain (such as divorce or job loss).
What can survivors do to reduce vulnerability to serious emotional reactions and to achieve the best recovery from disaster stress? Observations by mental health specialists who assist survivors in the wake of disaster suggest that the following steps help to reduce stress symptoms and to promote post-disaster readjustment:
Protect: find a safe haven that provides shelter, food and water, sanitation, privacy, and opportunities to sit quietly, relax, and sleep, at least briefly
Direct: begin working on immediate personal and family priorities to help you and your loved ones preserve or regain a sense of hope, purpose, and self-esteem
Connect: maintain or re-establish communication with family, peers, and counselors in order to talk about the experiences. Survivors may want to find opportunities to "tell their stories" to others who express interest and concern and, when they are able, to listen to others as they tell theirs, in order to release the stress a little bit at a time and try to create meaning
Select: identify key resources such as Federal Emergency Management Agency (FEMA), the Red Cross, the Salvation Army, local and state health departments for clean-up, health, housing, and basic emergency assistance. Identify local cultural or community supports to help maintain or reestablish normal activities such as attending religious services.
Taking every day one at a time is essential in disaster's wake. Each day is a new opportunity to take steps toward recovery. People affected by disasters should try to:
Focus on what's most important to themselves and their families today;
Try to learn and understand what they and their loved ones are experiencing, to help remember what's important
Understand personally what these experiences mean as a part of their lives, so that they will feel able to go on with their lives and even grow personally
Take good care of themselves physically, including exercising regularly, eating well, and getting enough sleep, to reduce stress and prevent physical illness
Work together with others in their communities to improve conditions, reach out to persons who are marginalized or isolated, and otherwise promote recovery.
How would I decide I need professional help?
Most disaster survivors experience many normal responses and for some, their personal resources and capacities may grow and their relationships may strengthen. However, many survivors experience reactions during and after disasters that concern them, often when the disaster was caused by human action or included horror or loss of life. Some problematic responses are as follows:
Intrusive re-experiencing (terrifying memories, nightmares, or flashbacks)
Unsafe attempts to avoid disturbing memories (such as through substance use or alcohol)
On-going emotional numbing (unable to feel emotion, as if empty)
Extended hyperarousal (panic attacks, rage, extreme irritability, intense agitation, exaggerated startle response)
Severe anxiety (paralyzing worry, extreme helplessness)
Severe depression (loss of energy, interest, self-worth, or motivation)
Loss of meaning and hope
Sustained anger or rage
Dissociation (feeling unreal or outside oneself, as in a dream; having "blank" periods of time one cannot remember)
If after the end of a disaster, these normal experiences do not slowly improve, if they worsen with time, or if they cause difficulties in relationships or work, it is helpful to find professional support. People who wish to consider therapy should select a trained mental health professional who is knowledgeable about trauma as well as natural- and human-caused disasters. A family doctor, clergy person, local mental health association, state psychiatric, psychological, or social work association, or health insurer may be helpful in providing a referral to a counselor or therapist.
Disaster, Trauma & Loss
Often large numbers of people are affected and they share their experience of trauma and traumatic loss. Many losses may occur after a disaster, including loss of loved ones, coworkers, neighbors, and pets, and loss of homes, workplaces, schools, houses of worship, possessions, and communities. Survivors may also lose their routine way of living and working, going to school, and being with others. Some may lose their confidence in the future.
Some disasters, such as terrorism, continue over a long period. These may create an on-going insecurity and exposure to danger or threat of danger, which may make it more difficult for some people to function in their lives.
After a disaster, it is normal to experience a number of stress reactions that may continue for a significant period. And after the sudden, traumatic loss caused by disasters, it is normal for grieving and mourning to be uneven, more intensely felt, and extended over time. In all disasters, the experience of safety, security, and predictability in the world is challenged, and a sense of uncertainty becomes a part of life.
What can I expect after experiencing a disaster?
Most child, adolescent, adult, and older adult survivors experience some of the following normal stress responses to varying degrees. They may last for many months after the disaster has ended, and even longer. Normal stress reactions include:
Emotional (feeling) reactions: feelings of shock, disbelief, anxiety, fear, grief, anger, resentment, guilt, shame, helplessness, hopelessness, betrayal, depression, emotional numbness (difficulty having feelings, including those of love and intimacy, or taking interest and pleasure in day-to-day activities)
Cognitive (thinking) reactions: confusion, disorientation, indecisiveness, worry, shortened attention span, difficulty concentrating, memory loss, unwanted memories, repeated imagery, self-blame
Physical (bodily) reactions: tension, fatigue, edginess, difficulty sleeping, nightmares, being startled easily, racing heartbeat, nausea, aches and pains, worsening health conditions, change in appetite, change in sex drive
Interpersonal reactions: neediness; dependency; distrust; irritability; conflict; withdrawal; isolation; feeling rejected or abandoned; being distant, judgmental, or over-controlling in friendships marriages, family, or other relationships.
Spiritual (meaning) reactions: wondering why, why me, where was God; feeling as if life is not worth living, loss of hope.
What factors increase the risk of lasting vulnerability?
During or after massive disasters, many survivors may be directly exposed to or witness things that may make them particularly vulnerable to serious stress reactions.
Disaster stress may revive memories or experiences of earlier trauma, as well as possibly intensifying pre-existing social, economic, spiritual, psychological, or medical problems. While trauma reactions can become lasting problems, the shared experience of disasters and people's resiliency can provide support. Being aware of risk factors is important. They include:
Loss of family, neighborhood, or community
Life-threatening danger or physical harm (especially to children)
Exposure to horrible death, bodily injury, or bodies
Extreme environmental or human violence or destruction
Loss of home or valued possessions
Loss of communication with or support from important people in one's life
Intense emotional demands
Extreme fatigue, weather exposure, hunger, or sleep deprivation
Extended exposure to danger, loss, emotional/physical strain
Exposure to toxic contamination (such as gas, fumes, chemicals, radioactivity, or biological agents)
Studies show that some individuals are more vulnerable to serious stress reactions and lasting difficulty, including those whose histories include:
Other traumatic experiences (such as severe accidents, abuse, assault, combat, immigrant and refugee experiences, rescue work)
Chronic medical illness or psychological problems
Chronic poverty, homelessness, unemployment, or discrimination
Recent or earlier major life stressors or emotional strain (such as divorce or job loss).
What can survivors do to reduce vulnerability to serious emotional reactions and to achieve the best recovery from disaster stress? Observations by mental health specialists who assist survivors in the wake of disaster suggest that the following steps help to reduce stress symptoms and to promote post-disaster readjustment:
Protect: find a safe haven that provides shelter, food and water, sanitation, privacy, and opportunities to sit quietly, relax, and sleep, at least briefly
Direct: begin working on immediate personal and family priorities to help you and your loved ones preserve or regain a sense of hope, purpose, and self-esteem
Connect: maintain or re-establish communication with family, peers, and counselors in order to talk about the experiences. Survivors may want to find opportunities to "tell their stories" to others who express interest and concern and, when they are able, to listen to others as they tell theirs, in order to release the stress a little bit at a time and try to create meaning
Select: identify key resources such as Federal Emergency Management Agency (FEMA), the Red Cross, the Salvation Army, local and state health departments for clean-up, health, housing, and basic emergency assistance. Identify local cultural or community supports to help maintain or reestablish normal activities such as attending religious services.
Taking every day one at a time is essential in disaster's wake. Each day is a new opportunity to take steps toward recovery. People affected by disasters should try to:
Focus on what's most important to themselves and their families today;
Try to learn and understand what they and their loved ones are experiencing, to help remember what's important
Understand personally what these experiences mean as a part of their lives, so that they will feel able to go on with their lives and even grow personally
Take good care of themselves physically, including exercising regularly, eating well, and getting enough sleep, to reduce stress and prevent physical illness
Work together with others in their communities to improve conditions, reach out to persons who are marginalized or isolated, and otherwise promote recovery.
How would I decide I need professional help?
Most disaster survivors experience many normal responses and for some, their personal resources and capacities may grow and their relationships may strengthen. However, many survivors experience reactions during and after disasters that concern them, often when the disaster was caused by human action or included horror or loss of life. Some problematic responses are as follows:
Intrusive re-experiencing (terrifying memories, nightmares, or flashbacks)
Unsafe attempts to avoid disturbing memories (such as through substance use or alcohol)
On-going emotional numbing (unable to feel emotion, as if empty)
Extended hyperarousal (panic attacks, rage, extreme irritability, intense agitation, exaggerated startle response)
Severe anxiety (paralyzing worry, extreme helplessness)
Severe depression (loss of energy, interest, self-worth, or motivation)
Loss of meaning and hope
Sustained anger or rage
Dissociation (feeling unreal or outside oneself, as in a dream; having "blank" periods of time one cannot remember)
If after the end of a disaster, these normal experiences do not slowly improve, if they worsen with time, or if they cause difficulties in relationships or work, it is helpful to find professional support. People who wish to consider therapy should select a trained mental health professional who is knowledgeable about trauma as well as natural- and human-caused disasters. A family doctor, clergy person, local mental health association, state psychiatric, psychological, or social work association, or health insurer may be helpful in providing a referral to a counselor or therapist.
Disaster, Trauma & Loss
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by Butterfly Faerie » Tue May 16, 2006 3:58 am
The diagnosis of PTSD accurately describes the symptoms that result when a person experiences a short-lived trauma. For example, car accidents, natural disasters, and rape are considered traumatic events of time-limited duration. However, chronic traumas continue for months or years at a time. Clinicians and researchers have found that the current PTSD diagnosis often does not capture the severe psychological harm that occurs with such prolonged, repeated trauma. For example, ordinary, healthy people who experience chronic trauma can experience changes in their self-concept and the way they adapt to stressful events. Dr. Judith Herman of Harvard University suggests that a new diagnosis, called Complex PTSD, is needed to describe the symptoms of long-term trauma.
What are examples of captivity that are associated with chronic trauma?
Judith Herman notes that during long-term traumas, the victim is generally held in a state of captivity. In these situations the victim is under the control of the perpetrator and unable to flee.
Examples of captivity include:
Concentration camps
Prisoner of War camps
Prostitution brothels
Long-term domestic violence
Long-term, severe physical abuse
Child sexual abuse
Organized child exploitation rings
What are the symptoms of Complex PTSD?
The first requirement for the diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization. Those symptoms include:
* Alterations in emotional regulation, which may include symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger
* Alterations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body
* Alterations in self-perception, which may include a sense of helplessness, shame, guilt, stigma, and a sense of being completely different than other human beings
* Alterations in the perception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge
* Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer
* Alterations in one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair
What other difficulties do those with Complex PTSD tend to experience?
Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.
Survivors may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma.
Survivors may also engage in self-mutilation and other forms of self-harm.
There is a tendency to blame the victim.
A person who has been abused repeatedly is sometimes mistaken as someone who has a "weak character."
Because of their chronic victimization, in the past, survivors have been misdiagnosed by mental-health providers as having Borderline, Dependent, or Masochistic Personality Disorder. When survivors are faulted for the symptoms they experience as a result of victimization, they are being unjustly blamed.
Researchers hope that a new diagnosis will prevent clinicians, the public, and those who suffer from trauma from mistakenly blaming survivors for their symptoms.
Summary
The current PTSD diagnosis often does not capture the severe psychological harm that occurs with prolonged, repeated trauma. For example, long-term trauma may impact a healthy person's self-concept and adaptation. The symptoms of such prolonged trauma have been mistaken for character weakness. Research is currently underway to determine if the Complex PTSD diagnosis is the best way to categorize the symptoms of patients who have suffered prolonged trauma.
What are examples of captivity that are associated with chronic trauma?
Judith Herman notes that during long-term traumas, the victim is generally held in a state of captivity. In these situations the victim is under the control of the perpetrator and unable to flee.
Examples of captivity include:
Concentration camps
Prisoner of War camps
Prostitution brothels
Long-term domestic violence
Long-term, severe physical abuse
Child sexual abuse
Organized child exploitation rings
What are the symptoms of Complex PTSD?
The first requirement for the diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization. Those symptoms include:
* Alterations in emotional regulation, which may include symptoms such as persistent sadness, suicidal thoughts, explosive anger, or inhibited anger
* Alterations in consciousness, such as forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body
* Alterations in self-perception, which may include a sense of helplessness, shame, guilt, stigma, and a sense of being completely different than other human beings
* Alterations in the perception of the perpetrator, such as attributing total power to the perpetrator or becoming preoccupied with the relationship to the perpetrator, including a preoccupation with revenge
* Alterations in relations with others, including isolation, distrust, or a repeated search for a rescuer
* Alterations in one's system of meanings, which may include a loss of sustaining faith or a sense of hopelessness and despair
What other difficulties do those with Complex PTSD tend to experience?
Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.
Survivors may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma.
Survivors may also engage in self-mutilation and other forms of self-harm.
There is a tendency to blame the victim.
A person who has been abused repeatedly is sometimes mistaken as someone who has a "weak character."
Because of their chronic victimization, in the past, survivors have been misdiagnosed by mental-health providers as having Borderline, Dependent, or Masochistic Personality Disorder. When survivors are faulted for the symptoms they experience as a result of victimization, they are being unjustly blamed.
Researchers hope that a new diagnosis will prevent clinicians, the public, and those who suffer from trauma from mistakenly blaming survivors for their symptoms.
Summary
The current PTSD diagnosis often does not capture the severe psychological harm that occurs with prolonged, repeated trauma. For example, long-term trauma may impact a healthy person's self-concept and adaptation. The symptoms of such prolonged trauma have been mistaken for character weakness. Research is currently underway to determine if the Complex PTSD diagnosis is the best way to categorize the symptoms of patients who have suffered prolonged trauma.
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by Butterfly Faerie » Tue May 16, 2006 3:58 am
When people find themselves suddenly in danger, sometimes they are overcome with feelings of fear, helplessness, or horror. These events are called traumatic experiences. Some common traumatic experiences include being physically attacked, being in a serious accident, being in combat, being sexually assaulted, and being in a fire or a disaster like a hurricane or a tornado. After traumatic experiences, people may have problems that they didn't have before the event. If these problems are severe and the survivor does not get help for them, they can begin to cause problems in the survivor's family. This fact sheet explains how traumas can affect those who experience them. This fact sheet also describes family members' reactions to the traumatic event and to the trauma survivor's symptoms and behaviors. Finally, suggestions are made about what a survivor and his or her family can do to get help for PTSD.
How do traumatic experiences affect people?
People who go through traumatic experiences often have symptoms and problems afterward. How serious the symptoms and problems are depends on many things including a person's life experiences before the trauma, a person's own natural ability to cope with stress, how serious the trauma was, and what kind of help and support a person gets from family, friends, and professionals immediately following the trauma.
Because most trauma survivors are not familiar with how trauma affects people, they often have trouble understanding what is happening to them. They may think the trauma is their fault, that they are going crazy, or that there is something wrong with them because other people who experienced the trauma don't appear to have the same problems. Survivors may turn to drugs or alcohol to make themselves feel better. They may turn away from friends and family who don't seem to understand. They may not know what to do to get better.
What do trauma survivors need to know?
·Traumas happen to many competent, healthy, strong, good people. No one can completely protect him- or herself from traumatic experiences.
·Many people have long-lasting problems following exposure to trauma. Up to 8% of individuals will have PTSD at some time in their lives.
·People who react to traumas are not going crazy. They are experiencing symptoms and problems that are connected with having been in a traumatic situation.
·Having symptoms after a traumatic event is not a sign of personal weakness. Many psychologically well-adjusted and physically healthy people develop PTSD. Probably everyone would develop PTSD if they were exposed to a severe enough trauma.
·When a person understands trauma symptoms better, he or she can become less fearful of them and better able to manage them.
·By recognizing the effects of trauma and knowing more about symptoms, a person is better able to decide about getting treatment.
What are the common effects of trauma?
During a trauma, survivors often become overwhelmed with fear. Soon after the traumatic experience, they may re-experience the trauma mentally and physically. Because this can be uncomfortable and sometimes painful, survivors tend to avoid reminders of the trauma. These symptoms create a problem that is called posttraumatic stress disorder (PTSD). PTSD is a specific set of problems resulting from a traumatic experience and is recognized by medical and mental-health professionals.
Re-experiencing Symptoms:
Trauma survivors commonly re-experience their traumas. This means that the survivor experiences again the same mental, emotional, and physical experiences that occurred during or just after the trauma. These include thinking about the trauma, seeing images of the event, feeling agitated, and having physical sensations like those that occurred during the trauma. Trauma survivors find themselves feeling as if they are in danger, experiencing panic sensations, wanting to escape, getting angry, and thinking about attacking or harming someone else. Because they are anxious and physically agitated, they may have trouble sleeping and concentrating. The survivor usually can't control these symptoms or stop them from happening. Mentally re-experiencing the trauma can include:
·Upsetting memories such as images or thoughts about the trauma
·Feeling as if the trauma is happening again (flashbacks)
·Bad dreams and nightmares
·Getting upset when reminded about the trauma (by something the person sees, hears, feels, smells, or tastes)
·Anxiety or fear, feeling in danger again
·Anger or aggressive feelings and feeling the need to defend oneself
·Trouble controlling emotions because reminders lead to sudden anxiety, anger, or upset
·Trouble concentrating or thinking clearly
People also can have physical reactions to trauma reminders such as:
·Trouble falling or staying asleep
·Feeling agitated and constantly on the lookout for danger
·Getting very startled by loud noises or something or someone coming up on you from behind when you don't expect it
·Feeling shaky and sweaty
·Having your heart pound or having trouble breathing
Because trauma survivors have these upsetting feelings when they feel stress or are reminded of their trauma, they often act as if they are in danger again. They might get overly concerned about staying safe in situations that are not truly dangerous. For example, a person living in a safe neighborhood might still feel that he has to have an alarm system, double locks on the door, a locked fence, and a guard dog. Because traumatized people often feel like they are in danger even when they are not, they may be overly aggressive and lash out to protect themselves when there is no need. For example, a person who was attacked might be quick to yell at or hit someone who seems to be threatening.
Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience. These symptoms are automatic, learned responses to trauma reminders. The trauma has become associated with many things so that when the person experiences these things, he or she is reminded of the trauma and feels that he or she is in danger again. It is also possible that re-experiencing symptoms are actually a part of the mindâs attempt to make sense of what has happened.
Avoidance Symptoms:
Because thinking about the trauma and feeling as if you are in danger is upsetting, people who have been through traumas often try to avoid reminders of the trauma. Sometimes survivors are aware that they are avoiding reminders, but other times survivors do not realize that their behavior is motivated by the need to avoid reminders of the trauma.
Ways of avoiding thoughts, feelings, and sensations associated with the trauma can include:
·Actively avoiding trauma-related thoughts and memories
·Avoiding conversations and staying away from places, activities, or people that might remind you of the trauma
·Trouble remembering important parts of what happened during the trauma
·Shutting down emotionally or feeling emotionally numb
·Trouble having loving feelings or feeling any strong emotions
·Finding that things around you seem strange or unreal
·Feeling strange
·Feeling disconnected from the world around you and things that happen to you
·Avoiding situations that might make you have a strong emotional reaction
·Feeling weird physical sensations
·Feeling physically numb
·Not feeling pain or other sensations
·Losing interest in things you used to enjoy doing
Trying to avoid thinking about the trauma and avoiding treatment for trauma-related problems may keep a person from feeling upset in the short term, but avoiding treatment means that in the long term, trauma symptoms will persist.
What are common secondary and associated posttraumatic symptoms?
Secondary symptoms are problems that arise because of the posttraumatic re-experiencing and avoidance symptoms. For example, because a person wants to avoid talking about a traumatic event, she might cut off from friends, which would eventually cause her to feel lonely and depressed. As time passes after a traumatic experience, more secondary symptoms may develop. Over time, secondary symptoms can become more troubling and disabling than the original re-experiencing and avoidance symptoms.
Associated symptoms don't come directly from being overwhelmed with fear; they occur because of other things that were going on at the time of the trauma. For example, a person who is psychologically traumatized in a car accident might also be physically injured and then get depressed because he can't work or leave the house.
All of these problems can be secondary or associated trauma symptoms:
Depression can develop when a person has losses connected with the trauma or when a person avoids other people and becomes isolated.
Despair and hopelessness can result when a person is afraid that he or she will never feel better again.
Survivors may lose important beliefs when a traumatic event makes them lose faith that the world is a good and safe place.
Aggressive behavior toward oneself or others can result from frustration over the inability to control PTSD symptoms (feeling that PTSD symptoms run your life). People may also become aggressive when other things that happened at the time of trauma make the person angry (the unfairness of the situation). Some people are aggressive because they grew up with people who lashed out and they were never taught other ways to cope with angry feelings. Because angry feelings may keep others at a distance, they may stop a person from having positive connections and getting help. Anger and aggression can cause job problems, marital and relationship problems, and loss of friendships.
Self-blame, guilt, and shame can arise when PTSD symptoms make it hard to fulfill current responsibilities. They can also occur when people fall into the common trap of second-guessing what they did or didn't do at the time of a trauma. Many people, in trying to make sense of their experience, blame themselves. This is usually completely unwarranted and fails to hold accountable those who may have actually been responsible for the event. Self-blame causes a lot of distress and can prevent a person from reaching out for help. Sometimes society also blames the victim of a trauma. Unfortunately, this may reinforce the survivorâs hesitation to seek help.
People who have experienced traumas may have problems in relationships with others because they often have a hard time feeling close to people or trusting people. This is especially likely to happen when the trauma was caused or worsened by other people (as opposed to an accident or natural disaster).
Trauma survivors may feel detached or disconnected from others because they have difficulty feeling or expressing positive feelings. After traumas, people can become overwhelmed by their problems or become numb and stop putting energy into their relationships with friends and family.
Survivors may get into arguments and fights with other people because of the angry or aggressive feelings that are common after a trauma. Also, a person's constant avoidance of social situations (such as family gatherings) may create hurt feelings or animosity in the survivorâs relationships.
Less interest or participation in things the person used to like to do may result from depression following a trauma. When a person spends less time doing fun things and being with people, he or she has fewer chances to feel good and have pleasant interactions.
Social isolation can happen because of social withdrawal and a lack of trust in others. This often leads to the loss of support, friendships, and intimacy, and it increases fears and worries.
Survivors may have problems with identity when PTSD symptoms change important aspects of a person's life such as relationships or whether the person can do his or her work well. A person may also question his or her identity because of the way he or she acted during a trauma. For instance, a person who thinks of himself as unselfish might think he acted selfishly by saving himself during a disaster. This might make him question whether he really is who he thought he was.
Feeling permanently damaged can result when trauma symptoms don't go away and a person doesn't believe they will get better.
Survivors may develop problems with self-esteem because PTSD symptoms make it hard for a person to feel good about him- or herself. Sometimes, because of how they behaved at the time of the trauma, survivors feel that they are bad, worthless, stupid, incompetent, evil, etc.
Physical health symptoms and problems can happen because of long periods of physical agitation or arousal from anxiety. Trauma survivors may also avoid medical care because it reminds them of their trauma and causes anxiety, and this may lead to poorer health. For example, a rape survivor may not visit a gynecologist and an injured motor vehicle accident survivor may avoid doctors because they remind him or her that a trauma occurred. Habits used to cope with posttraumatic stress, like alcohol use, can also cause health problems. In addition, other things that happened at the time of the trauma may cause health problems (for example, an injury).
Survivors may turn to alcohol and drug abuse when they want to avoid the bad feelings that come with PTSD symptoms. Many people use alcohol and drugs as a way to try to cope with upsetting trauma symptoms, but it actually leads to more problems.
Remember:
Although individuals with PTSD may feel overwhelmed by their symptoms, it is important for them to remember that there are other, positive aspects of their lives. There are helpful mental-health and medical resources available (see link below), and survivors have their strengths, interests, commitments, relationships with others, past experiences that were not traumatic, desires, and hopes for the future.
Treatments are available for individuals with PTSD and associated trauma-related symptoms.
Understanding the effects of trauma on relationships can also be an important step for family members or friends.
NCPTSD
How do traumatic experiences affect people?
People who go through traumatic experiences often have symptoms and problems afterward. How serious the symptoms and problems are depends on many things including a person's life experiences before the trauma, a person's own natural ability to cope with stress, how serious the trauma was, and what kind of help and support a person gets from family, friends, and professionals immediately following the trauma.
Because most trauma survivors are not familiar with how trauma affects people, they often have trouble understanding what is happening to them. They may think the trauma is their fault, that they are going crazy, or that there is something wrong with them because other people who experienced the trauma don't appear to have the same problems. Survivors may turn to drugs or alcohol to make themselves feel better. They may turn away from friends and family who don't seem to understand. They may not know what to do to get better.
What do trauma survivors need to know?
·Traumas happen to many competent, healthy, strong, good people. No one can completely protect him- or herself from traumatic experiences.
·Many people have long-lasting problems following exposure to trauma. Up to 8% of individuals will have PTSD at some time in their lives.
·People who react to traumas are not going crazy. They are experiencing symptoms and problems that are connected with having been in a traumatic situation.
·Having symptoms after a traumatic event is not a sign of personal weakness. Many psychologically well-adjusted and physically healthy people develop PTSD. Probably everyone would develop PTSD if they were exposed to a severe enough trauma.
·When a person understands trauma symptoms better, he or she can become less fearful of them and better able to manage them.
·By recognizing the effects of trauma and knowing more about symptoms, a person is better able to decide about getting treatment.
What are the common effects of trauma?
During a trauma, survivors often become overwhelmed with fear. Soon after the traumatic experience, they may re-experience the trauma mentally and physically. Because this can be uncomfortable and sometimes painful, survivors tend to avoid reminders of the trauma. These symptoms create a problem that is called posttraumatic stress disorder (PTSD). PTSD is a specific set of problems resulting from a traumatic experience and is recognized by medical and mental-health professionals.
Re-experiencing Symptoms:
Trauma survivors commonly re-experience their traumas. This means that the survivor experiences again the same mental, emotional, and physical experiences that occurred during or just after the trauma. These include thinking about the trauma, seeing images of the event, feeling agitated, and having physical sensations like those that occurred during the trauma. Trauma survivors find themselves feeling as if they are in danger, experiencing panic sensations, wanting to escape, getting angry, and thinking about attacking or harming someone else. Because they are anxious and physically agitated, they may have trouble sleeping and concentrating. The survivor usually can't control these symptoms or stop them from happening. Mentally re-experiencing the trauma can include:
·Upsetting memories such as images or thoughts about the trauma
·Feeling as if the trauma is happening again (flashbacks)
·Bad dreams and nightmares
·Getting upset when reminded about the trauma (by something the person sees, hears, feels, smells, or tastes)
·Anxiety or fear, feeling in danger again
·Anger or aggressive feelings and feeling the need to defend oneself
·Trouble controlling emotions because reminders lead to sudden anxiety, anger, or upset
·Trouble concentrating or thinking clearly
People also can have physical reactions to trauma reminders such as:
·Trouble falling or staying asleep
·Feeling agitated and constantly on the lookout for danger
·Getting very startled by loud noises or something or someone coming up on you from behind when you don't expect it
·Feeling shaky and sweaty
·Having your heart pound or having trouble breathing
Because trauma survivors have these upsetting feelings when they feel stress or are reminded of their trauma, they often act as if they are in danger again. They might get overly concerned about staying safe in situations that are not truly dangerous. For example, a person living in a safe neighborhood might still feel that he has to have an alarm system, double locks on the door, a locked fence, and a guard dog. Because traumatized people often feel like they are in danger even when they are not, they may be overly aggressive and lash out to protect themselves when there is no need. For example, a person who was attacked might be quick to yell at or hit someone who seems to be threatening.
Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience. These symptoms are automatic, learned responses to trauma reminders. The trauma has become associated with many things so that when the person experiences these things, he or she is reminded of the trauma and feels that he or she is in danger again. It is also possible that re-experiencing symptoms are actually a part of the mindâs attempt to make sense of what has happened.
Avoidance Symptoms:
Because thinking about the trauma and feeling as if you are in danger is upsetting, people who have been through traumas often try to avoid reminders of the trauma. Sometimes survivors are aware that they are avoiding reminders, but other times survivors do not realize that their behavior is motivated by the need to avoid reminders of the trauma.
Ways of avoiding thoughts, feelings, and sensations associated with the trauma can include:
·Actively avoiding trauma-related thoughts and memories
·Avoiding conversations and staying away from places, activities, or people that might remind you of the trauma
·Trouble remembering important parts of what happened during the trauma
·Shutting down emotionally or feeling emotionally numb
·Trouble having loving feelings or feeling any strong emotions
·Finding that things around you seem strange or unreal
·Feeling strange
·Feeling disconnected from the world around you and things that happen to you
·Avoiding situations that might make you have a strong emotional reaction
·Feeling weird physical sensations
·Feeling physically numb
·Not feeling pain or other sensations
·Losing interest in things you used to enjoy doing
Trying to avoid thinking about the trauma and avoiding treatment for trauma-related problems may keep a person from feeling upset in the short term, but avoiding treatment means that in the long term, trauma symptoms will persist.
What are common secondary and associated posttraumatic symptoms?
Secondary symptoms are problems that arise because of the posttraumatic re-experiencing and avoidance symptoms. For example, because a person wants to avoid talking about a traumatic event, she might cut off from friends, which would eventually cause her to feel lonely and depressed. As time passes after a traumatic experience, more secondary symptoms may develop. Over time, secondary symptoms can become more troubling and disabling than the original re-experiencing and avoidance symptoms.
Associated symptoms don't come directly from being overwhelmed with fear; they occur because of other things that were going on at the time of the trauma. For example, a person who is psychologically traumatized in a car accident might also be physically injured and then get depressed because he can't work or leave the house.
All of these problems can be secondary or associated trauma symptoms:
Depression can develop when a person has losses connected with the trauma or when a person avoids other people and becomes isolated.
Despair and hopelessness can result when a person is afraid that he or she will never feel better again.
Survivors may lose important beliefs when a traumatic event makes them lose faith that the world is a good and safe place.
Aggressive behavior toward oneself or others can result from frustration over the inability to control PTSD symptoms (feeling that PTSD symptoms run your life). People may also become aggressive when other things that happened at the time of trauma make the person angry (the unfairness of the situation). Some people are aggressive because they grew up with people who lashed out and they were never taught other ways to cope with angry feelings. Because angry feelings may keep others at a distance, they may stop a person from having positive connections and getting help. Anger and aggression can cause job problems, marital and relationship problems, and loss of friendships.
Self-blame, guilt, and shame can arise when PTSD symptoms make it hard to fulfill current responsibilities. They can also occur when people fall into the common trap of second-guessing what they did or didn't do at the time of a trauma. Many people, in trying to make sense of their experience, blame themselves. This is usually completely unwarranted and fails to hold accountable those who may have actually been responsible for the event. Self-blame causes a lot of distress and can prevent a person from reaching out for help. Sometimes society also blames the victim of a trauma. Unfortunately, this may reinforce the survivorâs hesitation to seek help.
People who have experienced traumas may have problems in relationships with others because they often have a hard time feeling close to people or trusting people. This is especially likely to happen when the trauma was caused or worsened by other people (as opposed to an accident or natural disaster).
Trauma survivors may feel detached or disconnected from others because they have difficulty feeling or expressing positive feelings. After traumas, people can become overwhelmed by their problems or become numb and stop putting energy into their relationships with friends and family.
Survivors may get into arguments and fights with other people because of the angry or aggressive feelings that are common after a trauma. Also, a person's constant avoidance of social situations (such as family gatherings) may create hurt feelings or animosity in the survivorâs relationships.
Less interest or participation in things the person used to like to do may result from depression following a trauma. When a person spends less time doing fun things and being with people, he or she has fewer chances to feel good and have pleasant interactions.
Social isolation can happen because of social withdrawal and a lack of trust in others. This often leads to the loss of support, friendships, and intimacy, and it increases fears and worries.
Survivors may have problems with identity when PTSD symptoms change important aspects of a person's life such as relationships or whether the person can do his or her work well. A person may also question his or her identity because of the way he or she acted during a trauma. For instance, a person who thinks of himself as unselfish might think he acted selfishly by saving himself during a disaster. This might make him question whether he really is who he thought he was.
Feeling permanently damaged can result when trauma symptoms don't go away and a person doesn't believe they will get better.
Survivors may develop problems with self-esteem because PTSD symptoms make it hard for a person to feel good about him- or herself. Sometimes, because of how they behaved at the time of the trauma, survivors feel that they are bad, worthless, stupid, incompetent, evil, etc.
Physical health symptoms and problems can happen because of long periods of physical agitation or arousal from anxiety. Trauma survivors may also avoid medical care because it reminds them of their trauma and causes anxiety, and this may lead to poorer health. For example, a rape survivor may not visit a gynecologist and an injured motor vehicle accident survivor may avoid doctors because they remind him or her that a trauma occurred. Habits used to cope with posttraumatic stress, like alcohol use, can also cause health problems. In addition, other things that happened at the time of the trauma may cause health problems (for example, an injury).
Survivors may turn to alcohol and drug abuse when they want to avoid the bad feelings that come with PTSD symptoms. Many people use alcohol and drugs as a way to try to cope with upsetting trauma symptoms, but it actually leads to more problems.
Remember:
Although individuals with PTSD may feel overwhelmed by their symptoms, it is important for them to remember that there are other, positive aspects of their lives. There are helpful mental-health and medical resources available (see link below), and survivors have their strengths, interests, commitments, relationships with others, past experiences that were not traumatic, desires, and hopes for the future.
Treatments are available for individuals with PTSD and associated trauma-related symptoms.
Understanding the effects of trauma on relationships can also be an important step for family members or friends.
NCPTSD
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by Butterfly Faerie » Tue May 16, 2006 3:59 am
Here are some of the problems associated with PTSD.
Acute Stress Disorder: A Brief Description
Explains briefly what ASD is, how common it is, who is at risk, how it differs from PTSD, and effective treatments
Alcohol: PTSD and Problems with Alcohol Use
Information on the impact of PTSD on alcohol use and dependence, which commonly occur in tandem with PTSD
Anger & Trauma
Describes the links between trauma and anger and treatment strategies for anger management
Avoidance
Explains what emotional and behavioral avoidance is and how it can get in the way of healing from trauma
Chronic Pain
Explains what chronic pain is and how it's related to PTSD, describes treatment options for patients and recommendations for health care providers
Physical Health
An overview of recent research that confirms that trauma and PTSD affect physical health
Self Harm
Includes information about what self-harm is, how common it is, who engages in self-harm and why, and treatments for self-harming behavior
Sleep & PTSD
Information on the effects of trauma on sleep patterns
Substance Abuse
An interview with Ismene Petrakis, M.D., about understanding and treating patients who have PTSD in combination with substance abuse disorders, particularly alcoholism
Suicide
Examines the connection between PTSD and suicide. Provides information about suicide as a traumatic event, reasons for suicide, and what to do if you are feeling suicidal or have been exposed to suicide
The following information is from NCPTSD Website.
Acute Stress Disorder: A Brief Description
Explains briefly what ASD is, how common it is, who is at risk, how it differs from PTSD, and effective treatments
Alcohol: PTSD and Problems with Alcohol Use
Information on the impact of PTSD on alcohol use and dependence, which commonly occur in tandem with PTSD
Anger & Trauma
Describes the links between trauma and anger and treatment strategies for anger management
Avoidance
Explains what emotional and behavioral avoidance is and how it can get in the way of healing from trauma
Chronic Pain
Explains what chronic pain is and how it's related to PTSD, describes treatment options for patients and recommendations for health care providers
Physical Health
An overview of recent research that confirms that trauma and PTSD affect physical health
Self Harm
Includes information about what self-harm is, how common it is, who engages in self-harm and why, and treatments for self-harming behavior
Sleep & PTSD
Information on the effects of trauma on sleep patterns
Substance Abuse
An interview with Ismene Petrakis, M.D., about understanding and treating patients who have PTSD in combination with substance abuse disorders, particularly alcoholism
Suicide
Examines the connection between PTSD and suicide. Provides information about suicide as a traumatic event, reasons for suicide, and what to do if you are feeling suicidal or have been exposed to suicide
The following information is from NCPTSD Website.
- Butterfly Faerie
- Consumer 6
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by Butterfly Faerie » Tue May 16, 2006 4:00 am
What are nightmares?
Nightmares refer to elaborate dreams that cause high levels of anxiety or terror1. In general, the content of nightmares revolves around imminent harm being caused to the individual (e.g., being chased, threatened, injured, etc.). When nightmares occur in the context of posttraumatic stress disorder (PTSD), they tend to involve the original threatening or horrifying set of circumstances that was involved during the traumatic event. For example, someone who was in the Twin Towers on September 11th, 2001, might experience frightening dreams involving terrorists, airplane crashes, collapsing buildings, fires, people jumping from buildings, etc. A rape survivor might experience disturbing dreams about the rape itself or some aspect of the experience that was particularly frightening (e.g., being held at knifepoint).
Nightmares can occur multiple times in a given night, or one might experience them very rarely. Individuals may experience the same dream repeatedly, or they may experience different dreams with a similar theme. When individuals awaken from nightmares, they can typically remember them in detail. Upon awakening from a nightmare, individuals typically report feelings of alertness, fear, and anxiety. Nightmares occur almost exclusively during rapid eye movement (REM) sleep. Although REM sleep occurs on and off throughout the night, REM sleep periods become longer and dreaming tends to become more intense in the second half of the night. As a result, nightmares are more likely to occur during this time.
How common are nightmares?
The prevalence of nightmares varies by age group and by gender.† Nightmares are reportedly first experienced between the ages of 3 and 6 years1. From 10% to 50% of children between the ages of 3 and 5 have nightmares that are severe enough to cause their parents concern. This does not mean that children with nightmares necessarily have a psychological disorder. In fact, children who develop nightmares in the absence of traumatic events typically grow out of them as they get older. Approximately 50% of adults report having at least an occasional nightmare1. Estimates suggest that between 6.9%2 and 8.1%3 of the adult population suffer from chronic nightmares.
Women report having nightmares more often than men do. Women report two to four nightmares for every one nightmare reported by men. It is unclear at this point whether men and women actually experience different rates of nightmares, or whether women are simply more likely to report them.
Nightmares and cultural differences
The interpretation of and significance given to nightmares varies tremendously by culture. While some cultures view nightmares as indicators of mental health problems, others view them as related to supernatural or spiritual phenomena. Clinicians should keep this in mind during their assessments of the impact that nightmares have on clients.
How are nightmares related to PTSD?
Nightmares are 1 of 17 possible symptoms of PTSD. One does not have to experience nightmares in order to have PTSD. However, nightmares are one of the most common of the 're-experiencing' symptoms of PTSD, seen in approximately 60% of individuals with PTSD. A recent study of nightmares in female sexual assault survivors found that a higher frequency of nightmares was related to increased severity of PTSD symptoms5. Little is known about the typical frequency or duration of nightmares in individuals with PTSD.
Are there any effective treatments for nightmares?
Yes. There are both psychological treatments (involving changing thoughts and behaviors) and psychopharmacological treatments (involving medicine) that have been found to be effective in reducing nightmares.
Psychological Treatment
In recent years, Barry Krakow and his colleagues at the University of New Mexico have conducted numerous studies regarding a promising psychological treatment for nightmares. This research group found positive results in applying this treatment to individuals suffering from nightmares in the context of PTSD. Krakow and colleagues found that crime victims and sexual assault survivors with PTSD who received this treatment showed fewer nightmares and better sleep quality after three group-treatment sessions. Another group of researchers applied the treatment to Vietnam combat veterans and found similarly promising results in a small pilot study.
The treatment studied at the University of New Mexico is called 'Imagery Rehearsal Therapy' and is classified as a cognitive-behavioral treatment. It does not involve the use of medications. In brief, the treatment involves helping the clients change the endings of their nightmares, while they are awake, so that the ending is no longer upsetting. The client is then instructed to rehearse the new, nonthreatening images associated with the changed dream. Imagery Rehearsal Therapy also typically involves other components designed to help clients with problems associated with nightmares, such as insomnia. For example, clients are taught basic strategies that may help them to improve the quality of their sleep, such as refraining from caffeine during the afternoon, having a consistent evening wind-down ritual, or refraining from watching TV in bed.
Psychologists who use cognitive-behavioral techniques may be familiar with Imagery Rehearsal Therapy, or may have access to research literature describing it. If you need help locating a cognitive-behavioral therapist in your area, try using the clinical referral directory of the Association for the Advancement of Behavior Therapy.
Psychopharmacological Treatment
Researchers have also conducted studies of medications for the treatment of nightmares. However, it should be noted that the research findings in support of these treatments are more tentative than findings from studies of Imagery Rehearsal Therapy. Part of the reason for this is simply that fewer studies have been conducted with medications at this point in time. Also, the studies that have been conducted with medications have generally been small and have not included a comparison control group (that did not receive medication). This makes it difficult to know for sure whether the medication is responsible for reducing nightmares, or whether the patientís belief or confidence that the medication will work was responsible for the positive changes (a.k.a., a placebo effect).
Some medications that have been studied for treatment of PTSD-related nightmares and may be effective in reducing nightmares include Topiramate, Prazosin, Nefazodone, Trazodone, and Gabapentin. Because medications typically have side effects, many patients choose to try a behavioral treatment first. If that does not help improve their symptoms, they may choose to try medication. For suggestions about how to talk to your doctor about your PTSD-related nightmares and the possible use of medications for your symptoms, consult the fact sheet below.
What happens if nightmares are left untreated?
Nightmares can be a chronic mental health problem for some individuals, but it is not yet clear why they plague some people and not others. One thing that is clear is that nightmares are common in the early phases after a traumatic experience. However, research suggests that most people who have PTSD symptoms (including nightmares) just after a trauma will recover without treatment. This typically occurs by about the third month after a trauma. However, if PTSD symptoms (including nightmares) have not decreased substantially by about the third month, these symptoms can become chronic. If you have been suffering from nightmares for more than 3 months, you are encouraged to contact a mental health professional and discuss with him or her the behavioral treatments described above.
Facts-NCPTSD
Nightmares refer to elaborate dreams that cause high levels of anxiety or terror1. In general, the content of nightmares revolves around imminent harm being caused to the individual (e.g., being chased, threatened, injured, etc.). When nightmares occur in the context of posttraumatic stress disorder (PTSD), they tend to involve the original threatening or horrifying set of circumstances that was involved during the traumatic event. For example, someone who was in the Twin Towers on September 11th, 2001, might experience frightening dreams involving terrorists, airplane crashes, collapsing buildings, fires, people jumping from buildings, etc. A rape survivor might experience disturbing dreams about the rape itself or some aspect of the experience that was particularly frightening (e.g., being held at knifepoint).
Nightmares can occur multiple times in a given night, or one might experience them very rarely. Individuals may experience the same dream repeatedly, or they may experience different dreams with a similar theme. When individuals awaken from nightmares, they can typically remember them in detail. Upon awakening from a nightmare, individuals typically report feelings of alertness, fear, and anxiety. Nightmares occur almost exclusively during rapid eye movement (REM) sleep. Although REM sleep occurs on and off throughout the night, REM sleep periods become longer and dreaming tends to become more intense in the second half of the night. As a result, nightmares are more likely to occur during this time.
How common are nightmares?
The prevalence of nightmares varies by age group and by gender.† Nightmares are reportedly first experienced between the ages of 3 and 6 years1. From 10% to 50% of children between the ages of 3 and 5 have nightmares that are severe enough to cause their parents concern. This does not mean that children with nightmares necessarily have a psychological disorder. In fact, children who develop nightmares in the absence of traumatic events typically grow out of them as they get older. Approximately 50% of adults report having at least an occasional nightmare1. Estimates suggest that between 6.9%2 and 8.1%3 of the adult population suffer from chronic nightmares.
Women report having nightmares more often than men do. Women report two to four nightmares for every one nightmare reported by men. It is unclear at this point whether men and women actually experience different rates of nightmares, or whether women are simply more likely to report them.
Nightmares and cultural differences
The interpretation of and significance given to nightmares varies tremendously by culture. While some cultures view nightmares as indicators of mental health problems, others view them as related to supernatural or spiritual phenomena. Clinicians should keep this in mind during their assessments of the impact that nightmares have on clients.
How are nightmares related to PTSD?
Nightmares are 1 of 17 possible symptoms of PTSD. One does not have to experience nightmares in order to have PTSD. However, nightmares are one of the most common of the 're-experiencing' symptoms of PTSD, seen in approximately 60% of individuals with PTSD. A recent study of nightmares in female sexual assault survivors found that a higher frequency of nightmares was related to increased severity of PTSD symptoms5. Little is known about the typical frequency or duration of nightmares in individuals with PTSD.
Are there any effective treatments for nightmares?
Yes. There are both psychological treatments (involving changing thoughts and behaviors) and psychopharmacological treatments (involving medicine) that have been found to be effective in reducing nightmares.
Psychological Treatment
In recent years, Barry Krakow and his colleagues at the University of New Mexico have conducted numerous studies regarding a promising psychological treatment for nightmares. This research group found positive results in applying this treatment to individuals suffering from nightmares in the context of PTSD. Krakow and colleagues found that crime victims and sexual assault survivors with PTSD who received this treatment showed fewer nightmares and better sleep quality after three group-treatment sessions. Another group of researchers applied the treatment to Vietnam combat veterans and found similarly promising results in a small pilot study.
The treatment studied at the University of New Mexico is called 'Imagery Rehearsal Therapy' and is classified as a cognitive-behavioral treatment. It does not involve the use of medications. In brief, the treatment involves helping the clients change the endings of their nightmares, while they are awake, so that the ending is no longer upsetting. The client is then instructed to rehearse the new, nonthreatening images associated with the changed dream. Imagery Rehearsal Therapy also typically involves other components designed to help clients with problems associated with nightmares, such as insomnia. For example, clients are taught basic strategies that may help them to improve the quality of their sleep, such as refraining from caffeine during the afternoon, having a consistent evening wind-down ritual, or refraining from watching TV in bed.
Psychologists who use cognitive-behavioral techniques may be familiar with Imagery Rehearsal Therapy, or may have access to research literature describing it. If you need help locating a cognitive-behavioral therapist in your area, try using the clinical referral directory of the Association for the Advancement of Behavior Therapy.
Psychopharmacological Treatment
Researchers have also conducted studies of medications for the treatment of nightmares. However, it should be noted that the research findings in support of these treatments are more tentative than findings from studies of Imagery Rehearsal Therapy. Part of the reason for this is simply that fewer studies have been conducted with medications at this point in time. Also, the studies that have been conducted with medications have generally been small and have not included a comparison control group (that did not receive medication). This makes it difficult to know for sure whether the medication is responsible for reducing nightmares, or whether the patientís belief or confidence that the medication will work was responsible for the positive changes (a.k.a., a placebo effect).
Some medications that have been studied for treatment of PTSD-related nightmares and may be effective in reducing nightmares include Topiramate, Prazosin, Nefazodone, Trazodone, and Gabapentin. Because medications typically have side effects, many patients choose to try a behavioral treatment first. If that does not help improve their symptoms, they may choose to try medication. For suggestions about how to talk to your doctor about your PTSD-related nightmares and the possible use of medications for your symptoms, consult the fact sheet below.
What happens if nightmares are left untreated?
Nightmares can be a chronic mental health problem for some individuals, but it is not yet clear why they plague some people and not others. One thing that is clear is that nightmares are common in the early phases after a traumatic experience. However, research suggests that most people who have PTSD symptoms (including nightmares) just after a trauma will recover without treatment. This typically occurs by about the third month after a trauma. However, if PTSD symptoms (including nightmares) have not decreased substantially by about the third month, these symptoms can become chronic. If you have been suffering from nightmares for more than 3 months, you are encouraged to contact a mental health professional and discuss with him or her the behavioral treatments described above.
Facts-NCPTSD
- Butterfly Faerie
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by Butterfly Faerie » Tue May 16, 2006 4:01 am
The following list is used in the Intake process to help assess whether a person may be suitable for a Ross Institute Trauma Program.
1. Suicidal Ideation.
2. A pattern of out-of-control and self-injurious behavior.
3. Self-destructive addictions:
a. Dual Diagnosis
b. Eating Disorders
c. Self Mutilation
d. Sexual Addictions
4. Intrusive thoughts, images, feelings and nightmares.
5. Flashbacks.
6. Extensive comorbidity/multiple diagnoses.
7. Inability to tolerate feelings or conflicts.
8. Intense self-blame and feeling unworthy.
9. Staying stuck in the victim or perpetrator roles.
10. Disorganized attachment patterns.
11. Black and white thinking and other cognitive distortions.
12. Pathological dissociation.
The following are examples of the types of questions that might be asked to assess for trauma in one of the Ross Institute Trauma Programs:
HOW TO ASSESS FOR TRAUMA
1. Have you ever experienced emotional abuse? By whom?
2. Have you ever experienced neglect? By whom?
3. Have you ever experienced physical abuse? By whom?
4. Have you ever experienced sexual abuse? By whom?
5. Do you ever have intrusive thoughts or images regarding the (emotional, neglectful, physical, and or sexual) experience that you previously mentioned?
6. Do you ever experience flashbacks or feel like the abuse is still happening?
7. Are your presenting symptoms (suicidal ideation, homicidal ideation, inability to function, self injurious behaviors, or addictions) in any way associated with your past experience?
8. Do you ever lose time?
9. Do you feel you often act on impulses and don't have control over your behaviors?
10. Do you have difficulty managing feelings of anger, sadness, shame and rage?
11. How did your family express their feelings when you were growing up?
1. Suicidal Ideation.
2. A pattern of out-of-control and self-injurious behavior.
3. Self-destructive addictions:
a. Dual Diagnosis
b. Eating Disorders
c. Self Mutilation
d. Sexual Addictions
4. Intrusive thoughts, images, feelings and nightmares.
5. Flashbacks.
6. Extensive comorbidity/multiple diagnoses.
7. Inability to tolerate feelings or conflicts.
8. Intense self-blame and feeling unworthy.
9. Staying stuck in the victim or perpetrator roles.
10. Disorganized attachment patterns.
11. Black and white thinking and other cognitive distortions.
12. Pathological dissociation.
The following are examples of the types of questions that might be asked to assess for trauma in one of the Ross Institute Trauma Programs:
HOW TO ASSESS FOR TRAUMA
1. Have you ever experienced emotional abuse? By whom?
2. Have you ever experienced neglect? By whom?
3. Have you ever experienced physical abuse? By whom?
4. Have you ever experienced sexual abuse? By whom?
5. Do you ever have intrusive thoughts or images regarding the (emotional, neglectful, physical, and or sexual) experience that you previously mentioned?
6. Do you ever experience flashbacks or feel like the abuse is still happening?
7. Are your presenting symptoms (suicidal ideation, homicidal ideation, inability to function, self injurious behaviors, or addictions) in any way associated with your past experience?
8. Do you ever lose time?
9. Do you feel you often act on impulses and don't have control over your behaviors?
10. Do you have difficulty managing feelings of anger, sadness, shame and rage?
11. How did your family express their feelings when you were growing up?
- Butterfly Faerie
- Consumer 6
- Posts: 9239
- Joined: Thu Mar 11, 2004 3:25 pm
- Local time: Wed Jul 02, 2025 9:45 am
- Blog: View Blog (0)
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