How does PTSD manifest?
Manifestations are combined into several groups. The first is obsessive re-experiencing: memories come without asking, nightmares and flashbacks arise, when a person seems to find himself in that moment again. The second is avoidance: attempts not to think, not to speak, not to be in places and situations that are reminiscent of the event. The third is constant tension: alertness, flinching from sounds, irritability, sleep and concentration problems. The fourth is changes in thoughts and mood: feelings of guilt, alienation from loved ones, a feeling that there is no future.
- Intrusive memories and flashbacks
- Nightmares about the event
- Avoiding conversations, places and reminders
- Increased alertness and flinching
- Sleep and concentration problems
- Feelings of guilt and alienation
- Irritability and angry outbursts
- Partial amnesia of individual details of the event
When a reaction becomes a disorder
Immediately after a difficult event, almost everyone experiences a shock: sleep is disturbed, thoughts return to what happened, and the body reacts with tension. This is a normal reaction to an abnormal situation and usually subsides within a few weeks. People talk about PTSD if after a month the symptoms persist, do not decrease and interfere with work, study, and relationships. Sometimes the disorder begins delayed, months later. Separately, there is a complex form after prolonged, repeated trauma, in which self-esteem and the ability to build relationships suffer more.
- The first weeks are an acute stress reaction
- More than a month with life disturbance - PTSD
- Delayed onset months after the event
- Complex PTSD with long-term trauma
- Often associated with depression and anxiety
Risk factors
Not everyone who experiences trauma develops PTSD, and this is not a matter of strength of character. Risk is increased by the severity of the event, threat to life, human violence, repeated trauma, and lack of support after the event. Previous circumstances also matter: childhood trauma, pre-existing anxiety and depressive disorders, alcohol abuse. Protective factors include family and community support, the ability to talk about what happened, and prompt access to help.
- Life-threatening and severe physical injury
- Violence committed by another person
- Repetitive traumatic events
- Traumatic experiences in childhood
- Lack of social support
- Pre-existing anxiety and depressive disorders
- Alcohol and substance abuse
Diagnostics
The diagnosis is clinical and is made on the basis of a conversation in which the doctor carefully clarifies the nature of the event, the set of symptoms, their duration and impact on life. It is not necessary to recount all the details of the injury at the first appointment: the specialist will structure the conversation in such a way as not to cause re-traumatization. Questionnaires are used to assess severity and dynamics. Concomitant conditions must be assessed: depression, anxiety disorders, alcohol use, and the risk of suicide. In case of a head injury, its consequences are additionally excluded.
- Clinical conversation at a safe pace
- Assessing duration of symptoms
- Specialized questionnaires
- Detection of depression and anxiety disorders
- Suicide risk assessment
- Eliminating the consequences of traumatic brain injury
Treatment and recovery
The main method is trauma-focused psychotherapy, in which, under the guidance of a specialist, the memory is gradually processed and ceases to be experienced as the present. Trauma-focused cognitive behavioral therapy and eye movement desensitization have been shown to be effective. Medications, primarily antidepressants, are used when symptoms are severe, depression is comorbid, or psychotherapy is not available. Alcohol brings short-term relief, but worsens the course of the disorder. Sleep patterns, physical activity and the support of loved ones who do not rush or devalue the experience are important.
- Trauma-Focused Cognitive Behavioral Therapy
- Eye movement desensitization and reprocessing method
- Antidepressants prescribed by a psychiatrist
- Avoiding alcohol as a way to numb symptoms
- Restoring sleep patterns and physical activity
- Support for loved ones without pressure or devaluation
- Return to normal activities gradually