DECODING PTSD

“The mind replays what the heart can’t delete”
Few weeks ago, a woman in her mid-thirties entered my consultation room appearing extremely fatigued and sleep deprived. The conversation during the appointment was initiated by her requesting for something to assist her with sleeping well at night. After a rapport was established with her and she felt at ease, she expressed that she was molested by someone close to her in her childhood who breached her trust and she felt like she would die. This incident made her feel like she would never be the same and thereafter, she never felt safe anywhere, not even at her home.
For months post the attack, whenever she closed her eyes, she would see the face of her attacker. She had terrible nightmares and flashbacks. For years, she was unable to sleep alone in her house. She would repeatedly check the windows and doors to see if they’re locked. Time passed by, and at the age of seventeen, she had no friends. She was fearful all the time and kept crying without any reason. She failed to understand why all this was happening to her.
Years lapsed and she gradually began to feel better. Most of her anxiety and restlessness had subsided until one day she went out with her family to see a movie. This movie triggered her memories and she felt she was back to where it had all begun. She was unable to concentrate and couldn’t even complete simple tasks. This was the point when she decided to seek help and consulted me.
I explained the nuts and bolts of what she was going through. And I believe it’s time that we all educate ourselves about this condition and how we can cope with it. Also, learn how we can use this knowledge to help those who are facing a similar situation in their lives.
PTSD (Post traumatic stress disorder) is a mental health condition that may develop after experiencing an event that made you fear for your safety or threatened your life. Unfortunately, everyone experiences traumatic events at some stage of their life and may experience some symptoms of PTSD like feeling fearful, having bad dreams and overthinking about the event. However, these are normal reactions to terrifying events and are usually short lived. You start to feel better in days or weeks, but in PTSD, it actually starts worsening as time passes by. You go into a state of psychological shock and your memories of the event get disconnected from your feelings of the event.
This condition has been most commonly seen in war veterans and rape victims, but any event or series of events that overwhelms you to feel hopeless and helpless and emotionally breaks you down can trigger PTSD especially if you had not predicted it and it felt out of your control. A good example can be of those who have lived through natural disasters, riots, have been discriminated based on their religion, caste, race or nationality.
It usually begins within three months of the precipitating event but it can even take years to develop. It usually varies from person to person as everyone has a different threshold for stress and they react accordingly. Sometimes the symptoms arise out of the blue and at other times, they are triggered by something that reminds you of the traumatic event like a noise, image or even smell.
PTSD not just affects people who experience the traumatic event but also those who have witnessed it or came later to pick pieces of the event such as emergency workers or law enforcement officers. It can also occur in children who experience physical or sexual abuse or undergo surgery, but are too young to understand it.
There are four main types of symptoms:
1. Re-experiencing the traumatic event- If we go back to the case presented at the beginning, you can recall that this woman relived the trauma over and over either through flashbacks, nightmares or memories that brought back the hopelessness and helplessness she felt as a child. The event never really left her completely.
2. Avoidance and numbing- The mind and body gets tired of experiencing the overwhelming emotions. You start avoiding anything that reminds you of the trauma, you learn to repress aspects of that ordeal. You don’t feel any one particular emotion, and operate almost in a mechanical way, detached from others and self.
3. Hyper-arousal- To not find yourself in a position where you can be threatened again, you start looking over your shoulder. You become suspicious, are extremely careful to the point where you find yourself easily startled and constantly on ‘red alert’. In addition, there can be sleep problems, angry outbursts and self-destructive or reckless behaviour.
4. Negative thoughts and mood changes like feeling alienated and alone, difficulty concentrating or remembering, depression and hopelessness, feeling mistrust and betrayal, and feeling guilt, shame, or self-blame are also common.
Managing PTSD:
There are a range of strategies to recover from PTSD. The treatment works differently for everybody and it is a slow and gradual process of recovery. The memories and fear doesn’t disappear overnight and it can make life seem difficult at times, but following up over a period of time ensures sustenance of improvement.
The treatment strategies are divided into two parts namely lifestyle choices and therapy.
1. Life style changes required are;
A. Regular Exercise
B. Get enough sleep
C. Take time to relax
D. Eat a healthy diet
E. Attend social gatherings
F. Avoid alcohol and drugs
G. Attend PTSD support groups
While these life style modifications help you avoid the symptoms of PTSD, it is necessary to face these fears and memories with the help of therapy from a mental health professional. Therapy has three main goals;
• Improve your symptoms,
• Teach you how to deal with them, and
• Improve your self-esteem.
The various kinds of treatment available are:
1. Trauma focused Cognitive-Behavioural Therapy: This form of therapy explores the relationship between thoughts, feelings and behaviour, and how changes within one can impact the other. It also focuses on learning healthier ways to cope with unhealthy thought patterns or emotions.
2. EMDR (Eye Desensitisation and Reprocessing): It helps the clients reconnect with the thoughts, feelings and physical sensations associated with the trauma in a safe and secure environment. The key is to take control of the traumatic experience and help your body learn that the trauma isn’t happening in the present moment.
3. Family Therapy- It largely helps those who have witnessed traumatic events and the primary focus is on creating a safe space to process the emotion.
4. Medications which include antidepressants and anti-anxiety tablets.
The most important thing is to know is that it’s never too late to seek help from a mental health professional.
More from Dr. Rahul Lalit Khemani
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