PTSD: Symptoms and Journey to Healing

Trauma is a fact of life in our current society. As Bessel van der Kolk, one of the world’s foremost experts on trauma states in his book, The Body Keeps Score, “Veteran and families deal with the painful aftermath of combat; one in five Americans has been molested; one in four grew up with alcoholics; one in three couples have engaged in physical violence.” (back cover)
In 1980, the new diagnosis, Posttramatic Stress Disorder (PTSD,) found its place in the Diagnostic and Statistical Manuel of Mental Disorders, spurring hope among professionals that identifying this diagnosis would allow funds to be channeled into research on how to best treat the group of disabling symptoms many combat veterans were experiencing years after returning from war. Research on trauma and brain imaging now clearly shows that one doesn’t need to be a combat veteran or a survivor of war to experience these PTSD symptoms. Interpersonal violence in families and communities can lead to similar disabling symptoms as the brain tries to cope with the overwhelming emotions that accompany the threat of death due to physical violence or natural disasters and the shame and disintegration of self
that results from sexual abuse.
It is normal to have many of the symptoms that characterize PTSD during the first month following a traumatic event; however, with a supportive, validating environment many people are able to process their experience, integrate it into their life history and experience a resolution of symptoms. When trauma symptoms continue several months after the trauma occurred, they may meet the criteria for PTSD and require professional therapeutic intervention to obtain healing and resolution.
Responses to trauma may include the following:
1. Reliving the event through nightmares or flashbacks that are triggered by sounds, smells, body sensations or pictures that remind you of the event and cause you to feel it is all happening to you again.
2. Avoiding anything that may remind you of the trauma and bring about the threat of reliving the event.
a. Stay busy all the time to keep yourself from ever having time to think about the event
b. Avoid driving if you had a car accident or avoid watching things on TV related to the trauma
c. Avoid crowds because they feel dangerous.
3. Negative changes in the way you think about yourself and others because of the trauma
a. Your emotions feel numb and you can no longer connect with loving thoughts towards others, so you avoid relationship
b. You feel the world is a dangerous place and no one can be trusted
c. You can’t remember aspects of the traumatic event due to dissociation so you avoid talking about it because you can’t explain why you can’t remember.
4. You feel constantly on the alert for danger (hyperarousal) and jittery which leads to being irritable, more easily angered, having difficulty sleeping and concentrating and having strong reactions to loud noises or being startled.
All of these symptoms are the body’s natural attempts to process and make sense out of the trauma while trying to avoid a similar experience in the future. During trauma, the mind becomes so overwhelmed with fear and a myriad of other emotions and body sensations that the problem- solving part of the brain goes off-line and the amygdala (fight, flight or freeze) takes over, causing automatic responses to try to preserve life. The amygdala is a primitive part of the brain which puts dangerous things into large categories and activates like a reflex to address perceived threat without relying on the slower “problem-solving” part of the brain. In a truly life-threatening situation, the amygdala’s quick action is very effective since response time is essential in survival and processing (thinking) can take place after the body has been saved from the danger. At the same time, the amygdala’s generalizations can result in experiences such as having terror of any dog, even a small one on the end of a leash, after you experienced being bitten by a large dog who was running loose in the neighborhood.
A key element in resolving flashbacks of trauma is being able to express your experience to another human being and have them validate how your confusing, sometimes shameful behaviors are “understandable” in the moment of terror and struggle to survive. But there are often many barriers to this experience of being “heard”.
First, hearing trauma stories is not an easy task for the listener, especially if they are a close friend or family member. Sometimes the trauma is a very personal experience, such as child sexual abuse and those who could be supportive, adamantly refuse to believe that the event could have occurred. In many cases of abuse, those inflicting the abuse threaten harm to the victim or others if the victim tells anyone about it. At times a whole society chooses to deny that atrocities are happening in their neighborhood such as in the case of Germans citizens under the Nazi regime in the towns near the concentration camps during the Holocaust.
Second, human beings have a deep desire to avoid painful things and processing traumatic events is painful work, full of grief and loss. Expressions of natural response to trauma (intense fear, pain, shame and sadness) are often viewed in our western society as signs of weakness, especially for men. This further reinforces avoidance and distraction behaviors that can lead to aggression, irritability, substance abuse and lots of others unhealthy behaviors.
Finally, it is not unusual for the brain to have some amnesia (forgetfulness) for key parts of the trauma, making it difficult for the traumatized person to recall all the details their trauma story that need expression. When the brain is overwhelmed by stimuli, it often focuses only on sensations that can help it survive. Yet dissociated sensations are still “remembered” in the muscles of the body and in the unconscious mind. Dissociated fragments of traumatic memory may surface in consciousness years later, triggered by something similar to the forgotten traumatic experience. For example, adults who have experienced sexual abuse as a child may suddenly begin to have memories of their own abuse as they begin caring for a child around the same age they were when their own abuse began.
Research on trauma is uncovering evidence that resolution these of trauma symptoms occurs as the survivor dares to notice the body’s physical experience in the face of the trauma triggers, give voice to those experiences through words, writing, drawing, drama, etc. and eventually be able to tell the story about the past while they are fully aware of their body’s sensations and utilizing relaxation techniques to calm the physical arousal of their body. The flashbacks and nightmares are resolved because individual now know experientially, not just cognitively, that the trauma experience occurred in the past and is no longer occurring in the present. The danger has ended in the spirit,
soul and mind.
References
Van der Kolk, Bessel. The Body Keeps Score. New York: Penguin Books 2015.
US Department of Veterans Affairs National Center for PTSD (August 2015) Symptoms of PTSD.
Retrieved January 31, 2018, from https://www.ptsd.va.gov/public/PTSD-overview/basics/symptoms_of_ptsd.asp.
Suggested readings
Herman, Judith. Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror. Philadelphia: Basic Books 1997.
US Department of Veterans Affairs National Center for PTSD website (https://www.ptsd.va.gov/index.asp) contains suggestions about how friends and family can assist individuals with PTSD as well as many other helpful resources.

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