What is Post Traumatic Stress Disorder?

The first reaction to a stressful event: the acute stress reaction

People who experience an emotionally stressful situation that changes their life significantly, such as an accident, a sudden resignation or separation, often react with strong techsupportreviews stress symptoms, such as an accelerated heartbeat, head pressure, they become pale or sweat heavily, them becomes nauseous and you may vomit. In addition, there are symptoms such as restlessness, irritability, but also disorientation and inner distancing (one has the feeling of experiencing the serious event like a spectator).

Psychologists refer to this as an acute stress reaction (PBTR). It usually occurs immediately after the event and usually subsides within hours or days, or at least does not last longer than a month.

Even with trauma, the person affected experiences the symptoms of an acute stress reaction. If it lasts longer,can lead to a mental illness: post-traumatic stress disorder.

Problems Accepting a Life Change: The Adjustment Disorder

Some people have great problems adapting to a changed, new life situation and are overwhelmed by it. For example, if someone refuses to admit the separation that their partner has consistently decided and continues to hold on to the idea for months that everything will work out again even though there are no signs of it, an adjustment disorder may be present. Since the reasons for this are usually strong fears, the person affected can also develop depression .

Difference: adjustment disorder and post-traumatic stress disorder

With an adjustment disorder, a person finds it very difficult to accept a change in their life situation and refuses them internally. In the case of post-traumatic stress disorder, the person concerned suffers from overexcitation (constant vigilance), avoids any situation that reminds him of the trauma, and yet experiences it again and again in so-called flashbacks (especially in dreams).

Depending on the sever of the symptom, the distinction is not always clear; even experts make different diagnoses. The so-called complicated grief reaction (also known as pathological grief) is seen by some psychologists as an adjustment disorder, and by other experts as post-traumatic stress disorder. The term describes a course of grief in which it is not possible for those affected to accept and deal with the death of a loved one even after many months (at least six months) or years. The affected person permanently feels overwhelming pain, which can lead to hopelessness and loss of identity.

The consequences of trauma: post-traumatic stress disorder

Post-traumatic stresses disorder develop as a result of an extremely stressful experience: trauma.

What is trauma If a person has had a negative experience, he can usually process it after a certain time and the memory of it is then part of his biography. A traumatic experience, however, is so harrowing that it often fails. Psychologists understand trauma to be an event in which a person concerned has experienced something horrific, their physical integrity is threatened or severely injured and they have felt completely powerless, defenseless and at the mercy of them. The affected person felt horror and extreme fear (fear of death).
Examples of such a traumatic experience are disasters such as a plane crash, a terrorist attack, a war effort, robbery, rape or the diagnosis of a life-threatening disease such as cancer.

Complex PTSD

Not only can the trauma be a single experience, but it can also have occurred repeatedly and over an extended period of time, such as sexual abuse or physical or emotional neglect in childhood. This can permanently shape and impair the thinking and feeling of the person concerned as well as his behavior. Psychologists refer to this as complex post-traumatic stress disorder.

Secondary trauma

It can also happen that the person is not the victim of the traumatic event himself, but can also be traumatized as an eyewitness, for example when he had to watch the assault on another person or the rape of his partner or as a paramedic terrible suffering, such as a cruel mutilation of victims. Psychologists refer to this as secondary trauma.

Acute and chronic PTSD

If the patient has symptoms of PTSD for more than four weeks, an acute post-traumatic stress disorder can develop. If the symptoms persist for more than three months, experts speak of chronic PTSD.

Frequency of PTSD

The likelihood of developing post-traumatic stress disorder also depends on the type of trauma. If the trauma was cause by another person, the risk that the victim will develop PTSD is particularly high. Up to 50 percent of all rape victims, victims of abuse (in childhood) and victims of war and torture develop post-traumatic stress disorder. After a traffic accident, however, only 10 percent are affected.

Symptoms: Post Traumatic Stress Disorder

If after the traumatic experience, the person's feeling of security and self-confidence are permanently deeply shaken and it is difficult for them to cope with the trauma, they can develop a post-traumatic stress disorder (also known as post-traumatic stress syndrome). This can arise immediately after the trauma, but also weeks, months or years later. A later occurrence may, for example, be because the victim had the traumatic experiences in childhood and no longer fully remembers them.

Typical symptoms of PTSD:

• Vegetative overexcitation : excessive vigilance, irritability and frightfulness, sleep disorders , concentration problems
• An avoidance behavior : try sufferers to avoid situations, activities, places and people that might evoke the memory of the trauma strictly. If someone has survived a plane crash, for example, it can happen that they not only no longer board a plane, but also strictly avoid getting near an airport at all or switch off the television immediately during a film scene depicting a passenger flight . Some PTSD patients isolate themselves emotionally so strongly that they develop numbness and inner apathy and indifference. 
• Reliving the trauma : repeated, intrusive memories of the traumatic event (intrusion), flashbacks, nightmares. Flashbacks (translated from English: lightning-like reliving) are usually triggered by a key stimulus (so-called trigger), such as a loud popping noise on the street or a special voice.

As a result, the person concerned is reminded of their past trauma (for example, a war mission or rape) in a split second and experiences it again with all sensory impressions, fears and painful feelings. The person concerned is not aware that it is “just” a memory, but at that moment has the feeling of actually being back in the war zone and being caught in fire or being attacked. He experiences the horror again. During the flashback, he no longer perceives the real environment and does not react to being spoken to.

Repeatedly going through the traumatic event is not only very exhausting, but can also retraumatize the person affected and increase the suffering even more.

Experts refer to these three main symptoms as the “ symptom triad ” of PTSD.

For many of those affected, the world view that people are generally protected from danger and not helpless has been massively shaken. They find it very difficults to trust others and they are extremely careful. Some suffer from strong feelings of shame (which can extend to self-loathing) and may blame themselves for experiencing the trauma (this can be fatal, especially for victims of crime or abuse).

Post traumatic stress disorder: treatment

Psychotherapy for PTSD

Therapy for post-traumatic stress disorder can usually take place on an outpatient basis. A hospital stay is only necessary in severe cases, such as when the patient suffers from severe depression, has an acute psychotic disorder or there is a risk of suicide.

Treatment consists of psychotherapy . It is divided into three phases: stabilization phase , processing phase , integration phase .

At the beginning of the treatment, the main aim is to stabilize the patient. This is made possible by the following factors:

• Therapy offers the patient a protected space where he can talk about all his feelings. It is crucial that a trusting relationship develops between the patient and the therapist. It is also important to approach the traumatic experience slowly and cautiously in the discussions; proceeding too quickly can harm the patient. Experts call this gentle trauma confrontation.

• The patient has the important experience of receiving support and understanding from the therapist . This can help him to alleviate his increased distrust and to strengthen his ability to trust. Sometimes the therapist is also the first person a victim tells about their trauma. Or he is the first person to listen carefully to the person concerned and to believe them. This is extremely important for the victim, especially in cases of abuse. This is the only way to heal the trauma at all. 

• In the healing process, it also plays a central role to activate the patient's resources , for example general resources such as his ability to develop courage, hope and confidence, but also physical resources such as body memories as a perception aid or external resources such as friends and family or a support group.

The next step is to process the traumatic experiences. In therapy, the patient learns to deal better with the stressful memories of the trauma and to gain increasing control over the occurrence of the intrusions. Trauma therapy methods such as EMDR and CIPBS are particularly suitable for this:

• EMDR (Eye Movement Desensitization and Reprocessing): With this treatment method, the patient recalls the traumatic experience. While the very stressful thoughts and emotions emerge, he simultaneously directs his attention to the therapist's hand, which he leads to the left and right. The patient keeps his head still, he only moves his eyes. It is believed that this stimulates both halves of the brain and initiates an important information processing process.

• CIPBS (Conflict Imagination, Patinting and Bilateral Stimulation): Here the patient imagines the stressful experience and directs his attention, so to speak, to the inner stage. Then he paints this inner picture and basically brings the trauma onto the outer stage. While the patient is concentrating on the painting process and the resulting feelings, a gentle tap with the fingertips on the body takes place (so-called tapping).

Finally, the integration phase takes place, in which the patient learns to integrate the traumatic experience into his or her life story. The therapist helps the person concerned to see a positive meaning in his life again, to find new goals and to concentrate on them as much as possible.

Some patients even see the trauma as a maturation process through which their inner strength has grown (psychologists refer to this as "trauma growth"). Often these victims get involved in victim organizations and help others to cope with a trauma. 

Medication for PTSD

For example, antidepressants or antipsychotics may be prescribed for the treatment of PTSD. They are usually used when the patient is (initially) unable to undergo trauma therapy. However, the medication should not be taken for a long time and is not a substitute for psychotherapy.

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