Shaken soul: What is behind post-traumatic stress disorder?

30. May 2019

We are all aware that our bodies are vulnerable. Traffic accidents, falls, sports injuries or violence can damage our limbs or our sensitive head area. Concussion, whiplash, fractures, wounds… We have all heard of these or possibly experienced them ourselves. But not only is the body vulnerable, so is our psyche. Things can happen to us in life that exceed our psychological resilience. These experiences are called traumatizing or traumatic. When the psyche is attacked by such an event, it is referred to as post-traumatic stress disorder (abbreviated as PTSD) or trauma sequelae disorder. But what are the clear symptoms of PTSD? Read for yourself!

What does the term “trauma” mean?

Translated into German, the Greek word trauma means injury. We cannot directly determine whether the injury is physical or psychological by the word alone. Psychologists, however, always understand the term trauma to mean a psychological injury and therefore refer to it, a little more concretely, as psychotrauma (Wittchen & Hoyer, 2006).

Sometimes it is not immediately clear whether the term means the triggering event, or the subsequent symptoms. It is correct to refer to the precipitating event as trauma and the subsequent symptomatology as the posttraumatic stress or traumatization. Posttraumatic thus means that the stress occurs temporally after the experience of the trauma.

Different types of trauma

It is impossible to predict which event will lead to post-traumatic stress disorder in which person. Our processing mechanisms and coping strategies, like ourselves, are extremely individual. Therefore, trauma can also be triggered by very different situations and experiences.

Nevertheless, there are some events that are more likely to cause traumatization because they are associated with intense stress and anxiety for most people. Science provides us with a helpful classification approach that distinguishes between type I trauma and type II trauma.

Type I trauma

– One-time trauma
– Short period of time

Examples: Traffic accident, robbery, sexual assault, natural disaster, fires, explosions.

Type II trauma

– Multiple traumas
– Long period

Examples: Abuse, torture, war experience, imprisonment, repeated violence, severe illness, prolonged natural disasters, kidnapping.

Researchers also differentiate whether the trauma is triggered by other people (“man made”), as in a sexual assault, or whether it is an incident in which no perpetrator can be identified. Many other forms of trauma exist, of course, as it is a highly individual experience. Examples include:

  • Occupational trauma (police officers, soldiers, firefighters)
  • Spectator trauma (witnesses to disasters, accidents, violence)
  • Secondary trauma (listening to dream reports of others)

Each affected person brings his own history of trauma! As with all mental illnesses, each person with their personal experiences and experiences must be considered in great detail.

What is a trauma sequelae disorder?

We speak of a trauma sequelae disorder when the distressing psychological symptoms are clearly attributable to a causative event. Of course, not everyone develops such a trauma sequelae disorder. For some individuals, a so-called acute stress reaction occurs shortly after the incident. We colloquially refer to this reaction as “shock.” It is quite possible that the affected person will not show any further symptoms after the shock. Many factors can ensure this, such as psychological resilience, post-event care, or strong social support. However, individuals who experience shock after trauma have a higher risk of suffering from PTSD at a later time in life. However, this can also develop if there was no shock reaction at all shortly after the event.

PTSD: Four letters that change lives

When a person seeks treatment with suspected PTSD, the doctor or psychotherapist has clear guidelines for when he can diagnose PTSD. He or she must follow the guidelines of the World Health Organization (WHO) Classification of Diseases, as all medical professionals or therapists do. Using the WHO’s ICD-10 diagnostic manual, he determines whether all the necessary symptoms are present to speak of PTSD:

  • Confrontation with a traumatic stressor in the past (see psychotrauma above)
  • Parts of the traumatization are vividly recalled (“flash backs”)
  • Stimuli or environments reminiscent of the trauma are avoided
  • Emotional numbness and depressive moods
  • General overexcitement, anxiety, and difficulty concentrating

Symptoms for PTSD must be present for a period of one month. It is imperative to keep in mind that post-traumatic stress disorder can occur years or even decades after the traumatic event. Sometimes it comes to light out of the blue, but sometimes it is associated with other mental illnesses, such as depression or anxiety disorders.

A PTSD and its consequences

The diagnostic criteria just listed seem factual. They can obscure the actual suffering of the sufferer. Imagine that the most agonizing memory of your life keeps popping into your mind unprepared, and with a vividness and accuracy that literally knocks you off your feet. PTSD sufferers regularly experience such a “flash back.”

This, of course, is accompanied by a great deal of anxiety. Fear of situations or stimuli that trigger the memory. This process is called “triggering“. Life becomes increasingly restricted to avoid these triggers. For example, it becomes impossible for some patients to drive a car or take a train, to socialize, or to be out in the dark.

In addition, there is an emotional emptiness that leads to things that used to bring joy no longer triggering anything. Hobbies are abandoned and friendships neglected. Interaction with familiar people becomes increasingly difficult, as high irritability and restlessness also frequently accompany the disease. The suffering of those affected is immense, but shame and worries about stigmatization often lead to treatment being avoided.

Another possible diagnosis: adjustment disorder

If not all the symptoms for PTSD are present, or the complaint cannot be clearly classified, a diagnosis of adjustment disorder is made. This may also be the case if the event has serious consequences for the individual but does not meet the above criteria for psychological trauma. Examples include the loss of a job or a difficult separation from a life partner. One should also distinguish PTSD from a grief reaction. This is because grief is a normal process when a loved one passes away. It must be decided on a case-by-case basis whether the grief lasts for an unusually long time and whether the circumstances of the death were potentially traumatizing.

What is behind trauma therapy?

The treatment of PTSD has made many advances in recent years, and promising new treatments have been tried. In addition to trauma therapy, additional co-occurring symptoms are also being treated. The most common concomitant disorders of PTSD include depression, anxiety, or obsessive-compulsive disorders (Wittchen & Hoyer, 2006).

Approaches to trauma therapy explained in more detail

Trauma therapy approaches differ in their approach because they are based on different explanatory models of how PTSD develops. In the overview, you will find examples of trauma therapies. However, other approaches do exist and often there is a blending of methods that have been shown to be effective.

Cognitive Behavioral Therapy

Changing negative, automated thoughts, reducing avoidance behavior by confronting fearful stimuli, trigger analysis (after Ehlers & Clark, 2000).

Narrative approaches

Re-experiencing the trauma from a distance, autobiographical work, emphatic support in retelling the trauma (According to emotion processing theory by Foa and Kozak, 1986).

EMDR

Eye Movement Desensitization and Reprocessing – post-processing of the stressful situation with additional stimulation of the brain: the patient follows the therapist’s finger movement with his eyes (bilateral stimulation).
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Do you need help?

If you or one of your loved ones is suffering from the described symptoms of PTSD and your daily life is affected by it, you should not hesitate to see a doctor or psychotherapist – this is the only way to help your shaken soul. You can find out who to contact and how to get help as quickly as possible here.

Just as we trustingly put ourselves in the hands of doctors when we have a physical injury, we should also seek help for psychological injuries. Sometimes it is difficult to recognize this, because psychological wounds are not visible from the outside. But they do exist and they need just as careful treatment as physical wounds. Give your soul a chance to heal, take care of your wounds and scars. They are worth it.

References

(1) Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour research and therapy, 38(4), 319-345

(2) Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological bulletin, 99(1), 20

(3) Wittchen, H. U., & Hoyer, J. (2006). Clinical psychology & psychotherapy (Vol. 1131). Heidelberg: Springer.

Categories: Trauma

Friederike Reuver
Autor:in Friederike Reuver
"Die LIMES Schlosskliniken haben sich auf die Behandlung von psychischen und psychosomatischen Erkrankungen spezialisiert. Mit Hilfe des Blogs möchten wir als Klinikgruppe die verschiedenen psychischen Erkrankungen näher beleuchten und verschiedene Therapien sowie aktuelle Themen vorstellen."

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