Trauma and Post-Traumatic Stress Disorder

What you have been through is a traumatic experience. It is, therefore, normal for us to experience trauma-reaction symptoms in the weeks and even months following assault. Research has shown that the majority of women who are raped, experience post-traumatic stress disorder (PTSD) symptoms in the two weeks following their assault.

What you were feeling, or may continue to feel, is a reaction to fear. You are experiencing the loss of control and vulnerability after a traumatic event. Traumatic experiences also damage our sense of security. When we survive something terrible, we learn the ways we’re unsafe.

We have experienced trauma. Unfortunately, this is an experience that is outside our control.

Still, our minds and bodies are capable of an incredible feat in a way of protecting us from a traumatic experience. Our bodies constantly work to keep us alive – breathing, eating, or sleeping – and our brains are also a part of that system. The reason why we repeat difficult memories is because our mind wants to make sure whatever has happened doesn’t happen to us again; it wants to solve what went wrong and prevent it. We then become what is known as hypervigilant: alert and constantly scanning our environment for similar and potential danger.

Or, we can also shut down and avoid our reminders entirely. It’s exhausting constantly feeling on edge, so forgetting is also a means of protection.

Whether we fixate or disassociate, these are both normal reactions to traumatic events. What happens with post-traumatic stress disorder, however, is that these feelings don’t go away. PTSD makes that past feel like the present: mentally and physically. And the brain can’t always distinguish between memory and reality, so our danger signals flare as though the trauma were happening now. Fear takes over, and we get locked in survival mode: fight, flight, or freeze, with all associated hormones, terror, and inability to think about anything else.

PTSD usually develops in the first six months after a traumatic event. But symptoms can also take years to form.

Now, as we go through the list of criteria for diagnosis; know these symptoms won’t always mean you have PTSD. Symptoms of regular anxiety are similar to those of PTSD. If you have experienced any of the features we’ve discussed for a month, however, please speak with a professional for a more thorough assessment.

Some of the symptoms of PTSD are:

• Flashbacks to what happened, including intrusive thoughts, dreams, and nightmares.

• Not being able to feel your emotions, a kind of emotional numbness that makes us unable to enjoy things and people we love.

• Feeling on edge, easily startled, and always alert.

• Lack of concentration and unable to focus.

• A lack of trust, even in close relationships.

• Being more irritable than usual; emotional outbursts; mood swings.

• Having trouble falling asleep.

• Loss of appetite or a change in eating patterns.

Others are:

• Extreme feelings of helplessness or horror.

• The inability to distinguish between the past and the here-and-now.

• Associating various words, events, or “triggers” back to your trauma - “triggers” are the sights, sounds, or feelings you associate with your traumatic event, which may bring back the traumatic memory.

• Avoidance of anything that might cause “triggers” to occur: situations, people, places, or touch. This includes refusing to talk about it, pretending it never happened, or unable to manage details.

• A feeling of low self-esteem and confidence.

• Deep embarrassment, shame, or guilt about the traumatic experience.

• If our trauma involved another person, we can also fixate on them.

Many of these symptoms relate to the physical processes that take place in our bodies when we remember a traumatic event. Our danger signals increase, and when our brain tells us that we’re in danger, it taps into one of two nervous systems. There’s our sympathetic nervous system, which is associated with that fight-flight-or-freeze response we mentioned before. It prepares our body to run away from danger. However, we also have a parasympathetic nervous system that restores our cells, and controls restorative processes like sleep and digestion. These two systems are meant to work in balance with each other. But of course, when we think we’re in danger every day, we can’t “turn on” this parasympathetic system.

Part of healing from trauma is learning how to offset our body’s natural reactions to trauma by re-training and strengthening our natural calming mechanisms. We can do this with formal therapies, or with mindful practices such as yoga and breathing exercises, which we will discuss later. However, you’ve actually probably already been practicing ways to regulate your nervous system and to turn the parasympathetic system on: these are often called coping mechanisms. Eating, drinking, or the more dangerous self-harm are ways of returning to that state of “calm”. In this way, we’ve already been taking care of ourselves; we just haven’t known that was what we were trying to do, or always had the resources to make the healthiest choices.

Whatever the symptoms, PTSD is only diagnosed in a single traumatic event. The trauma must be a one-time experience – for example assault, or natural disaster. If your trauma happens over a repeated period of time in which there’s no certain means of escape - such as situations of domestic violence or childhood neglect - there is a different stress-related disorder known as complex post-traumatic stress disorder (or C-PTSD).

C-PTSD happens after repeated or long-term trauma, in which there was no easy way out. Often, C-PTSD is a response to growing up in an abusive household or surviving domestic violence as an adult. Over the course of this abuse, our abusers create a world where they control and manipulate us, and convince us that they are our whole world. Because this environment feels permanent, we feel helpless against their cruelty, and that we have no choice but to suffer. But if we were to decide that there is nothing we could do, we would be doomed, as there is no way to “survive” a world this hopeless. So, it becomes easier to blame ourselves for the cruelty of others – not because we’re really responsible, but because we have control over our own actions. If “we” become the problem, it’s something we can fix. It may seem counterintuitive, but this is another smart way those with post-traumatic stress have already learned to survive.

In this way, C-PTSD includes many of the same symptoms of PTSD, but it also alters our sense of self. Because of the way we internalised a sense of blame for living in an abusive environment, we often have trouble knowing who we are. We also struggle with shame, and may falsely believe that we are responsible for our mistreatment.

However, we are not the ways we have been hurt or how we have coped. Our bodies are doing everything they can to keep us here. The work now comes in guiding ourselves into healthier patterns: by making the past the past, and to remember the present to build towards the future.

For C-PTSD: We did not get to choose our earliest memories, relationships, and experiences. We did what we could then, but we are no longer helpless - and none of our feelings of shame are permanent. We can choose now who we are.

For PTSD: The past is not the present, and there are ways we can make ourselves feel safer, confident, and move forward.

However difficult your PTSD symptoms are, or however they present themselves, they are not a flaw or a weakness. These diagnoses only show how you are already doing amazing things. Your symptoms and coping mechanisms are proof that you can do this, you have done this before, and are built to be here.

You have already been resilient.

There are also professional treatments for PTSD, which you can consider if you would like the help of someone trained in helping people heal from trauma.

• Trauma-focused cognitive behavioural therapy (CBT): CBT involves talking through your experience with a professional who helps you make links between your thoughts, feelings, and behaviours. The goal of therapy is to help you gain a greater sense of control in your thoughts and behaviours, feel new hope for the future, as well as help you to change or reduce past negative coping mechanisms and negative personal beliefs.

• Eye movement desensitisation and reprocessing (EMDR): EMDR involves paying attention to an outside stimulus, such as a light or a finger moving back and forth. You follow this object with your eyes as you think back to your trauma. Moving your eyes back and forth anchors your attention, and occupies your brain with repetitive patterns of activity. This allows you to access and process the traumatic memory without your mind becoming too overwhelmed, and you can ultimately form new associations with that memory.

• Medication: Although there are no medications specifically designed to treat PTSD, there are a variety of well-established medications used to treat other conditions such as depression and anxiety that can be helpful in managing PTSD symptoms.

For some of us, we might be worried that a therapist might ask us to do or remember things that are too painful. We’d like to remind anyone considering therapy that our therapist is meant to be our ally, and not someone pushing us towards anything we aren’t ready for. There is a difference between the discomfort we feel when we challenge ourselves (which comes from a place of growth) and harm. We do not have to hurt ourselves to get well. In seeking out treatment, remember that you are the client, and you get to decide which therapist works best to address your needs.

There are some other treatments that can be quite useful:

• For relaxation: Yin yoga or trauma-sensitive yoga, acupuncture, and progressive muscle relaxation have all been shown safe, effective ways of reducing stress

• Journalling

• Get enough sleep (8 hours per night), because during sleep our cells heal, and our memories settle

• If you want to destress throughout the day, try unclenching your jaw, letting your tongue relax in your mouth, dropping your shoulders, and just breathing.

Remember you have already protected yourself so well against this traumatic experience. You are everything you need to heal.