What is Post Traumatic Stress Disorder (PTSD) and why does it come about?
As the diagnosis suggests, post traumatic stress disorder comes about after the person has experienced some kind of trauma during which they had reason to believe they might die.
At present by far the most common cause of PTSD in the UK is being involved in a car accident. It is important to realise, however, that not everyone who experiences trauma will come to suffer from post traumatic stress disorder. This is due to a combination of various factors including the person's personality, their inherited arousal system, and the circumstances of the trauma itself.
PTSD can only be diagnosed officially if the symptoms have been present for more than a month after the trauma. Prior to that it is classified as an acute stress disorder.
Many trauma sufferers manage to resolve their anxieties within the first month or so. In effect they manage, albeit usually without realising what they're doing, to convince their survival instinct that the danger has passed, that they now are safe, and it can switch off. Those that don't, and who develop PTSD, continue to feel as if the disaster is still ongoing.
So what happens when Post Traumatic Stress Disorder develops?
The answer lies with the symptoms
People with Post Traumatic Stress Disorder have nightmares and/or flashbacks. During these the traumatic event is replayed like a film in their minds. They re-live it and feel the same emotions that they felt when it happened.
To the survival instinct there is no difference between real danger that's actually happening and your very vivid memory of that danger as you re-live it in your head. This is because the survival instinct bases its response on how you react to the warnings it gives.
If you react to them by being fearful all over again, it will keep giving you reminders because it believes the danger is still present.
Let's look at the example of a car accident.
As a therapist, I have never needed to treat anyone who had been involved in an accident and who also recognised that it was entirely their own fault.It seems that when someone causes an accident due to carelessness or maybe lack of attention, they don't usually also experience Post Traumatic Stress Disorder.
The most logical explanation for this would appear to be that the person who caused the accident is able to tell themselves that if they hadn't done such and such then it wouldn't have happened. This belief enables them to still feel a sense of control over their fate.
It's the sudden realisation that, although they were doing nothing wrong, they could easily have been killed that takes root in the mind of the innocent victim.
The innocent victim was doing nothing wrong yet, as they suddenly realise, they could have been killed. This not only evokes fear, but also causes many sufferers to experience a general loss of confidence. We each tend to feel confident when we feel able to control those things that matter most to us.
Being able to keep ourselves safe is paramount. It will then come as no surprise that people who are suddenly traumatically confronted by the realisation that they do not have such control will become anxious and feel vulnerable and lose confidence in their own abilities. This is explained as a symptom under loss of confidence.
At the time of the trauma, the survival instinct recognises the raised negative arousal (extreme fear) in the person and assumes that what's going on is life threatening. It then tries to record anything which it believes is connected to the trauma so that if/when it comes across it again it can warn them of the danger in advance.
So it might decide that being in a car itself is a danger signal. It may also link over factors that were present at the time such as flashing blue lights and/or sirens, the nature of the weather, the particular place it happens, etc.
Because the survival instinct is a very primitive system it sometimes makes links with aspects which aren't threatening in themselves - maybe someone who came to help at the scene was wearing a safety vest. It could well remember this as a danger signal in days to come simply because it was on the danger scene at the time.
In the days following the trauma, the PTSD sufferer is more anxious than usual simply because what happened was a shock. For this reason they are experiencing higher ongoing arousal than usual. Once the arousal level increases, the survival instinct is more alert and more ready to warn of danger.
It sees reminders of what happened, maybe on TV, in things people say, anywhere. Each time it finds such a reminder it gives the person a startle warning and a reminder. The person then starts recalling what happened all over again, having images of it in their mind and becoming anxious (raised negative arousal). This response to the startle warning just serves to let it know that yes, they are scared and so it was right to warn them. This encourages it to look for even more things to warn them about - and so it goes on.
When the sufferer goes to bed they are often unable to sleep. They tend to have constant raised arousal which their survival instinct interprets as meaning there's danger around. There is no way the survival instinct is going to let the person sleep when it has every reason to believe life is threatened.
If the sufferer does manage to fall asleep, they tend to dream about the trauma. This wakes them and they then go over what they just dreamt in their minds, and feel afraid in response to it. Again this keeps the arousal high and the fear flowing.
It is not therefore surprising that another symptom of ptsd, along with insomnia, nightmares, flashbacks, exaggerated startle responses and constant anxiety, is the inability to concentrate. If your survival instinct is constantly alerting you to possible dangers and locking your awareness onto them, there is no spare awareness to focus on everyday things.
To overcome PTSD the sufferer has to be taught to do three things:
1. To retrain the survival instinct to believe that the reminder warnings it keeps giving about what happened are no longer relevant. That the danger has passed.
This is done by learning to recognise the warnings and choose not to buy into them.
2. To recognise when they are responding to startle warnings with more negative arousal and learn and apply techniques for reducing it instead.
3. Finally the loss of confidence has to be addressed although once a sufferer realises they are making progress with 1 and 2 their confidence receives a boost anyway.
The approach to overcoming anxiety described on this website as the Feelgood Way contains necessary information and techniques to enable a PTSD sufferer to understand and to begin to overcome their anxieties.