- - Friday, February 23, 2018

ANALYSIS/OPINION:

The effects of Post Traumatic Stress Disorder (PTSD) can be far reaching. Originally understood as the after-effects of war on some military veterans, we now clearly know that PTSD is a mental health condition that can affect anyone.

It is triggered by a terrifying or traumatic event – either experiencing it or witnessing it. Also, it is important to understand what is considered traumatic differs among individuals. It can be physical, mental, or emotional and range from a violent assault, war combat, accident or crash injuries, surviving a natural disaster or terrorist attack, getting diagnosed with a life-threatening condition, losing a loved one, or any event in which you fear for life. Even hearing about the unexpected injury or violent death of a family member or close friend can start PTSD.

And in today’s high-definition broadcast news and social media news feeds, are gruesome stories along with upsetting images—of which some psychologist and digital media experts are underscoring brings traumatic and disturbingly graphic events even closer to you and your loved one’s lives. This means media and social media unsurprisingly could be taking its toll on your mental health. And in more recent studies on the topic, it has been found that, for some, the affects can be similar to post traumatic stress disorder (these include the 9/11 Twin Tower attacks, school shootings and suicide bombings).

The question is: Do you (or a friend or family member) re-live a horrifying event, again and again? This can happen both as a ‘flashback’ in the day and as nightmares when asleep. Or, are thoughts so realistic that it feels as though you are living through the experience all over again? You see it in your mind – but may also feel the emotions or physical sensations of what happened - fear, sweating, sounds and pain. It is important to understand the dynamics of PTSD and what actions to take.

DR. NINA’S WHAT YOU NEED TO KNOW: About Post Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD)
After experiencing a traumatic event, we, as humans, often experience a range of reactions—anger, fear, stress and anxiety. And, despite the far-reaching effects of PTSD, our understanding of “the how,” known in medicine as pathophysiology, is sparse.

What we do know is that dangerous situations and fear trigger our “fight or flight” response to create a state of hyperarousal to improve our chances of survival. For example, seeing a lion chasing us causes our heart to beat faster and deliver more blood to our muscles so we can run for our lives. It is believed that when PTSD occurs, the stress hormones involved in the “fight or flight” response, along with other neurotransmitters (chemicals that carry information between nerves), somehow go awry, causing symptoms to manifest.

Traumatic events are unique to each individual:
• While most people recover naturally, some go on to develop PTSD that can cause added distress and even become debilitating
• Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD
• It is generally agreed that not everyone with PTSD has been through a dangerous event but rather a shocking or unexpected one
• And, too, it is often accompanied by depression, substance abuse or anxiety disorders.

PTSD can begin at any age starting after the first year of life, occur within 3 months of the traumatic event, or manifest several years later.

Symptoms:
The symptoms of PTSD can start immediately or after a delay of weeks or months, but usually within six months of the traumatic event. These types of events generally undermine your sense that life is fair, reasonably safe and/or that you are secure. A traumatic experience makes it very clear that you could die at any time.

Experts have identified four symptoms:
• Re-living or re-experiencing the trauma. This may manifest as flashbacks or vivid memories; nightmares; or emotional or physical (heart racing, shortness of breath, sweating) distress when reminded of the event.
• Avoidance of people, things, places, or events that are a reminder of the trauma. And while this may work in the short-term to help cope and provide some temporary relief, in the long-term, it can have consequences.
• Arousal and reactivity are amplified. It may be seen as being easily startled; irritable, aggressive, on edge or angry; or having difficulty sleeping or concentrating.
• Negative thoughts or feelings such as an inability to remember key features of the trauma; pessimism towards oneself (doubt) or the world; feelings of guilt, blame, or isolation; or loss of interest in social or other enjoyable activities.

If it is more than 6 weeks since the event, and these experiences don’t seem to be getting better, call your doctor.

Risk factors: When the traumatic event is intense, long-lasting, or results in physical injury there is an increased risk of developing the illness.

Personal factors can also play a role such as prior traumatic exposure, age, gender (women are twice as likely to develop PTSD), and the level of stress in a person’s life at the time of the event. And, too, a person’s temperament can contribute—when one has externalizing behaviors, inappropriate coping mechanism, or other anxiety issues.

Environmental risk factors include family dysfunction, childhood adversity, cultural variables, a lack of social support, financial instability, or family history of psychiatric illness.

Conversely, experts have delineated resilience factors—factors that can help decrease the risk of developing PTSD and are something we have control over. They include seeking help from others such as friends, family, mental health professionals, or a support group. As well as learning coping mechanisms; physical exercise; developing (or maintaining) a positive outlook; and establishing a strong moral compass (living by meaningful principles, putting them into action through altruism).

Current Treatments and Therapies: Every case of PTSD is unique and a health professional can help tailor a treatment plan. Just as there are both psychological and physical aspects to PTSD, so there are both psychological and physical treatments for it.

At this time, the mainstay of treatment is psychotherapy (“talk” therapy) which can occur one-on-one or in a group setting. It can include teaching about trauma and its effects; use of relaxation and anger-control skills; advice on how sleep, eat, and be more physically active; address feelings of guilt or shame about the event; identifying triggers; and how to react to their PTSD symptoms.

In some cases, medications for depression, anxiety, or sleep may be appropriate. And, too, for someone who is undergoing on-going trauma, that situation must be addressed. For example, a spouse in a physically abusive relationship. Additionally, other mental health issues such as anxiety, depression, feelings of suicide, and substance abuse must be addressed.

What about children and PTSD? PTSD can occur in children as young as one year of age, though their symptoms manifest differently. In children age 6 and under it may include: thumb-sucking; whimpering or trembling; forgetting how to or being unable to talk; wetting the bed after being potty-trained; showing signs of fear, or having fear of the dark; or acting out the scary event during playtime.

Older children and teens are more likely to show symptoms similar to those seen in adults. They may have trouble in school or refuse to go to school; become quiet around others or try to isolate themselves; or start complaining of physical problems (e.g., headaches, stomach pain). In some situations, disruptive, disrespectful, or destructive behaviors may develop.

Steps that Can Help Following Such Events:
• Talk about what happened to someone you trust
• Keep life as normal as possible (back to your usual routine)
• Try relaxation exercises
• Eat healthy, exercise regularly and maintain quality sleep hygiene
• Take time to be with family and friends
• Be careful generally – accidents are more likely at this time
• Speak to your doctor
• Expect to get better

It is important to understand the impact of traumatic events and PTSD. And too, that family, friends and colleagues can all help in the process by connecting and asking general questions and letting the person tell their story, as they get the help they need moving forward.

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