“Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.” — Khalil Jibran
It’s normal to feel afraid during a catastrophic event. Emotions can be numb or painful, senses are heightened, and the “fight or flight” response kicks in. Some people want to run. Others find themselves shutting down or at the ready for a fight. Most also experience a range of reactions after the event, from numbness or emptiness to panic, misery, or rage, but usually these symptoms disappear over the course of days or a week.
However, some people develop trauma-related illnesses like Acute Stress Disorder (ASD) or Post-traumatic stress disorder (PTSD). These are both psychiatric conditions triggered by scary, shocking, or life-threatening events. Traumatic situations can include combat, accidents, abuse, sexual assault, and natural disasters. Learning about the violent death of a loved one can also trigger symptoms.
What are the symptoms?
In general, these disorders involve feeling fear or distress even when one is no longer in danger. The term ASD describe symptoms that last less than a month. Doctors diagnose PTSD in individuals who’ve struggled with stress-related problems for longer than a month. Symptoms include:
- Painful feelings, emotional numbing, or attacks of rage
- Feeling distanced from others or choosing to be a loner
- Nightmares or difficulty sleeping
- Unwanted, intrusive memories, thoughts or mental images of the trauma
- Avoiding objects, people, or situations that remind a person of the trauma
- Being sensitive to ‘triggers” that bring back memories of the trauma
- Flashbacks (“reliving” the trauma) or dissociation (when a person temporarily loses touch with reality)
- Jumpiness, sensitivity to noise, being tense or on-edge, unable to relax
- Difficulty enjoying things
- Sense that something bad is going to happen and the future is bleak
- Inability to remember the trauma
- Excessive feelings of guilt
These characteristics jumpstart problems in a person’s day-to-day life. Keep in mind that other causes (like medical conditions or substance use disorders) need to be ruled out before a diagnosis can be made.
“…Trauma shatters your most basic assumptions about yourself and your world — ‘Life is good,’ ‘I’m safe,’ ‘People are kind,’ ‘I can trust others,’ ‘The future is likely to be a good place’ — and replace them with feelings like, ‘The world is dangerous,’ ‘I can’t win,’ ‘I can’t trust other people,’ or ‘There’s no hope.'” — Mark Goulston
When do Acute Stress Disorder and PTSD usually start?
Some individuals have very serious symptoms right after trauma but return to normal after a few weeks; as described beforehand, this is called ASD. PTSD typically starts within weeks to months after the event. On occasion it kicks in years later, a phenomena called “delayed onset” PTSD. This is often related to a subsequent life-threatening situation that “jumpstarts” memories of the first event.
Why do some people get sick, while others don’t?
According to the National Center for PTSD, one out of every 7 or 8 people will experience PTSD at some point during their life. It’s unclear why some individuals are more susceptible than others to developing these disorders, but studies suggest the type and frequency of the trauma are influential. Repeated abuse, assault, or combat experience make PTSD more likely. Research also suggests that a history of trauma (especially childhood abuse) or having a psychiatric illness/substance use problem increase the risk of developing a trauma-related illness. On the other hand, good social support is considered protective. It actually lowers the risk of falling ill to ASD or PTSD.
What are the treatments?
ASD and PTSD affect people differently, so treatment that helps one person might not do the trick for another. To find the right help for you, we strongly encourage you get in touch with a mental health professional who can tailor to your needs. Call your insurance or contact your family doctor for recommendations for a psychiatrist and therapist. Alternatively, research local providers online. A psychiatrist prescribes medication. A social worker, psychologist, or licensed clinical practitioner does talk-therapy.
Treatment usually involves medications, individual and group therapy, education about the disorder, life-style changes (especially if the trauma is ongoing), and self-help. If you struggle with long-term PTSD, you might do well with a service animal like a companion dog. If depression or anxiety are present, a provider might target these symptoms independently. If you’re having difficulty with drugs of abuse or alcohol, your mental health provider might suggest you engage in community or residential treatment. Ultimately, the best plan is one that takes your uniqueness, strengths, and needs into account.
Which medications are helpful?
Although these illnesses can’t be cured, medications can diminish symptoms and improve quality of life. In ASD, doctor’s are more likely to prescribe as-needed medications for anxiety and sleep. PTSD often requires more long-term interventions.
- The most studied medications for PTSD are antidepressants. They’ve been shown to decrease negative mood and anger, and help with bothersome thoughts, tense feelings, and the reliving of the trauma. Examples include Prozac, Lexapro, Zoloft, Cymbalta, and Effexor.
- For nightmares, doctors recommend a medication called Prazosin.
- Neurontin, Vistaril, and the “benzo’s” (like Klonopin or Xanax) can help reduce anxiety. Keep in mind that the benzo’s are typically used “as needed” and for a short time because of their abuse potential.
- Depakote, Tegretol, and Trileptal can help with mood swings and rage.
- Agitation, aggression, and paranoia respond to antipsychotics like Risperidone, Zyprexa, or Seroquel, although antipsychotics aren’t the first medication doctors turn to because of side effects.
- Sleep medications include Trazodone, Ambien, Rozerem, Belsomra, and Benadryl.
- The antidepressant Remeron can help with sleep and depression.
What about psychotherapy?
People with ASD and PTSD typically benefit from seeing a counselor for therapy. A counselor can support you in different ways. Some methods focus on facing the trauma head-on. Others circumvent the trauma, allowing you to put it aside and focus on ways to minimize symptoms. These different techniques include:
(1) Exposure therapy: facing and controlling your fears, confronting your trauma little by little in a safe way
(2) Cognitive therapy: helps you process the bad experience, rewriting problem thoughts and improving your sense of the future.
(3) Supportive therapy: refocuses your energy away from the trauma and onto the present, where you learn new skills (like anger management, handling triggers, and relaxation methods) to get the symptoms and your life better under control.
(4) Eye Movement Desensitization Reprocessing (EMDR): a technique that helps the brain change its response to the trauma on a physiological level.
(5) Group therapy: helps you meet others who’re experiencing similar symptoms.
Each time you work through a traumatic memory, you’re better equipped to handle the next one. — Anonymous
What can I do to help myself?
Here are three tips for surviving trauma-related disorders:
(1) Know thyself. If you have ASD or PTSD, make sure to educate yourself about the disorder. Learn to recognize your triggers. Have ready-made plans for dealing with them when they occur. Pick up on anger early, before it balloons out of control, and channel it in a good direction. Know when it’s time to avoid the news and radio — or people in general. Help your family and friends understand PTSD so they can give you room when you need it.
(2) End abuse. Take firm steps to safely end any ongoing trauma in your life. If you need help getting out of an abusive relationship, reach out for assistance! Talk to someone you trust, call the domestic violence hotline at 1-800-799 -SAFE (7233), go to the emergency room, or do what you need to do. Just do so safely.
(3) Care for yourself. Don’t forget about self-help! That includes coping skills, relaxation exercises, anger-management, self-affirmations, mindfulness, meditation, distraction techniques, journaling, and a lot more. Don’t forget the doctor’s favorites: exercise, healthy diet, and avoiding drugs of abuse. But above all, remember humor, fun, creativity… and being kind to yourself!
“Sometimes self care is getting up just to go eat and go back to bed. Sometimes it is to blowing everything off and spending the day with someone you love. Sometimes it involves a really big cry. And sometimes it involves doing nothing at all.”