As per the diagnostic manual DSM-V, Post-Traumatic Stress Disorder (PTSD) can develop after “exposure to actual or threatened death, serious injury, or sexual violence” either through direct experience, witnessing the event, learning of the event occurring to a loved one, or experiencing repeated or extreme exposure to aversive details of the event. The identified symptoms cover four categories that reflect the impact of trauma on thoughts, feelings, behaviours, and physiology: Intrusion (thoughts), avoidance (behaviours), negative changes in thoughts and mood (thoughts, feelings), and changes in arousal and reactivity (physiology).
Intrusion symptoms involve recurrent memories or thoughts about the traumatic events that enter our mind involuntarily and can be difficult to push away. Such intrusion can also occur in form of nightmares or flashback, in which individuals may feel they are back in the traumatic circumstance. For example, the smell of smoke may trigger someone who has survived a fire to believe the building they are in is on fire or may even transport them into the scene of the actual fire they survived. In those moments, the brain finds it difficult to distinguish between reality in terms of current and past danger. As a result, there may be a strong emotional and physiological fear response, even when the individual is indeed safe.
Avoidance symptoms show up in avoidance of any memories, thoughts, feelings, triggers, cues, people, places, activities, objects and more that are linked to the traumatic incident. This can disrupt daily functioning at work and home as well as relationships and wellbeing. Such extreme avoidance can prevent healthy processing of the traumatic event, and thus can enhance trauma-related distress and symptoms.
Negative changes in thoughts and mood can be a result of the way our brain responds to trauma. For example, during acute trauma, our brain re-directs limited processing resources to the areas of our brain that are involved in our survival mode, while withdrawing resources from non-essential areas such as our higher cortical functioning. As a result, things like memory encoding may be impacted. In line with this, amnesia is a common symptom of PTSD, where parts or all of the incident are not remembered.
Further, trauma can shatter our assumptive worldview. The assumptive worldview hold three fundamental beliefs: the world is generally good, fair, and predictable. Traumatic incidents do not align with these beliefs, and can rather make the world feel unsafe, unpredictable, and cruel. Consequently, we may develop extreme negative or all-or-nothing beliefs about ourselves, other people, and the world as a whole. This can also manifest in persistent immense fear, anger, guilt, shame, and other distress, detachment, isolation, loss of interest, and difficulties experiencing positive emotions.
Changes in arousal and reactivity are linked to the extreme physiological response our bodies go through during trauma. In the book The Body keeps Score, Bessel van der Kolk elaborates on the various physical mechanisms that keep trauma stored in our bodies when trauma has not been fully processed . Even seemingly benign triggers can quickly activate hypervigilance, exaggerated startle response, anger outbursts, sleep issues, and reckless impulsive behaviours.
The DSM-V further specifies dissociation as a symptom of PTSD in addition to the categories of intrusion, avoidance, and changes in mood, thoughts, arousal, and reactivity. Dissociation can be seen when individuals feel detached from themselves or reality. They may describe this as not feeling like themselves, reporting that reality does not seem real, or like the world around them appears fuzzy and distant.
Written by Dr Esslin Terrighena.
PTSD symptoms can often be noticed by our loved ones before we notice them ourselves. If you think you or your loved one is experiencing any trauma-related symptoms, please book in a consultation on (852) 2521 4668 or firstname.lastname@example.org.