Post-Traumatic Stress Disorder (PTSD) – The Guide to Trauma-Related Stress Disorder

PTSD, a.k.a trauma-related stress disorder, post-traumatic stress disorder after a catastrophic event, or "combat shock", is a psychiatric disorder that occurs after exposure to or witnessing a traumatic event.
This disorder can deeply affect various aspects of a person's life, sometimes resulting in functional impairment. Therefore, early identification and diagnosis of the disorder, along with appropriate treatment, can significantly improve the difficulties faced by individuals suffering from PTSD.

In this current article, we will delve into the topic of Post-Traumatic Stress Disorder, including its different types, symptoms, and treatment options. Additionally, we will touch on complex PTSD, which often requires slightly different therapeutic approaches than "regular" PTSD.

What is PTSD?

Post-Traumatic Stress Disorder is a psychiatric disorder that may occur following a life-threatening event, such as a car accident, war, sexual assault, family violence, a natural disaster, and more. It can also result from a traumatic medical event (such as a heart attack) or a complicated childbirth.
Moreover, such events can be experienced directly by the individual or can occur when the person witnesses an event happening in front of them without being directly involved. For example, individuals involved in security and rescue operations, who are exposed to traumatic events, may develop PTSD.

Symptoms of Post-Traumatic Stress Disorder

People suffering from PTSD experience various disturbances in response to the factors that constitute a memory of the traumatic event. The intensity of these symptoms varies from person to person, and they can worsen if the disorder is left untreated.
People dealing with the disorder may experience:

• Re-experiencing: The person feels as if they are "reliving the trauma." This can manifest as intrusive thoughts, where thoughts about the traumatic event return and change uncontrollably, nightmares, recurring nightmares about the event, and flashbacks, where the person literally "sees" or feels the event again and again.
• Avoidance: The difficulties associated with even simple daily life activities may lead to recurring and changing memories of the trauma, causing avoidance of basic actions. For example, a person who survived an explosion may feel that any action could lead to another explosion, leading to avoidance of refueling their car, lighting a gas stove, and more. Avoidance may also lead to avoiding social gatherings. For example, a soldier who participated in a particular operation that ended tragically may not meet with their comrades from the unit with whom they shared the challenging experience.
• Emotional numbness: Many people may feel that they cannot enjoy activities that used to bring them joy in the past. The loss of enjoyment can lead to the intensity of depression symptoms, which is relatively common among those with PTSD.
• Guilt feelings: Guilt about the traumatic event, guilt about current difficulties due to PTSD, loss of satisfaction and enjoyment in activities that used to bring joy in the past, and the feeling that the world is a dangerous place – all of these can be symptoms resulting from the disorder.
  Conversely, emotional reactions can be intensified, leading to anger, fear, or anxiety. Such emotions may appear excessive or exaggerated. These feelings can lead to irritability, concentration difficulties, and more.
• Sleep Disorders: Sleep disorders are very common among individuals dealing with the disorder. Many suffer from nightmares that may include the traumatic event, difficulty falling asleep, and daytime fatigue, among other symptoms.
• Feelings of Disconnection: Some people with PTSD experience feelings of disconnection from themselves and the world. They may feel as if their body doesn't belong to them and that they are experiencing events as an outsider. At times, they may feel that the world around them is not real, as if they are watching events from the sidelines.

These symptoms can deeply affect a person's relationships, work performance, and daily functioning.

Intensity of Symptoms

The severity of symptoms in PTSD can change over time, with certain factors such as periods of stress potentially exacerbating the symptoms, along with exposure to triggers like noises, smells, specific sights, and more.
Receiving appropriate treatment for the disorder can significantly reduce the symptoms experienced by individuals, thereby improving their day-to-day functioning.

The onset time of post-traumatic stress

Symptoms of PTSD typically begin during the first month following a traumatic event. Initially, within the first month, these symptoms are referred to as "acute stress disorder" and may resolve without progressing into full-fledged PTSD. Receiving early treatment after the event can help prevent the development of PTSD.
If symptoms persist for more than a month, a qualified professional can diagnose post-traumatic stress disorder. Additionally, there are cases where the disorder does not manifest immediately after the traumatic event. Sometimes, symptoms may appear only several months or even years after the traumatic event. This delayed onset can occur in elderly individuals who experienced a traumatic event in their youth, with symptoms not emerging until later in life.

Why Does PTSD Develop?

Many people are exposed to challenging events during their lives, which can leave a distinct mark on their psyche. However, it's important to note that not everyone who experiences trauma develops PTSD.
To date, the exact cause of the development of PTSD is not known. However, the prevailing explanation today is that a combination of certain risk factors, such as genetics, alterations in the brain's delicate chemical balance, and individual coping mechanisms, all play a role in the disorder's development.
Furthermore, it has been found that individuals who experience multiple traumatic events in their lives (not necessarily related to each other) and those who endured childhood abuse are at an increased risk of developing the disorder. It does not mean that everyone who has undergone such difficult experiences will develop PTSD, but they may be more susceptible to it. Conversely, many individuals struggle with the disorder without a similar background.
Furthermore, some researchers argue that there may be a connection between stress hormone balance in the body, such as cortisol, and the development of post-traumatic disorder (PTSD). However, the exact mechanism linking the two remains unclear.

How Is PTSD Diagnosed?

The diagnosis of post-traumatic stress disorder is typically made by a psychiatrist or psychologist, specialists in mental health. Several criteria are necessary for making the diagnosis, based on the symptoms mentioned above, along with the connection of these symptoms to a traumatic event. Additionally, the mental health professional will assess how the disorder impacts the individual's life and ensure that the symptoms are not caused by another disorder.
If you suspect that you or someone close to you is struggling with post-traumatic stress disorder, it is essential to seek professional assistance as soon as possible. Various treatment options are available that can significantly aid in coping with the disorder, and without treatment, it can lead to profound disruptions in a person's life.

How Is PTSD Treated?

PTSD can be treated through various methods, often involving a combination of approaches to maximize the benefits of each treatment. Mental health professionals such as psychiatrists and psychologists can guide the most suitable treatment approach.
Two main categories of treatment are commonly employed:

• Trauma-Focused Therapy: There are several types of talk therapies designed to address trauma. Among them are Cognitive-Behavioral Therapy (CBT), Exposure Therapy, and Eye Movement Desensitization and Reprocessing (EMDR).
  EMDR is a therapeutic method specifically developed for dealing with post-traumatic stress disorder. This treatment involves a series of sessions where the therapist helps the patient process memories of the traumatic event while performing repetitive eye movements. The goal is to break automatic associations and connections between distressing memories and negative symptoms, ultimately alleviating the patient's suffering.
• Medication: Some medications have been found to alleviate the symptoms of post-traumatic stress disorder. The choice of medication depends on the specific symptoms experienced by each individual. In most cases, improvement in symptoms can be expected within a few weeks of starting treatment.

How to Prevent Post-Traumatic Stress Disorder (PTSD)

While it may not be possible to prevent all cases of PTSD, several steps may reduce the risk. If a person experiences a severe and extreme event in their life, it is crucial to provide appropriate support that can help them process the experience and potentially prevent the future development of PTSD.
Firstly, during the minutes and hours immediately following the event, once the danger has passed, it is important to emphasize to the individual that the danger has subsided, and they are now in a safe place. Ensuring that important figures in the person's life (support network) remain close to them in the immediate aftermath of the event and offer all necessary support is essential. Research has shown that encouraging the individual to share details of the event with close people can aid in coping.
It is also important to address how the person views their role in the traumatic experience. Self-blame or feeling responsible for the event can intensify negative emotions and hinder the healing process. Instead, encourage the survivor to see themselves as a "survivor," a perspective that allows processing the experience from a different angle.
Additionally, initiating treatment early after the event, such as Trauma-Focused Cognitive Behavioral Therapy (CBT), can also help prevent PTSD and is crucial for coping with the traumatic experience.

What is Complex PTSD?

In cases where there is prolonged exposure to recurring traumatic events, especially when these events occurred during childhood, Complex PTSD (CPTSD) may develop. Prolonged exposure can include situations of ongoing abuse, repeated sexual assault, or enduring extreme violence from someone close, among others. What these situations have in common is that the victim is under the control of another person, often unable to escape the situation.
The prevailing professional explanation today is that repeated exposure to difficult events at a young age may have a deeper impact on a person compared to "regular" post-traumatic stress disorder (PTSD). Complex PTSD can lead to difficulty in controlling emotions, damage self-image, affect relationships, erode trust in others, and more.
The treatments offered for PTSD may also be suitable for addressing Complex PTSD, but often there is a need to address additional symptoms. For example, practicing mindfulness, maintaining strong social support networks, finding alternative ways to express thoughts and feelings (such as through art therapy), and more.

A Few Words in Conclusion

Post-Traumatic Stress Disorder is not easy to cope with, and it is essential to approach it deeply while receiving professional treatment and support. Early diagnosis and treatment in the early stages of the disorder can prevent the worsening of symptoms and significantly improve the difficult emotions that individuals with the disorder may experience.
If you are struggling with post-traumatic stress disorder, remember that you are not alone. Psychiatrists, psychologists, and Leumit mental health services are here for you.
For your convenience, you can schedule appointments through the Leumit website and app, or by calling the customer service hotline at *507.
In addition to in-person appointments at healthcare centers, you can also schedule video and phone appointments based on your preferences.

Miri Danon, Clinical Psychologist and Trainer, Leumit.