PTSD Explained…. This 2nd article in the Beyond Trauma series will examine and explain what PTSD is, the biology, the causes and symptomatology.  In the next few articles that follow this one, I will examine the recovery journey from PTSD. How to recognise, understand and proceed through the ups and downs of the healing process. I will also examine preventions, such as critical incident debriefing and the most up-to-date treatment options including how to choose the best therapy/therapist. Raising Awareness Although it wasn’t until 1980 that PTSD was officially recognised as a mental health condition in the Diagnostic & Statistical Manual of Mental Disorders, the concept of PTSD has been around for much longer in history with origins within the military during the 1st world war. Due to increased clinical research into PTSD, there is a lot more awareness about PTSD today, both clinically and psychologically, allowing people to identify their symptoms, get diagnosed and begin recovery. There are also a lot more choices of treatment options available, however many people suffer the chaos that it causes in their lives without realising that they have a recognisable, treatable condition, struggling to continue their lives with recurring symptoms. There is help available, PTSD is treatable and it is possible to experience a happy life beyond trauma. I hope that this series of articles will raise awareness of this condition and the possibilities for healing and recovery. PTSD Sufferers To sufferers of PTSD, it can feel as if they are trapped in a deep inescapable hole that impacts every area of their life. It is like they are stuck on a merry go round of fear, depression and exhaustion that won’t stop. Apart from having to constantly relive the events or experience flashbacks of events they had blocked out or suppressed, the overwhelming feelings of terror, panic, fear, anger, helplessness, confusion and anxiety that seem to randomly occur without rhyme or reason can become so overwhelming that everything shuts down to protect the sufferer from them. The feelings of everything being out of control can lead to OCD, eating disorders and substance abuse, both prescribed and recreational. These can occur to numb from the feelings. The constant feelings of panic and despair take their toll and the sufferer can become emotionally numb and detached which can cause feelings of being isolated, alone and detached from everything, everyone and the world around them, damaging relationships at work and home. Being around this numbness, panic and despair can be very difficult for family and friends to deal with as they don’t understand what’s happening and the sufferer cannot explain as they, in many cases, don’t understand either. But sometimes even worse than the fear, can be the feeling of everything being totally out of control, the total inability to relax or feel safe, feeling constantly on edge and the utter disruption to normal functioning abilities, thinking, focusing, depression, anger, self-blame and criticism that destroy confidence, happiness, self-worth and self-esteem. This can unconsciously cause sufferers to create repeated long-term hurtful, painful and negative patterns that impact themselves and others. There are very real physiological reasons for all of these symptoms, understanding them can assist in recovery as it allows the sufferer to recognise and make sense of the symptoms they have been experiencing. What Is PTSD? Post-Traumatic Stress Disorder (PTSD) is a clinically recognised and diagnosable mental health disorder (Diagnostic and Statistical Manual of Mental Disorders). The onset of PTSD symptoms can occur after a person has been involved in or witnessed an extremely stressful, frightening or distressing trauma or event that causes the person to experience intense fear, horror or feelings of helplessness. PTSD symptoms can be different for each person, sometimes developing straight after an event or the onset of symptoms can be delayed, occurring months or even years after the original event. Emergency workers, friends and family members can also suffer from PTSD through their own experience of supporting others through their recovery.  PTSD has very real and measurable physiological effects on the mind and body, causing outer symptoms that can be very frightening and debilitating for the sufferer, especially as the symptoms seem to be uncontrollable, which further disorientates and scares the sufferer. Causes PTSD can be caused by being involved in, witnessing, or aiding the recovery of people involved in extremely stressful, terrifying or life threatening situations/events, such as accidents, attacks, natural and man-made disasters, terrorism or ongoing stressful events, such as mental, physical, emotional or sexual abuse, being in a war zone or living in a dangerous neighbourhood. Every person deals with stressful events differently; one person may process the event and move forward without any PTSD, while another can be severely affected.  PTSD can also be caused by dramatic life changes, such as losing a loved one, surgery, a disability or life threatening illness.  In some cases even a relationship breakdown can trigger PTSD. Biology So what is actually going on in the body and mind of a PTSD sufferer? There are two parts to this, the biology that occurs during the initial event and the biology that occurs afterwards in a PTSD sufferer. Normal Response to Initial Event In a life threatening situation, the body’s protection system; fight, flight, freeze or collapse, kicks in to create protection from the impending danger.  It instantly tells the body whether to fight or flee the situation (flight) for the best possibility of survival, or if those option are not available, the freeze response is activated in a last ditch effort to survive by staying still or playing dead, the collapse mode is when death is inescapable and the body literally gives up. All these responses happen in a few seconds and are unconscious, automatic and normal responses to threatening situations. Even though these normal responses are literally beyond conscious control in these moments many people later suffer with self-blame about how they responded. When in a high stress situation, the amygdala (the primal fear part of the brain), senses danger and starts a chain reaction that signals the pituitary gland to release stress hormones that activate the adrenal system to get the brain and body ready for action; pupils dilate, heart rate increases, blood flow is redirected away from normal activities, such as digestion to muscles to prepare for action.  When it feels threatened, the amygdala literally hijacks many of the body’s normal operating systems such as rationalisation and digestion. During this hijack, the brain’s normal rational thinking and ability to process situations is interrupted and replaced with irrational, immediate response survival thinking, so that the immediate danger can be quickly escaped.  Although this primal built in survival system is very essential at the time, it can play havoc with the whole system afterwards. PTSD Biology Studies in recent years have shown that the minefield of physiological and psychological PTSD sufferers experience have very real and measurable neurological and physiological causes. Through MRI scans it has been discovered that PTSD sufferers exhibit the following symptoms: neurologically the amygdala (the fear activation part of the brain) has been found to be over-active and in some cases enlarged which can promote hypervigilance and impairs the ability to identify danger, it’s like the danger switch has been triggered, so the system is always on alert and random stimuli can trigger a full blown fight or flight response again and again. The hippocampus which regulates memories and processes experiences allowing experiences to be put in context, shows decreased activity and size, this causes disruption and confusion, so that similar people, sounds, or situations can trigger flashbacks.  In an extreme situation the pre-frontal part of the brain (which usually switches off the fear responses and is in charge of conscious faculties and decision making) is switched off and can later appear reduced in size in those suffering with PTSD, so it feels like the the fear switch can remains in the ‘ON’ position.  Constant increased stress hormones such as adrenaline and noradrenaline that are only meant to activate for short amounts of time become increased over a long period of time. This increases heart rate and blood pressure and causes enhanced startle responses, so the sufferer is on contact alert mode, nervous and jumpy. The body’s feel good chemicals, such as serotonin, are reduced causing changes in mood, behaviour and continued reduced levels can cause depression. This combination of long term high arousal levels and decreased levels of the body’s calming hormones can create the condition for PTSD. These long term imbalances have negative effects on the health including:

• Adrenal fatigue
• Reduced immune system function,
• Pain of any kind
• Heart disease
• Digestive problems
• Sleep problems
• Depression
• Weight problems
• Autoimmune diseases
• Skin conditions, such as eczema

Symptoms Although symptoms vary for each individual, they always include the following:

• Re-experiencing the traumatic event.
• Avoiding reminders of the trauma.
• Increased anxiety and emotional arousal.

Common symptoms of PTSD
Avoiding anything that remind about the trauma Memories of the event Flashbacks Nightmares Insomnia Distress Increased heart beat Rapid breathing Anxiety Feeling unsafe Panic attacks Nausea and sickness Muscle aches and pains Sweating Feeling over emotional Suicidal thoughts or feelings *	Insomnia Crying Irritability Anger Inability to concentrate Hypervigilance (always on alert) Exhaustion Guilt & Shame Self-blame & criticism Feeling unsafe Substance abuse Suicidal thoughts Feeling detached & unemotional Feeling isolated & alone Loss of interest in socialising Loss of interest in hobbies Inability to relax Feeling helpless and hopeless

* If you are having a suicidal thoughts always contact an emergency line http://www.suicide.org/suicide-hotlines.html Diagnosis PTSD is a clinical diagnosable condition.  Many people may experience some of the above symptoms during their normal recovery from a trauma (PTS as explained in the previous article) and then go forward with their lives without developing PTSD.  However, if you think you may be suffering from PTSD, then it is advisable to go to a General Practitioner for diagnosis and then find the best trauma therapist and treatment for you, whether that is the medical or holistic natural approach, the options of which I will be examining in upcoming articles.  The main criteria for PTSD all describe the severity of the symptoms listed below, these are for people above 6 years old, for below this age there are different criterions:

Diagnosis Criteria

Criterion A: (1) Stressor (cause): event, witnessing event, caring for sufferer, direct & indirect exposure to event or events. Criterion B: (1) Intrusion symptoms: flashbacks, nightmares, reactivity to trauma related stimuli, disassociation, prolonged distress Criterion C: (1) Avoidance: of trauma-related thoughts or feelings or external reminders Criterion D: (2) negative alterations in cognitions and mood: persistent negative emotions, inability to remember event, lack of interest in activities, detachment. Criterion E: (2) alterations in arousal and reactivity: Irritability, aggressive behaviour, self-destructive, hypervigilance, exaggerated startle response, problems concentrating, disrupted sleep pattern Criterion F: Duration: criteria symptoms have lasted at least one month Criterion G: functional significance: affecting social / work / relationship abilities Criterion H: exclusion: disturbance is not due to medication, substance use, or other illness. Exhibition high levels of disassociation.

  Does Everyone Affected by a Trauma Develop PTSD? No. A lot of people experience a normal recovery from traumatic events. Clinical exploration of PTSD suggests everybody is unique with individual differences affecting each person’s ability to cope with catastrophic stress. Upbringing and environment can be contributory factors in how a person deals with stress, these can include:

More Susceptible to PTSD	Estimated Amounts of PTSD Sufferers
Previous mental health problems. Coming from a poor background. Lack of education. Being exposed to trauma in the past. A family history of mental illness	1 in 5 firefighters. 1 in 3 teenage survivors of car crashes. 1 in 2 female rape victims. 2 in 3 prisoners of war.

  Self-Help Recovery from any traumatic event takes time, it is a natural healing process and everyone heals at their own pace depending on how the effects of the event has impacted them individually.  But there are actions that can be taken to support one’s self through the healing process of normal PTSD symptoms:

• Seek help early: the earlier the symptoms are addressed the better
• Learn more about post-traumatic stress, understanding allows progression through symptoms
• Share your feelings and talk with someone you trust.
• Don’t isolate yourself from others, socialise and join in with your normal activities as much as possible.
• Regularly practise activities to relax and calm your mind, such as yoga/meditation/ being in nature
• Exercise helps to release stress from the body, increasing feel good chemicals.
• Avoid drugs and alcohol as these aggravate symptoms.

Treatment It is important to seek treatment if you have PTSD, just getting diagnosed and starting to understand the disorder allows you to start progressing. It is also important to find the best type of therapist and therapy for you and to realise that it is a recovery process. Therapist trained specifically in dealing with trauma will usually be the best route to take.  Seeking the assistance of trauma specialist to support you through the healing process forms an important support structure for recovery.  There are many trauma specialists available; the most important thing is that you feel safe and comfortable with the therapist that you choose.  Mindfulness, CBT, EMDR, emotional release techniques such as EFT and NLP are widely considered very valuable and effective in overcoming PTSD, although there are many new modalities that are gaining popularity and success in releasing trauma from the mind and body such as Access Bars and Reiki, which are more holistic approaches that can also provide a very safe and supportive role through recovery process.  These will be explored further in this beyond trauma article series. Views:]]>