The importance of awareness
I lived with Post-Traumatic Stress Disorder for years before finding the correct course of treatment or diagnosis, and some people go decades longer without ever knowing “what’s wrong with them” or “how to fix it.” Awareness around the immediate signs of post-traumatic stress disorder (PTSD)—along with the acknowledgment that it isn’t only an affliction that war veterans struggle with—has become slightly more prevalent today: nightmares, flashbacks, panic attacks, intrusive thoughts, reliving the event over and over again, fearing for your safety. Examples of include being directly impacted by acts of war, terrorism, or being the victim of a crime, a natural disaster or accident, witnessing or being a direct victim of sexual or domestic abuse, medical trauma, the loss of a loved one, even growing up in a dangerous or impoverished neighborhood or a dangerous or unstable home or family environment. Sometimes, symptoms take months or years to surface, and, when they do, they can sometimes be hard to detect, seemingly unrelated to anything you went through. For National Stress Awareness Month, I spoke with experts who help connect the dots between some of the pervasive and painful—along with some blink-or-you’ll-miss-it—reactions you may be having to everyday stressors and triggers.
Initial signs and symptoms
WAVEBREAKMEDIA/SHUTTERSTOCKWhen looking at the various ways people attempt to cope with exposure to one or a series of traumatic events, it’s important to recognize the ways that they may manifest, says Gary Brown, PhD, a licensed psychotherapist in Los Angeles who has worked with organizations like NASA and the Department of Defense in addition to seeing patients in his everyday practice. “You probably have a sense that something is wrong, you don’t quite feel like you normally do, and might alternate between feeling extremely upset or possibly nothing at all,” he says.
KIEFERPIX/SHUTTERSTOCKThis is an intense experience of thoughts, feelings, behaviors, and physical sensations resulting from the traumatic event. “The body’s chemical reaction to the trauma can put the person in extreme survival mode we know as “fight or flight,” says Dr. Brown. “When in a state of fight or flight—and we should really add the element of “freeze” when we become immobilized by fear—we feel completely out of control. Needless to say, this is a very painful and scary.” You may find that you get easily overwhelmed or worked up and can’t calm down, or can’t fall asleep at night.
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MONKEY BUSINESS IMAGES/SHUTTERSTOCKThis is the experience of persistent intrusive thoughts and feelings about the event—and sometimes, they’re unrelated but disturbing in nature. “The more it plays, the more distressed you become, because you are constantly reliving the trauma,” he says. “The problem is that you can’t find the ‘off’ switch, and the more it repeats, the worse you feel. Despite your best efforts, no amount of will-power or any form of distraction that you might normally use, you can’t stop the loop.” Essentially, it feels like you are out of control of your own mind. Here are eight warning signs of depression.
WAVEBREAKMEDIA/SHUTTERSTOCK“This could manifest as flashbacks or nightmares, or feeling like you are re-experiencing or reliving the fear from the event that triggered your PTSD when you encounter everyday triggers around you that remind you of something that has to do with the event,” says Shanthi Mogali, PhD, director of psychiatry at Mountainside Treatment Center. She also says to keep an eye out for sudden mood changes. “PTSD can actually manifest itself as depression or anxiety, or mood changes that make you feel low, high, sad, angry, upset, for ‘seemingly’ no reason,” she says. “This could be a less immediately recognizable sign that a person is really suffering.”
STOCK ASSO/SHUTTERSTOCKIt is common to try and steer clear of anything that could continue to trigger the persistent thoughts and feelings relating to your traumatic experience, says Dr. Brown, who also serves as a disaster mental health specialist and has provided on-scene support to various national level disasters including working directly at Ground Zero in the wake of the attacks of 9/11 and both natural and other man-made disasters. “One of the most common themes associated with this phenomenon is the desire to avoid any people, places, or objects that cause us fear and pain. It’s really a very normal response to an abnormal experience. Especially when we’re in survival mode. We don’t want to continue to experience the pain.”
ANZE MULEC/SHUTTERSTOCKWhen someone experiences a potentially traumatic event, says Mallory Grimste, LCSW, it is likely that person did not have much control over the situation or the fact this event occurred. “When we feel confident and in control of our life and circumstances, we tend to feel better in general. People will often attempt to engage in risky behaviors to recreate similar circumstances, or feelings and experiences related to the original trauma so they can regain a sense of control with the hope that the outcome will be different than the original experience,” Grimste says. She notes that it is not always a conscious decision, either—some examples of risky behaviors may be driving very fast or recklessly, walking alone in areas that are known to be dangerous, instigating arguments with others that are likely to result in possible physical fighting, or even something like procrastinating on work assignments just to push the envelope.
Inability to trust
AODAODAODAOD/SHUTTERSTOCKThis can be related to a lack of trust in other people and the greater world around you, but is often more likely rooted in a lack of trust in yourself. “After a traumatic experience, it’s common to be generally distrusting of others, the world, and one’s self. You might feel like you can’t take anything at face value, or you may be subconsciously ‘testing’ your relationship with people or constantly questioning the other person’s commitment or loyalty to you,” Grimste says. She continued to explain that you might start looking through another person’s phone or emails someone’s without their permission, calling or texting often to “check-in,” or even showing up to someone’s place unexpectedly. “On the other hand, you might have the opposite reaction and have an avoidant reaction, which means you won’t engage in any real relationship with anyone because that kind of vulnerability feels very risky,” she says. “You might find yourself starting to lie, pretend to like or enjoy something you don’t, or becoming paranoid about someone’s motivation, or even their lack of response during a certain period of time.” Here are games you can play to build trust.
PHOTOGRAPHEE.EU/SHUTTERSTOCKLiving with trauma can make work, social gatherings, even commuting a terrifying and exhausting experience. Over time, we learn and adapt our behaviors based on our past experiences and how we’ve processed them. Grimste notes that if you’ve experienced a traumatic event, you feel that if it happened once, it can happen again. In a way, this hypervigilance provides a sense of security—if someone is always “expecting the unexpected” they can be better prepared and hopefully enact a different outcome than when the trauma happened. It is, in a way, an attempt to protect yourself. “You are always on the lookout for when the next ‘bad thing’ is going to happen and actively try to prevent it by anticipating the threat and protecting yourself against it before it’s too late,” she says. “Unfortunately, the surge of adrenaline that makes us feel on edge, anxious, and panicked, like we have to do something or run, often create even more chaos, problems, and even physical health conditions.”
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FIZKES/SHUTTERSTOCKIt makes sense that to avoid all of the racing thoughts, anxiety, paranoia and other uncomfortable behaviors associated with the above symptoms that you might try to avoid being around people as much as possible or develop social anxiety. “Many people try to cope by withdrawing from typical sources of support, like family, friends, and colleagues,” says Dr. Brown. “The problem with social withdrawal is that we wind up leaving ourselves isolated and alone at precisely the time when we really need to be reaching out to others for help, comfort, and support. By withdrawing, we actually wind up prolonging our suffering.” Instead of withdrawing, he suggests, do the exact opposite. “Reach out to at least one or two people that you normally trust, and let them know what is happening to you,” he says. “This is one of the very best ways to begin your journey of recovering from the trauma.”
Drinking or using drugs
PHOTOMEDIAGROUP/SHUTTERSTOCKThere is a strong connection between PTSD and increased drinking or drug use, a behavior often referred to as self-medication. “People suffering from PTSD are often desperate to find a way to soothe these unpleasant feelings, and that’s where substance abuse enters the equation,” says Dr. Mogali. “They might think that self-medicating will help them feel better, and when they first start using, it does. Increased drinking in general, both alone and in social settings, is a common way that people cope, since it enables you to feel more relaxed when you’re otherwise unable to relax.” However, things usually don’t stay that way for long. Substance use—which commonly includes, in addition to alcohol, the use of marijuana, opiates, and benzodiazepines (Xanax, Klonopin or Valium)—increases your “feel good” sensations. The way your body is interpreting alcohol or drugs is “I feel happy and good.” However, she says, these feelings are always temporary, and often keep people from being able to recover from PTSD. In some cases, it can lead to addiction or dependence that only makes things worse. “You may not feel as depressed or anxious when using drugs, but when they’re not using, the anxiety and depression will rear itself in a really intense way. And the more you self-medicate, the harder time you will have in being able to feel in control of your own emotions and able to deal with them in a healthy way on your own,” says Dr. Mogali.
Avoiding normal activities
SHUTTERSTOCKIn addition to avoiding people you once held dear, you may also start steering clear of other daily routines that once represented life inside of a comfort zone that no longer exists after it’s been so severely disrupted, Dr. Brown observes. “A good night’s sleep has been out of reach for hours, days, weeks, and possible months, so you may have also stopped engaging in activities that normally brought you pleasure,” he says. “Maybe it was going to the gym four days a week, yoga classes, movies on Saturday nights, cooking dinner, a weekly book club, or nightly walk with your partner. Now, you find yourself sitting at home, no longer feeling any pleasure in anything.” Ideally, pushing yourself to show up for these activities or pick the routine back up would be an important way to “fake it until you make it” but if you feel unable to function at all, it’s important to contact a trauma specialist, like a therapist, or psychologist, immediately. Follow these 13 therapist-approved tips on finding the right therapist.
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Change in sexual behavior or romantic relationships
MARIDAV/SHUTTERSTOCKWhether you’re single, married, in a relationship, or something else altogether, people suffering from PTSD often find that their sexual relationships become dysfunctional or may engage in promiscuous behavior, says Dr. Mogali. “The reason for this is complicated, but can involve the trauma leaving behind feelings of worthlessness and beliefs of being unlovable,” says Dr. Mogali. It can also be a direct result of inhibition being let down by the aforementioned substance abuse or increased drinking, and a tendency to the also previously aforementioned tendency towards risky behavior. You may notice that the dynamic in your committed sexual relationship has changed, you seem somehow unable to have normal intimate romantic relationships and are shying away from physical encounters with your significant other. Perhaps you’re making decisions to have sexual intercourse with people on a whim, or while intoxicated and without thinking it through, or you’re cheating on your partner. You may find that you have feelings of low self-esteem when you used to be confident and bold, or that you’re suddenly using sex in your relationship as a way to assert control. “Also, those experiencing PTSD may cope by attempting to assert control in their sexual relationships. Performing sexual acts or having intercourse becomes a way of experiencing validation and can lead to an unhealthy way of coping,” says Dr. Mogali. “This behavior actually often results in an even lower feeling of self-worth and encourages a feeling of despair.
STOCK ASSO/SHUTTERSTOCKAt work, you may find that your mind is wandering mid-conversation with someone, even though you’re looking right at them. Or you may find yourself staring into space during a meeting at work instead of focusing on the task at hand. “Even ordering lunch at your favorite restaurant can become difficult as it’s difficult to pick between multiple options. For example you’ll be at the grocery store, but won’t be able to remember the items you came to buy,” says Ken Yeager, director of the Stress, Trauma and Resilience (STAR) Program at The Ohio State University Wexner Medical Center. “Now, your brain communicators are all firing at the same time, making it difficult for it to pick out what is important and what is not.” When you’re afraid that you can no longer get very basic things done or gain control over your own thoughts, you may find yourself taking part in some of those avoidance behaviors noted earlier. “This is a very scary space because it becomes a very short jump to if I can’t interact with anyone and can’t be effective in my life what am I doing here? This is the type of isolating thinking that leads many to consider ending their lives,” Dr. Yeager says.
ANTONIO GUILLEM/SHUTTERSTOCKIn order to keep yourself safe, you may start looking for things—or threats—that aren’t really there. “You can’t trust authorities, you can’t trust the government, and you can’t trust anyone or anything. If you were robbed at gunpoint and now have fear about the world not being safe, watching TV news and seeing stories about robberies and other crimes will reinforce your view that the world is not safe,” said Dr. Yeager. For example, if you’ve been the victim of a violent crime, you may feel compelled to constantly read the headlines or watch the news. Or, you may find it impossible to go to a football game or a concert—activities you previously enjoyed—because now there are too many people around and you don’t feel safe. “Nighttime may be your most difficult time, because it’s hard to see what’s going on around you, and things will start to sound noisy and dangerous. You may decide to stay home, where you feel safe,” says Dr. Yeager. “You’ll probably have problems with intimacy, and likely can’t talk about your traumatic experience because it’s just too upsetting.”
PRESSMASTER/SHUTTERSTOCKThere are many effective courses of treatment for PTSD ranging from cognitive behavioral therapy and dialectical behavioral therapy to EMDR (Eye Movement Desensitization and Reprocessing), and art therapy. These are often coupled with medications to treat the anxiety, depression, and insomnia that come along with the PTSD. Additionally, if you have turned to self-medicating to cope and find that you’re facing alcohol or drug addiction, checking out a 12-step recovery program may also be helpful, and of course, a holistic approach to finding inner peace, like yoga, exercise, and medication, are also excellent ways to round out the above courses of professional medical treatment. “The sooner you ask for help, the sooner you will begin to feel better. Left untreated, PTSD can have a devastating effect on a survivor and her or his loved ones,” says Dr. Brown. “I know, I’ve been there. The biggest mistake I made when I left the military was not immediately getting the help I needed.” And if getting help for yourself is not a good enough reason, he says, then ask yourself this: Am I the only one impacted by this? How are my loved ones impacted by what is happening with me?Those who reach out to family, friends, colleagues, and professionals trained in the treatment of psychological trauma, have significantly better outcomes than those who don’t. Helaina Hovitz is an editor, journalist, and author of After 9/11.