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  • Trauma and Its Aftermath
    Part I: You’re Not Crazy—But You Might Have PTSD

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    Susan* came to me in turmoil. For the past month, the 42-year-old attorney had been having terrifying nightmares about being chased down by men in hoods. Nagging, inexplicable anxiety drove her to check her locks repeatedly, and to look over her shoulder constantly, even when walking through her law office or her safe suburban neighborhood. At times the anxiety escalated into full blown panic attacks. Despite her strong stand on gun control, she confided that she was thinking of getting a hand gun for protection.“I can’t believe I’m even considering a gun. I think I’m going crazy.”

    As it turned out, Susan was not psychotic; she was suffering from posttraumatic stress disorder (PTSD).

    While she could not think of any reason for her current sense of danger, a brief history revealed that she had been sexually abused by a friend’s father when she was 8 years old. A few months ago, her own daughter turned 8—a milestone that triggered long-suppressed feelings to surface.

    Survivors of trauma often tell me they fear they’re going crazy. They’re not. But what happened to them was crazy, i.e., out of the bounds of normal human experience. Any terrifying event—be it combat, an assault, a car accident, a hurricane—kicks the brain into red alert status, which is exactly what our brains have evolved to do when we are under threat. This well-known “fight or flight” response of physical activation and hyper-alertness is designed to protect us from further harm. The best description I ever heard for traumatic stress came from one of my mentors, Nancy Lee PhD: it’s a normal response to an abnormal event. It’s only when it persists past its usefulness that we consider it a post-traumatic stress response.

    To meet the criteria for PTSD, an individual must have experienced or witnessed a life-threatening or terrifying event, and have enduring symptoms in four categories:

    1. Re-experiencing the event (flashbacks, nightmares, intrusive thoughts);
    2. Emotional arousal (anger, irritability, anxiety and hyper-vigilance);
    3. Avoidance (physically avoiding people or places associated with the traumatic event);
    4. Negative changes in mood and thoughts (shame, hopelessness, loss of engagement in life).

    Many trauma survivors will experience some of these difficulties initially, in what is known as Acute Stress Disorder. To meet the threshold for a diagnosis of Post-Traumatic Stress Disorder, the symptoms must persist more than a month beyond the traumatic event. In some cases, such as Susan’s, the symptoms don’t appear for months or even years after the trauma.

    Not everyone who experiences a traumatic event will develop PTSD. Research tells us anywhere from 10 to nearly 50 percent of survivors will go on to experience the enduring nightmares, flashbacks, anger, and/or emotional numbing of classic PTSD. What makes some people more vulnerable to PTSD, while others can bounce back from trauma? More on that next time.

    * Names and clinical details have been altered for client privacy

    To Learn More…

    National Institutes of Mental Health


    The Body Remembers by Babette Rothschild

    Invisible Heroes: Survivors of Trauma and How They Heal by Belleruth Naparstek

    Getting Past Your Past by Francine Shapiro, PhD