Fear gives the perpetrators of the world the upper hand. At least, this is something I heard mentioned many times after the tragic Paris attacks on the 13th November, 2015. And yet, this date may now be seared into the memories of those who were directly impacted by the shootings. Experiencing or witnessing traumatic events such as the above can trigger severe reactions including anxiety, flashbacks and nightmares- all symptoms of Post-Traumatic stress disorder (PTSD). It may be easy enough for others to say that living in fear is no way to live, but understanding the reality PTSD sufferers face may require actually walking in the sufferer’s proverbial shoes. 

The world is already a harsh enough place to live in, without experiencing uncontrollable thoughts about past tragedies. And yet, this is an additional burden faced by approximately 1 in 3 people who have had traumatic experiences (Kilpatrick et al, 2013). Triggers of PTSD include sexual assault, being a victim of violence, natural disasters, and military combat, to name a few. One of the main symptoms of PTSD is re-experiencing traumatic events (i.e. through nightmares, flashbacks and even physical sensations such as pain). Other symptoms include hyperarousal (e.g. angry outbursts, irritability) and avoidance behaviour towards the traumatising target.

Interviews conducted with a representative sample of 1010 Londoners after the 7/7 bombings revealed that 32% of participants travelled less (Rubin, Brewin, Greenberg, Simpson, & Wessely, 2005). This is an example of avoidance behaviour- people were avoiding public transport in London due to the perceived risk of danger. These interviews were conducted 11-13 days after the attacks. 

As with a lot of mental health disorders, PTSD can have particularly problematic impacts on a person’s life, as well as those surrounding the sufferer. It can contribute to work-related issues and a breakdown of personal relationships. PTSD can also make a show of its demonic head in different ways in children. Examples of child-specific symptoms include bedwetting and abnormal separation anxiety. A full list of PTSD symptoms can be found on the DSM-5 criteria for diagnosis, which I shall include in a link at the bottom of the post.

Speaking of symptoms, it may appear to some people that PTSD symptoms are just ‘normal reactions’ after traumatic experiences. However, substantial research has shown that there are cognitive differences between PTSD and non-PTSD sufferers. In a study conducted by Megías, Ryan, Vaquero, & Frese (2007), 210 participants who had all experienced traumatic incidents in the past were separated into PTSD and non- PTSD symptom groups. Results showed that those in the PTSD group had clearer recollections of their traumatic memories- evidence that PTSD sufferers perceive their experiences differently, and may be haunted by their trauma.

Interestingly enough, brain imaging studies have further supported the claim that there are differences in the way PTSD sufferers and non-sufferers process stimuli. In Liberzon et al’s (1999) study, 14 Vietnam veterans suffering from PTSD were exposed to white noise and combat sounds in two separate sessions. Blood flow in specific brain regions was measured using single photon emission computerized tomography (SPECT). It was found that in comparison to healthy participants, PTSD sufferers showed an increased activation in the left amygdala following exposure to combat sounds. The amygdala is commonly known as the brain region associated with the fear response. These findings suggest that PTSD sufferers may be more emotionally reactive to aversive stimuli that are reminiscent of their traumatic experiences.

There are a variety of treatments available for PTSD sufferers. An initial assessment is usually carried out to determine the best course of action for an individual’s needs. For those experiencing mild symptoms, ‘watchful waiting’ may be recommended- this is where the patient is encouraged to monitor their symptoms in order to see whether they can improve without treatment. For those suffering with more persistent symptoms affecting the quality of life of an individual, treatments available include psychotherapy, medication, Cognitive Behavioural therapy (CBT) and group therapy (further information can be found on the NHS website link below).  A relatively recent treatment for PTSD is Eye movement desensitisation and reprocessing (EMDR), a technique in which the patient moves their eyes side-to-side whilst recounting their traumatic experiences. A meta-analysis of 34 studies showed that EMDR patients showed significant improvement of symptoms in comparison to participants who did not receive treatment. However, EMDR did not appear to be any more effective that alternative exposure therapies (Davidson & Parker, 2001).

Before I end this blog post, I would like to offer my condolences to all those who have been affected by the recent Orlando attack at Pulse, as well as to all those who have been affected by the countless other tragedies occurring in the world. And to anyone reading this who suffers from PTSD, it is not a sign of weakness, but rather a strength- you are still here, and still battling through the many blows life throws in your path!

 

References and links

 

Davidson, P. R., & Parker, K. C. (2001). Eye movement desensitization and reprocessing (EMDR): a

meta-analysis. Journal of consulting and clinical psychology69(2), 305.

 

Kilpatrick, D., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013).

National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM-IV

and Proposed DSM-5 Criteria [Manuscript submitted for publication].

 

Liberzon, I., Taylor, S. F., Amdur, R., Jung, T. D., Chamberlain, K. R., Minoshima, S., ... & Fig, L. M.

(1999). Brain activation in PTSD in response to trauma-related stimuli. Biological

psychiatry45(7), 817-826.

 

Megías, J. L., Ryan, E., Vaquero, J. M., & Frese, B. (2007). Comparisons of traumatic and positive

memories in people with and without PTSD profile.Applied Cognitive Psychology21(1), 117-130.

 

Rubin, G. J., Brewin, C. R., Greenberg, N., Simpson, J., & Wessely, S. (2005). Psychological and

behavioural reactions to the bombings in London on 7 July 2005: cross sectional survey of a

representative sample of Londoners. Bmj331(7517), 606.

 

DSM-5 diagnostic criteria for PTSD:

http://www.ptsd.va.gov/professional/PTSD-overview/diagnostic_criteria_dsm-5.asp

 

NHS information on PTSD treatment:

http://www.nhs.uk/Conditions/Post-traumatic-stress-disorder/Pages/Treatment.aspx

Published by Faaizah Islam