After a tragedy like the one our country experienced on September 11, 2001, everyone who is touched by the tragedy experiences certain psychological reactions like shock, denial, anger, and grief. However, those who experience the disaster more directly and tragically are people in the buildings, eye witnesses, rescue workers, healthcare workers, family members, and to a lesser extent, everyone who watches the tragic scenes over and over may be subject to the development of Post-Traumatic Stress Disorder (PTSD).  Here are some commonly-asked questions about Post-Traumatic Stress Disorder, an often  serious and potentially chronic condition that is a dreadful part of the psychological aftermath of trauma.

 1. What are the symptoms of PTSD?

 According the diagnostic manual used by mental health professionals (DSM-IV) these are the elements that must be present for a diagnosis of PTSD.

 A. The person has experienced a trauma or life-threatening event that has the potential for bodily harm and that the individual responds to with fear, helplessness, or horror.

 At highest risk in this tragedy are the people who were in and around the buildings at the time of the attack and the rescue workers who are courageously risking their lives as they persist in search and rescue/recovery.

 B. The individual continues to relive the trauma in the form of "re-experiencing phenomena", which include nightmares, flashbacks, and intrusive thoughts about the traumatic event.

 The re-experiencing can be triggered by anything that reminds the person of the event or simply by thoughts that won't go away.  People who work hard to stay busy and not think about the trauma often have the experience come out in their dreams, when their conscious ability to push thoughts back is shut down.  The nightmares, which are actually experienced by most people with PTSD, can either be direct replays of the events or dreams of other situations that have the themes of fear, helplessness, and hopelessness.

 C. There is evidence of a persistent avoidance of situations reminiscent of the trauma event.

Avoidance of painful emotions is a normal, human survival reaction.  However, as I mentioned in yesterday's article, avoidance actually strengthens the fear.  It's impossible to avoid all the cues that trigger the painful emotions.  A person who tries to do becomes more and more withdrawn from people, places and activities.  I've worked with many people in my clinical practice who were homebound for months or years because their fears had become attached to so many things outside their very small, protected world.

 D. The person experiences a numbing of emotions. 

 A person with PTSD often feels quite emotionally "dead", unable to feel even positive emotions.  This is because the negative experiences were so overwhelming that the emotions, in a sense, shut down. It's kind of like a circuit breaker that works to preserve a system that is overloaded.

 E. There are persistent symptoms of physiological hyperarousal, such as an exaggerated startle response, irritability, difficulty falling asleep, and hyperalertness.

 It's easy to see why this happens.  Having confronted danger and death itself, people feel they must constantly be on guard to protect themselves and those they love.  The body stays constantly prepared to confront threats...the classic "fight or flight" syndrome of stress.  Constantly being "on guard" is exhausting.

 F. These symptoms must persist for at least one month after the traumatic event.

 Having passing experiences with these symptoms is distressing, but normal.  People with PTSD experience them for longer periods.

G. The symptoms cause clinically significant distress or dysfunction in the individual's social, occupational, and family functioning or in other important areas of functioning.

In other words, we're talking about emotional experiences that seriously affect your life.  If you haven't been there, it's hard to imagine the feelings of the person who was perfectly normal (well, almost perfectly) one day, then was emotionally devastated after the trauma. They often feel they've lost their very selves.

 2. Does PTSD always show up immediately after the trauma?

Usually symptoms do show up immediately. But sometimes the symptoms can occur six months, a year, or 20 years after the traumatic event. Sometimes, but not always, this is caused by the person having to "keep on keeping on" to do things to survive or to save others, like we see in the rescue workers now.  After they finish the job, the emotional trauma can hit, and hit hard.

 3. Is there a difference in the psychological reactions between man-made and natural catastrophes?

 Yes.  Survivors of man-made catastrophes often suffer from longer-term and more intense PTSD than survivors of natural catastrophes.  There are two probable reasons for this.  First, natural catastrophes tend to be of shorter duration.  The second and probably more important reason is that man-made catastrophes involve violence, human error, or betrayal.  Survivors of natural tragedies are less likely than victims of man-made ones to lose their trust in other human beings and in society. In other words, the fear of the specific perpetrators can spread within a person's emotional system and become a fear of people with similar characteristics or even people in general.

4. What is survivor guilt?

 Self-blame and survivor guilt are found among survivors of many different kinds of trauma.  Traumatic circumstances increase the likelihood of making mistakes, of being unable to rescue a victim, or of exercising poor judgment.  The shut-down of rational thought in a life-threatening crisis contributes to this.  Survivors can fail to take into account the horrendous circumstances under which they were operating.  They blame themselves for some imagined shortcoming or something they could have done differently.

Survivor guilt also involves wondering why someone else suffered more or even died.
 It's a way of saying, "If I had suffered more, you would have suffered less." Or "If I had died, you would not have died." While this thinking is not logical, it is a futile attempt to convince oneself that the effects of the disaster did not have to happen if only. 

 5. How is PTSD different from grieving?

 Grieving is a part of healing for each person with PTSD, but not everyone who grieves has PTSD.  Many who were not so intimately involved with the traumatic incident will mourn without having the other life-disrupting symptoms of re-experiencing, avoidance, and hyperarousal.  Anger is often a part of both normal grieving and PTSD.

 6. How important is it to get help immediately?

 The importance of getting help promptly cannot be overstressed.  Restorative and supportive experiences are an important part of healing.  When traumatized individuals receive the assistance they need...psychological, economic, and practical...as soon as possible following the incident, the long-term effects are less severe and of shorter duration than if assistance is delayed or unavailable. However, we have good treatments available, even for people who experienced the trauma long ago.

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Bev@MagneticWorkplaces.com or 601-264-0890.