Understanding Traumatic Events and PTSD

"What constitutes a TRAUMATIC EVENT?"

According to the American Psychiatric Association's Diagnostic and Statistic Manual of Mental Disorders, a traumatic event involves the "direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.... The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior)...."(APA, 1994, p. 424).

This can occur as the result of any of the following:

Common Reactions to Traumatic Stress

Although the actual cluster of symptoms experienced by any one individual will vary, the following two lists include common reactions experienced following exposure to a traumatic event. Typically, a traumatized individual will alternate between two distinct phases of hyperarousal and avoidance and his/her symptoms will reflect this alternating pattern.

Avoidance as manifested by:

For most people, these symptoms will subside significantly within a period of 30 days, with complete disappearance of nearly all symptoms in a few months. For others, these reactions will persist and the resulting disruption of day-to-day functioning can become chronic. When this occurs and the individual has enough symptoms to satisfy the diagnostic criteria laid down in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (currently in its Fourth Edition), his/her therapist will most likely make a diagnosis of Post Traumatic Stress Disorder or PTSD.

Some individuals who develop PTSD function very poorly, others appear to function well as long as they are successful at avoiding any stimuli that trigger reminders of the event and the emotions associated with it. For the latter, it can be easy to say "I've put it behind me" until something is triggered and they display an uncharacteristic amount of emotion which may also appear to be inappropriate to the current (external) situation.

Consequently, any of the symptoms above, if severe enough, can interfere with the individual's interpersonal relationships, leading to an increase in conflictual interactions with others, loss of job(s), or divorce/loss of relationship with a non-married significant other. So if you have experienced a traumatic event followed by any combination of the above (especially if they are persisting after one month's time), they could be contributing to your current difficulties and you should advise your therapist of the type of event you experienced and how it has impacted you.

The resolution of traumatic material involves the conversion of sensory aspects of the experience into a narrative about the event. This involves more than just the ability to recognize and verbalize that the incident happened; it means giving words to the full meaning/nature of the experience while it was happening and the impact that it had on the life of the person who experienced it. The latter may include loss of his/her sense of the world as a safe place, normal (but frequently disruptive) psychological symptoms experienced in the days following the event, reactions of family and friends and any other life changes associated with the event. Emotions associated with the event must be activated and a language developed to describe the meaning they have for the person(s) affected. In addition, any conflicts about what s/he "shoulda, woulda, coulda" done need to be explored and brought to an appropriate degree of resolution.

As you might expect this process can be very scary and painful for the person going through it; but a healthy diet, adequate sleep, exercise and the support of family and/or friends can help to mitigate the more difficult parts of this process. Any ongoing difficulties in any of these areas (especially if they persist for more than 2 weeks) should be reported to your therapist.

There is a hypothesis that traumatic events, that overwhelm an individual's usual coping mechanisms, may cause immediate neurochemical changes in the brain that manifest first in the initial reactions that people experience subsequent to a traumatic events and later (for some) in an inability to resolve the trauma by converting it to narrative memory.

Although researchers are still working to identify the factors leading to the development of PTSD, it is believed that multiple variables are involved. Included among these are

1. prior history of trauma exposure(s)/subsequent degree of resolution,
2. family history (including learned behavior patterns vis-à-vis coping with trauma such as asking for help when needed, talking/not talking about feelings/thoughts related to traumatic experiences, etc.),
3. personality,
4. availability or lack of an adequate support system,
5. the individual's preferred choice of defense mechanisms, and
6. the intensity of the trauma.

When a traumatic event occurs, we may be confronted with an overwhelming amount of information in the form of images, emotions, physical sensations, smells and sounds. It appears that under such conditions, the brain becomes overloaded with large volumes of information. The resulting neurochemical changes disrupt normal processing of this information, causing memories to be subsequently stored as fragments in their original distressing/disturbing state.

These memory fragments are stored in "associative networks" in which related thoughts, memories, images, emotions, and sensations are linked together (Shapiro, 1995; Lang, cited in van der Kolk, 1994). For example, an adult rape survivor who has also experienced childhood sexual abuse may have memory fragments of her most recent rape experience stored together with similar memories from her earlier experience(s). Later, discussion of an aspect of one event may trigger the recall of similar aspects of the other. This can happen even in situation where the client had no recent recollection of the past trauma. In either event, further exploration may trigger the recall of additional fragments.

The retrieval of memories typically re-activates a process of wanting to make sense of the new material -- to give the memories meaning and to find the words needed to fully describe the impact that the original event had. This process can be something like putting together a jigsaw puzzle -- but without the help of the picture on the outside of the box. As more and more pieces of the "puzzle" become available through additional work in therapy, the client's overall understanding of what happened can change, sometimes dramatically.

For this reason, an additional word of caution is well advised: For clients who first begin recovering previously repressed memories (especially if this occurs PRIOR to the completion of much of their therapeutic work), it can be a big temptation to trust one's first attempt to "fit" the pieces together and (in the case of some human-perpetrated traumas) confront the perpetrator(s). Consider the client who recalled in treatment having been sexually abused as a child. Among her initial memory fragments she recovered one that was an image of her father's face and assumed him to have been the perpetrator. Later, after more work in therapy, she recalled additional pieces of the puzzle and realized that the image of her father was from when he had come to her rescue and that the perpetrator had been someone else. This example illustrates the importance of delaying any confrontations of perpetrators until the bulk of your therapeutic work has been completed and you have had plenty of opportunity to seek corroborating evidence that supports the story you construct using recalled memories.

It is very difficult to know whether one's memories are accurate representations of past traumas. There are several different types of information that may be later retrieved during therapeutic work. In addition to memory fragments that are experienced by the client as having an accurate resemblance to the original trauma, there may be

It is important to know that mental health professionals cannot validate the historical truth of any memory. This is one of the limitations of psychotherapy and validation is something you would have to establish for yourself with independent corroboration.

This information is also not meant to discount the impact of your suffering nor to suggest that you not discuss the material that emerges in your treatment. These recollections (despite the issue of accuracy) are what shape self-esteem, influence behavior, and provide meaning and perspective for one's life.

References:

American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

Copyright © 1998  Hope E. Morrow, MA, MFT, CTS  All Rights Reserved.
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