Psychology 101: The 101 Ideas, Concepts and Theories that Have Shaped Our World - Adrian Furnham 2021
PTSD: Serious Reactions to Traumatic Events
A suicidal depression is a kind of spiritual winter: frozen, sterile, unmoving. (A Alvarez, The Savage God, 1974)
Pain hardens and great pain hardens greatly, whatever the comforters say and suffering does not ennoble. (A.S. Byatt, The Virgin in the Garden, 1978)
Read this case study:
Alex is an auto mechanic who was working three blocks from the World Trade Center on 9/11. Alex witnessed both towers falling. For months after the 9/11 terrorist attacks, these images still haunted Alex. He was unable to keep the memories of the attack out of his mind. Alex noticed that at night, he had difficulties relaxing and falling asleep. Scenes from the tower falling would run repeatedly through his mind and disrupt his focus on work. This also affected Alex’s day-to-day life; for example, when he crossed the Brooklyn Bridge into Manhattan, he started sweating and trembling, as this immediately rekindled certain horrific memories. He felt as though his emotions were numbed, and as though he had no real future. At home, he was anxious, tense and easily startled. He found himself avoiding social interactions, and became very fearful of being out in public.
What, if anything, would you say is Alex’s main problem?
How distressing do you think it would be to have Alex’s condition?
How sympathetic would you be towards someone with Alex’s problem?
In general, how happy do you think Alex is?
In general, how successful at his work do you think Alex is?
In general, how satisfying do you think Alex’s personal relationships are?
Alex has PTSD. But what exactly is that? According to the DSM manual the manifestations are defined by six broad aspects (A—F below):
A. The person has been exposed to a traumatic event in which both of the following have been present:
(1) the person experienced, witnessed or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others; (2) the person’s response involved intense fear, helplessness or horror.
B. The traumatic event is persistently re-experienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific re-enactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings or conversations associated with the trauma.
(2) efforts to avoid activities, places or people that arouse recollections of the trauma.
(3) inability to recall an important aspect of the trauma.
(4) markedly diminished interest or participation in significant activities.
(5) feeling of detachment or estrangement from others.
(6) restricted range of affect (e.g., unable to have loving feelings).
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children or a normal life span).
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep. (2) irritability or outbursts of anger. (3) difficulty concentrating. (4) hypervigilance. (5) exaggerated startle response.
E. Duration of the disturbance is more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of function.
We know that PTSD has a relatively low lifetime prevalence, estimated at 6.8 per cent in the US. PTSD has been re-classified as a ’trauma-and-stress-related disorder’ in DSM-V (APA, 2013), comprising four symptoms clusters: intrusion, arousal, avoidance and negative cognition and mood. Nonetheless, PTSD was first introduced as an anxiety disorder in DSM-III (APA, 1980), mainly in response to Vietnam War veteran trauma cases in the US. Since then, PTSD has become synonymous with military conflict.
One possible explanation for why recognition rates are not higher among general population or clinician samples could be the common association of PTSD with military personnel. The stereotype of veterans experiencing PTSD has persisted since the early twentieth century ’Shell Shock’ diagnosis. In fact, PTSD prevalence in the military is low relative to trauma exposure. PTSD can arise from a range of traumas, such as sexual or physical abuse, natural disaster, man-made disaster and road traffic accidents. PTSD prevalence from these other trauma sources are much higher. For example, the lifetime prevalence of PTSD among women with history of rape was 32 per cent, the PTSD prevalence rate following man-made/technological disaster was 30—60 per cent, and it was 5—60 per cent following natural disaster.
PTSD can be the result of either direct or indirect exposure towards traumatic events. Direct exposure is experience of the event in person and carries a greater risk of developing PTSD. There is increasing evidence that professionals involved in helping those who experienced trauma are vulnerable to developing PTSD through indirect exposure.
American Psychiatric Association (2003). Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington, D.C.: APA.
Brewin, C. R. (2003). Posttraumatic Stress Disorder: Malady or Myth? Yale University Press, New Haven, CT.
Merritt, C.J., Tharp, I.J., & Furnham, A. (2014). Trauma type affects recognition of Post-Traumatic Stress Disorder among online respondents in the UK and Ireland. Journal of Affective Disorders, 164, 123—9.