Post Traumatic Stress Disorder - Causes and Symptoms

A post-traumatic stress disorder occurs after a trauma - usually it begins in the first six months after the incident. Powerless rage, fear of death and sadness go hand in hand with emotional emptiness. The patient remembers the traumatic experience as if he is experiencing it at the moment. Experience in this case is also physical: Sweats, tremors, nausea, shortness of breath or tachycardia accompany the flood of images of the disaster.

On the one hand the person experiences flashbacks, that is, especially extreme flashes of remembrance that suddenly appear and appear hyperreal. On the other hand, he suffers from nightmares in which the traumatic event recurs and which robs him of sleep. In addition, "triggers" trigger the waves of remembrance, be it a smell, a sound or a person associating the brain with the trauma. For a traumatized person from the Balkan wars this can be a set of sentences in Serbo-Croatian, or in the case of a rapist, a drunk with long hair reminding them of the perpetrator.

contents

• The history of PTSD treatment
• The traumatized Tolkien
• The incomprehension
• causes
• symptoms
• Traumatized soldiers
• Who is at risk?
• Loss of security
• PTSD in partnerships
• treatment

Malcolm Mackenzie, who was discharged from the British Army for a stress disorder, says, "I drink too much and take too many drugs. I have difficulty concentrating and flashbacks. Sometimes I step away. After that I do not remember anything anymore. Other returnees have heart problems, ulcers and rashes. "

Posttraumatic stress disorder is a serious mental illness. Therapy can help those affected. Picture: hikrcn - fotolia

He describes triggers that make him experience the war anew: "During a fireworks, I grabbed my bed and searched for my weapon, which of course was not there. Sometimes I have shortness of breath and need to be in the fresh air, just like that. Then a car with teens comes up to me and Bosnia is back. "

The history of PTSD treatment

The psychiatrist Emil Kraepelin called the behavior of accident victims with fright neurosis. Soldiers with this syndrome were called "soldier hearts" in the American Civil War. In the First World War, terms such as garnet shock, garnet fever or war neurosis circulated. The English spoke of the Breaking Point in soldiers who were no longer operational. So doctors already knew in 1918 that it was a pathological syndrome. However, these traumatized people were generally regarded as cowards, and sometimes still have this reputation in the armies of almost all countries. The American psychologist Judith Lewis Herman called the syndrome PTSD.

Twelve percent of Germans who experienced World War II still suffer from traumatization today. Almost half of the generation experienced at least one traumatic event. Four percent suffer from a clear PTSD.

The traumatized Tolkien

J.R.R. Tolkien founded modern fantasy with the myth of Middle-earth. Frodo, the Ringbearer, can not return to his beloved Shire after the Middle-Earth War; the memories of the nightmarish Mordor haunt him. He also suffers from phantom pains. In the burned-out land of Sauron, Tolkien probably processed his own war experiences.

In 1915 Tolkien participated in the World War as a British officer. Only two of his friends should survive. His battalion was stuck on the Somme in one of the worst material battles of the modern war: shelling grenades, dying comrades in a scorched land and the wet cold gnawed at him. The writers of the war generation found different ways to process their experiences: Ernst Jünger glorified the murders in his "steel storms"; With his realistic novel "Nothing New in the West", Erich Maria Remarque relentlessly demonstrated the cruelty of the mass extinction - Tolkien escaped into the imagination.

The incomprehension

Post-traumatized people have problems sharing their suffering. They often avoid emotional ties with friends, family or love partners. Even among acquaintances and at work, they can hardly participate in the feelings of everyday life. They feel stupefied and often try to gain access to their feelings through extreme experiences - through alcohol and drugs, piercings or self-injury.

They feel alienated from "normal people". They are afraid that the others think they are crazy when they talk about their experiences - and often this fear is right. People without such experiences feel overwhelmed quickly, even if the person does not expect any help, but only tells what was. As a consequence, post-traumatized people seek proximity to people who have experienced something similar and can therefore understand it. This is sometimes helpful, for example, when those involved in self-help groups close together. Often, however, it brings the sufferers into a vicious circle - from the ex-soldier, who works as an errand boy in the red-light milieu, to the torture victim, who drowns in alcohol with the child of a violent offender. The massive problems of gaining a foothold in civil society are becoming a commonly experienced normality. Both experience feelings like depression and deep despair and can not save each other from the excitement.

Post-traumatized people can not complete their experience and find it difficult to cope with civilian life. Not only do they have flashbacks, they keep thinking about what's happening. Often they suffer from feelings of guilt and are ashamed.

causes

Not all people are obviously at risk of developing PTSD. The way people save memories is the key. PTSD patients store catastrophic events intensively.

People who experience cruelty release adrenalin in the organism, which activates the amygdala in the brain. The incident is burned. Such memory usually softens over time. This does not work for a PTSD. The hormone cortisol could play an essential role. The body releases cortisol under stress, thus blocking memory contents. Therefore, cortisol can help alleviate PTSD.

Traumas can be different experiences that are often coupled: childhood sexual and physical abuse, rape, torture and imprisonment, war, but also natural disasters such as earthquakes, apartment fires, shocking experiences as a police officer, paramedics, firefighters or train drivers who commit suicide.

PTSD and trigger event sometimes separate years. Sometimes the symptoms are therefore not associated with the trauma. In addition, traumatization means gaps in memory, so that the person concerned realizes that "something is wrong with him", but he does not know what it is. In addition, a few decades ago, PTSD was considered a sign of lack of (self-) discipline, and above all affected soldiers were mocked as a quitter.

Even witnesses of a terrible event can develop a PTSD, for example, children who were present when the father beat the siblings.

symptoms

On a trauma experience indicates the following: Sleep disorders, infections, emotional outbursts, low resilience, anxiety and nervousness, increased irritability. Traumatized people often develop a cynical worldview. Mental and physical neglect, alcohol and drug abuse, relationship problems and avoidance behavior are added.

Post-traumatic stress affects the affects. Those affected can control their impulses worse than before, they set up aggression against themselves; her sexuality is disturbed; they cross borders and behave dangerously.

Post-traumatized suffer from lasting memories of the stressful experience. They feel oppressed in situations that connect them with it. They avoid circumstances that might remind them of the trauma. They are incapable of remembering the incident in their entirety. They are sensitive. You have trouble sleeping and are always on alert. They can hardly concentrate and tend to rage.

They avoid conversations related to the trauma and repress emotions associated with it. Often they seek out the psychic place of horror but in a frenzy like the traumatized ex-soldier who looks at drunk Youtube videos of war criminals. Some also compensate for the trauma by bizarre interests such as Backyard Wrestling, in which the participants pull baton-wrapped clubs over their skin. Post-traumatized people also fall into speechless horror when they think of the trauma. They can not say how they think about what happened.

The sufferer's depression causes them to give up their social contacts and lose interest in hobbies. As with other depressions, they also fall into a downward spiral. The less social contacts they have, the greater the futility. Some post-traumatized people are acutely suicidal in these phases.

The opposite also belongs to the disease: The affected react as in a mental state of emergency. The danger lurks around her; they do not trust anyone. They become aggressive at lightning speed without the witnesses seeing a trigger. Some of those affected are "ticking time bombs". Especially with traumatized soldiers such irritation situations can be dangerous. They have stored the actions of the fight and physically attack others - even with improvised weapons. At the extreme, they even commit homicides in the affect.

In addition, there is a distorted perception of reality, which, as in the case of borderliners, mixes recurrent trauma, deliberate lies and actions of one's own. For example, a victim falls drunk off the bike and says a mob beat him. Or those affected invent events to convey their trauma to outsiders. The neighborhood in which they live becomes, depending on the trigger, a street war in Bosnia or a hiding place for rapists.

The injured accuse themselves. Through the trauma, they have lost a basic trust in other people and themselves. They doubt themselves and consider themselves weak. Whether they think that they have long had to process the events, whether they are responsible for what happened. A look into the past also darkens the future; Plans appear utopian; The society is racing towards an abyss in the eyes of the traumatized. The negative moods can cause the person to give up completely, no longer pay the rent, or sink into drugs.

The social environment can not erase the trauma, but it helps a lot in such phases. Relatives who after a "grace period" mean "now you tear yourself together", or even blame the victim "if you had not joined the army, you would not have happened," sprinkle salt in the emotional wounds. Unfortunately, many people are unaware that PTSD has nothing to do with character weakness.

Traumatized soldiers

German soldiers in the First World War, who suffered from PTSD, were then called Kriezitter. PTSD is recognized in the US, and therapists accompany affected soldiers returning from Afghanistan and Iraq.

Bundeswehr soldiers are also suffering from PTSD today; In 2014, there were 431. Probably only one in five, however, openly admitted a PTSD. On the one hand, they are afraid to be considered as "soft-blooded", on the other hand, a mental illness can end the career in the army.

At the same time, there is a lack of qualified doctors to treat those affected - in the Bundeswehr and in civilian life. Many traumatized people stop the service; Back in the community, however, many therapists do not dare to work with war veterans. Ex-soldier Malcolm Mackenzie says, "No one has been able to help me so far. I'm afraid to land in the closed prison or in jail. "

Who is at risk?

To view a PTSD as a disease is true of the symptoms, but strictly speaking it is not correct. Rather, PTSD is a healthy body reaction to dealing with threatening situations. For example, sufferers are less sensitive to physical pain than those who are not.

While there is no "typical" post-trauma, people who have previously had mental health problems are at particular risk. The same goes for people without stable and long-lasting relationships. Professionally in Disasters Workers such as police or paramedics are proportionately less likely to suffer PTSD than lay people.

Social circumstances before the incident also affect whether a PTSD is created: fragmented families, criminal parents, mentally ill parents and bad contacts with peers.

A study of traumatized Vietnam veterans revealed the following risk factors: pre-combat depression, hard-hitting parents, and unstable families. After the combat were added: illnesses, divorces, death of relatives and new traumas.

There were also factors that dampen traumas: close ties to parents and high socioeconomic status. After fighting, social support was particularly important.

Soldiers were said to have been traumatized by over 30% during the Vietnam War. In the wars in Iran and Afghanistan, however, it was significantly less, namely between 2.1% and 13.8%.

Loss of security

According to Maslow, human needs are staggered. Only when basic needs are satisfied, higher needs come on the agenda: safety follows sleep and food, so is still facing the need for social contacts, recognition and self-realization. Most people learn that their environment is safe. A trauma calls this certainty into question. The world becomes a threatening place, the order is chaos.

PTSD in partnerships

PTSD affects not only those affected, but also their loved ones. They are confronted with outbursts of anger and have to deal with self-doubt. Those affected feel as lonely as they are misunderstood, and their relatives must support them without being able to really "understand" the sufferer. In extreme cases, relatives must prevent suicide.

The family can help those affected with flashbacks: To relive what happened, infuriates the victim - the horror is back. The relatives can give him the feeling of security here: No matter what happens, we are there for you. You should not be pestering him with questions, but be close by.

Such "flashbacks" are associated with heartbeat, rapid breathing, nausea, muscle tension and sweats. In contrast, the deep breathing helps: The injured person should breathe deeply for four seconds, hold the breath for four more seconds and then exhale slowly for four seconds.

In order to stabilize the person concerned, he also has to feel safe in general: discussing the future with him, showing that he is open, keeping promises and creating routine are key points.

The relatives must know that the injured person does not retreat because his loved ones do not care about him. This is difficult because those affected no longer appear to meetings that were important to them before. This is hurtful, but should not be taken personally.

Those affected think badly of themselves and paint their situation in black colors. Teaching them love is therefore just as important as positive ideas. Relatives can also relieve the tantrums. When the person in question "gets going" his friends can go with him to the next room or go for a walk. It also helps to encourage the person concerned to write diaries. Writing channels feelings and thus dampens outbreaks. In addition, the person concerned will be so clear about his feelings.

With an affected person you should deal with fingertips. Traumatized persons are often hypersensitive and tense to the extreme. That's why you should avoid jerky movements, inform him if you make noise and report when you get home.

treatment

Many psychotherapies have been developed specifically for traumatization. When the victim is overrun by eruptive memories, therapists avoid addressing the trauma directly. Instead, they focus on memories that are associated with the trauma but not directly related to it. If the relapses are less severe, the therapist and patient can directly address the trauma. Usually, the patient has to stabilize himself until the methods of trauma therapy are used. After that, it can be about changing the behavior and circumstances of the patient.

Individual or group therapies can help to process the trauma. Image: Photographee.eu - fotolia

Cognitive behavioral therapy is also used to treat trauma. Above all, the confrontation therapy is successful. The patient should remember the traumatic experience here, in a protected environment.

The Eye Movement Desensitization and Reprocessing is directly focused on traumatization. Conversations lead the patient to the experience. The two halves of the brain are thereby stimulated so that the experience is integrated with remembering.

Imaginative procedures also help. For example, those affected withdraw to an imaginary location when the emotions become too intense.

In addition there is dream work to refute side effects such as nightmares. The person concerned imagines that a recurring nightmare comes to a happy end. This procedure also reduces the memory thrusts.

PTSD can also be treated with medication, in Germany with sertraline and paroxetine, among others. Mirtazapine is used for heavy war traumata. Trazodone helps against sleep disorders. Benzodiazepines should only be used for a short time. The risk of addiction is high, and PTSD patients are generally at risk of addiction.

Trauma therapies run in four phases. First, it's about safety, so to teach the patient to rebuild trust. Therapy should therefore provide a clear framework, and the therapist should prove to be a reliable partner. For this he discusses the goals and the duration of the therapy with the person concerned. He explains the symptoms and causes of PTSD and suggests different therapies to the patient.

In addition, the patient and therapist discuss the social relationships of the person concerned. If it turns out that acquaintances have a bad influence on his problems, or if he seeks relationships that hurt him, then the question is how the person concerned can handle them.

In order to restore inner security, therapist and client go through the "head cinema" of flashes of memory and dissociation. The affected person helps when the therapist separates the memories from the present.

If the client recovers internal and external security, the phase of stabilization begins. Here, the affected person gets to know his self-healing powers again. What impulses in him do him good when the images of horror explode.

In addition, the patient should now learn to build relationships that strengthen him and separate him from relationships that hurt him. This is very important for many traumatized persons, as they often seek an environment that reflects their trauma experience. But now it's about structuring everyday life again.

The "inner dialogue" method helps to regain and understand parts of the self split off by the traumatic process. The imagination, that is to call wholesome pictures, complements the inner dialogue. In psychologically stable, these methods can easily be used in everyday life; However, in traumatized individuals with severe dissociation, the inner images are so "torn" that this phase can take years.

If the stabilization is successful, the client can relax himself. Now "remnants" of traumatic images and emotions can be "scrutinized". A trauma never disappears completely, because the stored memories are "burned in". However, a stable sufferer has learned to distance himself from the traumatic images. They stay, but they no longer overwhelm him.

Inner distance means that disconnected affects, feelings and perceptions are brought into consciousness and integrated into the personality. At the end is the integration. Therapist and patient look back on the time of the trauma and put it off in the past. As an encapsulated memory it loses its terror. Therapist and sufferers develop new life goals. Ideally, the therapy proves itself in the practice of a self-determined life. (Dr. Utz Anhalt)