When The Trauma is Over But Feelings Persist

You don’t have to be a battle-scarred soldier to suffer from Post Traumatic Stress Disorder (PTSD). Anyone who has experienced a dangerous or threatening event is vulnerable to the condition. In my practice, I have found that the traumatic event is in the eye of the beholder. Any perception of a threatening or unsafe experience that does not go away after a few weeks can become PTSD.

Although mankind has chronicled the symptoms of PTSD for thousands of years, the term is a relatively new psychiatric diagnosis. Ancient Greeks, Egyptians, and American Civil War veterans have all described PTSD and “shell shock,” but it wasn’t until 1980 that it was first included in the Diagnostic and Statistics Manual III (DSM) – the bible of psychiatric diagnoses for mental health professionals.

We still have a great deal to learn about PTSD. Here’s what we do know:

• It is a relatively common diagnosis, affecting 5 percent of men and 10 percent of women in the U.S. It also adversely affects veterans. 12.5 percent of Iraq War veterans were diagnosed with PTSD after deployment
• Individuals can experience the same traumatic event, but only one in four will develop symptoms
• PTSD can persist for decades
• Sufferers often resort to substance abuse to manage their symptoms

Know the symptoms

1. Re-experiencing the event

• Flashbacks — reliving the trauma over and over, including physical symptoms like a racing heart or sweating
• Bad dreams
• Frightening thoughts

2. Avoiding reminders

• Staying away from places, events, or objects that are reminders of the experience
• Feeling emotionally numb
• Feeling strong guilt, depression, or worry
• Losing interest in activities that were enjoyable in the past
• Having trouble remembering the dangerous event

Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car.

3. Hyperarousal is a cluster of symptoms that stem from experiencing high levels of anxiety and may not relate to the traumatic event.

• Being easily startled
• Feeling tense or “on edge”
• Having difficulty sleeping and/or having angry outbursts

It’s natural to have some of these symptoms after a dangerous event. It’s rare to have all of them. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD.

There is help for PTSD

To help you get “unstuck” from symptoms, we successfully treat PTSD with forms of talk therapy like cognitive behavioral as well as cognitive processing treatments. We also utilize medications like selective serotonin reuptake inhibitors (i.e. Prozac) and others to help manage sleeplessness and hyperarousal.

If you suspect you experience any symptoms of this disorder, speak with your primary care physician to obtain a referral to a mental health practitioner. It is possible to make a full and complete recovery from PTSD.

Kevin A. Coffey, L.C.S.W., CGP, Ed.D., is the social work clinical coordinator for outpatient services in the URMC Dept. of Psychiatry. He primarily provides clinical evaluations to patients and facilitates group therapy sessions. He also is a Senior Clinical Instructor in Psychiatry and has a faculty practice in the department. He has worked at the University of Rochester Medical Center for 18 years.