What causes it and what doesn’t?
Almost everyone has heard the acronym PTSD before and probably know that it has something to do with experiencing something traumatic. Most people associate it with military personnel. While they can have the disorder, they aren’t the only ones. Who else is vulnerable?
PTSD stands for post-traumatic stress disorder and is a mental health condition that’s caused by experiencing or witnessing a traumatic event. It can disrupt your whole life. Typically, the event involves actual or threatened death, serious injury or sexual violation. Scientists don’t know what causes it to occur, but it’s probably related to a complex mix of items, including the amount and severity of trauma you’ve had throughout your life; inherited mental health risks, like family history of anxiety and depression; inherited features of your personality (temperament) and the way your brain regulates the chemicals and hormones released in response to stress. Some factors increase your chances of developing PTSD, such as going through intense or long-lasting trauma, having suffered other trauma earlier in life (ex. childhood abuse), having a job that exposes you to traumatic events (ex. military personnel and first responders), having other mental health problems, having issues with substance misuse, lacking a good support system of family/friends and having blood relatives with mental health problems. There are several events that commonly lead to PTSD, such as combat exposure, childhood physical abuse, sexual violence, physical assault, being threatened with a weapon and going through an accident. Other possible triggers include fire, natural disaster, mugging, robbery, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack or other extreme/life-threatening events. This means that people of any age can develop PTSD. It’s important to note that most people who go through traumatic events may temporarily have a difficult time adjusting and coping, but they usually get better, especially if they seek help when needed. With PTSD, the symptoms get worse to the point where they interfere with day-to-day life and they can last for months or even years.
In most cases, PTSD symptoms start within one month of a traumatic event, but sometimes don’t appear until years later. They’re generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time and are different from person to person. Intrusive memories include recurrent, unwanted distressing memories of the event, reliving the event as if it were happening again (flashbacks), nightmares about the incident and severe emotional distress or physical reactions to something that reminds you of the experience. Examples of avoidance are trying to avoid thinking/talking about the episode and avoiding places, activities or people that remind you of it. When you have negative changes in thinking and mood, you often have negative thoughts about yourself, other people or the world, feel hopeless about the future, have memory problems (like not remembering important aspects of the event), have trouble with close relationships, feel detached from others, don’t have interest in activities that you once enjoyed, difficulty having positive emotions and feeling emotionally numb. Some individuals have changes to their physical and emotional reactions, which includes being easily startled/frightened, always looking out danger, participating in self-destructive behavior (ex. drinking too much or driving too fast), difficulty sleeping, inability to concentrate, irritability, angry outbursts/aggressive behavior and overwhelming guilt/shame. Unfortunately, children go through traumatic events too, so for children 6 years old and younger, they may re-enact the event or aspects of it through play and can have frightening dreams that may or may not include parts of the incident. Some people have more symptoms when they’re stressed in general. Others have an increase in symptoms when they come across reminders of what they went through. Unfortunately, having PTSD raises your risk of having other mental health problems, like depression, anxiety, issues with drugs/alcohol, eating disorders and suicidal thoughts/actions.
It’s critical that if you’re having disturbing thoughts and feelings about a traumatic event for more than a month, if these thoughts/feelings are severe or you feel that you’re having trouble getting your life back under control, you should talk to a doctor or mental health professional. If you or someone you know is having suicidal thoughts, get help immediately by reach out to a close friend/loved one, tell a doctor, contact a minister/spiritual leader or call a suicide hotline number. The National Suicide Prevention Lifeline is 1-800-273-TALK (8255). If you’re a veteran, use that same number and press 1 to reach the Veterans Crisis Line. If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you know someone who’s in danger of attempting suicide or has made a suicide attempt, have someone stay with that person and call 911 or your local emergency number immediately. If you can safely, take the person to the nearest hospital emergency room.
Getting help in a timely manner may prevent normal stress reactions from getting worse and developing into PTSD. This can be done in a variety of ways, including turning to family and friends who will listen and offer comfort. Some individuals find it helpful to turn to their faith community. It can also mean seeking out a mental health professional for a brief course of therapy. By receiving support from others, you’re less likely to turn to unhealthy coping methods. Treatment can help you regain a sense of control over your life. The primary form is psychotherapy, but sometimes you’re prescribed medications. Many therapists have found that by combining these it helps to improve symptoms by teaching the person needed skills to address the symptoms, help them think better about themselves, others and the world, find new ways to cope if any symptoms come back, deal with other problems (ex. depression, anxiety or misuse of alcohol/drugs) and demonstrate that they don’t have to try to handle the burden of PTSD on their own. The types of psychotherapy used include cognitive therapy, exposure therapy and eye movement desensitization and reprocessing (EMDR). These are often done in individual therapy, group therapy or both. Several types of medications are used, such as antidepressants, anti-anxiety medications and prazosin. In order to get better, it’s vital that you follow your treatment plan, learn as much as possible about PTSD and take care of yourself by getting enough rest, eating a healthy diet, exercising and taking time to relax. It’s a good idea to reduce/avoid caffeine and nicotine since they can worsen anxiety. Be sure to not self-medicate by turning to alcohol or drugs to numb your feelings. If you’re feeling anxious, break the cycle by taking a brisk walk or working on a hobby to help you re-focus. Staying connected by spending time with supportive and caring people is critical.
When someone you love has PTSD, they may seem like a different person than they were before the trauma. This can cause significant strain on the emotional and mental health of loved ones and friends. It’s not uncommon for you to want to avoid talking to them about the trauma or feeling hopeless that your loved one will get better. Unfortunately, you can’t magically make their pain and suffering go away. However, you can learn about PTSD, recognize that avoidance and withdrawal are part of the disorder that has nothing to do with you specifically, offer to attend medical appointments, be willing to listen when your loved one is ready to talk, encourage them to participate in activities, make your own health a priority, seek help if you need it and stay safe since sometimes individuals experiencing PTSD can become aggressive and have angry outbursts.
Most of the times, we associate PTSD with something traumatic, like war or mass shootings. However, when we think about traumatic events, it’s not just what the event is, it’s your interpretation and what feelings the event causes for you. Each person is different in regards to what’s traumatic and causes fear. For the past several years, we’ve been in a particularly stressful political environment. Since 2016, some individuals have felt that what happens at political events could directly impact them going forward. Essentially, they feel like they’re under some kind of threat and need to protect myself. This led to some researchers questioning whether or not these individuals were experiencing a level of PTSD after the 2016 election. A team of researchers at Arizona State University (ASU) decided to survey 769 introductory psychology students in January and February 2017. The students answered questions in a psychological assessment, Impact of Event Scale, which is used to measure how an event might impact a person, resulting in them developing PTSD. This survey is often used by the military. The students were asked about their satisfaction with the election, if they were upset about the outcome and whether the results had affected their close relationships. The results were published in the Journal of American College Health. It’s important to note that the students received course credit for completing the questionnaires. Of the participants, about 250 identified as Democrats, about the same number were Republican, 109 were Independent and 90 selected Other. The group was fairly equal between the number of men versus women. The majority of students were white (446), then Latino (130), Asian (109), other (43) and African-American (36). About half (332), identified themselves as upper/upper-middle class with middle class coming in second (302), followed by lower-middle/working (133). The majority said they are heterosexual with only 68 identifying as being a “sexual minority.” Christianity was the largest religion represented (445) with nonreligious (218) surpassing non-Christian (97). The article found that 25% of the students had “clinically significant event-related distress” that is comparable to the average score measuring up to those of people seven months after witnessing a mass shooting. They authors argue that this can predict future distress as well as a diagnosis of PTSD. However, it doesn’t indicate the long-term consequences for mental/physical health of election-induced distress since the students only took the survey once. It also doesn’t establish the cause of the symptoms. The analysis of the data revealed that women, racial minorities, people from working and lower-middle social classes, Democrats, non-Christians and sexual minorities reported significantly more election-related distress. The most useful forecasters of stress were sex, political party, religion and perceived impact of the election on close relationships. It’s believed this study was the first of its kind examining an election’s psychological impact on college students. Many of the researchers are professors at the college and decided to study what was goes on when they noticed that many of their students were “visibly upset,” scared and anxious about policies that had been discussed on the campaign trail and the election of “a candidate who had an audio recording of him describing sexual assault.” The researchers point out that the 2016 election itself was not a trauma, but the threat of some form of personal injury that resulted in a sense of helplessness and fear was very real. This is why the researchers reject the notion that distress was a sign of emotional weakness. It’s something that young people can’t stop thinking about it and it interferes with their concentration or they try to avoid it by not talking about it. The researchers hypothesize that “issues of identity and social inequality prominent in election-related rhetoric” played a role in the development of the fear. They further stated, “Repeated exposure to visual stimuli and words relevant to one’s identity, when perceived to be threatening or priming negative stereotypes regarding social group membership, can negatively impact psychological well-being.”
The findings of the ASU research team are in line with those of other surveys. A poll was conducted in January 2017 by the American Psychological Association (APA) with the results being released in its “Stress in America” report. The numbers showed two-thirds of Americans were stressed about the future of the country after the 2016 election and felt that the future of the nation is a “very or somewhat significant” source of stress. In the survey, the APA found that those in Gen Z (15 to 21) are significantly more likely (27%) than other generations, including millennials (22-37) at 15% and Gen Xers (38-53) at 13%, to report their mental health as fair or poor. For Gen Zers, the most significant source of stress (75%) was mass shootings. Overall, Gen Zers are more stressed than adults about other issues, such as separation and deportation of immigrant and migrant families (57% to 45%) and sexual harassment/assault reports (53% to 39%).
Skeptics say that while an election can cause anxiety, it doesn’t threaten life or limb, so it could never lead to PTSD. They do state that it’s possible that some victims of previous trauma, like women who experienced prior sexual assault, were prompted by the election and related news stories to reexperience the original pain and humiliation that they went through. These people could have PTSD as a result. In addition, the skeptics do agree that contentious, fraught elections can cause severe anxiety, especially if individuals have perceptions that a particular outcome could negatively impact their lives or their families. They also acknowledge that chronic anxiety can be debilitating.
College campuses across the nation noted that many students came to campus mental health clinics after the election. According to the information reported, some students said that the election results were impacting underlying mental health conditions, while others were experiencing mental health issues for the first time. This has led to many wondering why is this generation of college students so stressed out. Some blame it on helicopter parents who hovered over their kids too much, which resulted in this generation of college students arriving on college campuses not fully prepared to be an adult. Also, the current generation of college students has been exposed to constant information and misinformation due to their high use of media, especially social media. This exposes them to cyberbullying and leads them to compare themselves with the popularity, success and looks of friends and acquaintances, which makes them less resilient. Other sources of stress include concerns over poor job and housing prospects. All of this heightens their anxiety. In response to what happened, many campuses now have mandatory resilience-building programs to help students learn stress management and coping skills. The good news is that researchers feel that the current generation of parents of students in middle school and high school are doing more social media monitoring, which is helping their children deal with bullying and social pressure. This in turn will create more resilience in middle school and high school making them better prepared to handle the independence of college.
In the past few months, a new concern about inducing a possible rise in the number of PTSD cases has emerged…COVID-19. For health experts, this is a major concern. They point out that after the SARS outbreak in 2003, both healthcare workers and people who were self-quarantined exhibited symptoms of PTSD. They feel that the COVID-19 pandemic could have a similar effect. Most of us have been directly impacted in one way or another. Some have been sick with the disease, others have had family and friends die from it and a good portion of people have been financially impacted. This is why it’s okay to feel some distress, on edge and anxious right now. Your brain’s way of adapting is to be on hyperalert in case you need to protect yourself. When you consider the risk of developing a life-threatening illness paired with the loss of the things that usually anchor us, like being able to physically visit with extended family and friends, we’ve suffered two major changes in a short period of time that would leave anyone feeling stressed out. Scientists are saying that the pandemic is bringing up similar fears that caused distress for many after 9/11, such as being harmed, losing loved ones and not knowing how much of a threat the situation will cause. While there are differences between 9/11 and COVID-19, the emotions people are experiencing are similar, including anxiety, fear, lack of control, panic and fear of death. Those most likely to be affect by PTSD are those who have lost a loved one, survivors of the illness, people affected economically and frontline workers.
The good news is that most people will be able to return to a normal level of functioning. The key is to manage the stress to help your mental health in the long term. One of the first things to remember is that we’re in the middle of the pandemic right now. The best way to think of it is as a marathon, not a sprint. Public health experts are saying that this could last multiple years with it flaring up at different times, so it’s essential to continuously taking care of the basics. This means eating healthy, getting sleep and creating life patterns and routines to help deal with the situation. It’s these small acts that happen over and over again that can have an enormous impact on how we cope. During this time, change is the only constant, so having flexibility, not only in your actions but in the way you think is crucial. Part of this is accepting the situation for the way it is. If your thought patterns are black and white or catastrophic, you can end up having distorted thinking and dysfunctional behavior. Instead, find a coping mechanism that can anchor you. Most people are able to cope with challenges better than they imagine. It’s important to realize that the brain often predicts that something will go wrong much more frequently than it actually happens. It can be helpful to consider how you’ve managed during stressful times in the past and to revisit this when you’re feeling unsure. In addition, many people experience what is called “post-traumatic growth” as a result of the pandemic. This is an increase in their perception of their ability to manage future difficulties.
There are several other things that you can do to help you not be as stressed. One of the most important is to keep in mind is that it’ll be over at some point. Another imperative thing to do is to take breaks from the news. Between 24/7 news channels and social media, the news is everywhere all of the time. This makes it incredibly challenging to not feel stressed. So, it’s a good idea to limit how much time you spend watching/consuming news information to just enough to stay informed, but not become overwhelmed. If you’re feeling anxious, practice relaxation techniques, like diaphragmatic progressive muscle relaxation or guided imagery, to help calm you down. Negative self-talk is another big issue. It can be help to use the acronym TEB (thoughts, emotions, and behaviors). This means that you should be paying attention to what you’re saying to yourself and how that’s making you feel and influencing your behaviors. Ruminating is a mental habit where you repeatedly think about “why?” and “what if?” in a way that doesn’t help to solve the problem. One study found that doing this can actually increase the likelihood of depression and stress symptoms after an event is over, even more so than being personally affected by the event. It’s essential to balance accepting difficult feelings, without multiplying them. It’s vital to remain connected to family and friends. You can do this despite social distancing by calling them on the phone or doing video chats. We’re all in this together. We’re all feeling isolated, frustrated and scared. Taking the time to connect can reduce these feelings not only for us, but those we communicate with. By continuing this connection, it helps us all to feel calmer. It’s key to find activities that you enjoy doing and participate in them, such as taking walks, listening to music, cooking or reading a book. Experts say that whatever your activity is, you should do it at least once a day. Finding a way to help others can give you a sense of purpose. If at any point you feel like you’re struggling, you can get help from a professional. Given the current circumstances, many therapists are offering telehealth services. Remember, seeking help is not a sign of weakness, but of strength.
Even before COVID-19, healthcare workers were already more at risk for depression and suicide. Unfortunately, mental health experts fear they’ll be even more so now. Many professionals on the front lines can’t control the crushing sense of inadequacy and anxiety they have regarding their ability to treat the volume and severity of patients. The World Health Organization (WHO) has put out a report about the pandemic’s impact on mental health. Within the document, they highlight the vulnerability of healthcare workers. A study published in the March edition of the Journal of American Medical Association’s Psychiatry looked at the psychological effects of the pandemic on healthcare workers in 34 Chinese hospitals. They reported that nurses, especially women, carried the heaviest burdens and there were elevated rates of anxiety, depression and insomnia. Experts are concerned that healthcare professionals’ psychological struggles could impede their ability to keep working with the intensity and focus that their jobs require. Even when the number of new cases and deaths begin to slow, the psychological pain for healthcare workers is likely to continue and even worsen. This is because as the intensity of the pandemic fades, so does the adrenaline, which means that the emotions of dealing with the trauma and stress of the pandemic are left behind. On top of this stress, many healthcare workers are missing familial, visceral contact since many are isolating from their families as a way to protect them. There is hope because therapists around the country, many affiliated with the Trauma Recovery Network, are offering free treatment to healthcare workers. The goal of offering therapy now is twofold. The first, and most important, is to prevent destructive symptoms from settling in long-term. The second is to help these individuals cope so they can keep doing their jobs.
When it comes to developing PTSD, there are a variety of things that can cause it. However, most people are incredibly resilient. Although situations, like elections and COVID-19, can be incredibly difficult to deal with, many people have great coping mechanisms and social supports that will help them get through it. Find and maintain the strategies that you know work for you. This will help to make sure you’re not suffering down the road. With the right techniques, you can, and will, make it through either on your own or with help.