that, let’s get started!
CHAPTER ONE
POSTTRAUMATIC STRESS DISORDER
“Almost every human body is under a great deal of stress, not because it is threatened by some external factor but from within the mind.”
— Eckhart Tolle, A New Earth
When we think of all of the external threats in our world today — worldwide pandemics, terrorist attacks, natural disasters, wars, motor-vehicle accidents, sex trafficking, bullying, workplace harassment, relationship and child abuse (mental, emotional, physical, and sexual), as well as other events that anyone would consider traumatic and extremely stressful — we cannot deny that trauma is part of many people’s lives at some point. While no one wants to believe PTSD can happen to them, the reality is that it can. Millions of people worldwide are affected by PTSD.
After a traumatic event, people want to “get over it” as quickly as possible and get on with their lives, but if you are suffering from PTSD, you haven’t been able to. Things are getting worse instead of better. The people in your life may not understand what you’re going through. Heck, you likely can’t make sense of it. You may have heard things to imply you’re exaggerating or being treated as “overly sensitive.” You may have heard, “What doesn’t kill you makes you stronger,” or “you just need to learn to deal with it”. This can be very frustrating and isolating as you find yourself fighting what seems to be a losing battle against the persistent, debilitating, and unpredictable “enemy” that is attacking you from within your own mind. The fact is, PTSD produces real, measurable changes to areas of the brain responsible for mediating stress, emotion, memory, as well as other cognitive and physiological functions. Although PTSD has many psychological effects, its basis is in your nervous system. However, this doesn’t mean there is nothing you can do about it. In fact, many do recover from PTSD to a point where they can live productive and meaningful lives, sometimes recovering to such a degree that they no longer experience symptoms or qualify for the diagnosis. Before talking about how to recover from PTSD, first it is important to understand what is happening to you. The aim of this chapter is to help you understand PTSD, trauma, signs and symptoms, risks and protective factors, as well as the duration, prognosis, and neurobiology of this condition. You may have already done your own research, in which case this chapter will serve as a review and will provide foundational knowledge for your recovery.
WHAT IS PTSD?
The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is the most comprehensive, respected, and utilized resource in the classification and diagnosis of mental disorders. In the DSM-5, which is the most recent version, PTSD is classified as a stress- and trauma-related disorder. There are arguments suggesting that PTSD should instead be classified as a mental injury and not as a disorder because a person has to be psychologically injured by a traumatic event in order to develop PTSD. There are good points for and against dropping the word “disorder,” and I do believe this change may happen in future editions of the DSM.
Whether PTSD is viewed from an illness or injury perspective (or both), no one can argue that PTSD creates adverse long-term changes in emotion, thinking, and behaviour as a direct result of exposure to trauma. The symptoms of PTSD are persistent and can cause much “dis-order” in a person’s ability to function in several, or all, areas of life — mentally, emotionally, physically, spiritually, socially, financially, and professionally.
PTSD develops in response to a traumatic event that breaks down the stress management system and dysregulates the normal functioning of the nervous system, which includes two branches, the central nervous system and the peripheral nervous system.
What we now know as Posttraumatic Stress Disorder originates from the effects of combat on soldiers who fought in World War One. It was originally called “shell shock,” “combat fatigue,” or “war neurosis.” It wasn’t until 1980 that PTSD first appeared in the third edition of the Diagnostic and Statistical Manual (DSM-III), but evidence of PTSD dates back to long before the war or the advent of modern psychiatry. Even though PTSD was first connected to war trauma, it was soon discovered that you don’t have to be a soldier or veteran to have PTSD. It is now well recognized that other professions are also at high risk, namely firefighters, paramedics, police officers, doctors, nurses, and other health professionals, because they are much more likely to experience repeated exposure to trauma. However, they are not the only ones who develop PTSD. Over the last forty years, the diagnostic criteria for PTSD has changed substantially to reflect its current definition as a trauma- and stressor-related disorder that can develop in anyone who is directly or indirectly exposed to major trauma.
The diagnosis and treatment of life-threatening illnesses such as cancer had been included in the fourth edition of the DSM as a traumatic stressor that can cause PTSD, but this has since been removed. The DSM-5 specifically states, “a life-threatening illness or debilitating medical condition is not necessarily considered a traumatic event. Medical illnesses that qualify as traumatic events involve sudden, catastrophic events.” As a result, many medical conditions no longer qualify for a diagnosis of PTSD. With that said, a disease like COVID-19 with mass worldwide infection and no vaccine or cure would be considered a “sudden, catastrophic event,” which has been compounded by things like social isolation, uncertainty, fear of transmission, lack of treatment and resources, negative media coverage, and immediate threat to life. This may leave those who have recovered, healthcare professionals, and family members at a high risk of developing PTSD.
Unfortunately, despite awareness campaigns and education efforts, many are still under the false impression that PTSD only occurs in those who have fought in wars. It is important to dispel this myth, since it can prevent people from recognizing they have PTSD, leaving them undiagnosed and untreated for far too long. Here is what a police dispatcher said:
I didn’t know I had PTSD for the first six years. I thought for sure I had cancer or some other serious physical illness. When my doctor diagnosed me with depression, it didn’t make sense. I had a good life. I’d never had depression before. I didn’t see myself as depressed, but I knew there was definitely something wrong. I couldn’t get out of bed for days. I felt intense guilt and shame. Things I’d heard during my eighteen years as a dispatcher were coming back in disturbing flashes. It was confusing, because these things had never bothered me the whole time I was working. It was the opposite; I’d get an adrenaline rush during times of crisis. I loved my job and never called in sick. But suddenly I had no energy or motivation. I didn’t know what was wrong with me.
When I was invited to a support group called “Wings of Change,” I didn’t think I belonged there because I didn’t think PTSD happened to dispatchers since we don’t actually see trauma; instead, we hear it. But when I heard another dispatcher sharing her story, which matched mine almost exactly, I had a huge sense of relief. It finally made sense. I knew what was going on with me and could start dealing with it.
Another woman said:
I was in a bad car accident and was lucky to survive. I had some physical injuries, which I mostly recovered from, but something was wrong in my head. I kept hearing the sound of the crash over and over. I had intense anxiety, panic attacks, and complete emotional meltdowns. People kept telling me I should be thankful to be alive, and I knew that, but I couldn’t control my thoughts and emotions. I ended up being diagnosed with anxiety and panic disorder, but eventually, as my symptoms worsened, a counsellor suggested I talk to my doctor about PTSD. I didn’t think I could have PTSD because I wasn’t critically injured in the crash. I honestly thought PTSD only happened to cops and veterans. But now that I know I have PTSD, I have been able to get the help I need.
Here is how an ICU nurse explained it:
There is a high mortality rate in the intensive care unit because we are treating the most critically ill patients. So, I guess I just got desensitized to people dying. I had no idea it was taking a psychological toll on me. When things started getting worse, I kept telling myself, “this is what I signed up for.” But you really can’t predict all the things you’re going to have to deal