You don’t expect to run out of personal protective equipment while treating patients with a highly contagious, deadly disease. I was having anxiety attacks before work and getting more and more angry at how things were being handled. I was having other symptoms too, but I thought maybe I was having a burnout or that I was just highly stressed like everyone else. PTSD didn’t even cross my mind at first.
PRACTICAL EXERCISE — GET SUPPORT
If you suspect you may have PTSD, even if you’re not sure, reach out for support and talk to someone about what you’re experiencing. There are a number of reasons you may not want to get professional help. Maybe it’s not available or is too costly. Perhaps you don’t feel ready or fear being stigmatized. Or you may have had bad experiences in the past. Whatever the reasons, I strongly encourage you to reconsider, since there may be things you can’t deal with on your own. Trying to process your trauma alone can leave you feeling more confused and distraught than before, so reach out to someone who can provide you with support. If a counsellor is not an option, find a trusted friend you can confide in. If you wish to access services and don’t know where to start, contact your doctor’s office or local counselling centres. If they do not offer the services you need, they will be able to point you in the right direction. If you’re not ready to make the call yet, find the phone numbers so you have them on hand if, and when, you need them.
REFLECTIVE QUESTIONS
• If your PTSD had a name, what would it be?
• How would you describe your PTSD? If it had its own personality apart from yours, what would it be? For example, how does it sound? What does it say? How does it think?
• Draw a picture of your PTSD. Don’t worry if you’re not much of an artist; you can find a photo online that would be a good representation. Once you have your image, put it in a safe place, because you will need it again in later chapters.
WHAT IS TRAUMA?
Trauma comes from the Greek word “wound,” which implies injury. Some widely accepted definitions for trauma include:
• a deeply disturbing and distressing experience
• an injury to living tissue caused by an extrinsic agent
• disordered psychic or behavioural state resulting from severe mental or emotional stress, or physical injury
While everyone is exposed to stressful events at some point in their lives, it is important to note that PTSD does not result from exposure to typical everyday stressors, like the pile of work on your desk, a stressful conversation with your boss, midterm exams, or even more stressful things like a cheating spouse, financial hardship, or other stressors that we can reasonably expect to encounter over the course of our lives. Rather, according to the most current edition of the Diagnostic and Statistical Manual (DSM-5), in order to be diagnosed with PTSD, “a person must be exposed to a traumatic event where death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):
• Direct exposure
• Witnessing the trauma
• Learning that a relative or close friend was exposed to a trauma
• Indirect exposure to aversive details of the trauma, usually in the course of professional duties.”
When traumatic events are experienced, the stress response is activated and the survival part of your brain takes over to get you through the crisis. Once the crisis is over, the stress response spontaneously shifts back to its pretrauma state over a relatively short period of time. However, with PTSD, the survival part remains in charge, and your stress response stays on high alert. The result is a whole host of debilitating mental, emotional, and physical symptoms that continue long after the traumatic event.
PRACTICAL EXERCISE — MEET YOUR TRAUMA
Take the time to reflect back on the traumatic experience that triggered the development of PTSD. There may be several traumatic experiences that contributed, but see if you can find the event that you most associate with developing PTSD. If you are not able to pinpoint just one, take the event that haunts you the most. Turn to the section in your workbook (or use your journal) and write everything you recall about this event without filling in any of the blanks in your memory. It is common not to remember certain aspects of your trauma. Some people have told their traumatic story many times and can talk about it from a detached emotional state. However, if you haven’t faced your trauma before, this exercise may be very difficult, so make sure your support person is available before starting. If you are worried about facing your trauma, remember that it is already haunting you, and trying to hide from it has not been successful. Take it slow. This does not need to be done in one session. If your fear, stress, anxiety, or physical symptoms become too unbearable, take a break. But make sure to come back to it later.
REFLECTIVE QUESTIONS
• What was the duration of your trauma? How long did it last (in hours, weeks, months, or years)?
• How much do you think about this event on an average day? In other words, how much does this traumatic event consume your thoughts?
• What do you think you’d be thinking about if PTSD wasn’t consuming you?
PTSD SYMPTOMS
It is completely natural to have an intense reaction during and after a traumatic event, but as the shock of the experience starts to wear off, most people return to a state of psychological and physiological balance. As they process their thoughts and emotions surrounding the traumatic event, their nervous system starts to settle down until it returns to its normal prestress state, a state often referred to as homeostasis or baseline. Those who develop PTSD, on the other hand, stay in a state of psychological shock, and as a result, their nervous system remains in a reactive survival state and several neurological systems become dysregulated.
Everyone experiences PTSD differently based on their unique nervous system, genetic makeup, and past experiences. Even when two people are involved in the same event, it can be experienced very differently, both at a perceptual level as well as at a biological level. For those who develop PTSD, their symptoms can vary widely, but there is a set of symptoms that must be present in order to meet the diagnostic criteria for PTSD:
• Symptoms must be present for at least one month.
• At least six months has passed since the trauma.
• Symptoms cannot be caused by medication, substance use, or other illnesses.
• Symptoms must be severe enough to create impairment in the person’s ability to function in several areas of their lives.
According to the DSM-5, these symptoms fall into four symptom clusters:
1. Intrusion symptoms
• Unwanted and involuntary thoughts, memories, flashbacks, and nightmares causing emotional distress and/or physical reactivity.
2. Avoidance
• Avoiding trauma-related thoughts, feelings, and external triggers (e.g., people, places, things, and situations that act as reminders of the trauma).
3. Negative alterations in cognition and mood
• Overly negative thoughts and assumptions about oneself, others, and the world, as well as persistent negative moods and difficulty accessing positive emotional states.
4. Arousal
• Hypervigilance (always being “on guard”) and heightened startle reaction (very jumpy).
In addition to the symptoms in these four categories, a person must also experience either derealization (the experience of feeling detached, disconnected, and dissociated from your surroundings) or depersonalization (the experience of feeling detached, disconnected, and dissociated from oneself, like an outside observer).
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