• Perceived level of threat:
• Was the traumatic event perceived as intentional or unintentional, expected or unexpected, uncontrollable or inescapable? For example, imagine you are on the reality show Fear Factor, and you are willingly eating maggots in an effort to win the game versus being forced to eat maggots by your older brother who enjoys tormenting you. In both scenarios you are eating maggots, but in the first scenario you have control, it is expected and escapable, and there is no real or perceived threat of harm.
PRACTICAL EXERCISE — UNDERSTAND YOUR PTSD RISK FACTORS
Using the list above, identify all of the risk factors you believe may have put you at risk for developing PTSD. Write them in your workbook or journal.
REFLECTIVE QUESTIONS
• Of the factors you identified, which do you believe put you at highest risk for PTSD?
• Are there other factors not listed that you believe may have put you at higher risk?
• In examining your personal risk factors for PTSD, is there anything that surprised you? Why or why not?
POSITIVE PREDICTORS
Just as there are several known risk factors for developing PTSD, there are also several factors that are associated with a positive prognosis. It is shown that people who receive support and practice healthy lifestyle habits are more likely to achieve higher levels of functioning and a better quality of life. Although things can feel hopeless at times, there are several things within your control (or at least partially within your control) that can positively affect your prognosis, including:
• Early treatment: Several studies found that the sooner treatment is received, the better the outcome
• Subjective interpretation of the trauma
• Availability of support immediately after the trauma
• Social support network and sense of community/belonging
• Abstaining from alcohol
• Avoiding re-traumatization
• Mental, physical, and emotional fitness/wellness prior to traumatic event
• Healthy habits (good sleep, regular exercise, proper nutrition, etc.)
• The belief that you can, and will, recover
PRACTICAL EXERCISE — GET MORE SUPPORT
In order to contribute to your own recovery, it is important to identify the factors that are within your control and to get support to tackle them. Joining a support group can be hugely beneficial. These benefits include things like being able to talk openly to people who understand what you’re going through, feeling normal and less alone, and getting advice and feedback on how to cope. Try to find a local support group in your community and go to a meeting this week. For example, in Canada, Wings of Change is a peer support group that is education and solution-based for those who experienced work-related trauma. If your trauma is not work-related or if you live in a different part of the world, a good starting place would be to contact your local hospital, doctor’s office, counselling centre, or do some online research to find out what’s available in your area. Avoid support groups that focus on the details of trauma and instead find one that is focused on healing and recovery.
REFLECTIVE QUESTIONS
• What, if anything, have you been doing to keep yourself as healthy as possible?
• What things could you start doing to increase your predictors for a more positive prognosis?
• Do you plan to join a support group? Why or why not?
CONCLUSION
When acute stress caused by trauma has negatively impacted you physically and psychologically, you can feel as though all hope is lost. That you will never again be able to enjoy a healthy, happy, and peaceful life, but research has consistently shown evidence of the neuroplasticity of the human brain. While influenced by early childhood experiences and environments, our neurology is not set in stone. In fact, our brain circuitry can be rewired and reprogrammed to a large degree. Human beings are dynamic, and we are capable of change from the inside out. By further understanding PTSD at a neurobiological level, there is real promise of unlocking the mysteries that will lead to reliable assessment, detection, and effective treatment of PTSD.
CHAPTER TWO
MENTAL, EMOTIONAL, AND PHYSICAL EFFECTS OF PTSD
“It isn’t in my past, it’s in my every day.”
— Helen Wilson
Regardless of how you may appear on the outside, if you have PTSD, you are dealing with a lot on the inside. The unwanted thoughts, emotions, and physical effects of PTSD can be extremely debilitating and can cause significant impairments in your ability to function in several areas of life — mentally, emotionally, physically, spiritually, socially, sexually, financially, professionally, and in relationships. Even when you’re smiling or laughing, you may be overwhelmed by the erratic, agonizing, persistent, and devastating symptoms of PTSD. Therefore, this chapter is aimed at helping you recognize and understand your symptoms. Since it is impossible to cover everything you may experience, I will cover the symptoms listed in the DSM-5, as well as some other common effects of PTSD.
INTRUSIVE SYMPTOMS
The reexperiencing of trauma is a hallmark feature and diagnostic marker of PTSD. Intrusive symptoms such as flashbacks, nightmares, and disturbing memories are common in the weeks and months following a traumatic event, even for those who do not develop PTSD. For most people who experience trauma, these flashbacks and other intrusions become less frequent and less intense as time goes on. However, for those with PTSD, the distressing intrusive reexperiencing of trauma does not subside with time.
Flashbacks consist mostly of vivid sensory perceptions (images, sounds, smells, tastes, textures) that were experienced during the actual event. Here are some examples:
I can feel his weight against my body, his breath against my ear.
I smell smoke. I could swear it’s real. I panic every time, even though I should know by now that it’s just a flashback.
I hear the car skidding out of control, the sound of the transport truck downshifting, the loud, crunching sound of metal. I can’t explain how real it feels, but it’s like I’m actually there in that moment again.
I see the look on his face right before it happened. It’s like he’s right here in front of me.
For the person experiencing a flashback, it’s almost like there is a warp in the space-time continuum and they are back in the past reexperiencing the event. Flashbacks are not the only types of disturbing scenes and imagery you may experience. You may also have disturbing memories or nightmares, as well as intrusive thoughts. These consist of horrible, violent, repulsive, disgusting, threatening, and deeply disturbing thoughts that may or may not be related to your trauma. It can be images of despicable things happening to you or to your loved ones, or even scenes of you doing horrific things that you would never do in reality (attacking someone, hurting a child, sexually inappropriate or illegal behaviour, public displays of aggression, etc.). These involuntary thoughts bring guilt and can make the person fearful that they may lose control and actually do something terrible. They may believe they’re a horrible person for having such thoughts and that if they’re capable of thinking these thoughts, it must mean they are capable of doing these things. But this is not the case. The fact is, everyone has seen or heard these aggressive and disturbing types of things on TV, on the news, or somewhere else, and everyone has forbidden thoughts. Before developing PTSD, you had the ability to filter these things out of your awareness and block them with little effort. After PTSD, due to changes in brain structures and functioning which will be explained in the