Only soldiers, veterans, and those in the line of fire experience post-traumatic stress disorder (PTSD). Or, at least, this is the image we have been presented with through a lack of understanding or appreciation of individual experiences, and the blurred lines of cinematic stories.
We are also led to believe that PTSD is not real, that a person should move on from whatever trauma they experienced, and that someone with PTSD will always be aggressive or violent and dangerous to be around. Limiting PTSD to the war-torn idea of shell shock or combat fatigue negates the reality of trauma and the impact this kind of intense distress can have on a person’s life. While war veterans are obviously at an increased risk of experiencing traumatic and violent events, trauma can be experienced in many ways and have a difficult impact on a person’s life. There remains a limited understanding of PTSD as a society. This mental health condition remains stigmatised, misconstrued, and narrated with an underlying theme of myths and misconceptions.
To break down the barriers and better understand PTSD, Jillian Doyle, Senior Clinical Psychologist and member of the Psychological Society of Ireland (PSI), balances fact from fiction.
1) Myth — Trauma will always result in PTSD
“Relatively few people who experience trauma will go on to develop PTSD,” confirms Doyle. We experience trauma, pain, suffering, and distress at varying levels throughout our lives, but the majority of those experiences will not result in PTSD. Various factors will determine how severe the response to the trauma will be. For instance, low self-esteem, poor connections with social groups, and repeated trauma will increase the risk of PTSD.
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“Most people will experience a traumatic event at some point in their life, however it is estimated that the prevalence of PTSD in the Irish population is 5%,” says Doyle. “People can experience traumatic events which push them into their fight or flight system and lead them to experience some of the symptoms of PTSD, but these symptoms resolve over time, in some cases with the assistance of a therapist, but without the need for a specific trauma focused intervention. Other people will develop post-traumatic stress disorder as a result of experiencing one or more traumatic events during their lifetime.”
Doyle reiterates that “whether a traumatic event develops into PTSD is not based solely on the event but on an interplay between the event, the unique strengths and vulnerabilities of the person who has experienced the traumatic event and the supports that person has had in their life both in the past and the present. At times two people may have experienced the exact same event and one person goes on to develop PTSD while the other person does not.”
2) Myth — PTSD will go away over time
There is often a belief that PTSD will occur immediately after a person experiences a traumatic event. However, this is not always the case and PTSD symptoms can appear months after an event. Similarly, a person may not recognise the symptoms of anxiety, stress, nightmares, and flashbacks as being indicative of PTSD, delaying a diagnosis.
“Like most mental health conditions, the symptoms of PTSD can ebb and flow over time depending on what is happening in a person’s life and the amount of stress they are under,” says Doyle. “PTSD is generally not diagnosed until three months after the occurrence of an event. Before this, clinicians adopt a supportive wait and see approach as sometimes some of the distressing symptoms settle by themselves. If a person continues to experience symptoms of PTSD after three months and these symptoms persist beyond a month then a diagnosis of PTSD may be warranted.”
The delay in recognising symptoms can be linked to how the brain stores memories after a traumatic or terrifying event. The memories are hidden away and difficult to process or recall as a result.
“Sometimes life events occur which could trigger PTSD symptoms that a person thought were resolved,” says Doyle. “For example, if a woman had a traumatic birth during her first pregnancy, she may experience symptoms of PTSD during a subsequent pregnancy. Most people who meet criteria for PTSD will benefit from engaging with a therapist with specialist training in this area. PTSD can be an overwhelming experience and the symptoms are very real and frightening therefore it is important that people experiencing this condition are supported to seek help.”
3) Myth — People with PTSD struggle to function
PTSD can be significantly debilitating with varying symptoms that can be especially persistent. It may feel as though the experience of PTSD will continue forever with feelings of fear and threat taking over a person’s life. However, this does not mean that a person will struggle to function.
“People with PTSD experience a number of difficult and distressing symptoms,” says Doyle, “for example re-experiencing the event, avoidance of anything to do with the event, high levels of fight or flight in the body, or feeling disconnected from themselves and others. Understandably, these symptoms can greatly affect a person’s quality of life and at times might impact on their ability to engage in certain activities.”
Doyle reiterates that at the severe end of the PTSD spectrum people might feel “very overwhelmed by their experiences and this makes functioning more difficult. However, most people with PTSD go about their daily lives — they have jobs, relationships, and hobbies.”
Adjusting to life after a traumatic event and getting the right support to treat the symptoms of PTSD will help a person adapt, change, and navigate their lives.
“One of the conversations I have with service users when I first meet them is around what coping mechanisms, helpful and unhelpful, they have developed in order to manage their emotions and trauma symptoms,” says Doyle. “It is important to help people think about the impact of their safety strategies on their life. Often times people seek treatment when the cost of their safety strategies become too high. With the right evidence-based treatment PTSD can be resolved and a person can be free to return to living without fear.”
Treatment options include Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Behaviour Therapy (CBT), talking therapies, medications, and group therapies. Treatment can greatly improve symptoms and a person’s quality of life post-trauma.
