Symptoms Of PTSD
What is PTSD?
PTSD stands for Post-Traumatic Stress Disorder and is a term used since the 1980s to describe the symptoms which can occur for those exposed to traumatic events.
Who is affected by PTSD?
1 in 5 people who experience a traumatic event go on to develop symptoms of PTSD.
PTSD receives most public recognition through its association with combat veterans and the debilitation it brings to many soldiers’ lives when they return from conflict.
It is also widely recognised as being a major risk for those who have witnessed large-scale terrible and horrific events, such as a major disaster, environmental catastrophe or terrorist attack.
There is a gradually increasing awareness that PTSD can, in fact, affect those involved in a whole range of traumatic life events. Some examples might include traumatic childbirth, assault, sexual assault, childhood abuse, robberies and hostage situations, traffic collisions and other serious accidents. It can also be caused by witnessing or learning of a traumatic event experienced by important others.
The reality is that trauma can involve any experience that was frightening, potentially life-threatening and totally overwhelming for the person involved. Whether an event is experienced as traumatic is subjective and linked to a number of factors.
Trauma can affect any one of us.
Symptoms of PTSD
How can you tell if you or somebody you know is suffering from PTSD? The symptoms of PTSD fall into four main categories:
- 1.Intrusion Symptoms
- 2.Persistent Avoidance
- 3.Negative Alterations in Cognition & Mood
- 4.Alterations in Arousal & Reactivity
Below is a breakdown of how each of the PTSD symptom groups might manifest themselves…
Recurrent, involuntary and intrusive memories
This is when a person just can’t stop thinking about all or aspects of the traumatic experience. It is when memories of the experience come flooding in when you don’t want them to and disturb your ability to live day-to-day life. This can be experienced as a whole memory or just fragments of it.
These are usually very vivid, disturbing or even haunting dreams from which you might wake up with a real startle. It might take some time to figure out where you are and that you were dreaming. Often such dreams are accompanied by strong physiological and/or emotional discomfort such as sweating, heart-racing or feeling very upset (explained more, below). You might not always remember what your dream entailed and it may not directly relate to the specific trauma you experienced. Traumatic nightmares usually feel very unpleasant, real and disturbing at the time.
Dissociative reactions (e.g. flashbacks)
Dissociative reactions occur if during the traumatic experience it was impossible to either escape (flight) or defend (fight). In such situations our brain/body system automatically goes into a shut-down (freeze) response, which involves numbing or immobilisation. People affected in this way often experience flashbacks, during which they feel as if part or all of the trauma is happening all over again, even though the trauma is over and in the past. This can feel so vivid and overwhelming that sometimes while this happens people don’t even notice their present surroundings. Sometimes, dissociative flashbacks can be so strong and overwhelming that they lead to periods during which a person blacks out completely and they loose temporary consciousness of their surroundings. This can be mistaken for an epileptic fit. There are several other dissociative reactions that can occur and they all include some disturbance of current reality. (Dissociation is such an important area that we will write more about this on a separate resource centre page).
Intense or prolonged distress at exposure to traumatic reminders
This refers to you experiencing distressing emotions that can even linger on for longer periods of time in response to unbidden reminders of the trauma. Such emotions, could, for example, be anger, sadness, rage, terror, horror, disgust, shame, guilt and others. They are directly triggered by memories of the trauma.
Marked physiological reactivity after exposure to trauma-related stimuli
The bodily reactions that people often experience when they are reminded of the trauma can be extremely distressing and can also linger on for some time. They might include heart-pounding, sweating, breathing difficulties, palpitations, cold shivers, headaches, migraines, strong tension, blurring of vision, muscle pain and others.
Avoidance of trauma-related thoughts or feelings
For many their traumatic experience has been so overwhelming that they can’t bear to re-experience any thoughts or feelings related to it. They avoid talking about it altogether or they may talk about it in a detached way that enables them to avoid those aspects that are deeply disturbing to them. When other people question them about details of the trauma they may try and change topic or turn things into a joke, attempting to minimise the true impact that these experiences have had. People may also engage in various distraction techniques to avoid the intrusive thoughts about their experiences.
Avoidance of trauma-related external reminders –
(people, places, conversations, activities, objects, situations)
Many of those affected avoid places, activities or people related to a traumatic experience in order to reduce the distress that might be caused by reminders of the event. Although an entirely understandable coping response the costs associated with this are often that a person’s daily life becomes very restricted, loses its spontaneity and a previously active social network and activities maybe significantly cut-down or curtailed. Some people lead very isolated and lonely lives as a result.
Negative Alterations in Cognition and Mood
Inability to remember key features of the traumatic event
For many people their traumatic experience has been so overwhelming that they have dissociated from certain aspects of it. These are those aspects which are ‘unbearable’ for them to remember. These are not lost but are retained in memory systems not immediately available to conscious recall. When specific therapeutic conditions are established that make the remembering of these aspects bearable, they can be brought into consciousness, safely processed and integrated. The not remembering of these aspects doesn’t make life easier, because these experiences and the associated bodily sensations and emotions still exist and have their impact on life, but because they are not remembered and not under a person’s conscious control they can have unpredictable effects.
Persistent negative beliefs and expectations about oneself, others or the world
Traumatic experiences can have a major impact on people’s view of themselves, others and/or the world. Depending on the nature of their experience, people may lose faith in the good in others or they may feel they have failed by having acted or not acted in ways which afterwards they are struggling to come to terms with. All this can result in persistent feelings of gloom and negativity with little hope of change in the future. Sometimes this is incorrectly diagnosed as depression, when the actual underlying problem is a trauma.
Persistent distorted blame of the self or others for causing the
traumatic event or resulting consequences
Blame arises when people struggle to accept what has happened. They still wish it was different and they find it hard to cope with their underlying feelings of very deep inner sorrow, sadness or anger. This may then get expressed in lingering feelings of blame or self-blame, which can really keep a person stuck.
Persistent negative trauma-related emotions –
(e.g. fear, horror, anger, guilt or shame)
Trauma is not something that people are prepared for and it usually leads to some negative, maybe even devastating outcome and often to profound changes or ruptures to life as it has been. It is therefore entirely understandable that people experience negative emotions as a consequence. They may feel uncontrollable bouts of anger or rage, or feel terror, fear or horror, or feel guilty about something they think they should have done differently. Some people also feel guilty about surviving when others didn’t. They may also feel shame about what happened. Shame is very common in trauma involving sexual abuse and may make it difficult for those affected to report a crime. Shame, guilt and self-blame may have been deliberately induced by perpetrators in an attempt to silence their victims.
Markedly diminished interest or participation
in pre-traumatic significant activities
People commonly lose interest in some or many activities they may have previously enjoyed. This is because their brain is so preoccupied with coming to terms with what happened that people feel utterly depleted with little motivation, energy or focus left to engage in outside activities. These may lose their previously positive meaning and people can’t access the enthusiasm which they may have felt before the trauma. Sometimes people are also now frightened to venture out and do things.
Feeling alienated from others
The impact of trauma can be so profound that those affected may start to feel very different from others around them, such as their family or loved once. They may feel that nobody understands the changes affecting their mind and body as they might find it very difficult to describe and communicate these in words. They may experience others as impatient with them. Subsequently, they may withdraw more and more and emotionally isolate themselves from others. People may feel that they are trapped in their own very lonely bubble alienated from others.
Persistent inability to experience positive emotions
Trauma programs the brain to be readily alert to new danger. The focus is therefore much more biased towards negative or dangerous stimuli rather than positive or pleasant ones. People frequently lose their natural capacity for humour and no longer laugh or find things funny which they used to find amusing before. They may also struggle to feel compassion or love and they may now feel numb or dull about things that they previously used to enjoy. It can feel quite hopeless and as if all sense of light-heartedness has left them.
Alterations in Arousal and Reactivity
Irritability or aggressive behaviour
When the brain is under constant arousal as a consequence of trauma, even small things can act as triggers. People’s level of tolerance is much lowered, and they frequently find themselves far more irritable or even aggressive than before their trauma. They may be quite unpredictable in their moods and this can make others around them quite vary and unsure, which can make their irritability even worse. Some people become quite aggressive, use bad language or shout or may lose control over their behaviour and become physically violent. If you are affected by the latter it is very important that you contact your GP or seek expert professional help in order not to harm yourself or others.
Reckless or self-destructive behaviour
For some people the trauma was so horrendous, or they survived under such extreme circumstances, that they may lose all care for others or themselves. They may now tempt fate and engage in very reckless and dangerous behaviour, almost as if to test that they shouldn’t have died. This is often associated with feelings of extreme inner numbness or a sense of real emptiness inside, often linked to severe dissociation. If you are affected by this, it is very important to contact your GP or seek expert professional help in order not to harm yourself or others.
Trauma has put your brain into a state of high alert in an attempt to avoid further danger. While this was vital at the time of the actual trauma, it is exhausting when this continues even when circumstances in your life now are safe. You may find yourself feeling on constant alert or you may get triggered into high states of arousal even in response to seemingly harmless triggers. You may also find yourself worrying about your family’s safety and you may scan your environment for things that aren’t even there. You may also find yourself engaging in so-called ‘safety-behaviour’, where you may over-check things for their safety or go through lengthy procedures in an attempt to keep things under control now, even when there is no danger.
Exaggerated startle response
Many trauma survivors experience strong startle reactions in response to sudden unexpected movement or sound. For some their reaction to this may be so strong that they may dive underneath a nearby table or engage in some other quite strong behaviours in response to these triggers. A sudden movement or noise may remind their brain/body system of noises or movements that happened during their trauma and now triggers flashbacks and fear responses, even though the here-and-now is safe. This can be very disturbing and disconcerting for a trauma survivor.
Problems with concentration
A traumatised person’s brain functions can become so pre-occupied with keeping the person safe in the here-and-now, that often there is less capacity available for tasks that require focus and concentration. People find that their memory is impaired, for example, they forget things, have to write themselves lists or can’t remember things that were previously easy for them. They lose track of conversations or while watching a movie. Some people struggle with reading a book even when before the trauma they were avid readers. People sometimes think that this is because they are getting older and they may be getting some form of dementia, but when there has been trauma, this is more likely to be the actual cause.
Sleep disturbance – (e.g. difficulty falling or staying asleep or restless sleep)
People often can’t settle easily and it may take them a long time to drop to sleep – lying awake for hours even though they know they are tired. Others experience frequent night waking, sometimes in response to bad dreams or nightmares and others early morning waking, unable to settle themselves back to sleep. People also report despite having slept not feeling rested anymore. Sometimes people experience all of these types of sleep disturbance and they feel exhausted and deprived of good quality sleep.
Dissociation, its Function and Effect
It is important for those affected by trauma to be aware of the function and effect of dissociation. The ability to dissociate is inherent in all of us. Without it the human species couldn’t have survived all the experiences of turmoil, conflicts, wars, pillages and violations that have been and are still pervading our beautiful planet Earth. Dissociation has the function to disconnect us from emotionally unbearable feelings and body sensations to regulate disturbing emotional or sensory overwhelm during traumatic events to ensure our survival. The unbearable emotional and sensory content of these traumatic experiences is split off into separate subconscious memory systems, which may not at all or only fleetingly or in very fragmented form enter our day-to-day awareness afterwards. This allows for another part (or parts) of the person to survive the traumatic experience. This process happens automatically during trauma as it is governed by the autonomic nervous system and it is not under conscious, rational control. For some people this creates the sense that it is almost ‘as if the trauma never happened’ or ‘they know that it did happen but can remember only certain parts of it’ or ‘they can’t access and feel the emotions or body sensations that they know should be connected to it’.
Dissociation is necessary and inevitable but can have long term negative effects
Although dissociation is a necessary and inevitable survival function during trauma, if maintained afterwards, it stops a person from remembering what really happened, from healthily working through the meaning of it and fully integrating it as part of their life experiences. Many people who have experienced traumatic events carry on with day-to-day life as if nothing happened, maintaining this split, which they may not even be aware of. While on the surface this may seem adaptive, it prevents a healthy and full living experience. It can also put a person at considerable risk because they can’t remember the full story which may give them a false perception of reality, minimizing or maximizing potential danger.
These split-off disturbing emotional or sensory memory structures do not spontaneously resolve or disappear. They remain in a person’s memory systems and negatively affect a person’s health and well-being, even without their conscious awareness. People who have been affected by trauma often are aware of an inner split between the part of them that tries to carry on with normal day-to-day life and their struggle with keeping overwhelming, intrusive emotional or sensory disturbing aspects at bay. These manifest as some of the symptoms of trauma described in the PTSD Symptoms section above, either during waking hours or also during sleep in the form of nightmares.
Coping with the inner state of fragmentation
With increased social alienation, the rupture of family systems and the lack of authentic emotional support in social communities many people feel very isolated following the aftermath of their horrifying experiences, not being able to resolve this inner split. Frequently, people try to cope with their inner state of fragmentation and unease through the use of alcohol, pharmaceutical or recreational drugs or other forms of addiction. Although this may provide temporary relief through the numbing or blocking of these emotions, ultimately it does not resolve the inner fragmentation or lead to integration and healing from people’s painful experiences. On the contrary it creates dependency and decreases a person’s self-governance, power and well-being.
It is therefore of utmost importance that the symptoms of dissociation in response to your trauma are recognised and worked with in a way in which the traumatic experience can be processed safely so that all aspects of it can be integrated into full conscious awareness. Depending on the severity of your traumatic experiences and your resulting degree of dissociation, therapy may require careful pacing and the length of your therapeutic process will need to be adapted accordingly.
Recognising the Symptoms of Dissociation
There are many potential symptoms of dissociation and some of these can be very subtle. People frequently do not experience all of these together but may just suffer from some of the symptoms listed below. Each person is unique and affected by trauma in different ways. Healthcare Professionals and therapists who are not trained in this area may not recognise the symptoms or realise that dissociation exists. If dissociative symptoms are not taken into account therapy might not work or may be experienced as re-traumatising and lead to a further increase in fragmentation. It is therefore very important that you work with specialist trauma therapists who are skilled at recognizing your symptoms of dissociation and can tailor your therapeutic process accordingly.
- Familiar surroundings no longer look the same even though nothing external has changed
- Surroundings, people or things in it are perceived through a haze, even though they are real, it feels to you as if you are in a daydream
- It feels as if you are not really in your body, as if you are floating or watching yourself from the outside. It may feel as if you are looking in on yourself and you don’t feel quite connected to your body
- You may feel numb or shut down in parts of your body and can’t feel yourself in those places
- You may struggle to recognize your reflection in the mirror, you may see someone/something other than yourself
- You may not feel the same height or size (maybe you feel much smaller, much bigger, much younger or much older than you are)
- It may be difficult to focus and keep on track with what is going on around you
- You may find yourself loosing significant amounts of time in your day during which you can’t remember what you did and where the time went
- You may have lapses in your memory, for example, being unable to recall significant and emotionally important events in your life or specific aspects of the trauma
- You may find yourself in places, locations or with people (sometimes totally unfamiliar) and have no idea or recall of how you got there
- You may find unfamiliar items at home of which you have no idea how they got there or when you bought these
- You may lose memory of salient conversations and agreements that you have made or forget to turn up to meetings or places
- You may have no or very little memory of what your childhood was like (even for ages 5 years onwards)
- You may not be able to complete threads of conversation because internal voices in your head distract you and you forget what you wanted to say
- You may be aware of different voices in your head or hear sounds that are interfering with your normal functioning or are disturbing
- You may be aware of different parts of Self, sometimes with totally different identities and behaviours (you may feel confused or embarrassed about this and try to compensate for this by covering this up)
- Somatic symptoms, such as unexplained physical pain, chronic headaches or migraine can also be a sign of underlying dissociation
- Sleep walking
- Some people experience involuntary, uncontrollable nervous tics or facial grimacing
- Catatonia. This is the involuntary ‘freezing’ into particular body postures and holding these for varying length of time. When a person experiences this they can usually not get themselves out of this even when asked to do so.
Recovering from PTSD
PTSD is a condition which can be overcome.
It may seem a bit daunting to realise how many different symptoms PTSD entails and it is therefore very important that you seek expert help with a professional who has experience of working with trauma. Every situation is different and so finding the best form of treatment for a person’s individual circumstances is the key to success.
When a person experiences trauma, the body stores information from the event both in the brain and the body. Because of this, both psychotherapeutic approaches and body-centric techniques have an important role to play in PTSD recovery.
Psychotherapies such as Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-Focussed Cognitive Behavioural Therapy (TF-CBT) are both widely recognised to facilitate recovery from PTSD. These are often most effective when combined with a range of body-centric approaches, including Comprehensive Resource Model (CRM), Sensorimotor, Somatic Experiencing, Trauma-Informed or Trauma-Sensitive Yoga Therapy or Mindfulness-Oriented Interventions.
You can learn more about PTSD symptoms, PTSD treatments, and read a PTSD case study by following the links to our other PTSD resource centre pages below.