POST-TRAUMATIC STRESS DISORDER (PTSD)

Post-Traumatic Stress Disorder (PTSD)

Classified as an anxiety disorder, Post-Traumatic Stress Disorder (or PTSD) is a serious condition that may develop after being expose or witness to one or more traumatic events. Though most people who experienced a traumatizing event may not developed PTSD, women are more likely to develop PTSD than men as women are more likely to be victims of domestic violence, abuse and rape. Children less than 10 years old tend to suffer less from PTSD than adults. Family members, friends or those in close contact with the victim can develop PTSD as they can be experiencing the paranoia of the sufferers. Their support or help given to the sufferer following the trauma can likewise influence the development of the trauma or reduce the severity of the symptoms, meaning that any confrontational attitude displayed by them can further exacerbate or re-traumatized the conditions of the sufferers. 

Those who do develop PTSD, the trauma may have lasting consequences causing many problems ranging from emotional issues like anger, intense fear, anxiety or irritability to psychological problems like survivor’s guilt, paranoia to panic attacks. Sufferers of PTSD is very wide ranging, while many victims do have direct experience of events like survivors of disasters, war, suicide attacks, accidents, violent personal assaults, rape or sexual abuse. But there are also many like those performing rescue work or disaster relief activities seeing the horrible situations, develops into PTSD as well. Children can develop PTSD after witnessing events like violent quarrels between parents leading to a divorce, drunken parent assaulting their spouses or seemingly as trivial as the death of a pet (like the death of a gold fish maybe trivial to adults, it may not be for the child). PTSD sufferers usually get depressive further isolating themselves from those around them, leading it to a vicious cycle of isolation. It is quite common for sufferers to use alcohol or substances initially to numb themselves but their inability to control the consumption of such intoxicants can eventually lead to becoming an abuser of such intoxicants instead. 

What Are the Symptoms of PTSD?

The severity and duration PTSD varies from individual to individual. Some people recover within six months, while others suffer much longer, even years if left untreated. Symptoms are often grouped into three main categories, including :

·         Disturbing recurring flashbacks – Many with PTSD will repeatedly re-experiencing the ordeal in the form of flashback episodes, memories, nightmares, hallucinations or frightening thoughts especially when the events or objects they experienced reminiscent of the trauma. Anniversaries of events can also trigger PTSD symptoms

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·         Avoidance or numbing of memories of the event – Sufferers of PTSD experiences emotional numbness, sleep disturbance, depression, anxiety, irritability or outbursts of anger. Feelings of intense guilt are also common among many sufferers. They may avoid certain people, places, thoughts or situations that remind them of the trauma leading to further feelings of detachment and isolation, even from their own family and friends. They may even lose interest in certain activities that they may have enjoyed previously.

·         Hyper arousal (high levels of anxiety) – includes excessive emotions, problems relating to other people including abilities to show affections or feelings, difficulty falling asleep, irritability, outbursts of anger, inability to concentrate and being “jumpy” or easily startled. Sufferers may also show physical symptoms like increased blood pressure, headaches, gastrointestinal distress, immune system problems, dizziness, rapid breathing, cheat pains, discomfort in other parts of the body or even diarrhoea. 

Children suffering from PTSD with risk increasing exponentially if their exposure to the event increases. They may suffer from delayed development in areas of toilet training, motor skills and language.

An example of post-traumatic stress disorder was the Oklahoma City bombing in the United States. Over a third of the bombing survivors developed PTSD, with half showing signs of anxiety, depression and alcohol abuse. After a year later, Oklahomans in general had a marked increase in the use of alcohol and tobacco products, as well as PTSD symptoms. As for children, even after two years later, 16 per cent of the children in a 100 mile radius of Oklahoma City with no direct exposure to the bombing had increased symptoms of PTSD. It could be due to weak parental response to the event, having a parent suffering from PTSD symptoms or increased exposure to the event via media coverage, i.e. TV reports, newspaper, posters, etc. or even photographs of the event, all increases the possibility of the re-traumatizing the child to develop PTSD symptoms as young children cannot distinguish between the actual event and the repeated viewing of the event in the media. 

How To Treat PTSD Sufferers?

The main goal of the treatment is to reduce the emotional and physical symptoms. Improving the sufferer’s daily functions can help the person to better cope with the event that triggers the disorder. Treatment for PTSD may involve medication, psychotherapy, non-verbal therapy ( expressive work ) and stress management.

In psychotherapy, it involves helping the sufferer to learn skills to manage symptoms and develop ways to cope with it. The treatment also aims to teach the person’s family members about the disorder but the main approach is to help the sufferer work through their fears associated with the traumatic event and the approaches used to treat sufferers includes the following :

·         Cognitive Behavioural Therapy – involves the sufferer learning to recognize and change thought patterns leading away from the troublesome emotions, feelings and behaviour.

·         Transformational Therapy – change therapy. 

·         Exposure Therapy – a type of CBT involving the sufferer reliving the traumatic experience or exposing the sufferer to objects or situation that cause the anxiety but it must be done in a well-controlled and safe environment. This form of therapy helps the sufferer to confront their fear, leading them to gradually become more comfortable with the situation that frightens them and causes the anxiety. This technique has been employed very successfully in the treatment of PTSD sufferers.

·         Psychodynamic Therapy – this method focuses on helping the sufferer examine their own personal values and the emotional conflicts caused by the traumatic event.

·         Family Therapy – an alternative way to treat the sufferer as the behaviour of the PTSD sufferer can have an effect on other family members.

·         Group Therapy – could be helpful to those suffering from PTSD by allowing them to share their thoughts, fears and feelings with other people who have experienced traumatic events.

·         Eye Movement Desensitization and Reprocessing (EMDR) – a complex form of psychotherapy that is designed to alleviate distress associated with traumatic memories.

CASE STUDY - POST-TRAUMATIC STRESS DISORDER (PTSD)

Case Study – A Child Who Suffered PTSD From The Death Of A Care-Giver

Apart from attending school, Winnie had to attend private tuition classes at her tutor’s home. She had been taking tuition classes for the past three years. Each time she was there, the tutor’s husband would play with her or cook for her. He treated her like his own daughter as they do not have a daughter of their own. She had grown very close to him. When she was around 12 years old, he was involved in a car accident and passed away. 

His death had traumatized her very much but she still had to go to the tutor’s house for her tuition. In the tutor’s home, a memorial altar was set up to honour the memories of him. Each time, she would be seeing the memorial altar with a picture of him adorned with flowers and candles. But it was his picture re-traumatizing her giving her a lot of fear. She tried her best to avoid looking at his picture. In her mind, she tried her best to believe that he is still alive and kicking. She even told her mother about her fears of going there, but her explanation was rejected and she was forced to go to the tutor’s home for her tuition. After repeated exposure, Winnie started to have flashbacks whenever she reached the doorstep of her tutor’s home, she would become very depressed and cried a lot. She was very angry at her mother as she felt that her mother didn’t care for her and for accusing her of lying.

Her condition may not have developed into PTSD, but from a very young age, her mother due to her own belief in ghostly manifestations would be talking to her and others, filling her mind with such things. She started to see his ghostly appearance first in the tutor’s home, but as time progresses, she began to see his ghost appearing in her own home as well. Her behaviour started to become very erratic, refusing to go anywhere within the house or even to the toilet if no one accompanies her at all. Her condition caused her mother to panic and her mother started to consult me about it. Before that they even brought Winnie to see some mediums  in the hope that their spiritual powers could exorcise his ghost and restore her back to her sanity. Instead, this was added on to her trauma. Apart from the run-around by her mother,  visitations to mediums . All this made Winnie develop a strong sense of helplessness and added on more impact in PTSD . 

Treatment Plan

Winnie’s treatment started off with some sessions that allowed her to share her story and let out her frustration pent up inside of her. As she was constantly being reminded that she was fabricating the story of seeing the ghost of her tutor’s late husband, these sessions were meant to communicate and build trust. So by listening and accepting her story as she told it demonstrates respect and acceptance of her. As she was over-protected by her parents, she lacked the space and privacy needed for her to grow and it affected her sense of belonging. She needs to feel that she is not going to be stigmatized in the same manner by them and she eventually develop her confidence in me. 

The sessions didn’t involve the use of psychotherapy because she was full of fear, overwhelmed by her negative emotions and pressures from her family. Also what she told me fell outside the purview of our sense of reality, e.g. ghosts or ghostly manifestations. It was better to work on her thought processes and how she could move on. In this case, I used Psychodynamic approach as well as Humanistic approach to help and support her with a lot of empathy. Added on to her treatment was the use of non-verbal therapies or expressive techniques as it allowed her to express her anger, fear, feelings and tears (for the trauma caused her to cry a lot). 

At this moment, she was still at the grief and loss stage. It made her very vulnerable, showing signs of depression and anxiety with the occasional outburst of anger. The non-verbal therapies allowed her to externalize her grief and loss. Slowly she started to feel relieved and then feeling good and regain her confidence towards herself. She eventually accepted the death of her tutor’s late husband. Apart from treating her condition, I had to rebuild her communication and bonding back with her parents because the support from her family is very important.

She eventually moved forward with her life happily, preoccupying herself with a lot of activities. She is much closer to her mother and since her mother’s realization of her trauma she was allowed to stop going to the tutor’s home to end her re-traumatizing herself. Even when she is off her treatment, I’m still giving her support. It is with my support and her re-bonding back to her mother that Winnie can move on ultimately.