Post Traumatic Stress Disorder
This is a specific form of stress-related illness that occurs after a person has experienced a highly traumatic event. It was first studied in the First World War when it was referred to as shell shock. Unfortunately, the army was not inclined to admit that these men were ill, preferring to view them as cowards, so many of those affected faced the firing squad. In the Second World War it was called battle fatigue. This time there was more willingness to understand and after the war asylums were opened where sufferers were treated and the condition studied. In recent years survivors of terrorist attacks and hostage ordeals have provided plenty of opportunity for further research.
Nowadays the commonest cause of PTSD in patients referred to me is road traffic accidents.
PTSD typically occurs when a person believes, if only for a moment in anticipation of the impact, that she will die or be terribly injured; or in witnessing a traumatic event, the person believes that a loved one is suffering, will suffer terribly, or will die. It tends to happen more to people who are affected by stress and its illnesses anyway, but it can happen to anyone, given trauma which is experienced as terribly disturbing.
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The symptoms emerge hours to some weeks after the event. The central one is flashbacks: vivid and intrusive memories of the event. These may be visual, like a film clip of the car approaching; auditory, like a tape of the sound of crunching metal; olfactory, such as the smell of burning fuel after the impact; tactile, such as pain from an injured limb; or gustatory, such as the taste of blood, for instance following being hit in the face by the steering wheel. In any case, these flashbacks cause great distress.
Together with flashbacks, a variety of other symptoms can be developed, including some, but usually not all of the following: a feeling of emotional numbness; withdrawal from social situations; irritability; jumpiness or a tendency to startle easily; inability to relate normally to family and friends; loss of interest in everyday things; anxiety; depression; and avoidance of cues that remind her of the event. She may avoid driving or being a passenger in a car, make long detours to avoid the scene of the accident, or be unable to watch anything on TV involving injury or death.
The flashbacks, hyper-arousal and withdrawal may render her totally unable to lead her life and this may go on for a long time if untreated. Sadly, the trauma of the event is sometimes surpassed by the losses that can follow a long period of symptoms: job, relationships, interests and self-esteem. However, in far more cases, the symptoms gradually fade over time, whether treated or not.
