Experiencing death, physical injury or sexual violence directly, being under the threat of experiencing these events in some way, witnessing what happened to a person or learning that it happened to a relative is defined as a traumatic experience in the psychiatric classification system . oneExperience of war as a civilian or military, physical violence (e.g. domestic violence, assault, extortion, etc.), sexual violence (e.g. childhood sexual abuse, rape, etc.), abduction, captivity, torture, terrorist attack , traffic accidents and natural disasters (eg earthquake, flood, hurricane, etc.) can be given as examples of traumatic events. Studies in Western countries show that one in four adults and almost everyone who has reached the age of 45 has experienced at least one traumatic event at some point in their lives. 2 It is accepted by experts that such events cause serious psychological problems in people.
Psychological Problems Developing After Trauma Experience
Studies show that the most common psychological problem in people who have experienced traumatic events is Post Traumatic Stress Disorder . Post Traumatic Stress Disorder, briefly referred to as PTSD , is a complex psychological problem defined by 20 symptoms. These symptoms are grouped into subsets of re-experiencing the trauma , avoidance , negative change in thoughts and feelings, and increased arousal . oneFor a person to be diagnosed with PTSD, it is not necessary to experience all of these symptoms together, it is sufficient to experience only a few of them in a way that impairs their functionality. Most people who develop PTSD have reexperiencing symptoms of anxiety and fear, and common avoidance behaviors. In some people, depression, malaise or irritability, which is accompanied by negative thoughts, may be more prominent. Some people show signs of increased arousal and reactivity more often, while others show signs of dissociation (dissociative symptoms).
Traumatic events can lead to many other psychological problems other than or in combination with PTSD, such as depression, anxiety disorders, alcohol and drug abuse or addiction, suicidal thoughts or attempts. Depression, which develops very frequently in people who have experienced trauma, also negatively affects the person’s life. If depression is not treated, it can cause substance abuse, social disability, family discord and increase the risk of suicide.
Post Traumatic Stress Disorder Symptoms
The person with PTSD recalls memories of the event in an involuntary way, but in a compulsive way. When the person remembers the event, he feels as if he is experiencing everything again, and he feels fear and distress and cannot easily get these memories out of his mind. Sometimes, when the person seems to be reliving the event, he loses awareness of what is happening around him, and may even exhibit the behaviors he exhibited during the event (eg shouting, falling, defensive behaviors). The person often has frightening, distressing dreams about the event. In the face of situations that remind the traumatic event, he feels depressed, distress, and fear, and often experiences physical symptoms such as heart palpitations, sweating, and trembling. Therefore, he tries to stay away from thoughts and feelings about the event he has experienced and situations that will remind him of the event he has experienced.
People who develop PTSD as a result of their trauma experience have ongoing feelings of anxiety, fear, anger, shame, and guilt. They often fail to feel positive emotions such as love, happiness, and satisfaction. They may distortly blame themselves or others for the event. Their thoughts about themselves, people, and the world in general become extremely negative (eg, no one can be trusted , no safe place , no control over my life ). They feel disconnected from the people around them, become withdrawn and lonely, and begin to lose interest in many things. Some people have difficulty remembering certain parts of the events they have experienced.
The person who develops PTSD spends days with an increased sense of restlessness. He suffers from insomnia most of the night, has difficulty concentrating and focusing, is irritable, and may show verbal or physical aggression by getting angry for trivial reasons. It is always on the alert in anticipation of a threat and often gives an extreme startle response at a sudden sound or movement. Some people engage in risky behaviors that harm or are likely to harm themselves (eg, cutting oneself, driving drunk, engaging in promiscuous sex).
After experiencing a traumatic event, it is expected that people will experience traumatic stress symptoms for a while. These symptoms usually develop within the first three months after the trauma and may subside spontaneously over time. Studies show that the probability of spontaneous recovery decreases after 6 months of trauma. Chronic PTSD negatively affects a person’s work, social, and family life and can last for years or even a lifetime if left untreated.
Example of a PTSD Case: Earthquake Trauma
To define PTSD through a concrete case example, let’s take a look at how a person who has experienced an earthquake usually experiences the symptoms of PTSD. For example, an earthquake survivor who was rescued from the rubble, the moment of the earthquake, the moments of being under the rubble and the moments he lived under the rubble, come to life for no apparent reason. Since these thoughts cause discomfort in him, he tries to get them out of his head. For this reason, he tries to distract himself with something, to distract himself from his thoughts. He is distressed by things that remind him of what he experienced during the earthquake. For example, because the clothes on that day, the things around him, the sounds of vehicles such as ambulances or helicopters remind him of the night of the earthquake, he becomes uncomfortable, excited, and has heart palpitations. The person has difficulty in entering buildings, cannot stay in the dark or alone, cannot sleep, take a bath, avoid images of debris or conversations, TV programs and news that reminds them of what they have experienced during the earthquake. In an earthquake, he thinks that people who do not experience what he has experienced will not be able to understand him, so he stays away from them. He cannot feel anything in the face of events that will bring joy to any person. The sentence “I can’t love my wife and children as much as before” is one of the most typical sentences that exemplify their inability to feel positive emotions. This person finds it pointless to make a plan or investment for the future because he has lost the house that he has been struggling with throughout his life and starts to live daily. He lives with the thought that his life can end at any moment. In addition to these, he waits on the watch with the expectation that an earthquake may occur at any moment, he often checks the lamps to see if we “wobble”. It gives an extreme startle response in the face of a sudden sound or movement. He cannot sleep at night and has nightmares about earthquakes. With the effect of insomnia and stress symptoms, his attention is impaired, he cannot give himself to his work, he makes mistakes, he experiences forgetfulness. Nervousness ensues. He attacks his wife, children, relatives and even others, shouts, swears, throws things, hits him with sudden bursts of explosion.
Risk Factors for PTSD
Events that threaten a person’s physical integrity can be so traumatic that it can be thought that anyone who experiences them will develop PTSD. However, studies show that 10% of people with trauma experience develop PTSD on average. 2, 3In other words, the vast majority of people who have experienced trauma can survive the event without developing psychological problems. The traumatic event that a person is exposed to is a very important factor that determines the risk of developing PTSD. Studies show that being sexually assaulted is the most likely event to cause PTSD in both men and women. In addition, conflict in war, childhood neglect and abuse, sexual harassment and physical assault seem to increase the likelihood of PTSD. Accidents, natural disasters, and witnessing a traumatic event seem to produce PTSD with a relatively lower probability.
It is possible to summarize the findings of studies examining risk factors for PTSD in three groups: pre-traumatic factors, traumatic event-related factors and post-traumatic factors: 1, 4-6
Pre-traumatic demographic and personal history factors:
- female gender
- History of psychiatric illness
- Family history of psychiatric illness
- Childhood abuse history
- low education level
- Low socio-economic status
Factors associated with trauma:
- trauma severity
- Perception of life-threatening danger during trauma
- type of trauma
- Negative emotional reactions such as fear, helplessness, loss of control, and horror during or immediately after the trauma
- Dissociation during trauma
Post-traumatic factors:
- Decreased sense of control over one’s life
- Financial loss due to trauma and related adverse events
- Perceived low level of social support
Effective Psychotherapies for PTSD
As the effects of traumatic events are understood, many psychological treatment approaches have been developed for PTSD and their effects have been tested in studies. Meta-analyses compiling the findings of randomized controlled clinical trials show that the most effective psychological treatments for PTSD are trauma-focused psychotherapies. 7,8 Trauma-focused psychotherapies are approaches that aim to eliminate the effects of the traumatic event on the person by changing their thoughts, beliefs, feelings and behaviors related to the trauma. The American Psychological Association’s Clinical Practice Guidelines strongly recommend the use of Cognitive and/or Behavioral Therapy protocols in PTSD cases . We will discuss these treatments in a separate article.
resources
1 American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Edition). Washington, DC:American Psychiatric Association.
2 Norris, F. H. & Slone, L. B. (2007) The epidemiology of trauma and PTSD. In M. J. Friedman, T. M. Keane, P. A. Resick (Eds.), Handbook of PTSD: Science and Practice (pp. 78-98). New York: The Guilford Press.
3 Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM-IVand DSM-5 criteria. Journal of Traumatic Stress, 26, 537-547.
4 Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology,68(5), 748-766.
5 Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Bulletin, 129(1), 52-73. Journalof Consulting and Clinical Psychology, 68(5), 748-766.
6 Basoglu, M., & Şalcıoğlu, E. (2011). A Mental Healthcare Model for Mass Trauma Survivors: Control-Focused Behavioral Treatment of Earthquake, War, and Torture Trauma. Cambridge:Cambridge University Press.
7 Bradley, R., Greene, J., Rus, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-27.
8 Bisson, J.I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner S. (2007). Psychological treatments for chronic post-traumatic stress disorder – Systematic review and meta-analysis. British Journal of Psychiatry, 190, 97-104.
