Many people experience a traumatic incident in their lives, yet most people do not develop PTSD (Post-traumatic Stress Disorder). Why is it that one person develops PTSD in response to a trauma, while another experiencing a very similar event does not? And how might having untreated PTSD be affecting your life?
Most people who experience trauma in their lives naturally recover. For example, lots of people are in car crashes, are impacted by an act of terror or natural disaster, or experience a sexual or physical assault and they experience little long-lasting impact. These people can get behind the wheel of a car again or go to public places or let themselves experience physical intimacy with little anxiety. This usually happens because they are naturally exposed to stimuli which has been associated with the traumatic incident (e.g., driving through a busy intersection, going to a crowded market) and they tolerate the anxiety that arises when faced with it. The stimuli reminds them of the trauma, they tolerate it and approach it, and they become used to it. Over time they no longer associate the stimuli, or “trigger,” with the traumatic event. For example, a survivor of a severe car crash might get right back behind the wheel as soon as they are physically able. Although that person might be nervous at first, if they get behind the wheel repeatedly, they will likely find themselves “getting used to the situation” or technically speaking “habituating” to the anxiety associated with the accident.
In contrast, someone else might suffer a car crash, and find it terrifying to drive again. In fact, that person might not even feel it safe to be a passenger in a car; or even safe to be around places where there is traffic congestion. Over time, they may become fearful of being on the road entirely, and may have difficulty going to work or leaving home. This type of avoidance and generalization of fear, is what fuels the development of PTSD.
People develop PTSD for many reasons and some people are more at risk than others. For example, people who develop PTSD after a trauma in adulthood, often have a history of childhood trauma (e.g., physical or sexual abuse, neglect) or other pre-existing traumatic events. Other risk factors for developing PTSD include having a predisposition to anxiety, or a tendency to rely heavily on avoidance behaviors (substance use, isolation, etc.) to cope.
PTSD has many symptoms, and the hallmark of these is avoidance. When someone suffers from PTSD, their world becomes much smaller as they avoid any reminders of the trauma including thoughts and feelings associated with the trauma, and also perhaps people, places, things, or situations that are associated with the trauma. People suffering from PTSD often find it difficult to speak about how they feel and what they are going through. The symptoms of PTSD are painful and frightening and the pull to avoid anything related to the trauma is powerful. As a result, they often avoid conversations about how they are feeling, what they are experiencing and what they are doing in their lives. In addition, other symptoms include excessive jumpiness, feeling always “on alert”, irritability, agitation and great difficulty feeling calm, or at ease.
As you would expect given these symptoms, PTSD can make relationships more challenging. People who have PTSD often start to feel more detached and uninterested and can over time begin to feel as though they can no longer relate to others, and others might not be able to relate to them.
The reality is that although avoidance alleviates anxiety in the here and now, avoidance holds long term consequences for our lives. The world becomes much smaller; and you may find yourself living your life without the joy you once had. Decision-making is no longer in service of living a full life, it instead is in service of managing fear, anxiety, and avoiding any reminders associated with the traumatic event.
So, can one recover and if so, how? And, given how scary this whole thing is, why would you even want to talk about your trauma? The reality is that PTSD is treatable and curable. PTSD however, does not just go away on it’s own; it requires treatment in order to resolve. Some of the reasons one might choose to get treated include not only the opportunity to regain autonomy over one’s life, but also to be able to feel physically and emotionally better. It can be very physically and psychologically exhausting to have PTSD and oftentimes, people with PTSD suffer from physical ailments, which are not necessarily diagnosable and treatable by a medical doctor. The brain and body are after all intimately linked.
The good news is that, with treatment, living a full life and returning to the people and experiences that once brought you joy is possible. Life does not have to be so small and limited and relationships and friendships can be rekindled. Treatment is designed to help you learn different and new coping skills in service of navigating the world by turning the volume down on avoidance as a coping strategy.
There are many evidenced based treatment options available, most notably, Prolonged Exposure therapy (PE), Skills Training in Affective and Interpersonal Regulation (STAIR), Cognitive-Processing Therapy (CPT) and Eye Movement Desensitization and Reprocessing (EMDR). All of these treatments are well researched, evidenced-based treatments for PTSD and complex trauma. If you or someone you love is experiencing any of these symptoms we encourage you to consider seeking treatment and explore all of your options as it will help you regain your life and work towards healing.