Trauma Counselling

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Post-traumatic stress disorder (PTSD) is a mental health disorder that begins after a traumatic event. That event may involve a real or perceived threat of injury or death.

Kinds of traumatic events

The most common events leading to the development of PTSD include:

· Combat exposure

· Childhood physical abuse

· Sexual violence

· Physical assault

· Being threatened with a weapon

· An accident

Many other traumatic events also can lead to PTSD, such as fire, natural disaster, mugging, robbery, plane crash, torture, kidnapping, life-threatening medical diagnosis, terrorist attack, and other extreme or life-threatening events.

People with PTSD feel a heightened sense of danger. Their natural fight, flight or freeze is altered, causing them to feel stressed or fearful, even when they’re safe.

Most people with post-traumatic stress disorder repeatedly re-live the trauma in the form of nightmares and disturbing recollections — called flashbacks — during the day. The nightmares or recollections may come and go, and a person may be free of them for weeks at a time, and then experience them daily for no particular reason.

PTSD can occur at any age, including childhood. The disorder can be accompanied by depression, substance abuse, or anxiety. Symptoms may be mild or severe — people may become easily irritated or have violent outbursts. In severe cases, they may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was initiated by a person — such as a murder, as opposed to a flood. Not only soldiers get PTSD — anyone can who’s experienced or witnessed something traumatic.

According to the American Psychiatric Association (2013), posttraumatic stress disorder involves five main components: experiencing a traumatic event, re-experiencing the event, engaging in avoidance, suffering from these experiences, and an increase in arousal symptoms (e.g., feeling “on edge” all the time).

The primary symptoms of PTSD revolve around experiencing a traumatic event — either directly, by witnessing it, or indirectly (by knowing someone who experienced it). The traumatic event must either involve death, serious injury, and/or sexual violence.

PTSD also involves a constant re-experiencing of the event, or intrusive thoughts or memories of the event. Many people with this condition experience nightmares and flashbacks of the event. They will often be more emotional or upset upon the anniversary of the event, or being reminded of it.

People diagnosed with PTSD also engage in avoidance of any types of feelings, people, or situations associated with the traumatic event. They experience significant problems in their everyday life due to these symptoms, such as having problems with remembering things, having a distorted sense of blame, being stuck in a cycle of negative emotions, and feeling detached, disconnected or isolated from others.

Finally, a person with PTSD feels “on edge” much of the time, resulting in increased irritability, difficulty with sleep and concentration.

Most people who go through traumatic events may have temporary difficulty adjusting and coping, but with time and good self-care, they usually get better. If the symptoms get worse, last for months or even years, and interfere with your day-to-day functioning, you may have PTSD

Symptoms

Post-traumatic stress disorder symptoms may start within one month of a traumatic event, but sometimes symptoms may not appear until years after the event. These symptoms cause significant problems in social or work situations and in relationships. They can also interfere with your ability to go about your normal daily tasks.

PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.

Intrusive memories

Symptoms of intrusive memories may include:

· Recurrent, unwanted distressing memories of the traumatic event

· Reliving the traumatic event as if it were happening again (flashbacks)

· Upsetting dreams or nightmares about the traumatic event

· Severe emotional distress or physical reactions to something that reminds you of the traumatic event

Avoidance

Symptoms of avoidance may include:

· Trying to avoid thinking or talking about the traumatic event

· Avoiding places, activities or people that remind you of the traumatic event

Negative changes in thinking and mood

Symptoms of negative changes in thinking and mood may include:

· Negative thoughts about yourself, other people or the world

· Hopelessness about the future

· Memory problems, including not remembering important aspects of the traumatic event

· Difficulty maintaining close relationships

· Feeling detached from family and friends

· Lack of interest in activities you once enjoyed

· Difficulty experiencing positive emotions

· Feeling emotionally numb

PTSD is one condition, but some experts break it down into subtypes depending on a person’s symptoms, also known as condition “specifiers,” to make it easier to diagnose and treat.

• Acute stress disorder (ASD) isn’t PTSD. It’s a cluster of symptoms like anxiety and avoidance that develop within a month after a traumatic event. Many people with ASD go on to develop PTSD.
• Dissociative PTSD is when you detach yourself from the trauma. You feel separated from the event, or like you’re outside of your own body.
• Uncomplicated PTSD is when you have PTSD symptoms like re-experiencing the traumatic event and avoiding people and places related to the trauma, but you don’t have any other mental health issues such as depression. People with the uncomplicated subtype often respond well to treatment.
• Comorbid PTSD involves symptoms of PTSD, along with another mental health disorder like depression, panic disorder, or a  substance abuse problem. People with this type get the best results from treating both PTSD and the other mental health issue.

Other specifiers include:

• “With derealization” means a person feels emotionally and physically detached from people and other experiences. They have trouble understanding the realities of their      immediate surroundings.
• “With delayed expression” means a person doesn’t meet full PTSD criteria until at least 6 months after the event. Some symptoms may occur immediately but not enough for a full PTSD diagnosis to be made.

  Changes in physical and emotional reactions

• Symptoms of changes in physical and emotional reactions (also called arousal symptoms) may include:· - Being easily startled or frightened
• Always being on guard for danger·
• Self-destructive behavior, such as drinking too much or driving too fast·
• Trouble sleeping·
• Trouble concentrating
• Irritability, angry outbursts or aggressive behavior
• Overwhelming guilt or shame.

 For children 6 years old and younger, signs and symptoms may also include:· Re-enacting the traumatic event or aspects of the traumatic event through play· Frightening dreams that may or may not include aspects of the traumatic event Intensity of symptomsPTSD symptoms can vary in intensity over time. 

You may have more PTSD symptoms when you're stressed in general, or when you come across reminders of what you went through. For example, you may hear a car backfire and relive combat experiences. Or you may see a report on the news about a sexual assault and feel overcome by memories of your own assault. 

Complications 

Post-traumatic stress disorder can disrupt your whole life ― your job, your relationships, your health and your enjoyment of everyday activities. Having PTSD may also increase your risk of other mental health problems, such as:· 

• Depression and anxiety
• Issues with drugs or alcohol use
• Eating disorders
• Suicidal thoughts and actions

Getting timely help and support may prevent normal stress reactions from getting worse and developing into PTSD. This may mean turning to family and friends who will listen and offer comfort. It may mean seeking out a mental health professional for a brief course of therapy. Some people may also find it helpful to turn to their faith community.· Support from others also may help prevent you from turning to unhealthy coping methods, such as misuse of alcohol or drugs. 

Getting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and improve function. According to Fluid Vulnerability Theory (Rudd, 2006), dynamic changes in cognitive, emotional, physical, and behavioral risk and protective factors determine changes in risk level from individual baseline. Shame and guilt possess qualities that fall into multiple risk categories.

Relevant cognitive factors include negative self-cognitions (e.g., self-blame or self-hate), and emotional factors include the emotional experience of guilt and shame and potential difficulty regulating them. Physical factors include autonomic arousal and the associated feeling of internal intensity or agitation. Indeed, when Bryan, Rudd, and Wertenberger (2013) examined self-reported reasons why active duty soldiers attempted suicide, they found that the primary reason was to relieve emotional distress. 

These findings suggest that the unpleasant intensity and inherent internal attributions central to shame and guilt may help explain why these emotions are powerful predictors of suicidal ideation (Bryan, Morrow, et al., 2013; Bryan et al., 2013a, 2013b; Bryan et al., 2015; Cunningham et al., 2017; Cunningham, Grossmann, et al., 2019; Cunningham, LoSavio, et al., 2019) and behavior (Bryan, Rudd, et al., 2013). 

A model comparison examining components of guilt showed that guilt cognitions were the most important facet of trauma-related guilt mediating the effects of PTSD symptoms on SI among veterans (Cunningham et al., 2017). Interestingly, trauma-specific guilt-related distress was not a significant factor, suggesting that it is negative self-cognitions (e.g., “what I did was unforgiveable”) and not the perceived intensity of guilt that impacts the PTSD-SI relationship. 

Complex PTSD

Many of the events that trigger PTSD — like a violent attack or car accident — happen once and are over. Others, like sexual or physical abuse at home, human trafficking, or neglect can continue for many months or years. Complex PTSD is a separate but related term used to describe the emotional repercussions of continued and long-term trauma, or multiple traumas. 

Chronic trauma can cause psychological damage even more severe than that of a single event. It should be noted that considerable debate exists among professionals as to the diagnostic criteria for complex PTSD. People with the complex type may have other symptoms in addition to the typical PTSD symptoms, such as uncontrollable feelings or negative self-perception. 

Any type of long-term trauma, over several months or years, can lead to CPTSD. However, it seems to appear frequently in people who’ve been abused by someone who was supposed to be their caregiver or protector. Examples include survivors of human trafficking or ongoing childhood sexual abuse by a relative. 

Other examples of long-term trauma include:

• ongoing physical, emotional, or sexual abuse
• being a prisoner of war
• living in an area of war for long periods of time
• ongoing childhood neglect