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In most cases, those who suffer from PTSD will recover, but the condition may also become chronic. In the worst cases it may cause enduring changes of personality.
Enduring personality changes after a catastrophic experience
The effects of a catastrophic experience may endure for years. Acute stress symptoms may no longer be evident, but the survivor is permanently in a state of desperation and depression. According to the WHO, a person having this disorder is characterised by:“ a hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of being on edge as if constantly threatened, and estrangement. Post-traumatic stress disorder may precede this type of personality change.” This state of mind might be described as a‘ burnt-out’ form of PTSD.
PART III: THEORY
Stressors are likely to be catastrophic events, which characteristically last for a long time:
• Experience of concentration camps.
• Natural disasters.
• Prolonged captivity or exposure to life-threatening situations, with imminent risk of being killed( for example, victims of abduction or terrorism).
• Torture.
Symptoms related to severe stress or stress disorders
It is possible to identify several categories of trauma symptoms. These are symptoms that must be present if a severe reaction is to be characterised as a trauma-related disorder( notably PTSD). Most symptoms fall within three clusters.
Intrusions: symptoms associated with re-experiencing a trauma
In a life-threatening situation the human brain does not behave in a normal way. Everything happens too fast to store events properly in the memory, so survivors often suffer partial memory loss because the traumatising event remains present in the unconsciousness.
• Flashbacks. One relives the trauma over and over. Invasive memories of the event trigger physical symptoms( rapid heartbeat, sweating). Because the body is still in a state of alert, it prepares over and over again to fight or flee the traumatising event( see hyper arousal).
• Bad dreams, nightmares. These cause severe sleeping problems. A survivor may also be disoriented when waking up.
• Frightening thoughts. These may surge up automatically, and cannot be stopped.
• Trauma-related stimuli. Words, objects, sounds, smells, and also inner stimuli trigger recollections of the traumatic event( in the form of flashbacks, nightmares, frightening thoughts), to which the body responds as if the event is recurring in reality.
All of the above cause severe problems in the survivor’ s everyday life.
Avoidance symptoms
A traumatised person naturally tries to avoid anything that might recall memories of the traumatic event. She employs cognitive, emotional and behavioural strategies to avoid exposure to such stimuli, and also tries to avoid all forms of traumatic memory and emotion. This can lead to numbness, and problems of recall( see‘ dissociation’).
This too creates serious problems in daily life because, for example, survivors will:
• Avoid places, events, or objects that remind them of their experience, and as a result may become isolated and solitary.