Louisville Medicine Volume 69, Issue 2 | Page 13

AUTHOR John J . Wernert , MD


AUTHOR John J . Wernert , MD
“ The world breaks everyone and afterwards , many are strong in the broken places . But those it does not break , it kills .” -Hemingway , “ A Farewell to Arms ” 1929

There is no right way to handle trauma . Life hands out lots of sorry and pain , and psychological resilience is the eventual outcome for those who get it in small doses . But what about those major traumas and life tragedies many unsuspecting people face ? Are there strategies we as physicians can employ to help mitigate the development of PTSD in our patients presenting post trauma ? In addition to being unable to anticipate when and where trauma might occur , we all move at our own speed and have variable abilities to confront pain and suffering . Much has been written and studied on the methods to treat or expedite healing from trauma once it occurs . But what do we know of prevention ?

The human condition is indeed hard and comes filled with inevitable losses and suffering . Other than leading a monastic life of isolation , are there ways to prevent the development of PTSD when traumas do occur ? Some of us have been blessed with strong characters and “ intestinal fortitude ” that usually is learned at an early age . Strong parents and good genes are a recipe for success . Unfortunately , many of us came from less than supportive homes where such resiliency skills were not modeled nor encouraged . The lack of a stable childhood free of neglect / abuse , and the slow social development caused by personal insecurity and chaotic relationships , sets the stage for individuals predisposed to exaggerated responses to trauma in their lives . This helps explain the seeming explosion of complex childhood trauma , adolescent anxiety and young adults experiencing “ failure to launch ” and performance anxiety . These predisposing characteristics are neither easy to identify or change .
Stress is a normal response to a life-threatening situation . But the experience of extreme stress in the aftermath of a very traumatic event may cause it to “ live on ” in the mind in especially vivid fashion , and can morph into full-blown PTSD . PTSD is considered a failure of normal adaptation and coping , and some are better at coping than others . PTSD will develop in about 25 % of persons exposed to extreme trauma , but the likelihood that symptoms will develop depends upon intensity and type of traumatic exposure as well as personality characteristics that establish resiliency . Obviously , individuals with a prior history of personal abuse , physical or sexual trauma are predisposed , but other factors come into play .
• Personality characteristics and values render some more vulnerable to developing PTSD :
» Perfectionism / compulsiveness » Need for control » Historical suppression of feelings » Exaggerated sense of responsibility
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