Traumatic Stress By Eric Lydon , MD
Traumatic Stress By Eric Lydon , MD
“ I have never been in the Army or seen combat , how can I have PTSD ?” I have had patients ask me this question on numerous occasions after discussing their diagnosis at the conclusion of an initial interview . There is a perception among people that Post Traumatic Stress Disorder ( PTSD ) is a diagnosis reserved only for those who have lived through the terrors of war , but that is not at all the case . The trauma could be any event in which the individual witnessed death , or was threatened with death , severe injury , or violence in a whole host of ways . In my practice , the most common trauma that results in a diagnosis of PTSD is sexual abuse and molestation .
The stress of living through such horrific events , or the fear of experiencing bodily injury or harm after such an exposure will increase ongoing anxiety . This can lead to a wide range of very unpleasant symptoms . The act does not always have to be experienced or witnessed by the individual for them to have symptoms of anxiety , depression , PTSD or another psychiatric disorder . The repeated stories of violence or knowing someone who suffered from a horrific event awakens our senses to the possibility of the same thing happening to us . Even going to a concert or ballgame where we are subjected to searches of handbags , our pockets , and having to pass through metal detectors make us all too aware that there is the possibility of some pending act that raises our arousal and puts us on edge .
Violence has become part of everyday life . The TV brings horrific images of school shootings , murders , and threats in the form of racist marches in our cities . We watch families being forcibly separated and victims being gunned down by police , on a far too frequent basis these days . These images of violence can have a profound effect on the psyche of our citizens . After a recent school shooting , a news report featured a middle school child who expressed that she knew this was going to happen at her school one day . When people begin to fear daily that their very lives are in jeopardy , increased anxiety , depression , insecurity and panic can ensue .
The effects of the trauma are profound and long-lasting . Treatment , for those who seek it , is usually very lengthy and requires a combination of medication and therapy . The therapy work can be extremely difficult because people get uncomfortable discussing their symptoms and reliving the experiences . Diagnostically , the criteria of PTSD include avoiding things or places that remind the victim of the trauma . Flashbacks are a common and troubling occurrence for victims of trauma , and therapy may trigger these flashbacks or bring to mind memories of events that are wished to be forgotten .
The repeated stories of violence or knowing someone who suffered from a horrific event awakens our senses to the possibility of the same thing happening to us .
Medication can be helpful , but I find it is rare that the first trial of a medication is effective . Often a trial of the three to four medicines or combination of medication is needed , not to mention that medication can take three to five weeks before becoming effective .
I have a patient that I began seeing in Spring of this year , and it was not until our third meeting that he had the courage to tell me what was truly bothering him and contributing to his symptoms of anxiety and depression . He is a foreign national living here as a student . His home country , like so many these days , has been torn apart by war . His fear of being sent back home into danger has severely affected his sleep , appetite , concentration , mood and ability to study . His personal relationships suffer because of his heightened levels of anxiety . He is fearful of applying for asylum because he thinks this may bring him to the attention of authorities and that he will now be on the radar to be sent back as soon as he earns his degree . He became tearful as he told me of friends and family dying , and the guilt he has because he got out of his war-torn country to be where it is safer . He has heard stories about people returning home who are harassed and arrested under false accusations . He avoids news reports about what is happening in his country and to his fellow countrymen because it makes his ruminations worse and increases his guilt of being safe . Medication has helped tamp down his symptoms but cannot ease his mind of the fear of being killed if he returns , or the fear for the safety of those left behind . The memories of his childhood : playing with friends in the street , going to school and being carefree , seem unreal and more like a dream than an actual reality .
Violence has a very profound effect and can have dire consequences to our physical health and long-term mental health . We know how to treat the symptoms of the resulting illness and continue to refine and look for new treatments , which is admirable . Studies need to be done to understand why these things occur , or how we may be able to protect ourselves from grave events . The real solution lies in violence prevention and in having open , civil discourse . Just as important is early recognition of symptoms and getting into treatment as early as possible .
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Dr . Lydon is a practicing psychiatrist and founder of Sensible Psychiatric Services .
6 VITAL SIGNS Volume 13 • Issue 3