Painful images keep flashing: Do I have PTSD?

Many friends will say, "I really have PTSD" when they encounter something that once made them feel scared and anxious. In fact, not all memories that make people feel scared and painful belong to the category of PTSD. People with post-traumatic stress disorder (PTSD) suffer from both physical and psychological distress for a long time. This mental disorder will not heal itself and will seriously endanger the patient's mental health. So what exactly is PTSD? How can we determine whether we have PTSD?

This article will use the symptoms, judgment criteria and currently recognized treatment methods of post-traumatic stress disorder (PTSD) to make PTSD mental disorder more understandable to the public, thereby providing PTSD patients with a more understanding and inclusive environment.

1. What is Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic stress disorder (PTSD) is a long-term and persistent mental disorder directly caused by an intense and prolonged psychological trauma event.

There are three main types of traumatic events:

1. Trauma caused by natural disasters (such as floods, earthquakes, volcanic eruptions, tsunamis and mudslides, etc.);

2. Trauma caused by man-made disasters (such as war, kidnapping, witnessing the death of others, sexual assault, domestic violence and abuse, etc.);

3. Trauma caused by technological disasters (such as factory explosions, plane crashes, shipwrecks, and large-scale traffic accidents)

It should be noted that traumatic events that cause PTSD are generally those that exceed people’s psychological tolerance and threaten their lives, but not all scary things will cause us trauma.

2. Criteria for judging post-traumatic stress disorder

The prevalence of PTSD in the general population is 6.4%-7.8%, and is significantly higher in groups that have experienced major public trauma events. So how do we determine whether we have PTSD?

According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) developed by the American Psychiatric Association, the following criteria are required for diagnosing PTSD:

(1) Traumatic experiences, such as sexual assault, terrorist attacks, and witnessing the death of others (preconditions for PTSD);

(2) In the following months or even years, psychiatric symptoms such as intrusion, avoidance, negative alternations in cognition and emotion, hypervigilance, and excessive tension appear.

Symptoms of Post-Traumatic Stress Disorder (PTSD)

Memories of the trauma often flash back to the patient in non-threatening locations, accompanied by strong emotions and feelings (e.g., a veteran suddenly lies down in his home, screaming in pain and fear because he heard loud noises outside and thought a battle was taking place nearby).

avoid.

The patient may avoid memories or thoughts about people or situations associated with the traumatic event (for example, a car accident survivor avoids riding in or being near cars).

Negative alternation of cognition and emotion.

Patients tend to engage in negative thoughts about themselves and the trauma (e.g., "The world is completely dangerous," "This is all my fault"), along with negative emotional states (e.g., fear, panic, anger, guilt, or shame). They lose their zest for life, their interest in important activities, and their ability to form attachments with others.

Hypervigilance and excessive tension.

People with PTSD may be easily startled or provoked (for example, by a tap on the shoulder), have difficulty concentrating on daily activities, and may have trouble sleeping. Severe PTSD patients may even engage in self-destructive behaviors.

3. Is post-traumatic stress disorder just constant pain?

In the event of a death, post-traumatic stress disorder (PTSD) is easily confused with another mental illness, prolonged grief disorder (PGD). PGD is a pathological grief reaction caused by the death of a loved one, that is, the bereaved person shows long-term and persistent grief for the death of the deceased six months after the loss.

The symptoms of PGD and PTSD overlap to some extent, but there are essential differences between the two. PTSD patients will have intrusive memories of death, while PGD patients will also have memories and images of the deceased before his death. They do not avoid these intrusive images, but may avoid those clues that remind them that the deceased has passed away. In addition, a typical feature of PGD is separation pain, which is concentrated in the desire and longing for the deceased, which is different from the fear and avoidance in PTSD.

It can be said that compared with PGD patients, PTSD patients are not always in a state of sadness and pain, but when traumatic memories flash at irregular intervals or encounter people or scenes that trigger traumatic memories, individuals will show fear and avoidance.

IV. Treatment of PTSD

Once you find out that you may have or have been diagnosed with PTSD, don't put too much psychological pressure on yourself. Through scientific treatment, PTSD can be cured. Since humans began to realize the existence of post-traumatic symptoms in 1980, there has been a long history of research on this mental disorder. Over the past 40 years, experts and psychologists in the field of mental health have conducted extensive research on PTSD, continuously deepening their understanding of this mental disorder, and the treatment methods for PTSD have become increasingly mature. Psychologists' understanding of PTSD has gradually changed from being difficult to cure to being curable.

There are two types of treatment for PTSD: medication and cognitive behavioral therapy (CBT). Compared with traditional medication, CBT has no side effects or potential drug conflicts, and from the perspective of treatment effect, CBT can fundamentally and more effectively treat PTSD. Let's take a look at the two most widely accepted cognitive behavioral therapies.

Prolonged exposure therapy (PE).

PE can help us do things we have been avoiding. When using PE, no medication is needed. The therapist will work with us to practice exposing ourselves to things we have been avoiding, such as a car accident survivor slowly approaching a car. Just like learning to swim, the initial practice process will indeed be painful, but with the company of the therapist, we will overcome the difficulties step by step at our own pace.

During PE therapy, we also talk about our traumatic events in detail with the therapist in a gradual way. Although it is painful to force ourselves to retell them, doing so can help us soothe emotions such as anger, guilt, and sadness.

PE treatment lasts about three months, and most people have significant improvements in PTSD symptoms after completing treatment. Although PE cannot completely eliminate our trauma, it can help us not be overwhelmed by trauma and coexist with it more peacefully.

Cognitive processing therapy (CPT)

CPT can help you break the negative thinking that holds you back. Small changes in cognition can have a huge impact on our emotions. PTSD makes us draw negative conclusions, but in CPT treatment, we will learn a new way of thinking and cognition that can make our evaluation and view of ourselves and the trauma more accurate and less frightening. In CPT therapy, the therapist will discuss with us the negative thoughts about the traumatic event, our sense of self-safety, self-control, and self-worth, and help us reshape our cognition with positive thinking.

CPT therapy can be very flexible. You can either have one-on-one therapy with a therapist or participate in group therapy with other PTSD patients. And CPT treatment time is not very long. It only takes three consecutive months of psychotherapy once a week to complete the treatment, achieve the purpose of liberating the body and mind, and start to enjoy the beauty that you missed before.

Judging whether a person's symptoms are PTSD is affected by many factors, and it is easy to confuse it with PGD, depression symptoms, and anxiety symptoms. When we find that we may have PTSD symptoms, we must go to the hospital for treatment in time. Do not make judgments easily and never avoid seeing a doctor. Different diseases have different treatments. We should prescribe the right medicine and scientific treatment according to the doctor's diagnosis.

No matter what kind of trauma, it is suffering brought by life. We must believe that mental disorders can never resist our own yearning for the good, and our strong will and courage are enough to overcome all the heavy blows. We should not be grateful for the harm brought to us by suffering, but we should be grateful for the one who was beaten into the dust by suffering but still able to bloom, the one who saw the truth of life but still chose to fight it tenaciously, the brave self full of vitality.

I hope that when facing PTSD patients, each of us can have fewer weird looks and more tolerance, and together create a gentle world full of understanding.

References:

[1] Zhou YG, Shang ZL, Zhang F, Wu LL, Sun LN, Jia YP, Yu HB, Liu WZ, PTSD: past, present and future implications for China, Chinese Journal of Traumatology, https://doi. org/10.1016/j.cjtee.2021.04.011

[2] Chen Beijing, Xie Fei, Dai Qin. Research progress on exposure therapy for the treatment of PTSD[J]. Psychological Monthly, 2022, (09): 232-234.

[3] Yang Dengxian, Xuan Ling, Chen Hongxu, Wang Wenjuan. Research progress on screening and diagnostic scales for post-traumatic stress disorder[J]. International Journal of Psychiatry, 2022, 49(03): 398-400+406.

[4] Xie Qiuyuan, Wang Jianping, He Li, Wei Wei, Tang Suqin, Xu Wei. Is prolonged grief disorder an independent diagnosis? — Relationship with post-traumatic stress disorder, depression and anxiety[J]. Chinese Journal of Clinical Psychology, 2014, (03): 442-446.

[5] Xu Kaiwen. Xu Kaiwen's Psychological Trauma Course: Breaking Through the Darkest Moments in Your Heart[M]. Beijing: China Renmin University Press, 2021: pages 5-17

Medical review: Wang Fang, attending physician of the Department of Psychiatry, Beijing Children's Hospital, Capital Medical University