Trauma is defined as a deeply distressing experience that may have been life-threatening and overwhelms an individual’s ability to cope. Post-traumatic stress disorder (PTSD) is when the impact of that traumatic experience is still affecting the person’s life months and even years later.
People returning from war are potentially at higher risk of PTSD, given what they have been through. But anyone who has experienced extreme situations – through abuse, violence, abandonment, illness – could potentially suffer from symptoms of PTSD. It’s not clear why some people develop PTSD and others don’t, but that can depend on a number of factors such as how strong they feel in themselves, how secure their upbringing was, and how the trauma was dealt with at the time.
The signs of PTSD don’t always occur straight away. They can emerge over time, and may not always seem connected to the traumatic event. If you’re worried about someone in your life – friend, partner, relative, colleague – who you suspect might be suffering from post-traumatic stress, here’s how to spot some of the symptoms.
Some signs of PTSD
Rage and anger. Is their fuse incredibly short? Do they fly into road rage if someone cuts them up while they’re driving? Are they often aggressive and irritable? Does their anger seem rather extreme in relation to what has triggered them? This speed to anger can be one of the main symptoms of post-traumatic stress. Situations during day-to-day life can trigger the feelings they felt, or were perhaps not aware of feeling, during the original trauma. The urge may be to ‘put right’ the trauma by fighting back this time, but sometimes anger can end up re-traumatising them.
Hypervigilance. They may always be on the alert to danger or threat, whether at home or out and about. They may be jumpy around certain people, as if poised ready to face a threat. When the original trauma happened, the fight or flight survival mechanism was triggered. For someone with post-traumatic stress, they are still in this adrenalised survival mode, and so their mind and body are perpetually geared up to fight or flee.
Numbness and emptiness. You may be in a room with your partner but it is as though they’re not really there. They can switch off from situations by dissociating (‘disappearing’ emotionally and mentally) or becoming numb to feeling. They may have had to dissociate to survive the original trauma. Flashbacks are an extreme form of dissociation: people can be triggered by a situation, or even a sound or a smell, and it’s as though they are reliving the traumatic event.
Nightmares and difficulty sleeping. They may find it hard to get to sleep or to stay asleep. Even when they do sleep they can suffer bad dreams. The nightmares can be the attempts of the unconscious part of our minds trying to resolve the original trauma.
Avoiding and withdrawing. They may be avoiding certain people, places and things in a bid to steer clear of any reminders of the original trauma. They may feel unsafe leaving the house and withdraw from social situations. They may lose interest in hobbies and pursuits and start to feel that life is meaningless.
Guilt and blame. They may suffer ‘survivor’s guilt’ which can happen when they live and someone else died during the traumatic experience. They can blame themselves for what happened, or ruminate on the other people who are to blame for the incident. They can continue to think ‘if only’ and can convince themselves that the experience shouldn’t have happened.
How to help someone with PTSD
Knowing about the signs and symptoms of PTSD is a good place to start. That knowledge will at least help you to understand what might be going on in the mind of your friend, relative or partner, and that trauma might be influencing their behaviour. Knowing the reasons behind their anger, emotional distance or their fear could help you be more sympathetic and compassionate when they get triggered.
It helps to be aware of triggers and to know how to manage them. Ask them what their triggers are – whether people, situations, sounds, memories – and what help they need if that happens. Work on an action plan beforehand so you know what to do and how to support them when and if they get triggered.
If rage is the issue for the person in your life, then it’s key for you to stay calm. Don’t get drawn into the drama of your partner’s experience. This isn’t always easy. Sometimes your partner may react to a situation in a ways you feel is exaggerated or magnified. They may start raging and blaming you for the coffee that’s spilled on the carpet, or the letter you forgot to post. It can be difficult not to take things personally. That’s when arguments can start.
If you manage not to react or fly into a rage yourself, then take a moment to observe your partner’s response and try and connect to their feelings. Body language gives it away too: rage and panic on their faces can show true fear. You will feel more compassion for them even though you maybe not always understand what is happening, but you know something is going on and it’s not really about the coffee or the letter. Give them space and time to calm down. It is best to wait until the fire has gone out of the moment before inviting them to talk.
If dissociation and numbness happen frequently to your friend, relative or partner, it can sometimes leave you feeling confused or frustrated. Again, awareness of what’s going on may buy you some patience while you sit out your friend or partner’s ‘absence’. Try not to feel abandoned or take it personally. Remember that dissociation was a necessary survival strategy at the time. They’re not doing it on purpose. Don’t push them during numb moments. Don’t blame them or goad them. Aim to stay grounded and compassionate and be there for them when they do feel safe enough to come back into the room.
If hypervigilance is the issue for your relative, friend or partner, it can feel quite exhausting to be around them. Being constantly on high alert, and the anxiety that comes with it, can be contagious. Think of that extreme anxiety as being a smoke alarm that goes off whether the house is on fire or whether it’s just the toast that’s burning. Your loved one’s highly tuned response mechanisms can’t tell the difference. You can. Stay calm and seek to reassure, providing evidence where necessary. Again, this will require patience and staying grounded.
They may not want to talk. They may just want you to sit with them. When they do talk, make sure you truly listen and affirm what they are saying. Reassure where you can. Ask them how best you can help, and what they need right now. If you feel they need more help than you are personally able to offer, encourage them to see a therapist.
How psychotherapy can help with PTSD
Seeing a psychotherapist for long-term work is not a quick fix for post-traumatic stress. It’s not about focusing on symptoms alone. Most people seeking therapy believe they have a particular issue to deal with, but the process of seeing a therapist weekly eventually enables them to start to talk about themselves in a way they may not have explored before.
Some people fear coming into therapy, thinking they will have to share everything all at once and this will make them feel worse. Sharing how they feel at their own pace relieves unconscious and conscious feelings so they don’t feel they’re carrying those feelings around on their own. Therapists trained to work with trauma will also work with the sensations in the body that are stimulated when the person is stressed, so they can learn to know their triggers and to self-soothe.
Psychotherapy for trauma doesn’t necessarily mean diving into the original experience of trauma, but it will help you feel more able to deal with the effects of that trauma. It is often the ability to build a relationship with the therapist that can create a sense of safety in life. People can build a positive attachment to their therapist, and work through ways of building up the sense of self and a belief in one’s own resources to cope with difficult situations.
PTSD has lots of triggers, sometimes when you least expect them, which can lead to people isolating themselves. Therapy can help people work out coping strategies to manage tricky situations, especially when triggered. Once those strategies are in place they can start to feel as though they have some control again.
Psychotherapy can help the person experiencing PTSD to realise that they are much more than their wounding. Often the post-traumatic stress symptoms bring them into therapy. Once through the door the psychotherapy journey is the path to self-discovery and development, which can come in all shapes and sizes. Once the fear has lifted, people can begin to feel intrigued about themselves and can be surprised about what they will find as they begin this journey into a deeper understanding of self.
If you feel that you or someone in your life could benefit from psychotherapy for trauma or PTSD, call 020 8673 4545 or email firstname.lastname@example.org to book an appointment with one of our therapists.