This is the term used to describe the symptom picture that may eventuate from exposure to a traumatic event where there is a real threat to the person’s life, or to others and where the symptoms have persisted for longer than one month after the event. It is a response of the system to overwhelming traumatic experience. A Trauma is defined as any situation where over whelming demands are placed intensely upon an individual so that their coping resources are exhausted in a very short time. As a result the General Adaptation syndrome of the body (The Body’s Stress Response) goes into over drive and the system runs down. It involves multi focal stressors, threat to life, and will have a heavy grief component that will often provoke an existential crisis (a crisis of meaning, purpose, direction, faith/philosophy, and hope).

People who have experienced these things in varying situations have said the following things to me in the clinic. “The trauma has been transforming for me; everything is changed in how I see life, things, relationships, and the people around me”. “It feels like a slowly healing sickness; I feel wounded, yet there are no physical scars”. “I feel somehow dirty, defiled, unclean sort of; as if something has made me something I was not before”. “I feel marginalized, isolated, even in crowds, I look at people and think to myself, ‘they don’t know shit’, they don’t know what life is about! (yet I know that this is not me, at least, it’s not the me I used to be)”. “I find I am drawn to people who have pain and suffering in their past life; I have quick and powerful bonds with people who have shared this sort of thing”. “Since that day I do not open up to people who do not share my experience; I have held things inside too long”. Defence mechanisms can become quite strong if the people involved do not find people to speak to who do understand. “I did not realize how much I had been drinking”. “I have been shocked at the number of lovers I have had since that time; what have I been searching for?” “Since that time I have felt unsafe everywhere; it is almost as if I am expecting bad things to happen to me again”. “I have been thinking of death quite a lot; I had never considered my life time as limited but now I do not expect to grow old.” “People tell me I am irritable. I don’t think I am, it’s just that I have less time for fools now, and I guess I spot more of them.”

Different events will have different traumatic impact on different people. A group of diverse people going into the same traumatic event will have diverse reactions to that event. Variables that affect the impact of a traumatic event are:

1. The nature of the event (natural, man-made) and the level of personal threat felt.
2. The duration and intensity of the event(s).
3. The potential for recurrence.
4. The control felt through the event; how active and empowered they felt.
5. Previous life experiences which “prepared” them for being active, “in control”.
6. Personality traits of low self esteem, poor locus of control, poor stress coping.
7. Personal health crisis at the time, which led to further feelings of weakness.
8. Pre-existent mental health issue; esp anxiety/depressive/personality disorder.
9. Dealing with an existential/age/stage crisis at the time trauma strikes.
10. Faith/philosophy that provides robust resilience, frame work of understanding.

The “normal” response to abnormal events will be “abnormal” symptoms of distress, for they are “in proportion” to the events experienced. This is the criteria for assessment in such situations; what is in proportion to the event must be considered “normal”. It is the persistence of disturbing symptoms that leads to the diagnosis of “disorder”. A disorder is a cluster of symptoms that have “disordered” life; it’s enjoyment and function.

The clusters of symptoms of Post Traumatic Stress Disorder (PTSD) (if they persist longer than one month) are as follows:

1. INTRUSION Intrusive distressing recollections, dreams, reliving experiences of any sort. Will be associated with impairment of normal social function due to the distress felt.
2. AVOIDANCE Numbing, detachment, being “in a daze”, feeling unreality while in the midst of recollecting the awful reality. Also marked avoiding of stimuli that arouse any memories or recollections of the event. Restriction of emotional feelings towards others. Sense of fore-shortened future.
3. AROUSAL Persistent increase in anxiety and arousal of emotion and it’s associated symptoms; sleep loss, concentration difficulty, hypervigilance, exaggerated startle response.

NONE OF THESE are caused by any substance abuse, or other pre-existing cause, and persist for longer than one month after the traumatic event(s).

The best treatment approach for this very “normal” condition when people face traumatic over load has been found to involve elements of the following:

1. Education about trauma and the way it affects us all.
2. Basic stress management techniques; getting control back by activity, that involves relaxation strategies and endorphin boosting activities!
3. Enhance all control in the person’s life. Keep them active rather than passive.
4. Enhance all relationships that are positive, or able to be made so.
5. Utilize appropriate medication for sleep, and elimination of irritability that might drive support away.
6. Utilize an appropriate form of grief work or establish mourning rituals.
7. Keep hope alive for recovery and greater strength as a result of their survival.

A team approach will be best in dealing with ASD and PTSD, with the GP, Psychologist, Counsellor, family, friends, fellow survivors, and appropriate religious figure, all having their place in support and growth through the incident and it’s aftermath. Beware of the “simple formula” people, for all people require to find their own path through what is “their experience” of the traumatic event. Critical Incident Stress Debriefing techniques can be very useful with trained personal who have pre-incident training, and a strong esprit de-corps, but are dependent on the skill of those leading, the nature of the incident and the nature and training of the people going through it. Good organizational websites on this subject are; Critical Incident Stress Management Foundation of Australia, International Critical Incident Stress Foundation, and Emergency Support Network.

© DR JOHN C MCEWAN Revised 3 January 2005