Psychological Trauma

Have I suffered from Psychological Trauma?

Many people suffer from emotional or psychological trauma at some point of their life. But it is often not recognised or treated.

It is the result of extremely stressful events that leave you feeling helpless, overwhelmed and isolated.

These often involve a threat to life or safety.

But any event that leaves you feeling overwhelmed and lonely can be traumatic, even if it does not involve any physical hurt (Robinson, Smith, & Segal, 2018).

Whether or not an event is traumatic is not really dependent on the type of event. Rather, it is your emotional experience of the event that determines whether or not you have been traumatised.

What are the common triggers for trauma?

Ref: (Giller, 1999)

Trauma can be caused by

• powerful one-time incidents like
  • accidents
  • natural disasters
  • crimes
  • surgeries
  • death
  • violent events
  • sexual abuse
• or repeated incidents
  • emotional abuse
  • physical abuse
  • neglect
  • war

You can feel distressed and afraid during and after a traumatic experience. Almost everyone will experience a range of reactions after trauma, but most will recover from these initial symptoms naturally.

Sometimes people can have very serious symptoms that go away after a few weeks. This is called acute stress disorder (ASD).

And when the symptoms doesn’t go away after a month and seriously affect one’s ability to function, you might be having post-traumatic stress disorder (PTSD) (DSM-V).

What is acute stress disorder (ASD)?

ASD is a risk factor for developing subsequent PTSD (Bryant, 2016). However, not all individuals who meet criteria for ASD will go onto develop PTSD, and many individuals who develop PTSD do not first have an ASD diagnosis (Bryant, 2011).

Regardless of whether an individual goes on to develop PTSD, a diagnosis of ASD is important so that individuals experiencing early significant distress in response to a trauma can be identified and treated.

What is post-traumatic stress disorder (PTSD)?

PTSD is a condition that develops when a person has been involved in or witnessed a traumatic event that threatens life or safety (e.g. severe accident, rape, life-threatening assault, torture, natural disaster, seeing someone killed). During the trauma, the person’s response is to feel intense fear, helplessness or horror.

After the incident, the person has recurring distressing memories, flashbacks and other symptoms. These anxious feelings that they did not have before are so intense that their lives are disrupted. (American Psychological Association)

The difference between ASD and PTSD is that in PTSD, the symptoms persist for more than 1 month.

In most people, PTSD occurs within the first month after the trauma, but in a minority, the symptoms develop several months or even years later (McNally, 2003).

The symptoms are similar to those of ASD and include:

Reference: DSM-5

• Unwanted upsetting memories
• Flashbacks (re-experiencing the event)
• Numbed feelings
• Avoidance of thoughts or conversations about the event
• Staying away from places, events or objects that are reminders of the event
• Distress on exposure to events that resemble the traumatic incident
• Inability to recall key features of the trauma
• Depression and/or anxiety
• Difficulty sleeping, often due to distressing dreams
• Over-sensitivity to noise, smells, sudden movements etc that trigger the memory
• Poor concentration
• Irritability or aggression
• Feelings of guilt and shame
• Moodiness
• Decreased interest in activities
• Risky or destructive behaviour
• Heightened startle reaction

It is normal to feel upset after a traumatic event. For some, the distress eventually eases with time. However, for people suffering from PTSD, these feelings and symptoms persist, and may lead to other problems like depression and substance abuse.

Why do some people develop PTSD while others do not?

Reference: National Institute of Mental Health

It is important to remember that not everyone who lives through a dangerous event develops PTSD. In fact, most people will not develop the disorder.

Many factors play a part in whether a person will develop PTSD. Some examples are listed below. 

Some factors that increase risk for PTSD include:

• Childhood trauma
• Having little or no social support after the event
• Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
• Having a history of mental illness or substance abuse

Some factors that may reduce the risk of developing PTSD include:

• Finding support from other people e.g. friends and family
• Finding a support group
• Learning to feel good about one’s own actions in the face of danger
• Having a positive coping strategy, or a way of getting through the bad event and learning from it
• Being able to act and respond effectively despite feeling fear

How can I get treated for trauma/ASD/PTSD?

While no treatment will completely erase all memories of the trauma, it is still important to seek treatment to relieve symptoms and manage these feelings.

Even if the person does not fit the criteria under ASD or PTSD, he/she may be suffering from trauma that does not meet the clinical definition of these disorders. Regardless, treatment is still important and can have a life-changing impact.

Furthermore, it is important to seek help early, as research has shown that early clinical intervention can be very successful in patients who complete treatment. On the other hand, those who delayed treatment had symptoms that lasted longer (Shalev et al., 2012).

To get started, you can pay us a visit. We are a team of psychologists working closely with doctors who have a special interest in mental health. Alternatively, you can also visit your GP, but do note that not all GPs are currently comfortable with diagnosing and treating mental health issues.

You can also seek help at IMH, or hospitals such as NUH or IMH. You may also wish to see private psychologists or psychiatrists.

Psychotherapy

Psychotherapy (sometimes called “talk therapy”) involves talking with a mental health professional to treat a mental illness. You may find it useful to bring your family and friends along for the sessions so that they can learn more about your condition and help you recover.

You might also be taught how to relax and control your anger, and ways to improve your lifestyle (e.g. better sleep, diet, exercise routines).

A widely-used and effective method is cognitive behavioural therapy (CBT).

Cognitive behavioural therapy (CBT)

CBT is an effective approach to deal with PTSD (Iribarren, Prolo, Neagos, & Chiappelli, 2005), as well as a first-line treatment of ASD. Not only can it treat ASD, it can also help to prevent its progression to chronic PTSD (Kar, 2011).

CBT can include:

• Exposure therapy
  • This gradually exposes patient to the trauma they experienced in a safe way, using imagining, writing or visiting the place where the event happened.
  • Eventually, the person will learn to face and control their fear.
• Cognitive restructuring
  • This helps people make sense of the bad memories.
  • Sometimes, people remember the event differently from how it actually happened. Hence, they may feel guilt or shame about something that is not their fault.
  • The therapist will help the patient look at what happened in a realistic way.

A new wave of CBT, known as the third wave CBT, is also gaining popularity. It emphasises mindfulness, acceptance, values, and dialectics (investigating or discussing the truth of opinions).

Mindfulness, which has Eastern origins, involves coming into contact with the present moment and observing that moment in a nonjudgmental way. Your therapist may teach you to meditate to develop mindfulness.

Research on bringing mindfulness into existing treatments for trauma is promising. Mindfulness has been shown to be useful in treating a variety of psychological disorders. It encourages acceptance rather than avoidance, and can help patients manage the distress that occurs when exposed to their fear and trauma (Didonna, 2009).

Medications

Your doctor or psychiatrist may prescribe antidepressants and other medications along with psychotherapy if they feel that you require them.

The most commonly used and researched medications for PTSD are antidepressants. They may help to control PTSD symptoms such as sadness, worry, anger, and feeling numb inside (National Institute of Mental Health).

Examples of such antidepressants include sertraline (Zoloft), fluoxetine (Prozac) and olanzapine (Zyprexa), which have been found to reduce PTSD symptoms (Iribarren, Prolo, Neagos, & Chiappelli, 2005).

References

Acute Stress Disorder – PTSD: National Center for PTSD. (n.d.). [General Information]. Retrieved May 18, 2018, from https://www.ptsd.va.gov/professional/treatment/early/acute-stress-disorder.asp

Follette V.M., Vijay A. (2009) Mindfulness for Trauma and Posttraumatic Stress Disorder. In: Didonna F. (eds) Clinical Handbook of Mindfulness. Springer, New York, NY

Giller, E. (1999). What Is Psychological Trauma? | Sidran.org. Retrieved May 18, 2018, from https://www.sidran.org/resources/for-survivors-and-loved-ones/what-is-psychological-trauma/

Greist, J. H. (2014). Acute Stress Disorder (ASD) – Psychiatric Disorders. Retrieved May 18, 2018, from https://www.msdmanuals.com/professional/psychiatric-disorders/anxiety-and-stressor-related-disorders/acute-stress-disorder-asd

Health (UK), N. C. C. for M. (2005). Post-traumatic stress disorder. Gaskell. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK56506/

Iribarren, J., Prolo, P., Neagos, N., & Chiappelli, F. (2005). Post-Traumatic Stress Disorder: Evidence-Based Research for the Third Millennium. Evidence-Based Complementary and Alternative Medicine, 2(4), 503–512. https://doi.org/10.1093/ecam/neh127

Kar, N. (2011). Cognitive behavioral therapy for the treatment of post-traumatic stress disorder: a review. Neuropsychiatric Disease and Treatment, 7, 167–181. https://doi.org/10.2147/NDT.S10389

Murtagh, J. (2016). Patient education. North Ryde, N.S.W.: McGraw-Hill Education.
NIMH » Post-Traumatic Stress Disorder. (n.d.). Retrieved May 18, 2018, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

PTSD and DSM-5 – PTSD: National Center for PTSD. (n.d.). [General Information]. Retrieved May 18, 2018, from https://www.ptsd.va.gov/professional/ptsd-overview/dsm5_criteria_ptsd.asp

Robinson, L., Smith, M., & Segal, J. (n.d.). Emotional and Psychological Trauma: Healing from Trauma and Moving On. Retrieved May 18, 2018, from https://www.helpguide.org/articles/ptsd-trauma/coping-with-emotional-and-psychological-trauma.htm