Posttraumatic stress disorder

After experiencing threatening life stress, the nervous system becomes extremely stimulated. This response helps one prepare for similar cases. However, an excessive or abnormal response can be a medical condition. This is when such a state of anxiety remains even without such threats, or after the event has passed. These neurotic symptoms are not normal anxious states to protect oneself from risks; these states are pathological, and are termed posttraumatic stress disorder.

Patients with PTSD experience three characteristic symptoms.

The first is the reliving of the same incident. For example, those with PTSD from wars experience terror associated with sounds similar to gunshots. They experience replays of the event very vividly, or sometimes more vaguely, as if experiencing a dream. They may also have dreams of such episodes. Some may have dreams of getting hurt although not they do not experience replays of the actual event.

Traumatic events can be suppressed but cannot be forgotten completely. Some may reexperience the traumatic event through their senses. These reexperiences may not be associated with a specific event, and may occur while attending a class or sitting quietly alone, when feeling bored, or when asleep, listening to the radio or watching TV. Repeated replays of the accident lead to anxiety and fear.

The second is avoidance. For example, a person who has been in a car accident may refuse to ride in a car again. These people tend to avoid being placed in a situation similar to a previously experienced traumatic event. They may also avoid words, phrases or environmental cues that may remind them of the event. As a result, they may become severely suppressed psychologically, avoiding interaction with the outer world, and may become vacant and soulless. Some may actually not be able to remember part of the event.

The third symptom is a state of excessive arousal. For example, a person may jump with surprise when the phone rings, or experience palpitations and be unable to calm down. They will become very aroused and have hypervigilance to stimuli. They may not be able to sleep well and will have poor concentration. Some may become very irritable.

The symptoms of PTSD usually arise sometime after the event. However, the painful symptoms from a single event may last for several months, and may take years to recover from. Some may suffer from the symptoms for the rest of their lives. Therefore, prevention and treatment are very important.

Yet, while some may have PTSD following an event, others may only suffer from light psychological side effects from the same event. Some may be fine after experiencing several life-threatening events in a war, whereas some may suffer lifelong psychological symptoms from experiencing a sudden stop in a car. This is because people have different natures and have diverse responses and coping mechanisms to stressors. This is “resilience,” which is defined as an individual’s ability to properly adapt to stress and adversity. Hence, it is important to train oneself to respond well to stress to prevent symptoms of PTSD.

The best and most realistic method of prevention is to help and support those who are affected so they can recover sleep and their nutritional state, and then can talk about their experiences sufficiently. This should ideally happen as soon as possible after the event. Therefore, when large-scale accidents happen, it would be beneficial to have national organizations on site, or psychiatrists to continue counseling services for those affected.

If you feel that you are suffering from symptoms of PTSD following a traumatic or life-threatening accident, do not hesitate to see a psychiatrist as they can offer various effective treatments. Supportive psychotherapy is important to recreate the traumatic event, and pharmacological treatments can effectively suppress the previously described symptoms including insomnia, anxiety and hypervigilance. Cognitive behavioral therapy and family therapy can also be used, as well as group counseling treatment. 

By Jeon Hong-jin

The author is a doctor in the department of psychiatry at Samsung Medical Center and a professor at Sungkyunkwan University’s School of Medicine. ― Ed.