PTSD
A terrible experience - an accident, a natural disaster, an experience of violence - can happen to anyone and can temporarily cause us all a great deal of psychological stress.
If this stress does not subside over time or even intensifies and symptoms such as tension, uncontrollable memories, sleep disorders or severe insecurity affect your everyday life, you may have post-traumatic stress disorder (PTSD). The course of PTSD is variable, but in many cases a cure can be expected with correct, timely treatment.
Post-traumatic stress disorder is a persistent psychological reaction to a stressful event of exceptional threat or catastrophic proportions. Trauma therefore does not refer to difficult life situations such as separation or job loss, but to events in which physical integrity or even life is at stake. Traumatic experiences can last a very short time – such as a traffic accident or an assault – or extend over many years, for example in the case of sexual abuse or political imprisonment and torture. Traumatic situations are characterized by the fact that they cannot be controlled and actively managed by those affected; accordingly, such events usually trigger deep despair, fear and helplessness.
It is not only those directly affected by such experiences who can develop symptoms of PTSD, but also eyewitnesses, close relatives or people who are repeatedly confronted with trauma in their work, e.g. war photographers, employees of emergency services or emergency chaplains. In Central Europe, traumatic experiences are comparatively rare, but statistically speaking, around half of us will be affected by trauma at least once in our lives. Whether you subsequently develop PTSD depends on the type and severity of the trauma as well as other factors.
The type and severity of a traumatic experience have an influence on the subsequent psychological consequences. To put it simply, it can be said that interpersonal traumas, such as sexual violence, which are often intentional, are more difficult to cope with than fateful ones, such as an earthquake or an accident. Long-lasting or repeated experiences usually leave deeper traces than one-off, short-term events. Finally, the time of the experience also plays a role: years of emotional or sexual abuse in childhood not only result in typical PTSD symptoms, but also affect the entire personality development, the self-image and world view, and the ability to trust and relate.
However, the type of trauma is not the only influencing factor. Another decisive factor is what resources are available for coping with a traumatic experience. If the person affected by a trauma is already under a lot of pressure due to conflicts at work, divorce or illness, there may not be enough stress reserves available to cope with a trauma. Conversely, even the most severe traumatic experiences can sometimes be absorbed if a supportive social environment and stable framework conditions are in place. Ultimately, therefore, it is the relationship between stress and support factors that determines the risk of mental illness.
Post-traumatic stress disorder can develop immediately after a stressful event, but sometimes years later. Typical symptoms include re-experiencing, vegetative overexcitability, avoidance behavior and negative changes in thoughts and feelings.
The inner re-experiencing of the traumatic situation can manifest itself in the form of unpleasant memories or nightmares. These are not only images or the “inner movie”, but often also memories of smells, sounds or bodies. At the same time, this can also activate thoughts and feelings of the traumatic situation, such as fear of death. In so-called flashbacks, this re-experiencing feels so real that those affected feel as if they have been transported back to the traumatic situation and can temporarily lose touch with the present.
Re-experiencing symptoms can be triggered by situations that are similar to the traumatic event. These triggers are sometimes obvious, for example a gunshot-like bang or a dark street, but sometimes they are also very subtle and difficult to recognize, such as the discreet smell of an aftershave. Re-experiencing symptoms cannot be controlled voluntarily and can be very stressful psychologically.
In a threatening situation, the autonomic nervous system is strongly activated. This corresponds to a biological protective reaction: the body and mind are activated to the maximum in order to improve the chances of survival. It is typical of post-traumatic stress disorder that those affected remain in this state of activation even after the traumatic situation has ended or are repeatedly put back into it as part of the re-experience. Vegetative hyperexcitability manifests itself in tension, anxiety or a feeling of constant threat. Body and psyche remain trapped in a kind of alarm state. This can also be accompanied by irritability, nervousness, impulsiveness, sleep and concentration disorders. Symptoms of vegetative overexcitability can alternate with symptoms of emotional blunting and apathy.
Re-experiencing and vegetative overexcitability can be very stressful. Accordingly, most of those affected try – sometimes consciously, sometimes unconsciously – to avoid situations in their everyday lives that could trigger or reinforce memories of the traumatic event. After a traffic accident, people may avoid driving or using public transport. After political imprisonment, you might no longer go into the dark, damp cellar or avoid contact with people in uniforms. Particularly in the case of interpersonal trauma, there is often a tendency towards general social withdrawal and mistrust. Such avoidance strategies are understandable and can also contribute to short-term relief. However, they can lead to severe impairments in everyday life in the long term. As people usually also avoid dealing with the traumatic experience, avoidance contributes to the chronification of post-traumatic stress disorder.
Traumatic events are beyond our everyday experience. Powerlessness and the existential threat of a traumatic situation contradict our more or less pronounced sense of security, competence and ability to cope, which usually guides us through life. Accordingly, traumatic experiences often shake up our view of the world and people, as well as our ideas about ourselves. Insecurity, fear, mistrust, anger, bitterness, pessimism, but also feelings of disgust, shame and guilt can be the result. These feelings are not only stressful, but they often separate those affected from their social environment, making it more difficult to receive support.
The earlier PTSD is treated, the better the treatment prospects. However, the first step is often not easy: the prospect of having to talk about and deal with the traumatic situation is stressful and often has a deterrent effect. If you decide to undergo an assessment, we will ask you questions about your symptoms, their cause and your life background, but you will not be pressured into anything and can decide for yourself what you want to report. Building trust takes time, especially in the case of interpersonal trauma, and particularly difficult aspects can often only be revealed in the process. In addition to personal interviews, we also occasionally use standardized questionnaires to better assess the severity of symptoms.
As post-traumatic stress disorder is not the only possible consequence of traumatic experiences, we will also discuss other clinical pictures during the assessment, such as depression, an anxiety disorder or burnout, which can occur together with PTSD or on their own. The use of tranquilizers, alcohol or drugs is also often found in the sense of self-treatment in order to calm down a little or to have less anxiety, and we will therefore inquire about this. Finally, accompanying physical symptoms such as muscle tension, trembling, sweating, palpitations, pain or psychosomatic complaints are also common and are investigated further by us if necessary.
With appropriate therapeutic help, post-traumatic stress disorder can often be dealt with and overcome. It is therefore important to seek professional support at an early stage if this is suspected. The longer the symptoms remain untreated, the higher the risk of chronification, the more serious the impact on your everyday life and your environment and the greater the treatment effort required to achieve an improvement in symptoms. If you are unsure whether clarification is indicated, it is best to contact us for a consultation.
As a patient, you cannot register directly for a consultation. Please get a referral from your primary care physician, specialist.
University Hospital Zurich
Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine
Culmannstrasse 8
8091 Zurich