A PTSD diagnosis is based on a severe trauma which causes distressing symptoms such as hypervigilance, being easily startled, having exaggerated responses to minor stressors, insomnia, and constantly re-experiencing the trauma in some way as in flashbacks, an inability to stop thinking about it, or in nightmares. The symptoms need to last longer than a month and have a great negative impact on a person’s life or their functioning in life.
Dennis Charney, M.D., who has done extensive research on PTSD, said during one of his educational talks in 2004, “I feel it is an underrecognized, underdiagnosed disorder. It is also undertreated. It hasn’t been researched enough to develop new treatments.” I spoke with a prison psychologist recently who told me that about 60 percent of prison inmates in an Auckland prison had PTSD. So what is also underrecognised is the huge damage it can wreck in people’s lives, within families, and the larger community.
Years ago I would have thought that a severely traumatising event would have to be something off the map, like a stranger breaking into my house and threatening me with a weapon. Or being raped, or assaulted viciously in some dark street on my way home from work. Natural disasters come to mind, like being caught in a flood or a bush fire. Then there are car accidents that can traumatise us with severe injuries, or the death of loved ones. I would never have thought of childhood sexual and physical abuse, childhood neglect, and being diagnosed with a life-threatening disease as traumatic events frightening enough to be a risk factor for developing PTSD. Yet they are.
After the Vietnam War, it was perhaps understandable that around 30 percent of veterans were diagnosed with PTSD, because combat was easily recognised as a truly terrifying trauma. Within these veterans it became obvious that PTSD is a very debilitating mental health problem. It also often had other problems associated with it like substance abuse, depression, and problems in interpersonal relationships at home and/or at work. Some veterans were violent in their homes, while a significant number also became homeless, or in other ways withdrew from society. It was also found that veterans who had a history of child abuse were more vulnerable to developing combat-related PTSD.
Yet you might be surprised to know that combat is a minor cause of PTSD in terms of the population as a whole. PTSD is more common among women. One of the reasons this is so is because rape (for both men and women) is the highest risk factor for developing PTSD, and women are much more likely to be raped than men.
Yes, men also experience rape. A male friend of mine was raped twice by men. The first time was when he was hitchhiking and a man pulled a gun on him after stopping to give him a lift. At gunpoint he drove my friend to an isolated place and raped him. The second incident involved someone drugging his coffee at a diner and he awoke hours later on a train with his underpants stuffed in his pocket feeling like he had been gang raped. Perhaps not surprisingly, he was also sexually violated by a math teacher as a young boy at a boarding school.
Coincidentally, while I was writing this article I received an email from a distressed woman whose ex-boyfriend was raped by his brother when he was just eight-years-old, and she wanted to know how she could help him. Unfortunately, rape is a much more common occurrence in families than any of us might like to think. As a child I was taught to be wary of strangers, but it was members of my own family who created my most traumatic memories. This is especially problematic for children as they can become totally overwhelmed by a trauma caused by someone they love, to the point where they can develop amnesia or dissociate. Both are symptoms of PTSD.
Yet there is another trauma associated with a rape by someone children know and trust, and that is betrayal trauma. Not only can the act of rape or sexual abuse alter a child’s world view and their sense of safety in the world, so can a betrayal of trust.
For a child, and even for an adult, rape and sexual abuse are intensely shaming. Often a child is forced to keep this abuse secret because of a threat made by the adult, of the dire consequences that will occur if the child should tell anyone. This denies the child the support they need to overcome the trauma. When there is no emotional support, it is more likely the child will develop amnesia because the double trauma of rape and betrayal, along with the threat and the anxiety that comes with keeping a secret, and the shame that makes a child feel ‘bad’ and ‘wrong,’ all serve to completely overwhelm his or her ability to emotionally deal with such abuse. The brain then shuts out the memory of the trauma so they can cope.
In this way, the righteous anger the child should feel gets cut off from its source. And so does the shame. Later in life, the unresolved trauma can manifest unexpectedly in intense anger, tantrums, and rage in situations where the person feels the same sense of powerless he or she felt as a child, which can become especially problematic during the breakdown of an intimate relationship – especially if they also feel a sense of betrayal.
It is at this point that many people enter therapy, where the underlying source of such emotions needs to be explored, for a new life cannot be built upon a foundation of unresolved trauma. This would be akin to building a new house on rotten foundations. You could imagine therefore, that it wouldn’t be long before the new house collapsed. Yes, it is painful exploring old abuse memories, but this work allows you to remove all the rotten foundations (along with negative beliefs you have about yourself, others, and the world) and build new ones that will support the new life you want to live and even the new person you want to be.
Yes, PTSD can be treated with drugs to dampen or alleviate its symptoms, but these drugs cannot heal or cure PTSD that has developed with traumas overlaying other traumas from early childhood. Research now shows that these traumas create changes in the brain that have a long-lasting impact right into, and throughout adulthood. To complicate things, children who experienced abuse at the hands of family members are more likely to be revictimized as an adult, thereby adding new trauma onto unresolved early trauma. The stress this creates can permanently alter the wiring of the brain, which can then constantly activate the fight/flight stress response to release a surge of stress hormones, two of which are adrenaline and cortisol.
When this flight/fight response does not turn off, the overexposure to cortisol and other stress hormones can disrupt almost all your body’s processes. This puts you at increased risk of numerous health problems, including, but not limited to:
- Heart disease
- Sleep problems
- Digestive problems
- Memory impairment
- Worsening of skin conditions, such as eczema
Stress plays a pivotal role in many illnesses. However, this is often downplayed or ignored in relation to potentially threatening conditions like high cholesterol. Much is made of the right diet and exercise, for example, but little is said about reducing stress. Switching to low fat foods and heart friendly oils can be undone when your liver produces cholesterol when under constant stress.
Another strain on your body that has been connected with child abuse and trauma is inflammation (indicated by raised levels of hsCRP, high sensitivity C-reactive protein), found in a sample of people at the age of 32 from Dunedin in New Zealand, who are part of an ongoing longitudinal study. Raised hsCRP indicates low-level immune stimulation, which can cause problems in the body over time and possibly lead to heart disease, cancer, or other serious conditions.
The point of telling you all this is to raise your awareness that unresolved early trauma can have a lifelong negative impact, not only on your body, but your quality of life, and also quality of relationships that make up an important part of your life. Another reason I am telling you this is because June is PTSD awareness month in North America, and this is my contribution to that awareness.
As a person dealing with chronic PTSD from an early history of childhood trauma, overlaid by numerous traumas in my adult life, I can attest to the high importance of seeking help to reduce the negative impact PTSD can have on your life. I have learned that seeking help is not an admission that one is weak, for it takes great strength of character and courage to confront the pain of the past. However, what makes people afraid to seek help is often an underlying sense of shame (caused by the abuse or trauma) which gives them a sense of being somehow ‘defective.’
Trauma can make even the strongest amongst us falter and fall. There are too many variables within life and within trauma itself to compare one person’s experience with another. A person who seems like a stoic who can deal with any stress that comes their way, may be the one who suddenly dies from a heart attack or cancer as a result of a lifetime of holding all their stress inside.
When you are constantly reacting in negative ways to stressful situations, you are not in control of your life. Conversely, the stress is in control of you, and the smallest of triggers will keep you jumping to its tune. Alternatively you may seek to have rigid control over others or your life experiences. Either way, you are not really in control of your stress.
Personally, I see PTSD as a gift – even though I wrestle with its impact on my body almost daily. It is helping me to change from the Type-A behaviour common in so many driven and perfectionist people. It is showing me how dysfunctional my life was and is making me slow down and learn to enjoy quiet moments walking along the beach or appreciating the beauty within nature. Instead of always giving 100 percent (most often more), I am learning to give much less, aiming now to achieve a more modest and realistic for me, 70 percent.
It has taken me this long to realise that if I keep giving 100 percent, which in reality is everything I have got, I leave myself with no reserves. What will happen in an emergency or, heaven forbid, another trauma? Yes, I will likely have a stress breakdown. So by slowing down to bring my PTSD symptoms off the boil, I am enjoying a more creative lifestyle that particularly suits me, and which I find emotionally nurturing.
Continuing in this way I know I will create more happiness and joy than I have ever experienced in my life, and which has eluded me for long periods in recent years. By becoming more ‘functional’ (by healing the dysfunctions in my life caused by early trauma) I am more likely to attract other ‘functional’ people with whom I can create happy relationships that jointly serve our continued growth, well-being, and happiness.
Trauma and Recovery: The aftermath of violence – from domestic abuse to political terror, Judith Herman, M.D., 1997
The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain, 2nd Edition, Louis Cozolino (2010) Chapter 14: Trauma and Neural Network Dissociation, pp. 262-285
The Peace of Mind Prescription: An Authoritative Guide for Finding the Most Effective Treatment for Anxiety and Depression, Dennis S. Charney, M.D., Charles B. Nemeroff, M.D., Ph.D, with Stephen Braun, 2004, Chapter 4: The World of Anxiety Disorders
The Invisible Epidemic: Post-Traumatic Stress Disorder, Memory and the Brain, by J. Douglas Bremmer, M.D.
Childhood maltreatment predicts adult inflammation in a life-course study, Andrea Danese, Carmine M. Pariante, Avshalom Caspi, Alan Taylor, and Richie Poulton.
Adrenal imbalance — the effects of stress and high cortisol levels, Marcelle Pick, OB/GYN NP