POST TRAUMATIC STRESS DISORDER CHANGES PEOPLE IN WAYS MANY CAN’T ARTICULATE.
ANXIETY FOLLOWS THEM IN THEIR DAILY LIFE.
TAKE A LOOK IN BIANCA’S DAILY LIFE AND MEET THE CHALLENGES.
By: MAX BAKKER (2599707) ZAINAB IQBAL (2590358) KIMMY BISHESAR (2571482) VRIJE UNIVERSITEIT AMSTERDAM KEY STRATEGIES IN DISABILITY AND NEUROPATHY MONDAY 8TH OCTOBER 2018
“According to the first diagnosis, I had borderline. And even though they knew about my traumas, I was not treated for it. My complaints were getting worse. Mental complaints. Physical complaints. My life became more limited.
I would be dangerous and there has never been so much hunting for me. I became halfway paralysed, couldn’t talk, and had a double vision.
My situation became worse and worse, and then… they finally diagnosed me. A mental disorder that was usually only seen with soldiers, but became booming in the early 2000s.
I have a Post Traumatic Stress Disorder, PTSD.”
Bianca has been diagnosed with PTSD. As a child she has experienced several types of violence, including physical, mental and sexual violence. This resulted in several traumatic situations. The mental disorder PTSD develops after a person has experienced a traumatic situation (Shalev et al., 2017). The biological assertion for PTSD is that it develops because of overpressure of the limbic system (Hakstege & Klaassens, 2017).
This can be explained due to the functions and the location of the limbic system in the brain. The limbic system is a structure that surrounds brain parts such as the amygdala and the hippocampus.
These two brain parts are the main components of the brain that make up the long-term memory. The limbic system is also involved in operating emotions, behaviour, and motivation (Medlineplus, 2018). Therefore, the limbic system is closely involved in experiencing threats and anxious situations and processing painful memories from the past.
In addition, anxiety activates the fight or flight mechanism (Seligman M.E.P., 2001).
PTSD does not develop immediately after the exposure to a traumatic situation but it develops after a period of time (Shalev et al., 2017). In more than 50% of the cases, PTSD occurs in combination with anxiety and/or mood disorders. It also causes disability and medical illnesses (Shalev et al., 2017). People with PTSD try to avoid all situations that relate to their traumatic experiences because they fear that the situation would lead to the same trauma.
PTSD and the anxiety that the disease brings with it affect Bianca’s daily life. She has problems with bonding and social ties; she experienced difficulties with school and still experiences difficulties with working; she suffers from overstimulation by light and sound, with the result that she is avoiding crowds and can’t travel with public transport; she suffers from nightmares and can’t sleep well for a day. Take a look in Bianca’s daily life and meet the challenges.
The first thing that comes hand in hand with PTSD is the anxiety of being lonely. There is often a lack of essential support for individuals who suffer from PTSD. The behaviour of people with PTSD is not well understood by their family and friends. Family and friends don’t know how to support a person with PTSD and a person with PTSD doesn’t know how to involve their family and friends.
“A trauma of one impacts the whole family. You can’t live a normal life with someone with PTSD, because of the spines they have. A person with PTSD doesn’t realise that he or she can be difficult. A person with PTSD thinks that he or she is pathetic, that he or she is the victim.
But in reality they are not the only victims, because they are also making victims around them. There is a lot of loneliness and no social network.”
Loneliness and no social network are characteristics of people with PTSD. They can get extremely angry for very small reasons and family members often don’t understand this. So, the family members start feeling guilty of hurting their loved ones and become a bad person in their own eyes.
To prevent such situations, PTSD sufferers as well as the family members create a distance between each other.
Some people with PTSD experience the benefits of having a dog. Owning a dog can lift their mood by providing companionship. Dogs are fun and can help PTSD sufferers reduce stress. Dogs are also a good reason to go out of the house and spend time outdoors.
“I couldn’t connect with people, but I could create this beautiful bond with my dog.
My dog has been a great support for me. He played a major part in my recovery. My dog remained by my side when I was facing extreme difficulties. We have a special bond.”
In 2016 Bianca discovered an institution that offers a new treatment for PTSD and registered for it. The treatment consisted of 2 times 4 days of intensive therapies. However, possibly due to its extreme intensity this treatment did not prove to be very helpful at first.
But later on, Bianca decided to follow a second course of the same treatment, which consisted of 3 times 4 days. Fortunately, this treatment proved to be extremely beneficial and helped Bianca to recover and thus move forward in her life.
The institution focused on Intensive8®, this is a combined therapy, including exposure treatment and Eye Movement Desensitisation and Reprocessing (EMDR).
EMDR is a processing treatment at which people with PTSD have to think about their trauma in combination with a distracting stimulus, this treatment stimulates the body’s natural processing system.
Exposure treatment is a generic term for exposure-based treatments. This includes breathing retraining, psycho-education, in vivo exposure, and imaginal exposure and processing.
During psycho-education, Bianca worked on her social ties.
“Taking responsibilities for my own life was the first step. I had to work on my social ties, in order to bond with my partner.”
People with PTSD experience difficulties with school. Due to anxiety problems, depression and dissociation, students with PTSD have a lower grade-point average, more days of school absence and decreased rates of high school graduation. In addition, they have decreased social competence and increased rates of peer rejection (Kataoka et al., 2012).
“I didn’t go to school anymore. I had aggression problems and couldn’t control it. The temper tantrums were provoked because other students ran into me on the stairs, because they looked at me the wrong way, because they didn’t agree with me.
I attacked them and never apologised. Fearless. I was fearless. I was about to physically harm someone, which I wanted to prevent. I didn’t get any support from the school dean; they said I was a difficult-to-raise child. So I quit school.”
Not only school is a problem for people with PTSD, another issue is their job. They have difficulties getting a job because they often don’t have a certificate/grade. In addition people with PTSD feel different from other people and can have problems communicating and interacting with others.
People with PTSD also find it hard to focus on their work because most of the times it can be a stressful environment. A study from the American Psychiatric Association showed that about two-thirds of PTSD sufferers are unemployed.
“My work weeks depend on how I feel. Some weeks I can easily work 50 hours, but other weeks I can barely handle 10 hours. I once resigned, because I passed out at work for a few hours. I didn’t think this job was worth all the stress and trouble.
This feeling can be caused by a heavy therapy session. Due to the session I can be overly tired and I have trouble focussing on my job. It is hard to accept the fact that I am not always able to work.
Unfortunately, I haven’t found a job, which fulfils my needs. So, I work for myself at home. I have a website and offer support to other people with PTSD.”
PTSD sufferers do not only cause the unemployment rate. It is also a consequence of the social stigmas. The stigma leads to several prejudices regarding mental illnesses. The common prejudices are: individuals with mental disorders are less intelligent, they are just pretending to get more attention, and their illness is not severe, so it will be over soon.
Despite living in a modern and educated environment, there are still too many stigmas for mental disorders (Paulienstuut, 2018). Therefore, most people do not take mental disabilities seriously. This leads to a lack of essential support for individuals who suffer from these disorders.
Another challenge for people with PTSD is overstimulation by light and sound. Too many incentives overwhelm their brain.
“I struggle with crowded places. I remember Queensday, a national holiday in the Netherlands. I didn’t know what to expect, so I went to Amsterdam. I was 23 years old. I walked in the overcrowded streets and didn’t know what happened to me. I’m about to scream. I am dying. I will attack people.
It became hysterical in my mind, but I didn’t want to express what was going on in my mind. I looked at the sky and focused on the clouds, while I was screaming on the inside, it was a hell.”
Where most people don’t have problems going outside, for people with PTSD this can be very stressful. Bianca struggled with simple things as doing the groceries and going outside for a walk.
The feelings Bianca experienced during Queensday are typical symptoms of PTSD. Even the little things in life can be very stressful for someone with PTSD.
Bianca has found clever ways to deal with certain problems. She is using her noise-cancelling headphone, which helps her to reduce the stimulus from the surrounding environment and helps her to remain calm.
Next to the headphone, Bianca uses sunglasses to prevent overstimulation by exposure to excessive light. Every time she has to go outside, she tries to plan everything before she steps outside. She uses this to eliminate the unknown and to keep her focussed on what she has to do. This also helps her to get home as quickly as possible, but she has a hard time to recover from these stressful moments.
“I can’t go out to places that are crowded. I can handle some situations, but I’ll pay the price for it later. I have to recover if I am back home. I can’t go to the city, can’t go to parties, and can’t go to birthdays. I live like a hermit.”
Staying awake during the nights due to nightmares is a major symptom of PTSD. On an individual level, PTSD can lead to various biological processes, such as modulating the adrenalin content. This change can affect the central nervous system and result in pseudo-neurological symptoms.
In addition, the altered adrenaline levels can disrupt the day-night rhythm and lead to deregulations in the autonomic nervous system (Gupta, 2012). In the long term, PTSD can cause: outbursts of anger, concentration problems, quicker fright reactions, trouble sleeping through and the patient’s irritability (G, 2015).
Research suggests two types of post-traumatic nightmares, symbolic and replicative (Brownlow, 2015). Symbolic nightmares may contain normal dream content, with distortions, irrational structures, and eidetic images, with some aspect of the trauma being represented symbolically.
On the other hand, replicative nightmares, which are specific to PTSD, seem to replicate part or all of the traumatic events. These dreams are more logical and lacking in the distortions characteristic of normal dreaming.
Recurrent nightmares have been associated with poor overall sleep quality, depression, and heightened risk of suicide (Brownlow, 2015).
“At first sight it looks like nothing is wrong with me. But there is an assassin in me. I’m extremely depressed on the inside and relive my traumas over and over again every night. It makes me feel lonely.”
PTSD is a mental illness that develops after exposure to a trauma. PTSD goes hand in hand with anxiety and this anxiety delivers challenges in daily life. Bianca experienced anxiety problems and described her daily challenges.
PTSD sufferers are often feeling lonely and can’t retain social ties with their loved ones. Due to anxiety and a decreased social competence they experience difficulties in their school time and can’t find an appropriate job.
Overstimulation by light and sound, another consequence of PTSD, arouses fear of going outside to do simple things as doing groceries and travel with public transport.
Another challenge for people with PTSD is nightmares and not sleeping well for a single day. Despite these daily fear challenges, most people find their own way to tackle these challenges and live their lives, and so also has Bianca.
“I once read this book. And even though I’m not a theist, I keep remembering this paragraph of the book. It contained the following: ‘God created us perfectly, with everything we need to survive in us. Traumas exist as long as humans exist.
Things as child mortality, natural disasters, and maltreatments are of all centuries. If we were not being equipped with the right tools to survive, we were already extinct. Traumas belong to life.’
People with PTSD have to get rid of their old story, and write a new story to create a future. PTSD is a lifelong process with ups and downs, but the journey is beautiful. It takes courage to look at it like that.”
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