Symptoms of PTSD

Symptoms

While PTSD usually appears within three months of the trauma, sometimes it can surface months or even years later (APA, 1997). Psychiatrist's categorize PTSD's symptoms in four categories:

intrusive symptoms
avoidant symptoms
symptoms of hyperarousal
associated features

Intrusive Symptoms

The symptoms in this category are perhaps the most distinctive and readily identifiable. Here the traumatic event remains a dominating psychological experience that evokes panic, terror, grief, or despair as manifested in daytime fantasies, traumatic nigtmares, and psychotic reenactments known as PTSD flashbacks (Friedman, 1996). These flashbacks are so strong that the individual thinks that he or she is actually experiencing the trauma again. When a person has a severe flashback, he or she is in a dissociative state (APA, 1997). When this occurs, the indiviidual may actually start to act out the incident as if he or she was experiencing the traumatic event again.

Avoidant Symptoms

Avoidance symptoms are characterized by emotional constriction or numbing -- a need to avoid feelings, thoughts, and situations reminiscent of the trauma, a loss of normal emotional responses, or both (Long, 1997). These symptoms reflect the behavioral, cognitive, and emotional strategies used by PTSD patients to attempt to reduce their psychological response to the traumatic stimuli (Friedman, 1996).

Patients try to avoid all situations that might serve as stimuli for the traumatic event. When taken to the extreme, this may superficially resemble agoraphobia because the PTSD patient is afraid to leave the house for fear of confronting reminders of the traumatic event (Friedman, 1996). Dissociation and psychogenic amnesia are included among avoidant/numbing symptoms by which individuals cut off consious experience of trauma based memories and feelings

Because PTSD patients cannot tolerate string emotions of any kind, they percieve only the cognitive aspects of psychological experience and not the emotional aspects. This "psychic numbing" acts as an emotional anesthiseia and makes meaningful interpersonal relationships exptrememly difficult (Friedman, 1996; Long, 1997).

Symptoms of Hyperarousal

Individuals with PTSD often act as though they were constantly threatened by the trauma that caused their illness (Long, 1997). These symptoms most closely resemble thoses seen in panic and gerealized anxiety disorder (Friedman, 1996). Although some symptoms such as insomnia and irritability are generic anxiety symptoms, hypervigilence and startle are more unique. The hypervigilence in PTSD may sometimes become so intense that it appears to simply be paranoia. The startle reaction of PTSD patients also has neurobiological implications (see "Etiology" for more on the neurobiological causation of PTSD).

Associated Features

The person with PTSD may attempt to rid themselves of painful flashbacks, loneliness, and panic attacks by abusing alcohol and other drugs. These serve the purpose of blunting the patient's emotions and helping them to forget their trauma. Related, a PTSD patient may also show poor control over his or her impulses, increasing the risk of suicide (APA, 1997). (See "Epidemiology" for statistics on drug abuse and suicide among individuals with PTSD).

à Link to "Etiology" for more information on the neurobiological causation of PTSD.
à Link to "Epidemiology" for statistics on drug abuse and suicide among individuals with PTSD.

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Questions? E-mail the author: Gregory Bayse