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The Wisdom of Psychopaths
In this engrossing journey into the lives of psychopaths and their infamously crafty behaviors, the renowned psychologist Kevin Dutton reveals that there is a...
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Stress is an inevitable part of our life. Yet whether our daily hassles include the incessant gripes of a nasty boss or another hectoring letter from the Internal Revenue Service, we usually find some way of contending with them. In rare instances, though, terrifying events can overwhelm our coping capacities, leaving us psychologically paralyzed. In such cases, we may be at risk for post-traumatic stress disorder (PTSD).
PTSD is an anxiety disorder marked by flashbacks, nightmares and other symptoms that impair everyday functioning. The disorder is widespread. At least in the U.S., it is thought to affect about 8 percent of individuals at some point during their lifetime.
Although PTSD is one of the best known of all psychological disorders, it is also one of the most controversial. The intense psychological pain, even agony, experienced by sufferers is undeniably real. Yet the conditions under which PTSD occurs—in particular, the centrality of trauma as a trigger—have come increasingly into question. Mental health professionals have traditionally considered PTSD a typical, at times even ubiquitous, response to trauma. They have also regarded the disorder as distinct from other forms of anxiety spawned by life’s slings and arrows. Still, recent data fuel doubts about both assumptions.
Shell Shock
PTSD did not formally enter psychiatry’s diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), until 1980. Yet accounts of syndromes that mirror PTSD date back to Sumeria and ancient Greece, including a mention in Homer’s Iliad. In the American Civil War, veterans suffered from “soldier’s heart”; in World War I, it was called “shell shock,” and in World War II, the term used was “combat fatigue.” In the 1970s some soldiers returning from the war in Southeast Asia received informal diagnoses of “post-Vietnam syndrome,” which also bore a striking resemblance to the DSM’s description of PTSD.
According to the DSM, PTSD occurs in the wake of “trauma”—defined by the manual as an extremely frightening event in which a person experiences or witnesses “actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” (Less violent experiences such as serious relationship or financial problems do not count.) The most frequent triggers of PTSD thus include wartime combat, rape, murder, car accidents, fires, and natural disasters such as tornadoes, floods and earthquakes.
PTSD is now officially characterized by three sets of symptoms. These include reliving the event through intrusive memories and dreams; emotional avoidance such as steering clear of reminders of the trauma and detaching emotionally from others; and hyperarousal that causes sufferers to startle easily, sleep poorly and be on alert for potential threats. These problems must last for a month or more for someone to qualify for the PTSD label.
Immune to Trauma?
After the terrorist attacks of September 11, 2001, many mental health experts confidently predicted an epidemic of PTSD, especially in the most severely affected locations: New York City and Washington, D.C. The true state of affairs was much more nuanced, however. It is certainly true that many Americans experienced at least a few post-traumatic symptoms following the attacks, but most of the afflicted recovered rapidly. In a 2002 study psychologist Roxane Cohen Silver of the University of California, Irvine, and her colleagues showed that about 12 percent of Americans suffered significant post-traumatic stress between nine and 23 days after the attacks. Six months later this number had declined to about 6 percent, suggesting that time often heals the psychic wounds.
Work by epidemiologist Sandro Galea of the New York Academy of Medicine and his colleagues, also published in 2002, revealed that five to eight weeks after 9/11, 7.5 percent of New Yorkers met the diagnostic criteria for PTSD; among those who lived south of Canal Street—that is, close to the World Trade Center—the rates were 20 percent. Consistent with other data, these findings suggest that physical proximity is often a potent predictor of stress responses. Yet they also indicate that only a minority develops significant post-traumatic pathology in the aftermath of devastating stressors. Indeed, the overall picture following the 9/11 attacks was one of psychological resilience, not breakdown.
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11 Comments
Add CommentDoes Post-Traumatic Stress Disorder Require Trauma?
Reply | Report Abuse | Link to thisDoes a traffic accident require motor vehicles?
Trick question, right?
Reply | Report Abuse | Link to thisDid someone really ask this question? I mean really-or is it a long typo?Hey-othere than that, cant come up with better comments than the first two.
Reply | Report Abuse | Link to thisIs losing a loved one a "physical" trauma to you?? I'm not a doctor but know it hurts more than hitting my thumb with a hammer. A lot more.
Reply | Report Abuse | Link to thisTrauma implies "blood", but "stress" implies psychological issues. Therefore, is "Traumatic Stress" an oxymoron??
Can you be afraid of being blown up without being blown up first?? Can you be traumatized by seeing trauma??
It sounds to me like someone is afraid that somebody else might be "faking it". OK, some people do that. I say we err on the compassionate side, with our Vets anyway.
However, if the person is a Democrat, I say we tell them, "Welcome to the real world, take an aspirin, and get on with your life."
Traumatic disorder require Trauma.Particularly Trauma of childhood is very dreadful.It afflicted and tormented with unbearable fear ,pain and not curable.Joseph LeDoux did excellent research in his the emotional brain on PSTD.There are many variates in childhood trauma.Recent research in neuroscience particularly "Mirror neutrons and empathy" has also terrible effect on PSTD..I am suffering from mirror neutrons and empathy form last 76 years and I gone through anguish guilt feeling horribly.As I study the life of Dostoevsky, Hitler I found out both were victims of mirror neutrons.I wrote both of them a essays and experts appreciated.
Reply | Report Abuse | Link to thisThe basic problem here is, what is the definition of "trauma"? As much as science has uncovered that everything that goes on in the human psyche has an underlying neurobiological component, there still exists this false dichotomy of "physical" threat, disease, or injury and those of the "mental" realm.
Reply | Report Abuse | Link to thisPersonally, I believe that the heightened incidence of PTSD symptoms in individuals for whom there is no evidence of an "actual," meaning physical, threat, is due precisely to the unseen nature of what they perceive as threatening. The ability to hide, bury, ignore, and become numb to emotions is hallowed in our society; therefore, without a physical scar, sufferers of psychological trauma are often belittled (or are afraid that they will be belittled). Absent a clear way to acknowledge the pain, they don't heal, or the healing is extremely difficult and slow, fraught with neuroses and behavioral problems along the way.
Not sure what's "new" here. Complex PTSD (C-PTSD), proposed for inclusion in the DSM-V, was described in 1992 by trauma expert Judith Herman in her classic "Trauma & Recovery". The notion, in a nutshell, is that various life stressors and events can collectively lead to PTSD-like symptoms and conditions, which may be remediated via treatments used for conventional PTSD, notably EMDR.
Reply | Report Abuse | Link to thisYitzchak Samet, MA, LMHC
Of topics not mentioned are those who suffer from earthquake related PTSD and these days there's far more of them post Haiti (2010) and Japan (2011), though others around the world suffer from anxiety in fear The Big One won't be to far afield from today's noted earthquake reports.
Reply | Report Abuse | Link to thisYet, what of persons who experience horrendous events in hospitals? They may not seek counseling, (thus being under the radar), though I think it difficult not to believe when experiencing a life threatening illness and painful treatments it won't leave an indelible mark on ones life.
However, for many it's still seen as a weakness to live in fear about something that happened long ago that doesn't quite go away and with that age old thought that everyone who seeks counseling is crazy I think your study numbers may be on the low side.
i live in a black mouth that with their hussle habits can robber and fighting that no one can help or protect us from them, not trauma but just the police let them fight and robbering us. They really not educated, terorist and komunist. You cant say i am trauma with what your journal write here, the situations take in charge.
Reply | Report Abuse | Link to thisVery interesting article, Thanks! The definition of "trauma" seems a bit arbitrary. Seeing a loved one die slowly from cancer is not traumatic but seeing a loved one killed suddenly in an accident or crime is traumatic...not sure about that.
Reply | Report Abuse | Link to thisAnother thing to consider is the age of the sufferer. An independent adult who loses (to death, imprisonment or abandonment) a loved one may be very sad, but it's less likely that they will feel that their life is threatened than a child, who may be very dependent upon the loved one for food, safety, etc.
What's yours?
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