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PTSD: Persistent Perceptions of Threat
Post traumatic stress disorder (PTSD) is a mental health condition that can develop in response to witnessing or experiencing one or more threatening or horrific event(s). PTSD is characterised by three key categories of symptoms, (ICD-11). The first of these is re-experiencing. Here, common manifestations include flashbacks, vivid intrusive memories or nightmares. The second core component of PTSD is that of avoidance, which refers to minimising or preventing exposure to any internal (i.e. psychological) or environmental stimuli that trigger memories of past trauma. In addition to re-experiencing and avoidance, the third key feature of PTSD is that of persistent perceptions of threat. Dissociative symptoms may also present in single incident PTSD although a more common feature of C-PTSD.
Persistent perceptions of threat, the focus of this article, is exactly what the category title suggests – a chronic state of thinking (and feeling) under threat. For example, a young person who has witnessed domestic violence may fear being around a parent, or alter their behaviour, such as remaining silent, for fear of violence. They might freeze with fear if someone raises their voice, or jump out of their seat if a door slams. If a person has experienced sexual violence then they may walk to a bus stop after work and constantly check behind them, for fear of getting attacked again. They may find themselves scanning rooms to identify an escape route, or avoid sitting with their back against a door. In other situations, sitting in a coffee shop and seeing certain types of people that remind the person of past violent perpetrators, can cause intense fear. Common also is difficulty trusting people, for fear of being betrayed, abused or abandoned. The fear can also manifest due to a belief that others are under threat or in danger too. This chronic alertness for danger can manifest in various settings, including home, social, work, or educational.
When trauma occurs, and it is unaddressed, it becomes stuck in the brain, and the person continually reacts to various trauma memories that surface, which in turn, further embeds negative core beliefs concerning safety. The fear can be made significantly worse if further traumas are experienced. Encountering childhood trauma, and then experiencing harassment as an adult, for example.
Some of the signs of a persistent perception of threat can include:
- Constantly being on guard for danger
- Chronic nervousness or shakiness
- Agitation
- Difficulty relaxing
- Problems concentrating
- Jumpiness and feeling highly sensitive
- Startle reactions to sudden sounds
- Panic attacks
- Exhaustion/fatigue
Chronic fear severely impairs cognitive functions, causes persistent emotional distress, results in physical sickness and limits the ability to function well in daily activities. Studies show that unaddressed trauma can cause problems with concentration, memory, shrinkage of the hippocampus, and impair decision making. Common physical symptoms reported include nausea, dizziness, sleep problems, changes in appetite, headaches and fatigue. Chronic fear has also been linked to specific physical conditions such as cardiovascular damage, ulcers, irritable bowel syndrome, decreased fertility, osteoporosis, and type 2 diabetes. Furthermore, in addition to PTSD, other conditions that can develop include different types of depression disorder, general and/or specific anxiety conditions, dissociative disorders and substance abuse.
PTSD: Tips to heal
Addressing post traumatic stress is therefore crucial. Fortunately, trauma symptoms can be healed effectively. Following, I share some tips for addressing post traumatic stress, however do be mindful that it is general advice and not a replacement for personalised tailored support.
- Acknowledge the problem. If you are experiencing chronic fear, as well as other mental, emotional and physiological symptoms of distress, where possible, acknowledge that this is so. Regularly try to check in with what you are thinking, how you are feeling, what sensations you are noticing and the quality of your breathing. This will help you to feel more present and calm.
- Learn to relax. Remember, any perception of threat will activate the sympathetic branch of the autonomic nervous system, that is the fight or flight stress response, which, if chronic, will severely impair your health and wellbeing. Applying any technique that helps you get in to the parasympathetic relax and restore state, will benefit you. Deep diaphragmatic breathing can help here. One method that works for many includes placing your hand over your heart, and then imagine breathing in to the heart for 5 breaths, and then exhaling for 5. Fully focus on the physical sensation of breath, and consciously relax on the exhale. Other relaxation techniques include self-hypnosis, progressive muscle relaxation, EFT, and walking in green space, to name a few.
- Try to shift your attitude. Here you can practice techniques such as daily gratitude, forgiveness of self and others, as well as positive affirmations. These will also make you feel more empowered, which can reduce trauma symptoms.
- Move your body. Trauma symptoms manifest as a felt sense in the body, and research is showing that applying movements can help shift negative trauma energy in the body. There are numerous techniques you can apply, such as shaking your arms, legs and hips. One method I would recommend is Trauma Release Therapy (TRE), which can help you release the freeze response felt at the time of the trauma.
- Get personalised therapeutic support. Applying the aforementioned or other self-care techniques may not be possible because of the nature of symptoms, or they may only benefit if symptoms are mild. Moreover, simply working with a compassionate and supportive therapist is an effective intervention for treating trauma. Other techniques therapists are trained to apply that can effectively help you heal trauma(s) include EMDR and hypnotic suggestion, somatic therapy and cognitive restructuring methods. Therefore, I highly recommend getting therapeutic care, especially so if symptoms are chronic and interfering with your day to day activities.
I hope you found this article useful. If you have any further questions or to discuss treatment and support options, then feel free to get in touch.
With warm wishes,
Sadaf
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