How to Write Trauma, Fear, and Anxiety: What is PTSD?
PTSD or Post-Traumatic Stress Disorder is a stress disorder classified by exposure to a traumatic event, then persistent re-experiencing, avoidance of trauma related stimuli, persistent negative thoughts and feelings, and persistent arousal and reactivity.
PTSD is distinct from psychological shock (acute & short term) and from physical shock (loss of blood). Shock and Acute Stress Disorder may present like PTSD, but they must resolve themselves by 1 month. If it lasts longer than 1 month, it is PTSD (so long as it also meets the criteria).
The Criteria According to the DSM 5 are:
Criteria A: Exposure to a traumatic event, or a stressor. This event can be:
actual or threatened serious injury
actual or threatened sexual violence
It can be experienced by:
Direct exposure (Personally experiencing it)
Directly witnessing it in person
Learning that a close friend or family member was exposed to accidental or violent trauma
Indirect exposure that is repeated, extreme and work related, such as by first responders or medical personnel.
Criteria B (Minimum 1): The traumatic event is persistently re-experienced in the following way(s):
Recurrent, involuntary, and intrusive thought or memories.
Nightmares related to the trauma.
Dissociative reactions and/or flashbacks; re-experiencing the trauma as if it were happening again
Intense or prolonged distress after exposure to trauma related stimuli/reminders
Intense or prolonged physical reactivity after exposure to trauma related stimuli/reminders
Criteria C (Minimum 1): Avoidance of trauma-linked stimuli after the fact:
Avoidance of trauma-linked memories, thoughts, or feelings
Avoidance of trauma-linked external reminders (people, places, things)
Criteria D (Minimum 2): Negative thoughts, feelings, or moods that began or worsened after the trauma:
Inability to recall important parts of the trauma
Persistent and distorted negative thoughts about oneself and the world
Persistent and distorted blame for oneself and others regarding the trauma
Persistent negative emotions (predominantly trauma-linked)
Persistent and significant loss of interest in activities and hobbies enjoyed before the trauma
Isolation, detachment, alienation, and estrangement from others
Persistent inability to experience positive emotions
(Depression is highly comorbid in PTSD)
Criteria E (Minimum 2): Trauma-linked arousal and reactivity that worsened or began after the trauma:
Irritability, aggression, or anger
Reckless or self-destructive behavior
Exaggerated startle response
Difficulty or problems with concentration
Sleep disturbance / Difficulty sleeping
These symptoms must last for at least 1 month and create significant distress or impairment in social, educational, work, etc settings. It must also not be caused by medication, substance use, or other illness.
If symptoms are not expressed until six months after the trauma, it is delayed onset. And it can be with or without dissociative symptoms (depersonalization and realization).
What does PTSD feel like?
What does PTSD feel like…? It feels like a sensation between deja vu and being stuck in a groundhog day loop. It’s being unstuck in time and time traveling, but it’s only to one specific point in time (or more depending on the trauma) and it is the worst experiences of your life. It is being cognitively- and it feels like physically- somewhere and somewhen else every time you’re even remotely reminded of the thing.
It’s being constantly on edge, waiting for the next blow, the next crash, the storm, next piece of danger. It’s muscle tension and clenching your muscles so much you don’t remember how to relax them. It’s jumping a foot into the air at the slightest noise and feeling your heart explode at loud ones. It’s sleepless nights because every time you close them you have nightmares, but falling back asleep anyway because you see the same thing just as vividly when your eyes are open and you’re awake. It’s having only one or two nightmares a night be an improvement.
It’s depression and anxiety and irrational anger because everything is too much. Because people say the wrong thing triggering you and you have to run and hide. It’s people being too loud and big and confrontational. It’s not going out to eat because the diner is too noisy and crowded and it sends the hypervigilance into overdrive. It’s throwing out leftovers you loved the night before because tonight they’re making your stomach churn and you can only remember what the food tasted like five years ago and the chaos that went on around it.
It’s standing in the middle of the room, hearing a conversation from years ago while a busy world goes by around you. It’s mentally leaving your body and not feeling your nails scrape your skin as you try and get some physical sensation to ground yourself. It’s reading a phrase or hearing a word and bursting into tears, it’s seeing a person and feeling sick, it’s being triggered and feeling the worst you’ve ever felt all over again.
It feels like you’ve been stuck at the end of the world for years, and instead of your life flashing before your eyes, it’s the moment of your death.
