Post-traumatic stress disorder (PTSD) is a psychological condition that can affect a person who has experienced or even just seen a life-threatening, violent and terrifying event like a natural disaster, assault, or military combat. Although the condition was first described in soldiers, it can develop in anybody. Post-traumatic stress disorder is not uncommon; it affects roughly 3.5 percent of adults in the US. About one out of 11 people will develop PTSD during their lifetime.
The symptoms of PTSD fall into four broad categories: 1) intrusive thoughts like nightmares or flashbacks, 2) avoidance of anything that reminds of them of the trauma, 3) negative feelings and thoughts, and 4) hyperarousal or reaction. The last group of symptoms includes hyper vigilance, difficulty sleeping or concentrating, and reckless or self-destructive behavior.
1. Agitation
Everybody feels restless or fidgety at times. Agitation is a more extreme form of that, and it is defined more by the behavior more than the accompanying upsetting emotions. A person who is agitated will talk a lot, and they won’t be able to stay still. They may pace, wring their hands, shuffle their feet, clench their firsts, or pick at their clothing or hair. The agitated person’s movements are a reflection of their inner emotional turmoil. The purposeless movements can be accompanied by tension, excitement, impulsiveness, refusal to cooperate, hostility, and disruptive or violent behavior.
Agitation is always a symptom and not an illness in its own right like depression. It can develop gradually or suddenly. It may last only a few minutes, or it may last a lot longer. At first, the patient will simply seem restless, sarcastic and irritable. As the patient becomes more agitated, they will start pacing, clenching their fists and lashing out verbally. The patient may then start to become threatening or combative. In an agitation crisis, the patient’s condition has escalated to the point that they have become a danger to themselves or to others.
2. Irritability
Irritability is part of the fourth broad group of symptoms of post traumatic stress disorder and is thus an indication of “dysfunctional arousal and reactivity.” The irritable person overreacts to situations or people. Irritability is generally defined as anger or frustration with a person or situation. In severe cases, it can lead to aggressive and violent behavior. Spouses of PTSD patients often find irritability the hardest symptom to live with. While it is a symptom of PTSD, it can occur in other psychological conditions. For example, men often become irritable during the early stages of depression. People with non-psychiatric conditions like diabetes, hypothyroidism, the flu or allergies can also become irritable.
3. Hostility
Fortunately, not all patients with post traumatic stress disorder experience problems with hostility, anger or increased aggressiveness. Researchers from the Veterans Affairs and the University of North Carolina at Chapel Hill interviewed 676 veterans, and they learned that veterans who had trouble controlling hostile or angry impulses tended to have several characteristics in common. For example, many had grown up in violent homes. They also had served in combat for at least a year and fired a weapon during that time. In addition, the veterans’ extreme hostility was linked to hyperarousal symptoms like hypervigilance. Some did also show signs of having suffered traumatic brain injury, but the link was weaker than that between hostility and hyperarousal.
4. Hypervigilance
Hypervigilance is one of the better-known symptoms of post-traumatic stress disorder, and it is another form of hyperarousal. A person who is hypervigilant is always on guard and constantly scanning their surroundings for threats. They often overreact to loud noises or unexpected stimuli like unfamiliar and strong smells. If they have to go someplace crowded or busy, they can become irritated or agitated, for there will be too many stimuli for them to scrutinize. A person who is hypervigilant will be suspicious and read too much into situations and people’s actions. They differ from a truly paranoid person in that they are aware of their own abnormal behavior, while a truly paranoid person is not. A person with hypervigilance also often has trouble sleeping.
5. Flashbacks
In a flashback, the patient feels as if they are reliving the traumatic event. They often experience the same horror and fear they felt when the trauma actually occurred. Flashbacks often have triggers, which are sounds or sights that remind the patient of the trauma. Examples of such triggers can be seeing a car accident that reminds a crash survivor of their own accident, hearing a car backfire that sounds like gunfire to a former soldier, or seeing a televised news report of a rape that stirs memories in a rape victim.
Many people who experience flashbacks try to avoid triggers as much as possible. Many patients refuse to talk about the original trauma.
6. Fear
Post-traumatic stress disorder can be described as “getting stuck in a state of fear.” Under normal conditions, the brain will respond to a frightening situation by causing various physiological changes like increased heart rate to prepare for a flight or fight response. After the person reaches safety, the changes subside. While the person may feel anxious for a few weeks, that stress fades, especially if they receive reassurance that they are safe. A person assaulted in a bar, for example, may be afraid of bars for a time, but the joy of celebrating with trusted friends will gradually overcome their fear. A person with PTSD, by contrast, remains fearful.
7. Anxiety
Anxiety is another unpleasant emotion that most people experience from time to time. Many people feel anxious when they’re applying for a job or worrying about their ability to pay bills. Normal anxious feelings fade after the stressful situation is resolved in some fashion. In post-traumatic stress disorder, by contrast, the anxiety is persistent and overwhelming, regardless of the patient’s circumstances. In some patients, the anxiety can become so overwhelming that it interferes with their ability to function. Out-of-control anxiety can cause the patient to avoid social situations for fear of being humiliated or judged by others. It can also cause panic attacks that seem to come from nowhere.
8. Guilt
Many people with PTSD experience guilt related to their trauma. They often believe that they could have done something different at the time of the event to achieve a different and better outcome. A patient with trauma-related guilt might believe that they should have been able to prevent the trauma or handled it better. A rape victim, for example, might blame herself for not fighting back. Survivor’s guilt is a type of trauma-related guilt seen in PTSD patients who survived an event that killed someone else. A soldier with PTSD, for example, will often feel guilty for surviving a battle while some of his comrades perished.
9. Insomnia
Insomnia and nightmares are two of the symptoms of PTSD. Nightmares obviously interfere with sleep and are very common in PTSD patients; some research has indicated that between 71 and 96 percent of PTSD patients have nightmares. As with flashbacks, the patient relives the trauma in their dreams. Worse, a nightmare caused by trauma often occurs earlier in the night than an ordinary bad dream. A patient who suffers from frequent nightmares may actually become afraid to go to sleep. Some patients may self-medicate with drugs or alcohol, and many of these substances can make it harder to get to sleep and/or make the sleep less restful.
10. Mistrust
Mistrust is another symptom of post-traumatic stress disorder, and it is especially likely to develop if the patient is hypervigilant. Someone who is hypervigilant is always on guard and watching for threats. They, therefore, tend to be extremely suspicious of other people. They constantly watch other people for signs of hostile or untrustworthy behavior. A patient with PTSD often expects to be betrayed by someone else. In extreme cases, the patient may break off a relationship with a loved one in order to prevent a betrayal. The patient can get so obsessed with the activities of other people that they may be completely oblivious to things that are obvious to other people.
