Post-Traumatic Stress Disorder: What Are the Warning Signs?

Through the centuries, how individuals respond and react to trauma has been well documented in historical records as well as in literature ranging from Homer’s 8^th-century Iliad to the writings of Shakespeare and Dickens. In the modern age, we understand well that anyone may be subject to experience a genuine—and valid—physical or psychological response to a traumatic event.

Particularly well recognized over the years were the stressful effects of battle on soldiers of war. In 1980, researchers who were engaged in psychiatric work with Vietnam veterans coined the term post-traumatic stress disorder, or PTSD. They noted that many former soldiers appeared well-adjusted when they returned home from battle, yet, perhaps even years later, they began to display symptoms of stress. Hence, the title post-traumatic stress disorder: intense or disturbing stress occurring sometime after trauma is experienced.

What Is Trauma?

PTSD is associated with events that are traumatic—extremely stressful and out-of-the-ordinary: war, torture, violent crime, large natural disasters, or man-made disasters like car accidents or plane crashes. Although more normal life events such as death, divorce, or financial challenges can add stress, they do not typically bring on PTSD. However, these losses can certainly cause grief and depression.

But what qualifies as “traumatic”? Because we all respond to stress differently, the reality of trauma can vary from individual to individual. One person may experience an event as traumatic; in another person, it might trigger a less complex form of stress.

Most people who experience trauma will not develop PTSD—yet some do. Each individual processes stress through the filters of their own unique personality and experience, so reactions to stress can vary widely from person to person. For example, being in close proximity to the World Trade Center on 9/11 was undoubtedly traumatic. But might that stress potentially be the same for a person who saw those events happening live on TV? Or for an individual who repeatedly watched replays of the disaster? Or for someone who lost a loved one that day?

PTSD Symptoms

Post-traumatic stress disorder can trigger very real, even debilitating symptoms in an affected individual. It may cause that person to:

• Re-experience trauma in flashbacks or recurrent dreams
• Avoid reminders of the event, such as a particular location, or TV news coverage or conversation about it
• Feel emotionally numb, with difficulty connecting to others or recalling details of the trauma
• Exhibit hyper-vigilance—for example, repeatedly check the house for intruders, or sleep with a weapon
• Experience sleep, memory, and concentration problems
• Show uncharacteristic irritability or be quick to anger
• Self-medicate with drugs or alcohol
• Experience an exaggerated startle response—for example, in reaction to loud noises

I had my own experience with the latter on Independence Day. Recently back from Army duty in Somalia, I heard what I thought was gunfire and instinctively dropped to the floor. Then I realized that the noise was simply coming from fireworks. Fortunately, I had this reaction only once. PTSD becomes a concern when multiple symptoms last for longer than a month.

PTSD is very sensitive to triggers—an ambulance siren, a loud noise, even a smell. It’s also common for symptoms of PTSD to recur periodically; battle veterans who’ve been symptomless for decades may suddenly experience new onset. For example, many Vietnam vets have reached the age where they are retiring, perhaps their health has declined a bit, or perhaps they’ve lost a spouse or some friends. Add 50^th-anniversary news coverage of the war and images of battle, and the sudden stress it generates may be surprising.

A person suffering from PTSD may not even realize that he or she is in trouble. Instead, warning signs are often reported by someone close to the patient. It’s also important to note that anxiety, depression, and PTSD are very similar and can be interconnected; so, a clear clinical diagnosis by a trained medical professional is therefore imperative.

PTSD Treatment

When symptoms impair someone’s ability to work or have a successful home life, it’s time to intervene and start treatment for this disorder, in the form of medication, therapy, or other interventions.

• We know that medication works well, especially when anxiety and depression are involved; however, not everyone is receptive to medication.
• Useful therapy focuses very much on the present, and what the patient can do, right now, to reduce stress day by day.
• Other interventions may include activities like meditation, yoga, or exercise that deliver a soothing or relaxing effect—maybe something as simple as a daily walk at lunch to enjoy the fresh air. Finding a quiet environment and taking 10 deep breaths can have a dramatic, positive effect on state of mind.

I tell all my patients: find something healthy you love to do, and do more of it.

Can PTSD be prevented or avoided?

It’s anticipated that soldiers may experience a level of trauma in their role, so today we train them to be prepared. Certain occupations—medical first responders and other jobs in which PTSD is a real possibility—can do well to follow the military’s example in preparing for stress-inducing situations.

What we can all do is be aware of and attuned to recognizing the signs of trauma or stress in ourselves and others, and act quickly when things seem amiss.

PTSD and COVID-19

Will the coronavirus pandemic trigger PTSD to some degree in all of us?

Throughout the pandemic, the presence of COVID-19 has been a source of stress. But each person has, of course, experienced that stress in his or her own way.

Many have sheltered in place as directed and, while perceiving COVID-19 as a threat, may have had no direct personal experience with it. Others, like those living in harder-hit areas such as New York City, may have experienced the death of a loved one or a more heightened level of fear and tension due to the greater incidence of infection in their environment.

The most common stressor resulting from this pandemic, one we’ve all felt to some degree, has been fear—15 months fearing contagion from an invisible force. Everyone we encounter could potentially infect us with a life-threatening virus—and, conversely, each of us could be a potential threat to someone else. As a population, we’ve been forced to be very isolated, separating from others and avoiding touching, hugging, or shaking hands.

Now, with the success of vaccines and with infection declining across the U.S., we’re all beginning to get out and about. But for some, the prospect of being around others again is causing another type of stress—reunion anxiety. Are we ready to take off our masks and be with people again? For many, the answer may be “not yet.”

And, although the situation is much improved in this country, we’ve seen a surge of infections in countries like India, which can also compound feelings of stress, especially for those with ties to those areas.

And then there are the “long-haul” COVID-19 survivors. Many of them feel unique forms of post-illness stress—especially patients with lingering and disconcerting aftereffects such as fatigue or brain fog. Many others feel the stress of anger, wondering, “How could this happen here? Why weren’t we better protected?”

Health crises are, by their nature, stress-inducing—but, for most of us, the COVID-19 pandemic will not cause lingering stress in the form of PTSD. We should, however, keep a watchful eye on our first responders and on frontline workers such as emergency medicine and critical care providers. Depending on their working environment and how much support they’ve received during the pandemic, they may be at higher risk for lingering symptoms.

The final chapters of the pandemic are yet to be written, but I expect that our learnings will parallel those of our 9/11 experience: the closer you were to ground zero, the more likely you may be to experience some level of post-traumatic difficulty.

Stay Alert to Warning Signs

So remember: Most people who experience a psychological trauma will not develop PTSD. But for the small percentage who will, it can be frightening, overwhelming, and very disruptive.

Probably our best approach to managing stress levels in our lives is to understand PTSD symptoms and warning signs—and take action when we notice them in ourselves or in others. The more attentive we are to such changes and signals—especially those that linger for longer than a month—the greater success we’ll have at counteracting them.