In TSD, the victim cannot get rid of the memory of the traumatic experience. At

least one of the following symptoms of intrusive memory is present: recurrent and

intrusive recollection of the event, distressing dream, intense distress if any internal

or external cue symbolizes or resembles the traumatic event. For example, after a

terrorist attack, the sound of a car tier bursting may remind the victim of the sound

of firing and bring back the distress The person may have experienced, witnessed or been

confronted with an event or events that involved actual or threatened death, serious

injury or threat to integrity of self and others. The reactions of the person would be

predominantly fear, helplessness, and terror. At least three of the following behaviours must be present. The victim tries to get rid  of the thoughts, feelings and activities related to the trauma, though the effort is often not successful. She feels a kind of detachment and experiences a restricted range of

emotions. For example a victim may feel that she is incapable of loving anybody.

Indeed, after the Second World War many captives of the Nazi camp had this feeling

of not being able to relate to others.

  • Time of Onset of TSD

When does TSD begin?

This is indeed a controversial issue, as in many cases it

has been observed that symptoms show up not immediately after the event, but

months or years later. There are two contending explanations. On the one hand it is

possible that the victim of the trauma has initially erected a strong defense, but

gradually it failed to serve its purpose and the memory of the trauma returns with full

severity. A second and alternative explanation is that the trauma at best developed

a vulnerable personality in the victim. A third explanation is that the delayed symptoms are not at all related to the original trauma but are reactions to some recent life events



Now you know that not all persons who encounter traumatic events develop PTSD

in the long run. What predisposes them who succumb to the symptoms? You may

learn about the biological, psychological and social factors in the section below.

  • Biological Factors

The biological factors include the temperamental factors that may contribute to

development of vulnerable personality. Twin studies have shown that vulnerable

personalities may run in families. Besides, exposure to trauma may activate the

noradrenergic system. As a result the norepinephrine level is elevated. This in turn

may result in exaggerated startle responses and heightened emotional arousal.

  • Psychological Factors

Although psychoanalytic, behavioral and cognitive approaches have tried to explain

PTSD, none of them can adequately explain why some persons develop PTSD and

others do not. It seems that personality and life events are very important in this

regard. You must also note that ultimately there is a breaking point for every individual.

Some succumb to symptoms earlier and some later. It has also been observed that

the severity of symptoms is directly proportional to the severity of the trauma. For

example, the symptoms in combat stress are directly related to the number of killings.

  • Treatment of Traumatic Stress Disorder

Immediately after the trauma, often a range of psychoactive drugs may be used with

the victims of trauma to ease out the terror. Antidepressants and tranquillizing medicines

have found to have some effect. Especially SSRIs have been particularly successful.

Apart from medicines, Short term crisis therapy may also be needed at these

difficult times. Here you have to be proactively engaged with the persons, giving

information, supporting and clarifying things as far as possible.

In the long run, however, you must provide ways for integrating the experiences into

the daily life of the person. For all approaches, the key is to gradually expose the

person to the memories of the trauma and to teach her the coping skills. Usually after

the event or series of events, the person loses trust and sense of security in the world.

Sometimes fear of losing one’s stability predominates. As a therapist your first task

would be to educate the person about the nature and expected symptoms of TSD

and emphasize that these can be handled.

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