9. PTSD Can Show Up In Many Ways
Updated: Oct 18, 2023
The Residual Potential Of Traumatic Stress
Post-Traumatic Stress Disorder (PTSD) is the body, brain, and nervous system's potential response to surviving a traumatic event. For reasons unknown to me, some people develop PTSD, while others don't. Not everyone who suffers trauma necessarily develops PTSD, yet it is relatively common, and a lot of survivors endure some version of it. I am one of the survivors who developed PTSD as the result of my body's response to sexual trauma.
It's challenging to give a full description of how PTSD can manifest because although it's possible to list the general ways it can show up, it's difficult to accurately convey the potential extent to which it can impact a person. Discouragingly, there is an extensive scope of ways it can present. Each person is different, yet it's helpful to know that if you are experiencing some version of PTSD, there are others who can relate.
Diagnostic Criteria
PTSD is a clinical term that refers specifically to the occurrence of a problematic series of reactions that some people develop in response to being in traumatic circumstances. There is no shame in having a mental health disorder. Everyone has challenges, and those of us with mental health conditions are no less than those who have never suffered from a mental health disorder. If anything, more compassion is needed towards those of us who suffer. When a phenomenon is categorized as a mental health disorder, that can have a variety of meanings. Sometimes, mental health conditions arise from biological roots, while other times from environmental situations. With PTSD, it occurs in response to traumatic life events.
In the field of psychology, The American Psychiatric Association (APA) creates a Diagnostic and Statistical Manual (DSM) containing criteria for defining mental health situations, which is utilized by mental health providers to diagnose and treat a variety of challenges. This manual is continually evaluated and updated as more is learned about how people manifest symptoms indicative of a variety of conditions. PTSD first became a clinical diagnosis in the 3rd version of the DSM in 1980. In the time since its inclusion as a mental health disorder, psychologists have developed a further understanding of the manifestations it can include. I anticipate this will continue to evolve over time.
**Trigger warning: In this section and the next section, I describe how PTSD can result from sexual trauma. I do not write explicit details.**
In its 5th and current edition, the DSM-IV lists that people can develop PTSD as a result of direct exposure to trauma, such as personally experiencing a trauma or witnessing a trauma, or as a result of indirect exposure to trauma, such as learning about a close friend or family member experiencing a trauma, or learning details of another person's trauma, and defines PTSD as including all of the following criterion:
1. A traumatic event (includes at least 1 of the following): exposure to actual or threatened death, serious injury, or sexual violence.
2. Re-living that traumatic event (includes at least 1 of the following): through memories, flashbacks, nightmares, emotional distress, or physical reactivity.
3. Avoiding associations with the traumatic event (includes at least 1 of the following): reminders, thoughts, or feelings.
4. Negative thoughts and/or feelings that began after the traumatic event (includes at least 2 of the following): inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self (or others, if trauma was witnessed) for causing the trauma, negative affect, decreased interest in activities, feeling isolated, or difficulty experiencing positive affect.
5. Trauma related reactivity or overstimulation that began after the traumatic event (includes at least 2 of the following): irritability or aggression, risky or destructive behavior, hyper-vigilance, heightened startle reaction, difficulty concentrating, or difficulty sleeping.
6. These symptoms show up for more than a month.
7. These symptoms create distress or functional impairment.
8. These symptoms are not related to medication, substance use, or another illness.
Specifications:
PTSD can also include, but does not have to include particular versions, such as:
A. Dissociative Specification: includes depersonalization and derealization.
B. Delayed Specification: the full manifestation of all PTSD symptoms show up at least 6 months after the traumatic event.
Further Description
That description might seem pretty clear, but what do those symptoms actually look like when they manifest? What the DSM-IV cannot capture is the extent to which PTSD can reach into any area of a person's life. These are just a few examples of the effects that PTSD can have on a person, that offer a further description than DSM criteria alone could attempt to convey.
1. A traumatic event.
One source of PTSD that many people are familiar with is related to military involvement. Soldiers are frequently involved in traumatic events threatening their lives, and the lives of others. It's easy to understand how PTSD could develop after being in a war. In the past, there was far more stigma, but these days, as more and more people become aware of why this is so likely to happen to soldiers, many people have some awareness of the subject and recognize it as a serious issue.
All those same manifestations of PTSD can happen as a result of sexual trauma as well. Not only is it an act of violence, it's threatening our life force in a variety of ways too. It makes just as much sense that people who have a history of sexual trauma could develop some version of PTSD, and it is absolutely just as serious as the PTSD endured by veterans, though it may not share the same originating trauma. When a person is attacked, all forms of attack can read the same way, as threats to our lives. And when a person witness an attack, again, the same is possible.
2. Re-living the traumatic event.
One of the worst parts of PTSD is re-living the original trauma. It's already awful that it happened, but then remembering it is excruciating. Survivors can be bombarded by horrible memories, dream about the traumas, have flashbacks and feel like we are re-living the traumas. This is not only torturous, but also emotionally, physically, and energetically exhausting.
Another element of PTSD involves what we call triggers. Triggers are basically unseen trip-wires that survivors can inadvertently happen upon that can set off flashbacks of the original traumatic events. For many, accidentally setting off a trigger can result in major panic attacks. What are panic attacks? They include intense sudden onset of fear, manifested through a combination of various forms, often associated with fearing losing control or fearing death is imminent, feelings of unreality or of being detached from oneself, along with heart palpitations, chest pain, sweating, trembling, challenges breathing, feelings of choking, nausea, abdominal discomfort, dizziness, hyperventilating, numbness or tingling, chills or hot flushes, and this can additionally be accompanied by a lot of crying. Panic attacks are very commonly a part of PTSD. As a person who has faced a lot of panic attacks over the years, I can vouch for them being awful.
3. Avoiding associations with the traumatic event.
The memories of the trauma can create red flags to the survivor about what is associated with danger. Avoidance of the location where the trauma took place is fairly common. Other areas of avoidance can include not just the physical location where abuse took place, but other physical locations associated with the abuser, such as the location where the survivor initially met the abuser, or any locations the survivor spent time at with the abuser. Additional areas of avoidance can include people associated with the abuser, such as the abuser's friends or family, or any sensory information from other people that reminds the survivor of the abuser, such as clothing style, fragrance, hair style, or even physical build or facial structure.
When a survivor has weathered panic attacks after inadvertently happening upon triggers, it can cause hyper-vigilance to attempt to avoid setting off the alarm bells again. This can amplify avoidance behavior even further, by limiting exposure to new locations, contexts, and people not originally involved in the trauma, but somehow reminding the survivor of the original trauma.
4. Negative thoughts and/or feelings that began after the traumatic event.
From my experience, I can say that I have certainly lived many of the manifestations that typically exemplify PTSD. The one area listed that I don't relate to is from 4.'s potential for an inability to recall key elements of the trauma. I have remembered trauma in minute detail, which has made the flashbacks all the more horrifying and torturous. This, in part, has kept my trauma fresh in my brain, making it more challenging to create distance between myself and what happened to me.
Self-blame is a completely wretched aspect of PTSD, which causes survivors to somehow feel responsible for the atrocities committed against us. This has been a particularly large battle for me, but thankfully, it is one I am now defeating.
Feelings of isolation are another destructive element that regularly manifests with PTSD. For me, this was particularly pronounced until I met another survivor and finally felt understood. There are so many of us who have been through hell, even if it wasn't the same hell, and know it just as personally.
For those of us living with PTSD, the default time zone becomes the past. It's particularly difficult to feel enjoyment in the present when so many memories from the past show up constantly. This is the part of PTSD that has genuinely done the most damage in my life because it prevented me from enjoying myself for so much time after my trauma. I couldn't feel peaceful or have fun when I kept re-living my torment. And in the moments between re-living torment, I was either recuperating or preparing to face it again the next time a trigger brought it back. Exhausting barely begins to describe the emotional and physical toll of returning to something awful from the past.
Common beliefs of people living with PTSD include feeling like it will last forever and having a hard time imagining the future. These may sound potentially contradictory to each other. Each does draw from the long-reaching potential for trauma to impact a person, and strangely, these impressions can co-exist. When a person is living with PTSD, the symptoms can take over so much of a person's life and alter a sense of time. That concept, "Time flies when you're having fun," when switched, can express that when you are suffering, it can feel endless. PTSD symptoms can indicate perceptions of immediate danger, and with an imminent peril mindset, only the present moment exists, so there is not space to imagine a future any different than the present.
It can be quite challenging to imagine life ever normalizing. The symptoms can almost re-write previous ways of existing, replacing old interaction styles with brand new ones, that once established, can be impossible to imagine ever shifting back from in a return to normalcy.
5. Trauma relative reactivity or over-stimulation that began after the traumatic event.
It's pretty common for people with PTSD to feel on edge, jumpy, and like they are amped up and can't calm down. This can make everyday tasks like work pretty hard to accomplish, and can turn every night into a battle to fall asleep or stay asleep. Some people can feel agitated and lash out, as you can imagine it might feel obnoxious to be constantly ready for something bad to happen and always in an energetic fight, flight, or freeze stance. For survivors with PTSD, perpetually existing in this high stakes state greatly taxes the nervous system.
6. These symptoms show up for more than a month.
The difference between a survivor without PTSD and a survivor with PTSD is the degree and extent to which the person's suffering is sustained. When a survivor has PTSD, it can prolong the length of time it takes to recover by keeping that person in a more heightened state of fear, panic, and terror, adding the additional challenge of calming down all the alarm bells to allow healing to take place. Distressingly, people can suffer from PTSD for prolonged periods of time, and may need specific interventions to help reset equilibriums back to normal. Fortunately, a lot of progress has been made with regard to treatment options for people living with PTSD, with EMDR (Eye Movement Desensitization and Reprocessing) now a leading technique offered as a successful treatment strategy for people healing from PTSD.
7. These symptoms create distress or functional impairment.
I think it's already pretty clear that living with PTSD would be distressing. The type of fear responses that can accompany it can have debilitating effects on what used to be normal activities. The concept of functional impairment includes the potential for PTSD to interrupt regular functioning, such as preventing a survivor from being able to work or go to school, or even preventing a survivor from even feeling safe enough to fall asleep, or to leave the house to get groceries. Basically, life isn't normal in the ways it used to be prior to the trauma.
8. These symptoms are not related to medication, substance use, or another illness.
It's essential to differentiate between PTSD symptoms that happen organically as a body's response to a traumatic event and PTSD symptoms that might be induced by other substances, such as elicit drugs. Hallucinogens, in particular, can induce intense states of fear and panic, similar to the type of torment experienced by people with PTSD. While the manifestations of terror can be similar, and such events with drugs can be in themselves traumatic, they should be distinguished as having separate sources.
Are You Experiencing PTSD?
Fortunately, a lot of people with histories of sexual trauma never develop textbook PTSD. Some people are able to heal from the traumas without experiencing this short-circuiting to their nervous systems. That doesn't mean that they don't suffer from any of the aspects that clinical PTSD can entail. It's important to note that any survivor can go through hell recovering after. They may feel a lot of pain, emotional turmoil, and challenges with trust. They may encounter all of the same symptoms as those mentioned above, but for a shorter period of time than a month. Not everyone who undergoes traumatic life events reaches diagnostic criteria for PTSD, but we all deserve support to heal after them. It's vital to treat all sexual trauma seriously, and recognize that any version of it has the potential for interrupting normal functioning, whether or not it creates symptoms of PTSD.
If these symptoms describe your reality after sexual trauma, you may have PTSD, though I would not recommend relying on a self-diagnosis, or even a diagnosis based on this post. I would suggest making an appointment to speak with a counselor or therapist who specializes in supporting clients who have been through traumatic events to determine if you do in fact have PTSD and if you do, you can begin to receive support. Please know that if you are suffering from PTSD, there is hope of dismantling its impact on your life. I didn't believe it was possible until I started gaining back sovereignty over my life. I believe it can happen for you too.
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