When you hear PTSD, what do you think?
Let me guess – what comes to mind is a soldier, someone who has been in combat, maybe stationed overseas and has seen some gruesome war scenes. That’s the average portrayal in the media.
It’s also the basis of most studies, as researchers usually reach out to veterans: their trauma is easily traceable and the CAPS-5 – the preferred standard symptom criteria questionnaire used in research – was based on information gathered from ex-military personnel with PTSD, and might be of little relevance to other survivors[1].
The truth is, that most PTSD cases aren’t military induced.
In fact, while the prevalence of PTSD in one year in males is 1.8%, the prevalence in women for the same period of time is 5.2%.
According to the DSM, post-traumatic stress disorder can only be caused by extremely traumatic events, in which the person or someone close to that person has survived or witnessed, first hand, a significant near-death experience, such as physical sexual assault, severe injury, torture, terrorist attack, war or child abuse.
However, there is some evidence that autistic individuals can develop PTSD as a result of “lesser” traumas, such as ABA therapy[2]. 20% of those who experienced such trauma would develop PTSD, but some traumas are apparently worse than others, because as many as 50% of people who survived a rape or torture, go on to develop PTSD[3]. In other words, most of us didn’t go to war, we are still here, invisible[4].
“because most treatments are first tested on military veterans, most of the PTSD population is left with no new-treatment options for years”
The fact that PTSD is a well-recognized condition, and the fact that it has a definite onset and cause, could be considered a privilege – we aren’t treated as crazy, like some depressed individuals. The fact that something happened to start this horrible condition, makes it easy for others to accept us.
However, because most treatments are first tested on military veterans, most of the PTSD population is left with no new-treatment options for years, and even when treatments are approved, they might not be suitable for certain traumatic backgrounds.
Suicide attempt rates in PTSD population is estimated at over 22%[5]. Family members often want to shake us out of it, telling us that “it’s been that many years, get over it” – but we can’t. in our heads, it keeps on happening.
PTSD Symptoms
“Post-traumatic stress disorder brings a nightmare of symptoms that resembles a well-attempted torture. From flashbacks, in which we relive the traumatic event and its sensory aspects, to random panic attacks, to fight or flight attacks, to hypervigilance.”
In the first year after my diagnosis, I couldn’t eat, couldn’t sleep. My heart rate was 130bpm while at rest. The medication messed with my head, made me groggy and depressed. It took years of very intensive treatment until I started functioning again. I still have some trouble leaving the house, and I don’t really sleep. When I do, I re-experience everything that’s happened. For my brain, the trauma never ended – it keeps on happening.
You’ve all seen the trend of “trigger warning” in posts, but I don’t know if you know how a trigger feels, or what it does.
In a split second, you are back there. It isn’t a delusion or a hallucination, you don’t really believe that you’re there. But your mind and body think that you’re there, and it takes over, and there is nothing you can think or do to convince it that you’re safe.
Triggers don’t have to be external, or psychological. Physical triggers are a huge part of the problem.
I can exercise, and my pulse can reach a point that might be similar to the one I had during trauma – and BAM! A flashback.
I can hop into a steamy shower, and whoops, I’m there again.
Someone can grab my hand in a certain angle,
or I can wear a shirt in a certain color.
I never know what will trap my brain next.
Hypervigilance makes it so I can’t close my eyes at night. At university, I have to sit at the first seat of the row, because if I’m between people, my body reacts as if I’m blocked and signals that I need to escape. Everything makes me jump – and when I say jump, I mean JUMP. No more tiny startles from a big noise – the only way I roll now is a huge startle from a tiny noise.
“Fight or flight, when happens in public, is another major issue. It’s nothing like the autistic fight or flight, in which your body becomes overwhelmed.”
Fight or flight, when happens in public, is another major issue. It’s nothing like the autistic fight or flight, in which your body becomes overwhelmed. In the PTSD form of fight or flight, you have two options – literally, to fight or to run. Fight feels like, well, a fight. You have an overwhelming need to defend yourself.
I’ve never hurt anyone in those attacks, and I don’t think PTSD is an excuse for hurting anyone or anything else. I’m also not an angry person, and haven’t been before my trauma, but these attacks still come. When they happen, I go away, to be alone. I usually need to hit something: if I’m lucky, there’s something soft nearby. If I’m not, I stim, sometimes harmfully.
I guess this is where my Asperger’s come in handy, because it taught me ways to deal with overflowing emotion. The flight, that sometimes is preferable, is less controllable. I run, or fast-walk. I walk pretty fast as it is, but in a flight attack I’m in turbo mode. I walk or run with seemingly unending, propelling energy. I have to pay attention, because I can get too far, too fast, alone.
I learned that mindfulness meditation can help to give me enough control to choose between these two modes when the attack comes, but I cannot shut it down completely.
Freeze is another symptom that is invisible to others. I have yet to find a way to notice when it’s about to happen. I got pretty good at predicting meltdowns, and pretty good at managing fight or flight attacks, but the freeze just… happens. It can happen anywhere.
Once, I was at university and talking on the phone with my mom. At some point, I sat down. And I couldn’t get up. I could move my legs, I could move my body, and talk. I was not in a bad mood, and I didn’t notice any trigger. The only thing I couldn’t do was to get up. I was frozen. At some point, one of my professors approached me and I explained the situation. He asked me to come with him. Suddenly, I could.
Later, I was told by a professional that this type of freeze reaction is more primal, and so the motivation to get up gets blocked by the brainstem. Usually, I need someone to physically escort me away, and this is one of the main reasons I think I could benefit from a service animal.
How to Help Someone with PTSD
“The best way to help someone who suffers from PTSD, is to ask what you can do.”
Don’t assume the other person needs support in the form of a hug – touch can worsen triggers.
Sometimes, the best way to handle things is to be left alone.
In other times, just hearing that someone cares and is there for us makes the whole difference.
I could have never survived the last three years without my support system. I would have never had the power to go on, to try every treatment under the sun, if it wasn’t for them. Maybe the best thing that came out of my PTSD was to learn that I truly have people I can rely on through thick and thin, through unimaginable things. People who are able to put up with me and my symptoms, even if they can’t completely understand. Having a support system is the most important protection against suicide [6]. If you suffer from PTSD and don’t have a close knit support system, find one online.
Since my autism diagnosis, I’ve found a place for myself among people who can understand me, mostly Asperger’s and autism subs on Reddit. Even if I can’t say those people are my friends, they make me feel less alone, and are a great addition to the friends and family I already had.
Another big way to help maintain a trigger-free environment is to lessen noise in public places. This advice is also valid for helping other conditions, like autism, ADHD and SPD. Specifically, for PTSD, sudden noise is the most triggering – a car honking, a door shutting or car exhaust can worsen hypervigilance symptoms or bring a whole panic attack into motion. Be mindful of your children’s loud toys, and please limit the use of fireworks and firecrackers.
Please try not to make sudden moves around someone who is in distress, and be accepting of environmental needs: Maybe the next time someone asks you to let them sit in your spot, consider that this person might have PTSD, and that your spot might be the one with the most escape routes.
And most important – please remember that most of us are women, and most of us did not go to battle. Please remember that what we survived is usually unthinkable. Please be sensitive, we already feel guilty, and like it’s our fault.
Please don’t ask what gave us PTSD, we don’t like to think about it.
And the next time you think to yourself, “If I were her I would have acted differently”, or, “This could never happen to me”, please remember that it could happen to you, and that you have no idea how you’d react in that kind of situation. Usually, in a real emergency, your body is on automatic pilot. You act to survive, not to minimize harm. You freeze. You misunderstand. You live. Because deep down, we are just an animal, that thrives to live.
Dana is a neurodivergent, LGBTQ+ writer, artist, cognitive researcher, and animal rehabilitator based in Israel. She has autism, ADHD, and PTSD.
References
[1] https://www.ptsd.va.gov/professional/assessment/adult-int/caps.asp
[2] https://www.emerald.com/insight/content/doi/10.1108/AIA-08-2017-0016/full/html
[3] https://www.emerald.com/insight/content/doi/10.1108/AIA-08-2017-0016/full/html
[4] https://www.therecoveryvillage.com/mental-health/ptsd/related/ptsd-statistics/#gref
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