The symptoms of Post Traumatic Stress Disorder (PTSD) are a common response to a traumatic event. They include vividly re-experiencing the event and associated anxious arousal, but also growing avoidance of anything related to the trauma, and an increasingly negative view of the world. For the majority of people such symptoms will subside over time, particularly if they are well supported in the period after the trauma. But for a significant minority the symptoms will persist.
Not all responses to trauma fit this picture however. The situation is often complicated when we are exposed to more than one traumatic event, when we experience trauma as a child, or when our trauma has an interpersonal element, as in abuse. Feedback loops that develop after trauma can set in motion processes associated with other disorders, such as anxiety and depression. And many people will become addicted to alcohol or other drugs in an unhelpful attempt to manage these complex and self-reinforcing symptoms, and addictions cause a whole set of problems by themselves.
It may be helpful to think of each person’s trauma response as a point floating somewhere in the Venn Diagram below, often falling within the PTSD oval, but just as often encompassing greater complexity. And so to make sense of these complexities it is useful to consider other diagnoses and their relationship with PTSD.
Anxiety symptoms are often prominent after trauma. We commonly react to anxiety by avoiding the things that make us anxious, but avoidance undermines our confidence and leads to further anxiety and avoidance in a vicious cycle. The traumatised person may avoid doing things and going places that remind them of the trauma, and may avoid even talking or thinking about the trauma. As their cycle of avoidance widens, they may begin to experience difficulty just leaving the house, or carrying out everyday tasks. I’ve worked with highly trained and very competent members of the military who were reduced to staying at home all day, reluctantly going out only with their partner, or who found it difficult to answer the phone and check their emails in case it meant doing something they felt unable to handle. In this way anxiety becomes its own problem as it spreads and leads to conditions like agoraphobia (roughly defined as a fear of public places), social anxiety, severe worry and stress.
Negative thinking and mood states are now formally part of a PTSD diagnosis, and the effects of trauma are so debilitating that people may understandably respond with the feelings of hopelessness and helplessness closely associated with depression. When you feel nothing can be done to help, you may give up and withdraw from life, and if you think nobody understands you, or that you are a burden on others, you may isolate yourself socially. Severe and chronic depression works against people seeking help and engaging in treatment, so when depression is bad enough clinicians may opt to treat this before addressing trauma symptoms, even if they think the trauma symptoms came first.
Borderline Personality Disorder (BPD)
This diagnosis represents long standing problems with strong and chaotic negative emotions, interpersonal insecurity, confusion with one’s own identity, and frequent self-harming behaviours, including suicide attempts. There are many variations of symptoms that can earn this label, so BPD can be experienced quite differently by different people. It may well develop from early experiences of repeated abuse, including sexual abuse, hence the relationship with trauma. The methods used to treat PTSD can be quite different from those appropriate for someone with BPD symptoms, so differentiating between them is important.
Perhaps it is to now state the obvious that determining how someone has been impacted by trauma is critical for planning their recovery, so I recommend an assessment by a qualified clinician as a good first step.