Content warning: the topics discussed may be triggering for some. Please take breaks throughout your reading and seek professional support if needed.
A professor and counsellor once told us, “We are always healing. We never stop healing because we are never fully healed.” Now, as humans, we are not machines. We are resilient. We are stronger than we know. That being said, we are very much exposed and susceptible to trauma (some more than others), which does leave a lasting mark. In this blog post, we’ll shed some light on various forms of PTSD as well as sharing a bit about Post Traumatic Growth.
What is PTSD?
According to the American Psychiatric Association (2022),
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event, series of events or set of circumstances. An individual may experience this as emotionally or physically harmful or life-threatening and may affect mental, physical, social, and/or spiritual well-being. Examples include natural disasters, serious accidents, terrorist acts, war/combat, rape/sexual assault, historical trauma, intimate partner violence and bullying … People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people. People with PTSD may avoid situations or people that remind them of the traumatic event, and they may have strong negative reactions to something as ordinary as a loud noise or an accidental touch.
When researching PTSD, please keep in mind that symptoms can range from person to person. It is important to discuss this with a health care professional such as a psychiatrist, psychologist, or psychotherapist. Please be mindful that hypochondria and cyberchondria are very real disorders that could cause us to over-identify with illnesses and make us believe we are experiencing all illnesses we read or hear of (Cleveland Clinic, 2021; Mathes et al., 2018). However, if you suspect to be experiencing PTSD given the definition provided, please consider booking an appointment with a health care professional.
In addition, did you know there’s more than one type of PTSD?
Multiple Types of PTSD
Secondary Traumatic Stress Disorder
The National Child Traumatic Stress Network defines Secondary Traumatic Stress (STS) as “the emotional duress that results when an individual hears about the firsthand trauma experiences of another” (n.d.). Administration for Children and Families explains that “It is a set of observable reactions to working with people who have been traumatized and mirrors the symptoms of post-traumatic stress disorder (PTSD)” (n.d.).
So, in other words, we don’t always have to endure trauma firsthand to be severely impacted by it. Sometimes it just takes listening to someone else’s story, seeing someone get into a car accident, watching another person get abused despite being safe yourself … these are all scenarios that could lead to STS.
Despite not being physically involved in the traumatic incident, that should not take away from the toll it could take on us. Your feelings are valid. Your experiences are valid and they are yours – outsiders cannot tell you otherwise. Acknowledge how you might feel without being judgemental or comparing yourself to others.
As stated by the National Center for PTSD (2018), PTSD+DS, in addition to meeting full criteria for PTSD, captures people who additionally respond to trauma-related stimuli with dissociative symptoms (depersonalization or derealization) and associated emotional detachment. This is in addition to the two dissociative symptoms contained in the core diagnostic criteria for PTSD: dissociative flashbacks and dissociative amnesia (for the traumatic event)
Essentially, folks with PTSD+DS have out-of-body experiences that can lead to being physically present but mentally disengaged by either being stuck in a past memory, or forgetting/supressing the traumatic instance.
As mentioned by Moore (2021), “the main difference between this one and others is that it does not coexist with other mental health conditions such as depression”.
This is a very common form of PTSD and is highly receptive to therapeutic interventions.
Moore (2021) describes Complex PTSD as the aftermath of something that “occurs when repeated, or multiple, traumas happen over a period of months, or even years, instead of a traumatic event that happens once and is over”.
This differs from a stand-alone traumatic incident such as surviving one car crash or being assaulted one night. This does not take away from the trauma individuals face from a singular event as that is still traumatic nonetheless. However, Complex PTSD acknowledges the significant change that multiple, frequent, and reoccurring traumatic events can have on a person. An example could be a military veteran that has served multiple tours, been in the line of fire many times, perhaps seen colleagues pass away, and possibly killed others while on duty. This individual would be carrying a very different burden in comparison to someone who was shot once because of being at the wrong place at the wrong time.
Notwithstanding, all experiences are valid and bring their own challenges. Everyone has a right to their emotions, regardless of how they compare to the experiences of others.
Better help (2023) describes this as, Unlike other types of PTSD, comorbid PTSD deals with more than one mental condition … Comorbid PTSD is quite common. Examples of comorbid conditions commonly associated with PTSD include depression, panic disorder, and anxiety. Another name for this disorder is “co-occurring disorder” since it co-occurs with other disorders.
In a nutshell, individuals with Comorbid PTSD are often faced with multiple mental health impairments. This could mean they are dealing with PTSD and one other mental health illness such as anxiety, or it could mean they are suffering from PTSD in addition to five or ten other disorders. The number can vary, although more than one disorder is what comorbidity refers to.
How does PTSD affect the brain?
Bremner (2006) stated that “Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Traumatic stress can be associated with lasting changes in these brain areas. Traumatic stress is associated with increased cortisol and norepinephrine responses to subsequent stressors”.
As Brainline (2019) describes, we have an alarm system, a brake system, and system recall errors. Commencing with the former, an alarm system would be regulated by our amygdala, which sends our brains a signal that evokes a fear response. This system could be overactive and working overtime, which often feels like it’s working against us. Our brake system would be monitored by our prefrontal cortex, which helps us “think through decisions, observe how you’re thinking, and put on the ‘brakes’ when you realize something you first feared isn’t actually a threat after all”. This system could be underactive, leading us to believe everything is a real threat. In addition, our hippocampus is the memory center of our brains. Our memories could be impacted by a traumatic event, forcing our hippocampus to work hard in efforts to make sense of what happened. In summary, “Your amygdala, prefrontal cortex, and hippocampus all contribute to the feelings and actions associated with fear, clear thinking, decision-making, and memory. Understanding how they work also might explain why some therapies can help you work through PTSD”.
What does this mean? What can I do?
Oftentimes, psychological terms can seem scary or overwhelming. Being diagnosed or wondering if you’re experiencing a mental health illness are both a lot to process – and that’s okay! Take time to sit with the million emotions and thoughts that might be bouncing around your body. But, don’t stay stuck in those feelings or thoughts alone; please consider sharing this with a health care professional if it’s weighing on you.
Now, on to the positives! Let’s chat about resiliency and neuroplasticity. The American Psychological Association (n.d.) says that “Resilience is the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands”. Another definition provided by Psychology Today (n.d.-a) mentions that,
Resilience is the psychological quality that allows some people to be knocked down by the adversities of life and come back at least as strong as before. Rather than letting difficulties, traumatic events, or failure overcome them and drain their resolve, highly resilient people find a way to change course, emotionally heal, and continue moving toward their goals.
A silver lining is that we are all capable of this. In fact, you are more resilient than you know! And, the best part is that we can always train ourselves to be more resilient. A helpful combination to do so would be the right tools, supports, and time.
One indicator of how resilient humans are would be our neuroplasticity. Psychology Today (n.d.-b) defines this as,
Neuroplasticity is the brain’s capacity to continue growing and evolving in response to life experiences. Plasticity is the capacity to be shaped, molded, or altered; neuroplasticity, then, is the ability for the brain to adapt or change over time, by creating new neurons and building new networks.
Puderbaugh & Emmady (2022) also defined this as,
Neuroplasticity, also known as neural plasticity or brain plasticity, is a process that involves adaptive structural and functional changes to the brain. It is defined as the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections after injuries, such as a stroke or traumatic brain injury (TBI).
In simple terms, the brain is able to keep changing well after childhood. I once heard the metaphor of our brains being like a highway.
Think of how many times you take the same road home from work or school. That’s similar to a recurring thought. The more we think of something, the more often we recall or reinforce this memory, and the easier it is to continue thinking this way or trying to prove our thought correct. In example, if I constantly think “I’m a bad person”, I will associate many things I do to this thought. Which, in turn, can become a core belief.
However, if we try to change this path and go down a new road, it would be like taking the backroads or driving on unpaved grounds. It might feel bumpy at first. It might not feel as instinctive – maybe we’ll make a mistake that leads us to old habits, maybe we’ll have to get off that road once we’re already on it. But, with time, this NEW thought and road will become more familiar to us until slowly it feels like second nature. For example, the more I tell myself “I am a good person”, the more likely I will not feed into the “I am a bad person” thought, which will slowly rewire my brain.
Post Traumatic Growth
The PTSD Association of Canada (n.d.) explains,
Post-traumatic growth (PTG) can be defined as positive personal changes that result from the survivor's struggle to deal with trauma and its psychological consequences1. The process of post-traumatic growth can lead to improved relationships with others, more compassion, openness, appreciation for life, spiritual growth, personal strength, and a renewed sense of possibilities in the world. This personal growth extends beyond pre-trauma functioning. Therefore, PTG it is not merely a bouncing back to the level of functioning prior to the trauma, but rather a sense of positive growth beyond pre-trauma functioning.
Collier (2016) explains the five areas of Post Traumatic Growth (PTG):
To evaluate whether and to what extent someone has achieved growth after a trauma, psychologists look for positive responses in five areas.
1: Appreciation of life
2: Relationships with others
3: New possibilities in life
4: Personal strength
5: Spiritual change
To summarize, PTG is a positive change that occurs following trauma. Yet, this doesn’t happen overnight, nor does it happen easily. It takes work to acknowledge our trauma, relive it, and decide how we want to grow and move forward.
No matter what your story or journey is, please know that you are not alone. Life is very hard. But, there’s hope for us all. Stay connected, stay true to yourself, acknowledge your feelings and experiences, and congratulate yourself for every step forward you take.
To shift your perspective and close, I’ll leave you with the thought of Kintsugi. For starters, what is Kintsugi? As Sho (2021) wrote, it means “joining with gold”. This art form has been around for centuries, although its significance is beyond aesthetics. “For the Japanese, it’s part of a broader philosophy of embracing the beauty of human flaws”.
Have you ever broken a plate, bowl, or mug? How did you feel when that happened? What did you do with the broken pieces? It is very likely that you felt frustrated or angry and tossed everything straight into the garbage – I know I’ve been there, done that! However, in Japanese culture, they see broken bowls differently than we do. Sho (2021) explained that, adorning broken ceramics with a lacquer mixed with powdered gold is part of a more than 500-year-old Japanese tradition that highlights imperfections rather than hiding them. This not only teaches calm when a cherished piece of pottery breaks; it is a reminder of the beauty of human fragility as well … [it] is a reminder to stay optimistic when things fall apart and to celebrate the flaws and missteps of life … In an age of mass production and quick disposal, learning to accept and celebrate scars and flaws is a powerful lesson in humanity and sustainability.
Now think, how can this relate to you? How can we see ourselves as those bowls and practice Kintsugi? Are we not just as beautiful with all our scars, with all our gold cracks shining through? I would argue that we absolutely are.
Administration For Children and Families. (n.d.). Secondary traumatic stress. https://www.acf.hhs.gov/trauma-toolkit/secondary-traumatic-stress
American Psychiatric Association. (2022). What is posttraumatic stress disorder (PTSD)? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
American Psychological Association. (n.d.). Resilience. https://www.apa.org/topics/resilience#:~:text=Resilience%20is%20the%20process%20and,to%20external%20and%20internal%20demands.
Better help. (2023, April 3). 5 Types of PTSD and how to treat them. https://www.betterhelp.com/advice/ptsd/what-you-should-know-about-each-type-of-ptsd/
BrainLine. (2019, May 6). How PTSD affects the brain. https://www.brainline.org/article/how-ptsd-affects-brain
Cleveland Clinic. (2021, February 2). Illness anxiety disorder (hypochondria, hypochondriasis). https://my.clevelandclinic.org/health/diseases/9886-illness-anxiety-disorder-hypochondria-hypochondriasis#:~:text=People%20with%20illness%20anxiety%20disorder,high%20risk%20of%20becoming%20ill.
Collier, L. (2016). Growth after trauma. American Psychological Association. https://www.apa.org/monitor/2016/11/growth-trauma
Mathes, B. M., Norr, A. M., Allan, N. P., Albanese, B. J. & Schmidt, N. B. (2018, January 3). Cyberchondria: Overlap with health anxiety and unique relations with impairment, quality of life, and service utilization. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/29324396/#:~:text=Abstract,excessive%20concerns%20about%20physical%20health.
Moore, M. (2021, May 24). Types of PTSD. PsychCentral. https://psychcentral.com/ptsd/types-of-ptsd
National Center for PTSD. (2018). The dissociative subtype of PTSD: An update of the literature. https://www.ptsd.va.gov/publications/rq_docs/V29N3.pdf
Psychology Today. (n.d.-a). Resilience. https://www.psychologytoday.com/ca/basics/resilience
Psychology Today. (n.d.-b). Neuroplasticity. https://www.psychologytoday.com/ca/basics/neuroplasticity
PTSD Association of Canada. (n.d.). What is post-traumatic growth? http://www.ptsdassociation.com/post-traumatic-growth
Puderbaugh, M. & Emmady, P. D. (2022, May 8). Neuroplasticity. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK557811/
Sho, T. (2021, January 8). Kintsugi: Japan’s ancient art of embracing imperfection. BBC. https://www.bbc.com/travel/article/20210107-kintsugi-japans-ancient-art-of-embracing-imperfection
The National Child Traumatic Stress Network. (n.d.). Secondary traumatic stress. https://www.nctsn.org/trauma-informed-care/secondary-traumatic-stress#:~:text=Secondary%20traumatic%20stress%20is%20the,disasters%2C%20and%20other%20adverse%20events.