By Dr. Stefano Casali
What it is and how it manifests itself
"I was raped when I was 25. For a long time, I talked about violence as if it was something that happened to someone else. I was perfectly aware that it had happened to me, but I felt no emotion. Then I started having flashbacks. "They were kind of sudden and had the effect of a cold shower. I was terrified. Suddenly I was reliving the violence. Every moment was surprising. I didn't notice anything about what was happening around me, I was in a bubble, like I was floating in the middle air, and it was scary.
"I suffered violence the week before Christmas and I can't believe the anxiety and terror I feel every year nearing the anniversary date. It's like seeing a rabid wolf. I can't relax, I can't sleep, I can't sleep. I want to see nobody. I wonder if I'll ever be free from this terrible problem. "
"On every social occasion, I was afraid. I was anxious even before leaving the house and this feeling intensified as I approached a lecture at the university, a party, or whatever. I felt sick to my stomach as if I had the flu. My heart throbbed, my palms became sweaty and I had this feeling of detachment from myself and from everyone else. "
"When I walked into a room full of people, I became red and felt like I had everyone's eyes on me. I felt embarrassed standing in a corner on my own but I couldn't think of something to say to someone "It was humiliating. I felt so awkward that I couldn't wait to leave."
"I'm scared to death just by the idea of flying and I'll never do it again. I'm beginning to fear a plane trip a month before I have to leave. It's a terrible feeling when the airplane door closes and I feel trapped "My heart beats frantically and I sweat so much. When the airplane starts to climb, the feeling of not being able to get out has grown stronger. When I think of flying, I see myself losing control, going crazy and climbing walls, but of course I never did "I'm not afraid of falling or turbulence, but of being stuck. Every time I thought about changing jobs, I thought, " Will I be asked to fly? "
"Currently I only go to places where I can drive or take a train. My friends always emphasize that I could not even get off a train that travels at high speed, so why don't trains bother me? I simply say it is not of a rational fear. "
These three statements made by people who have experienced or would better say suffered traumatic events give an idea of the magnitude of the stresses and their consequences. Let's go into the details a little more:
Post-traumatic stress disorder (PTSD) is similar to "acute stress disorder" with the difference that in this case the symptoms last for more than a month and differ in some details.
Symptoms
The symptoms of post-traumatic stress disorder are:
- persistent memories of the traumatic event through nightmares, images, thoughts or perceptions;
- feeling of reliving the moment as if it were really coming back (there may also be flashbacks, hallucinations, illusions, episodes of dissociation);
- intense discomfort at the sight of something that can remember what happened, like a place or a person;
- avoidance of thoughts, feelings, places and people who remember the trauma;
- avoidance of conversations about trauma;
- inability to recall relevant aspects of the event;
- decline in interest in activities in general;
- feeling of detachment from others (difficulty in feeling feelings towards them);
- feeling of no longer having future prospects.
Other symptoms:
- Irritability, difficulty sleeping, low concentration, state of alarm and restlessness.
Causes
The probability of developing the disorder can increase in proportion to intensity and with physical proximity to the stressor factor. From these general diagnostic considerations it is a force to deduce that many people currently suffer from PTSD in connection with Islamic attacks. Surely among them we will find the survivors and relatives of the victims, but also the New Yorkers, especially those in Manhattan.
The idea that catastrophes or experiences of considerable emotional impact can determine characteristic symptoms has long been known. The non-medical descriptions of these phenomena are certainly older than the various diagnostic categories. Only in 1980, with the drafting of the DSM-III, was a specific diagnostic category introduced for these clinical pictures, the Post-Traumatic Stress Disorder (PTSD) on the basis of a hypothesis supported by various studies, in particular those conducted on the veterans of the Vietnam war. The mental disorders resulting from the experience of an extreme event (aggressions, wars, natural and technological disasters, concentration and extermination camps) were quite characteristic, specific and constant, both on the etiological and on the phenomenological level, to justify the construction of a column in the classification of mental disorders.
It is also known that post-traumatic stress disorder can be particularly severe and prolonged when the stressful event is designed by man and in this case it can easily be induced that the symptoms will be very marked and lasting. This means that for a long time many people will be practically disabled because the symptoms of PTSD can be very devastating.
Thus the concept of PTSD has taken the place of the older one of traumatic neurosis or post-traumatic neurosis. Contrary to what was previously believed, exposure to an extreme stressor is not the "conditio sine qua non" for the development of PTSD. In the DSM-IV there is no longer the "catastrophic" quantitative threshold in criterion A that defines the traumatic event. Exposure to an event "outside the usual human experience" is no longer necessary to diagnose PTSD. A growing body of data has in fact underlined the importance of risk factors such as genetic predisposition, psychiatric familiarity, age at the time of exposure to stress, personality traits, previous behavioral and psychological problems, exposure to previous stressful events. About 19 percent of those with post-traumatic stress disorder who have never required treatment or who are not aware of the disease have a high suicidal risk. This disorder also occurs in association with certain medical diseases, for example hypertension, bronchial asthma and peptic ulcer, or with other psychopathological disorders, for example depression, generalized anxiety disorder and abuse disorders of substances.
