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Secondary Survivors
By Namid
Monday, September 22, 2008

Rated "PG13" by the Author.

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This is an excerpt from Secondary Survivors

Chapter 13 – Living with PTSD


Post-Traumatic Stress Disorder is a disorder that affects most survivors.  PTSD is a rather complex disease, and as a loved one of a survivor, can be very difficult to live with at times.  Only a licensed psychiatrist or psychologist can truly diagnose PTSD.  If you suspect your loved one is suffering from PTSD, see if they would be willing to undergo some testing in order to properly diagnose it.

A primary issue for the loved ones of the PTSD patient is to truly understand PTSD.  It is more than critical to fully understand PTSD, and how it affects your loved one.  By completely understanding and respecting the illness for what it is, the easier it will be to continue to love and support your loved one.  If you are the friend or family member of a PTSD patient, it is important for you to support the patient in their quest for counseling and treatment.  I am also a very big supporter of the idea of going to counseling together.  What better way to understand your loved one and their condition than to speak with them and their primary care-giver together?  Counselors, psychiatrists and psychologists can give you so much insight into the condition, and how it will affect you.  PTSD is a disease that directly affects the people around the patient.  In fact, the National Institute of Mental Health even states, “The family is very important in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive but not help perpetuate their loved one’s symptoms. Family members should not trivialize the disorder or demand improvement without treatment.  They say the loved ones of survivors need to be “educated allies and help you succeed in therapy.

In my opinion, the biggest obstacle a PTSD patient has is their choice to receive treatment or not.  We live in a society that still places a stigma on mental health issues.  No one wants to be labeled as “crazy” or “weird,” and to openly discuss a mental disorder and/or the medications that treat such disorders is to put yourself out for public scrutiny.  That’s a horrific problem.  Countless people are suffering with mental disorders and are not receiving proper treatment as a result.  For years, I didn’t receive treatment because I was afraid of what people might think of me when they found out I was on medication.  Let me ask you this, though: do you scrutinize a diabetic for taking their insulin?  No.  The same applies - or needs to apply – to mental disorders.  PTSD is my condition; that is my diabetes.  My pills are my insulin.  They are what keep me alive and well.  Now, that doesn’t sound so evil and scary, now does it?  Society as a whole needs to recognize that and take that stigma away.  More people need to understand that PTSD is an illness, just like any other.  Just as you might take antibiotics for an infection, so must you take medications for PTSD.  As a secondary survivor, it is imperative that you recognize and understand this.  If you do, both you and the survivor will heal more thoroughly and quickly.  To understand this is to understand and support the survivor.

Like all mental disorders, PTSD can also be problematic to treat.  Proper treatment may not happen right away.  Finding the correct medication(s) at the correct dosage(s) may take several months, or perhaps even years.  Be patient with yourself, the survivor, and the doctors involved.  Together, you can all make a good determination as to what is best for the survivor.

So, what is PTSD?  According to the National Center for Post-Traumatic Stress Disorder, “Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger. You may feel afraid or feel that you have no control over what is happening.

The National Institute of Mental Health describes PTSD as “…an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat, …mugging, rape, torture, being kidnapped or held captive, child abuse, car accidents, train wrecks, plane crashes, bombings, or natural disasters such as floods or earthquakes.”

They go on to describe it well: “People with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. They may experience sleep problems, feel detached or numb, or be easily startled.  Post-traumatic stress disorder (PTSD) develops after a terrifying ordeal that involved physical harm or the threat of physical harm. The person who develops PTSD may have been the one who was harmed, the harm may have happened to a loved one, or the person may have witnessed a harmful event that happened to loved ones or strangers.

People with PTSD may startle easily, become emotionally numb (especially in relation to people with whom they used to be close), lose interest in things they used to enjoy, have trouble feeling affectionate, be irritable, become more aggressive, or even become violent. They avoid situations that remind them of the original incident, and anniversaries of the incident are often very difficult. PTSD symptoms seem to be worse if the event that triggered them was deliberately initiated by another person, as in a mugging or a kidnapping. Most people with PTSD repeatedly relive the trauma in their thoughts during the day and in nightmares when they sleep. These are called flashbacks. Flashbacks may consist of images, sounds, smells, or feelings, and are often triggered by ordinary occurrences, such as a door slamming or a car backfiring on the street. A person having a flashback may lose touch with reality and believe that the traumatic incident is happening all over again.

The NIMH also notes some very interesting facts.  They said, “Not every traumatized person develops full-blown or even minor PTSD. Symptoms usually begin within 3 months of the incident but occasionally emerge years afterward. They must last more than a month to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic.

Women are more likely to develop PTSD than men, and there is some evidence that susceptibility to the disorder may run in families.  PTSD is often accompanied by depression, substance abuse, or one or more of the other anxiety disorders.

PTSD can come from years of childhood abuse, or one traumatic assault.  It is said that people who have survived years of abuse, or any other prolonged exposure to a traumatic event are said to have Complex PTSD, or C-PTSD.  Wikipedia differentiates PTSD from C-PTSD this way, “…it has been suggested that a differentiation between the diagnostic categorizations of C-PTSD and that of Post traumatic stress disorder (PTSD), as C-PTSD better describes the pervasive negative impact of chronic trauma than does PTSD.

As a descriptor, PTSD fails to capture some of the core characteristics of C-PTSD. These elements include psychological fragmentation, the loss of a sense of safety, trust, and self-worth, as well as the tendency to be revictimized, and, most importantly, the loss of a coherent sense of self. It is this loss of a coherent sense of self, and the ensuing symptom profile, that most pointedly differentiates C-PTSD from PTSD.

Most of the symptoms are similar between the two, as well as the treatments.  Some people do amazingly well with therapy and short-term treatment, while for others, it is a life-long condition.  Regardless, PTSD is treatable, and those who suffer from it are able to lead normal, full, productive lives.

The National Center for PTSD breaks the symptoms down well.  They state, “Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger: a sound or sight that causes you to relive the event. Triggers might include: Hearing a car backfire, which can bring back memories of gunfire and war for a combat veteran; seeing a car accident, which can remind a crash survivor of his or her own accident; seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped. 

The NCPTSD goes on to describe certain behaviors that are common to PTSD patients: “You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.  …some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.  You may find it hard to express your feelings. This is another way to avoid memories.  You may not have positive or loving feelings toward other people and may stay away from relationships.  You may not be interested in activities you used to enjoy.  You may forget about parts of the traumatic event or not be able to talk about them.  You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal.

That is PTSD.  That is the disorder that most affects rape, sexual assault, and incest/molestation survivors.  I have this disorder, and I know I’m not alone.  According to the NIMH, approximately 7.7 MILLION adult Americans suffer from PTSD.  There are many of us out there.  There is help, and there is hope.

PTSD manifests itself in various ways.  Some of the most common are: flashbacks, panic attacks, emotional numbness, and hyperarousal.  The physical problems associated with PTSD can range from GI and digestive disorders to migraines, and more.  Also, they can go from the minor to the severe.  Like so many medical conditions, there is a wide range here, and it is important to note that all the symptoms associated with PTSD need to be taken very seriously. 

Let’s look at some of the more common mental and emotional symptoms of PTSD:

Flashbacks, also called reliving or re-experiencing.  Nightmares can also fall under this category.  This is where the survivor relives the event in their mind.  Certain sights, smells, sounds, or touches may trigger the survivor into this “mode.”  This is a very real experience for the survivor, and it can be difficult for them to come back into the present moment.    If your loved one is experiencing flashbacks and nightmares, comfort them, as these can be very scary to live through.  Remind them that they are safe.  Do what you can to bring peace and calm to them,

In May of 2007, I was involved in a very bad car accident.  A drunken, and most likely suicidal man, ran out in front of my truck.  I swerved and slammed on the brakes, but he made sure to run where I was going, instead of away from me.  Try as I might, I was not able to stop in time.  Thankfully, the man just dropped where he was.  I hit him, but I did not run him over.  I administered first aid until the paramedics and police got there.  Within just a couple of hours, I received the news that the man lived and was being released from the hospital (thank GOD!).  He was alright, but I was left with my C-PTSD in full force.  Not a few weeks later, one of our cats escaped, and got trapped under the transfer case of an SUV.  While I was under the car, trying to save my cat, I kept reliving the accident, and seeing that man under my own truck.  I actually had to walk away from my cat before I lost it completely.  I took a few minutes to calm down, get centered and come back into the present moment.  When I came back to my cat, it only took but a few seconds for me to rescue him.  The visions I had, though, were flashbacks.  They were very real, and extremely upsetting. 

That is what a survivor goes through when they are reliving.  They see it all over again.  They are completely re-living the trauma.  It is a horrific experience to say the least.

Panic attacks are a very scary experience.  Typically with panic attacks, the person has shortness of breath, feels very agitated and nervous, perhaps even claustrophobic.  You feel completely panicked, but you may not know why.  Again, certain sights, smells, sounds or touches may trigger a panic attack.  I personally used to suffer from panic attacks right around the times of the anniversaries of my rape and the termination.  My mind knew what was coming, and so it kind of got “geared up” if you will.  In my own experience, panic attacks differ from flashbacks, because you’re not reliving the moment.  You are in the present, but yet you are experiencing all these physical symptoms.  If your loved one is suffering from a panic attack, it is important to talk to them, and not to do anything until you know that it is alright with the survivor.  For example, do not hug or put your arms around them unless they say it’s ok.  They very well could be feeling claustrophobic, and by doing so, you may actually make things worse.  Panic attacks typically don’t last too long. 

This is a great write-up on panic attacks from the Mayo Clinic: “It can happen anytime, anywhere — when you’re alone, with others, at home, in public, even awakening you from a sound sleep. Suddenly, your heart begins to race, your face flushes and you experience shortness of breath. You feel dizzy, nauseated and out of control. Some people even feel like they’re dying.

You may have experienced a panic attack — a sudden episode of intense fear that prompts severe physical reactions in your body. Many people, thinking they’re having a heart attack, go to the emergency room. Others try to ignore the signs and symptoms, not realizing that they’re experiencing a panic attack.

More women than men are affected by panic attacks. Some people are affected by frequent panic attacks, a condition known as panic disorder.

Although panic attacks were once dismissed as nerves or stress, they’re now recognized as a potentially disabling, but treatable condition. A variety of approaches, including medications, therapy and relaxation techniques, can help you control or prevent panic attacks.”

The worst panic attack I personally ever experienced hit me while I was in my truck stuck in Philadelphia traffic (anyone who has ever driven on the Schuylkill knows what that traffic is like).  I felt so trapped, and I had no where I could go.  That is not an uncommon feeling.  If you are with the survivor when they are experiencing a panic attack, try relaxation or breathing exercises, certain beverages (water is number one, but something like milk is not a bad idea as it has tryptophan which can help them to calm down or even sleep), or any other suggestions you may have from your counselors in order to help calm the person down.

Again, this is a very frightening occurrence for the survivor, so be supportive and understanding in words and actions.  That will mean more to them than you could ever imagine.

Emotional Numbness may seem like a rather unusual issue, perhaps one that doesn’t even seem note worthy.  In all actuality, it is.

For most of my life, I could easily talk about the details of my abuse and not bat an eye.  There were definitely no waterworks when I spoke.  In fact, there was no emotion at all.  Why?  Because I was numb.  I had distanced myself from it so that I wouldn’t feel or remember again.  Emotional numbness is quite real, and can significantly inhibit healing. 

There is not really anything that you as the loved one can do that can initiate the survivor to feel again and discard the numbness.  If someone talks to you about a traumatic event and they seem numb about it, know that they aren’t lying about the incident, they are protecting themselves from the pain.

If the survivor seems to be very numb, cold and/or distant when talking about the abuse/assault, you may want to encourage them to seek counseling.  In my experience, that was the best way to address the numbness.

Hyperarousal is being in an overly aware state, or “keyed up.”  The NCPTSD states, “You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause you to:

  • Suddenly become angry or irritable
  • Have a hard time sleeping
  • Have trouble concentrating
  • Fear for your safety and always feel on guard
  • Be very startled when someone surprises you.

I always have a hard time sleeping, and I do startle incredibly easily.  I am on meds to help me to sleep.  Unfortunately, I still frighten rapidly.  But I know WHY I am like that.  I think it is extremely important to understand why we do some of the things that we do.

If the survivor in your life shows signs like these, know that they stem from PTSD and the trauma that the survivor had to endure.  If possible, do all that you can to avoid situations where they may startle easily, or feel justified in constantly feeling fearful.  Anything that you can do to help them feel calm and safe will help them to heal.  Bear in mind, the faster they heal, the faster you will heal as well.

It took me several years after being diagnosed with C-PTSD to take it seriously.  Now that I have truly studied it and understand, and I’m receiving treatment, I fully believe that my C-PTSD is under control.

If your loved one is showing/experiencing any of these signs or symptoms, it might behoove both of you to look into diagnostics for PTSD and of course, treatments.

People with PTSD are also at a high risk for some unhealthy behaviors and habits.  According to RAINN, survivors are three times more likely to suffer from depression; thirteen times more likely to abuse alcohol; twenty-six times more likely to abuse drugs; four times more likely to contemplate suicide.  Survivors are also at a high risk for self-injury, also known as “cutting.”  The National Center for PTSD also lists:

  • Feelings of hopelessness, shame, or despair
  • Employment problems
  • Relationships problems including divorce and violence

These behaviors and issues are very harmful, and can be detrimental to healing.  If you suspect that your loved one is engaging in or suffering from any of these unhealthy behaviors, please seek immediate help.

If left untreated, PTSD can be a very difficult AND scary disorder to live with.  Once you know and understand the condition, that difficulty and scariness begins to wash away.  Be patient with yourself and the survivor.  PTSD is not an easy thing to live with, but it is treatable, and you can all go back to living your lives and not be under the control of PTSD. It is crucial to understand this condition that really affects us all.  It affects us in our day to day lives.  You must work together in healing. 

PTSD is a very misunderstood condition.  It is more than important to truly understand this condition.  It affects so many survivors, and it affects the people around us.  It is a medical condition, and needs to be treated as such.  With proper medical treatment, survivors can live a normal, full life, and truly enjoy the people around them.  Research it, ask your counselor, and work together.  Because together, we can all heal from the illness that is PTSD.

       Web Site: The R.A.P.E. Foundation

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