After a sudden, painful event, a strong impression is normal. If it doesn't fade within days, and images, memories or emotional numbness persist, the person may have post-traumatic stress disorder (PTSD), the effect of an emotional rather than physical blow. First studied in war veterans, it can follow accidents, a loved one's death, sudden abandonment by a partner, job loss, witnessing something intense, or physical or sexual assault, and it can occur at any age.
Symptoms the author lists
- Dreams and nightmares about the event, and sudden flashbacks.
- Heightened sensitivity to reminders, including anxiety around anniversaries (she mentions the days before 9/11).
- Avoiding emotions or situations linked to the trauma, such as being unable to watch car accidents on TV after being in one.
- Partial memory loss about the event.
- In young children, regression: losing skills such as toileting or speech.
- Feeling detached and alone even among family; difficulty feeling love, respect or trust.
- Loss of hope about the future (marriage, career, success).
- Trouble falling or staying asleep, and difficulty concentrating.
- Brief disconnection from reality while reliving the event, which can make driving or caring for small children dangerous.
- Strong physical reactions to reminders, such as racing heart and sweaty hands in an elevator after being robbed in one.
Symptoms should gradually fade within a month or two. If they last beyond about three months, therapy is needed; otherwise they can become chronic or lead to depression, severe anxiety, or alcohol or drug use.
Emotional numbing
One of the most common symptoms. The author describes a client who, years after an assault, could talk about it only intellectually, as if it had happened to someone else. She couldn't sustain intimacy, ended relationships before they got close, and grew anxious and withdrawn every year around the anniversary. When a caring partner wanted a serious relationship, she found herself overwhelmed and stuck, and finally sought therapy. The author presents this as typical: a person believes they've moved past the trauma, but it limits them whenever something recalls it.
Children
Children also experience post-traumatic stress, showing up as behavior changes, poor concentration, withdrawal, hypersensitivity and trouble sleeping. A child with several of these signs should have a psychological evaluation to uncover what happened, since they may be too afraid or ashamed to say. Unresolved trauma can hold a child back for years and keep a person from being happy even when they have everything they need. With psychotherapy, symptoms can resolve relatively quickly.
Note: Current clinical criteria are somewhat different from the book's (for example, PTSD is generally diagnosed when symptoms last more than a month), so a professional evaluation is the right step whenever symptoms persist.