Understanding Single Incident Trauma and Post Traumatic Stress Disorder (PTSD)
When to Seek Professional Help
Recognising Single Incident Trauma
Single-event trauma relates to a single, unexpected event, such as a physical or sexual assault, a natural disaster, an accident, a serious illness or injury. It's important to recognise the signs and symptoms of single-incident trauma, in order to seek the necessary support and intervention. For instance, if we have been through a single incident trauma, we may experience intrusive memories that disrupt our daily activities, causing emotional distress and mood changes. This might mean we have constant flashbacks of the event, feel intense fear, anger or sadness, and struggle to engage in activities we once enjoyed. Recognising and understanding these effects on our mental health, is crucial for understanding what is happening to us after an event.
I work with clients who feel unable to connect their symptoms to what they have experienced. This is due to a self-protective process of minimising and discounting the true impact of the event. The downside of this is that we then experience a block to self-compassion. Secondary self-criticism can occur as we berate ourselves with thoughts such as “I should be over it by now”, “Worse things happen to others”, “I should be grateful I’m alive and should be living life to the full now”. The “should” and “musts” circle like sharks and shame insidiously seeps into every part of our lives sinking the ship of recovery.
Understanding the impact of single-incident trauma is essential for promoting empathy and awareness from those close to us. We can find that those close to us cannot emotionally tolerate that we have been through what we have and as a consequence, they discount the impact. This can lead to a sense of isolation and abandonment for us. By recognising these effects early, we can start to explore self-help strategies and seek professional help if we feel stuck or overwhelmed.
Understanding PTSD
Post-traumatic stress disorder (PTSD) is a debilitating mental health condition triggered by a terrifying event, and it can affect anyone who has been through or witnessed a traumatic experience. For example, a combat veteran may develop PTSD after experiencing the horrors of war, while a survivor of a serious accident may also exhibit symptoms. There can also be survivor guilt that adds complexity, if the loss of others has been experienced.
The symptoms of PTSD can manifest differently for different people, ranging from intrusive memories and nightmares to emotional distress and mood changes. The concept of diagnosis in itself is another debate. Clients I work with have varying views. Some find the label hinders their recovery and some find it really helps to externalise their symptoms and put them in a framework they can understand.
The key for any professional working in a trauma-informed way is to normalise, validate and invite the client to find what is right for them. The trauma itself has violated and intruded upon our life and if a professional is forceful with their views or dismissive this shuts down our voice. We might also be told we do not meet criteria, for a formal diagnosis. The whole process can be a re-traumatisation, if not handled empathically. Unfortunately, many professionals do not understand the intricacies of how best to help those recovering from trauma.
Even if the concept of diagnosis does not resonate with you, it is useful to understand how others may make sense of what you are experiencing and the mainstream container for understanding. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides specific criteria for the formal diagnosis of PTSD, outlining the necessary symptom criteria. These include the exposure to a traumatic event involving the threat of death, violence, or serious injury, as well as the manifestation of various symptoms impacting an individual's daily life and functioning. For instance, a person who has been through a distressing event may meet the diagnostic criteria for PTSD if they experience persistent intrusive memories, emotional numbness, and avoidance of trauma-related stimuli. These active trauma markers can lead to challenges in concentration and memory impacting work/school life and can leave us feeling less able to function in the way we did before the incident. This can bring feelings of guilt, anger and shame as we try to rejig our sense of self, the world and others.
Dissociation (emotional, physical, mental disconnect) can also occur as a protective mechanism. This is not always considered in-depth by professionals. It can serve to mask symptoms and a surface appearance of coping and well-being might be seen. Eventually, this can make it even harder to disclose what is going on underneath and in fact we may not always be aware if we are dissociating and therefore do not connect cognitively with the full impact of our experience. However, in the words of Bessel Van der Kolk “The body holds the score”.
Seeking Professional Help for Trauma
The impact of single incident trauma on an individual's daily life and functioning should not be underestimated. For example, if we have been involved in a car accident we may exhibit symptoms such as avoiding driving or experiencing intense anxiety when near the site of the incident. These manifestations can significantly hinder our ability to lead a normal life or perform routine activities, highlighting the importance of seeking help.
In some cases, traumatic events can also affect our ability to drive safely. Therefore, consulting with a GP or relevant healthcare professional is crucial to address any potential risks and ensure the safety of both ourselves and others.
The other complication can be that what appears like a single-incident trauma can re-trigger prior suppressed, more chronic childhood experiences or prior single-incident traumas that we have dissociated from. I have seen this many times in clinical practice. A client may be referred to process trauma following a car accident but something about the process of the incident itself may parallel early life traumatic experiences. For example, the other driver leaving the scene and a parent leaving a child when they were hurt. The car accident then peels back the scar tissue of the original abandonment and pain to the underlying wound. The very fact that there is an underlying wound may have created some predisposition of the accident trauma developing into a post-traumatic stress response.
Treatment Options for PTSD
When it comes to treating PTSD, there are various options available, each tailored to address specific needs, depending on how trauma is presenting for us and our history of any prior incidents of loss, trauma or other mental health concerns. Psychotherapy is one of the primary treatment methods, and it encompasses diverse approaches, aimed at helping us process our traumatic experiences.
Cognitive Behavioural Therapy (CBT) focuses on challenging and altering the negative thought patterns associated with the traumatic event, thus aiding in the management of distressing symptoms. This may include elements of exposure therapy which involves gradual and safe exposure to the trauma-related memories or situations, allowing us to gain control over our thoughts and emotions.
However, given that a diagnosis of PTSD means we are operating from a dysregulated nervous system, a survival response of (fight, flight, freeze or fawn (people pleasing), and our higher level thinking skills are disengaged at this time, the thinking required in CBT is often a challenge as first level treatment. Working top down (mind to body) is often problematic.
Eye Movement Desensitisation and Reprocessing (EMDR) involves recalling the traumatic incident whilst making eye movements, hearing sounds in either ear, following a light bar, or tapping either side of your body. This creates something called bilateral stimulation which is stimulating both hemispheres of the brain to allow material to integrate and move back from being the fragmented parts that trauma creates to a more coherent narrative and merging of thoughts, emotions and bodily sensations. This is a somatic treatment as it can move stuck elements of trauma held in the body.
Somatic Experiencing uses, sensation, imagery, behaviour, affect and meaning, to reconnect us with our bodies from the bottom up (body to mind).
Medication can be prescribed in the treatment of PTSD. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to alleviate the symptoms of PTSD, particularly those related to mood and anxiety. These medications can contribute to stabilising emotions, enabling us to engage more effectively in therapy and daily activities. Not everyone wants to take the route of medication and it is finding the treatment fit that feels right for us that is essential to recovery.
Importance of Early Intervention and Treatment
Recognising the signs and symptoms of PTSD and seeking professional help at the earliest opportunity is crucial, as it can mitigate the long-term effects of PTSD and improve our overall quality of life. If we leave symptoms untreated for a long time, a secondary level of mental health concerns such as anxiety and depression, begin to layer on top of the underlying trauma.
Early intervention can provide us with coping strategies and tools to navigate our emotions and responses to triggers before an unbearable degree of overwhelm is experienced. This empowers us and offers a sense of control. Trauma is a curve ball, thrown at us suddenly which means the world is no longer a safe place and the way we made sense of life before, has gone.
Support and Resources
Support from friends and family is vital for anyone with a diagnosis of PTSD. Loved ones can offer emotional support, assist in following treatment plans, and educate themselves about PTSD to provide informed care and support. For example, a friend or family member can attend medical appointments with us, and help create a safe and understanding environment. They can also help us to recall what has been said. Memory is interrupted in trauma and it is really hard to retain information in a the way we could before.
Below are some charities that can also offer support:
Combat Stress – a military charity specialising in helping ex-servicemen and women.
Rape Crisis - A UK charity providing a range of services for women and girls who have experienced abuse, domestic violence and sexual assault.
Victim Support – providing support and information to victims or witnesses of crime.
CRUSE – A UK charity providing support and information for people who have experienced bereavement.
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