The 4 stages of PTSD.

Jason Brien.

     Post-traumatic stress is a relatively new psychological phenomena which was classified in the early 1970s largely in response to a proportion of Vietnam War veterans who were reporting and experiencing a unique type of distress and social/emotional/familial/occupational dysfunction. The notion of post-traumatic stress was legitimized when it was first introduced into the DSM-III in the 1980’s. The symptomology of ptsd as it is classified within the DSM-5 today differs markedly from the ptsd symptomology classified in earlier DSM editions.

     Of all the disorders classified with the DSM-5, PTSD is unique in that a formal ptsd diagnosis explicitly depends upon eitology. That is, a diagnosis of ptsd demands a causal link between an external factor/event (criterion A) and psychopathology (distress). However, the criterion A ( ‘trauma’) is a notoriously difficult construct to clearly and definitively operationalise due to a wide variety of external factors/events having the potential to be subjectively and objectively appraised as being traumatic.

     The DSM-5 clearly stipulates that a formal diagnosis of ptsd must rely upon a definition of ‘traumatic event’ (criterion A) which is defined by a restricted and finite number of external factors - exposure to actual or threatened death, serious injury or sexual violence which must be experienced directly, as a witness, indirectly or vicariously. Furthermore, the diagnostic criteria of ptsd within the DSM-5 focuses specifically on discrete (single) events. Therefore, the current classification of ptsd does not account for the effects of long-term chronic complex trauma or experiences of trauma due to other self-defined potentially traumatic events (PTE).

     Many people mistakenly believe that trauma and ptsd are the same thing. This is simply not true. Trauma is a standalone construct or condition which exists prior to and independent of ptsd. That is, not all trauma will lead to, or satisfy the conditions of, ptsd. It is important to understand that a ptsd diagnosis can only be made when it abides by the strict criteria within the DSM-5. If a traumatic event doesn’t meet the DSM-5 standards (such as bullying that doesn’t involve serious physical injury), then it is not ptsd. Post-traumatic stress disorder occurs in four stages.

1. Impact or “Emergency” Stage.

     This stage occurs immediately following exposure to a traumatic event. The aftermath of a traumatic event leaves an individual confused and struggling to come to grips with what has occurred. The individual will be struggling with shock in addition to being hypervigilant, experiencing atypical anxiety and possibly experiencing feelings of guilt, shame or embarrassment. Due to this sudden influx of emotions and thoughts, a person is highly vulnerable and they may struggle to seek immediate help. They may feel that if they do seek help, they may be rejected, misbelieved or misunderstood.

2. Denial Stage.                 

     This stage is NOT universal amongst people who have been exposed to a traumatic event. For the people who do experience this stage, they will exhibit strong feelings and emotions triggered by flashbacks and intrusive thoughts related to the traumatic event leading them to try and avoid the intense and unwanted emotions and feelings. This avoidance can either be conscious or unconscious. People who engage in alcohol or drug use during this stage are particularly vulnerable to avoidance coping as the substances will assist with emotional numbing and, if excessively used, forgetting as the substances will eventually deteriorate neural pathways leading to partial or complete memory loss.

3. Short-term Recovery Stage.                 

     This is the stage in which a person suffering from ptsd will try to return to their pre-trauma everyday life. Nightmares and flashbacks continue which can make the return to normal everyday living difficult. Individuals can experience shifts in values and attitudes which can lead them to either continue seeking support and help from others or lead them to become disillusioned, despondent and hostile leading to the rejection and avoidance of help and support. Sometimes the trauma healing and recovery is hampered by the lack of support and professional help.

4. Long-term Recovery Stage.                 

     During this stage, the individual continues to experience trauma related symptoms such as anxiety and nightmares however, with continued professional, familial, occupational and social help and support, these symptoms can be managed, reduced and eventually overcome. A person who is experiencing this last stage of ptsd often feels a greater sense of hope that life can return to normal. They may struggle with the reality that their life cannot return to its pre-trauma life and as such they must accept that their life has changed. This is the phase most associated with the concept of Post-Traumatic Growth (PTG).

     In the mid-1990’s, psychologists Richard Tedeschi and Lawrence Calhoun suggested that individuals who had endured significant trauma, either singularly or repeatedly, are likely to experience positive growth afterwards. Post-traumatic growth is therefore associated with a deeper appreciation for life, a strengthening of close relationships bonds, greater altruism and compassion, greater empathy, more future oriented thinking and focus on achieving goals, a strong desire to finding and achieving a purpose in life, more insight of one’s personal strengths and weaknesses, stronger religious or spiritual motivation and participation and enhanced creativity.


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