This is an illustration of the key components of a diagnosis of PTSD.
I think PTSD can arise from an actual, threatened or witnessed event. The PTSD may not last as long but there are definitely cases of PTSD that arise from being a witness to a horrific event that occurred to someone else, especially if it is a close relationship.
Intrusion and Protection
Notice how the 4 symptom categories can be divided between intrusion and protection.
1. Intrusion would be moments in which the nervous system is activated by the trauma intruding into one’s present reality – this includes re-experiencing (flashbacks, nightmares) and hyperarousal (fear states due to triggers, or things that trigger memories of the trauma)
2. Protection would be moments in which the system is trying to protect itself – this includes avoidance of anything trauma related and numbing – flat affect, emotional numbness, shutting down, non-responsiveness. I would also include dissociation in this category of protection.
One of the strangest parts of having PTSD is living with these two things going on simultaneously. Intrusion and protection are like being very hot and very cold at the same time. We can feel both extremely agitated/very frightened and yet at the same time completely emotionally numb and flat, or we can have a sudden flashback (intrusion) that leaves us frozen in immobility (protection). It’s tough to handle the hot and cold of intrusion and protection as the nervous system tries to process all the information flooding it about a very overwhelming experience.
Deeper, Persistent Wounds Beyond Definition
Even as PTSD lessens to the point where it is not “clinically significant impairment,” there can still be a lot to heal, for example: self-esteem, feeling trust, feeling safe, handling the anger, emerging from survival thinking, developing socially, exiting isolation, and overcoming all the feedback loops that threaten to take us into the various downward spirals associated with PTSD (feedback loops will be discussed in future posts).