Post-traumatic stress disorder (PTSD) - causes and symptoms

Post-traumatic stress disorder (PTSD) - causes and symptoms

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A Post-traumatic stress disorder occurs after trauma - most often begins in the first six months after the incident. Fainted anger, fear of death and sadness go hand in hand with emotional emptiness. The person concerned remembers the traumatic experience as if he is experiencing it at the moment. In this case, experience is also physical: sweats, tremors, nausea, shortness of breath or rapid heart rate accompany the flood of images of the catastrophe.

On the one hand, the person concerned experiences flashbacks, i.e. particularly extreme memories that suddenly appear and appear hyperreal. On the other hand, he suffers from nightmares in which the traumatic event recurs and which rob him of sleep. In addition, “triggers” trigger the memory waves, whether it be a smell, a sound or a person who associates the brain with the trauma. For a traumatized from the Balkan wars, this can be a snippet of sentences in Serbo-Croatian, or for a rapist, a drunk man with long hair who reminds her of the perpetrator.

Malcolm Mackenzie, who was released from the UK Army because of a stress disorder, says: “I drink too much and take too many drugs. I have difficulty concentrating and flashbacks. Sometimes I step away. After that I don't remember anything. Other returnees have heart problems, ulcers and rashes. ”

He describes triggers that let him relive the war: “During a firework display, I reached for my bed and looked for my weapon, which of course was not there. Sometimes I have shortness of breath and need to get some fresh air, just like that. Then a car with young people drives towards me and Bosnia is back. "

The history of PTSD treatment

Psychiatrist Emil Kraepelin called the behavior of accident victims with fright neurosis. Soldiers with this syndrome were called "soldier hearts" in the American Civil War. In the First World War, terms such as grenade shock, grenade fever or war neurosis circulated. The English spoke of the breaking point for soldiers who were no longer operational. So physicians already knew in 1918 that it was a pathological syndrome. However, these traumatized people were generally regarded as cowards and sometimes still have this reputation in the armies of almost all countries. The American psychologist Judith Lewis Herman called the syndrome PTSD.

Twelve percent of Germans who experienced the Second World War still suffer from trauma today. Almost half of the generation experienced at least one traumatic event. Four percent suffer from a clear PTSD.

The traumatized Tolkien

J.R.R. Tolkien founded modern fantasy with the myth about Middle-earth. Frodo, the ring bearer can no longer go back to his beloved Shire after the war for Middle Earth; memories of the nightmarish Mordor haunt him. He also has phantom pain. In the burned-out land of Sauron, Tolkien probably processed his own war experiences.

In 1915, Tolkien took part in the World War as a British officer. Only two of his friends should survive. His battalion was stuck on the Somme - in one of the worst material battles of the modern war: grenade fire, dying comrades in a burned country and the wet cold were wearing him down. The writers of the war generation found different ways to process their experiences: Ernst Jünger glorified the murder in his "steel thunderstorms"; With his realistic novel "Nothing new in the West", Erich Maria Remarque mercilessly showed the cruelty of mass extinction - Tolkien escaped to the imagination.

The lack of understanding

Post-traumatized people have problems sharing their suffering. They often avoid emotional ties to friends, family, or love partners. Even among friends and at work, they can hardly share in the feelings of everyday life. They feel numb and often try to gain access to their feelings through extreme experiences - through alcohol and drugs, piercings or self-harm.

They feel alienated from “normal people”. They are afraid that others will think they are crazy when they talk about their experiences - and this fear is often true. People without such experiences quickly feel overwhelmed, even if the person concerned does not expect help, but only tells what was. As a consequence, post-traumatized people seek proximity to people who have experienced something similar and can therefore understand them. This is sometimes helpful, for example when those affected join together in self-help groups. However, it often brings the sufferers into a vicious circle - from the ex-soldier who works as an errand boy in the red light milieu to the victim of torture who drowns in alcohol with the child of a violent perpetrator. The massive problems of gaining a foothold in civil society are becoming the normality experienced together. Both experience feelings such as depression and deep despair and cannot save each other from being cut off.

Post-traumatized people cannot finish with their experience and therefore find it difficult to find their way in civilian life. Not only do they have flashbacks, they keep thinking about what is going on. They often feel guilty and ashamed.

Post-traumatic stress disorder: causes

Apparently, not everyone is at risk of developing PTSD. The way people save memories makes the difference. PTSD patients save catastrophic events intensively.

People who experience cruelty release adrenaline in the organism, which activates the amygdala in the brain. The incident is branded. Such memories usually diminish over time. That doesn't work with a PTSD. The hormone cortisol could play an important role in this. The body releases cortisol under stress and thus blocks memory. That's why cortisol can help relieve PTSD.

Traumas can be different experiences that are often linked: sexual and physical abuse in childhood, rape, torture and prison, war, but also natural disasters such as earthquakes, house fires, shocking experiences as a police officer, paramedic, firefighter or train driver who convicted suicides.

PTSD and triggering event sometimes separate years. Sometimes the symptoms are not associated with the trauma. In addition, traumatization means gaps in memory, so that the person affected notices that "something is wrong with him", but he does not know what it is. In addition, only a few decades ago, PTSD was seen as a sign of a lack of (self) discipline, and soldiers in particular were ridiculed as slackers.

Witnesses to a terrible event can also develop PTSD, for example children who were there when the father beat up the siblings.

Post-traumatic stress disorder: symptoms

The following indicates a trauma experience: sleep disorders, infections, emotional outbursts, low resilience, anxiety and nervousness, increased irritability. Traumatized people often develop a cynical view of the world. Psychological and physical neglect, alcohol and medication abuse, relationship problems and avoidance behavior are added.

The post-traumatic stress affects the affects. Those affected are less able to control their impulses than before, they direct aggression against themselves; their sexuality is disturbed; they cross borders and behave riskily.

Post-traumatized suffer from persistent memories of the stressful experience. They feel pressured in situations that they associate with it. They avoid circumstances that could remind them of the trauma. They are unable to fully remember what happened. You are sensitive. They have trouble sleeping and are on permanent alert. They can hardly concentrate and are prone to outbursts of anger.

They avoid conversations that are related to the trauma and suppress feelings that are connected with it. Often they go to the psychological place of horror in a frenzy like the traumatized ex-soldier who watches drunken YouTube videos of war horrors. Some also compensate for the trauma through bizarre interests such as backyard wrestling, in which the participants pull sticks wrapped in barbed wire over their skin. Post-traumatized people also fall into speechless horror when they think of the trauma. You cannot say how you think about what happened.

The depression of those affected means that they give up their social contacts and lose interest in hobbies. As with other depressions, they also get into a downward spiral. The fewer social contacts they have, the greater the senselessness. Some post-traumatized people are at risk of suicide in such phases.

The opposite is also part of the disease: those affected react as if in a psychological emergency. Danger lurks around them; they don't trust anyone. They become aggressive at lightning speed without the witnesses seeing a trigger. Some of those affected are "ticking time bombs". Such stimulus situations can be dangerous, particularly with traumatized soldiers. They have saved the actions of the fight and physically attack others - even with improvised weapons. In extreme cases, they even commit homicide offenses with affect.

In addition, there is a distorted perception of reality that, like with borderliners, mixes the recurring trauma, deliberate lies and self-actions. For example, a victim falls drunk from a bike and says that a mob beat him up. Or those affected invent events to convey their trauma to outsiders. The district in which they live becomes, depending on the trigger, a street war in Bosnia or a hiding place for rapists.

The injured accuse themselves. Due to the trauma, they have lost basic trust in other people and themselves. They doubt themselves and see themselves as weak. Be it that they think they should have dealt with the events long ago, or that they are responsible for what happened. Looking into the past also darkens the future; Plans appear utopian; society races towards an abyss in the eyes of the traumatized. The negative moods can lead to the person giving up completely, no longer paying the rent or sinking into drugs.

The social environment cannot erase the trauma, but it can help a lot in such phases. Relatives who after a "grace period" mean "now pull yourself together", or even blame the victim "if you had not gone to the army, it would not have happened to you", sprinkle salt in the mental wounds. Unfortunately, many people do not know that PTSD has nothing to do with character weakness.

Traumatized soldiers

German soldiers in World War I who suffered from PTSD were called war tremors. PTSD is recognized in the United States and therapists accompany the affected soldiers who are returning from Afghanistan and Iraq.

Bundeswehr soldiers also suffer from PTSD today; In 2014 there were 431. Probably only one in five openly admitted to a PTSD. On the one hand, they fear to be seen as "wimps", on the other hand, a mental illness can end their career in the army.

At the same time, there is a lack of qualified doctors to treat those affected - in the Bundeswehr and in civilian life. Many traumatized people end their service; Back in society, however, many therapists do not dare to work with war victims. Ex-soldier Malcolm Mackenzie says: “Nobody has been able to help me so far. I'm afraid of ending up in a closed facility or in jail. ”

Who is at risk

Viewing PTSD as an illness is true of the symptoms, but strictly speaking is not correct. Rather, PTSD is a healthy response from the body to deal with threatening situations. For example, those affected are less sensitive to physical pain than those not affected.

While there is no such thing as a "typical" post-traumatized person, people who have previously had psychological problems are particularly at risk. The same applies to people without stable and long-lasting relationships. Professionals in disasters, such as police officers or paramedics, suffer from PTSD proportionately less than lay people.

Pre-incident social conditions also affect whether PTSD arises: fragmented families, criminal parents, mentally ill parents, and poor contacts with peers.

A study of traumatized Vietnam veterans found the following risk factors: depression before combat, severely punishing parents and unstable families. After the battle there were also: diseases, divorces, death of relatives and new traumas.

There were also factors that dampen traumas: a close bond with parents and a high socio-economic status. After the combat mission, social support was particularly important.

Soldiers are said to have been over 30% traumatized in the Vietnam War. In the wars in Iran and Afghanistan, however, there were significantly fewer, namely between 2.1% and 13.8%.

Loss of security

According to Maslow, human needs are staggered. Only when basic needs are satisfied will higher needs be put on the agenda: safety follows sleep and eating, before the need for social contacts, recognition and self-fulfillment. Most people learn that their environment is safe. Trauma questions this certainty. The world becomes a threatening place, order becomes chaos.

PTSD in partnerships

PTSD affects not only those affected, but also their relatives. They face outbursts of anger and have to deal with self-doubt. Those affected feel lonely as well as misunderstood, and relatives have to support them without really being able to “understand” the sufferer. In extreme cases, relatives have to prevent suicide.

The family can help those affected by flashbacks: reliving what has happened makes the victim afraid - the horror is back. The relatives can give him the feeling of security here: No matter what happens, we are there for you. You shouldn't punch him with questions, but be close by.

Such "flashbacks" are associated with heartbeat, rapid breathing, nausea, muscle tension and sweating. Deep breathing helps, on the other hand: the victim should breathe in for four seconds, hold their breath for four more seconds, and then exhale slowly for four seconds.

In order to stabilize the person concerned, he must generally feel safe: Discussing the future with him, showing that it is open, keeping promises and creating routine are essential points.

Relatives must know that the victim does not withdraw because he does not care about his loved ones. This is difficult because those affected no longer appear at meetings that were previously important to them. This is hurtful, but must not be taken personally.

Affected people think badly about themselves and paint their situation in black colors. So conveying love to them is as important as positive ideas. Relatives can also alleviate the outbursts of anger. When the person concerned "gets going", his friends can take him to the neighboring room or go for a walk. It also helps to encourage those affected to write diaries. Writing channels feelings and thus dampens outbreaks. In addition, the person concerned will be clear about his feelings.

One should handle fingertips with a victim. Traumatized people are often hypersensitive and tense to the extreme. Therefore, you should avoid jerky movements, inform him when you are making noise and report when you get home.

Post-traumatic stress disorder: treatment

Many psychotherapies have been developed specifically for traumatization. If the victim is flooded with eruptive memories, therapists avoid addressing the trauma directly. Instead, they focus on memories that are associated with the trauma but are not directly related to it. If the memories are less violent, the therapist and patient can tackle the trauma directly. Most of the time, the patient has to stabilize until the methods of trauma therapy are used. After that, it can be about changing the behavior and living conditions of the patient.

Cognitive behavior therapy is also used to treat traumas. Confrontation therapy is particularly successful. The patient should remember the traumatic experience here in a protected setting.

The Eye Movement Desensitization and Reprocessing is directly focused on traumatization. Conversations lead the patient to the experience. The two halves of the brain are stimulated, so that what is experienced is integrated along with the memory.

Imaginative procedures also help. Here, for example, those affected withdraw to an imaginary place when the feelings become too intense.

In addition, there is dream work to counteract side effects such as nightmares. The person concerned imagines that a recurring nightmare comes to a good end. This procedure also reduces memory flare-ups.

PTSD can also be treated with medication, including sertraline and paroxetine in Germany. Mirtazapine is used for severe war trauma. Trazodone helps against sleep disorders. Benzodiazepines should only be used for a short time. The risk of addiction is high and PTSD patients are generally at risk of addiction.

Trauma therapies run in four phases. First of all, it's about safety, that is, teaching the patient to rebuild trust. Therapy should therefore provide a clear framework and the therapist should show himself as a reliable partner. To do this, he discusses the goals and duration of the therapy with the person concerned. He explains the symptoms and causes of PTSD and suggests the different therapies to the patient.

The patient and therapist also discuss the social relationships of the person concerned. If it turns out that acquaintances have a bad influence on his problems, or that he is looking for relationships that harm him, the question is how the person concerned can deal with it.

In order to restore inner security, therapist and client go through the "head cinema" of flashes of memory and dissociations. The person concerned helps when the therapist separates the memories from the present.

If the client regains internal and external security, the stabilization phase begins. Here the affected person gets to know his self-healing powers again. What impulses in him are good for him when the images of terror explode.

In addition, the patient should now learn to build relationships that strengthen him and separate from relationships that harm him. This is very important for many traumatized people, because they often look for an environment that reflects their trauma experience. But now it's about structuring everyday life again.

The method “inner dialogue” helps to regain and understand parts of the self that have been split off through the traumatic process. The imagination, that is, to call healing images, complements the inner dialogue. With mentally stable people, these methods can easily be used in everyday life; for traumatized people with severe dissociations, however, the inner images are so "torn" that this phase can take years.

If the stabilization is successful, the client can relax himself. Now "residual stocks" of traumatic images and feelings can be "scrutinized". Trauma never disappears completely, because the stored memories are “burned in”. However, a stable victim has learned to distance himself from the traumatic images. They stay, but they no longer overwhelm him.

Inner distance means that split-off affects, feelings and perceptions become conscious and are integrated into the personality. In the end there is integration. The therapist and patient look back on the time of the trauma and put it aside in the past. As an encapsulated memory, it loses its terror. Therapist and sufferer develop new goals in life. Ideally, the therapy will prove itself in the practice of a self-determined life. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • Professional associations and specialist societies for psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany and Switzerland: What is post-traumatic stress disorder (PTSD)? (Accessed: August 27, 2019), neurologen-und-psychiater-im-netz.org
  • Institute for Quality and Efficiency in Health Care (IQWiG): Post-traumatic stress disorder (accessed: August 27, 2019), gesundheitsinformation.de
  • DeGPT (German-speaking society for psychotraumatology): Post-traumatic stress disorder (accessed: August 27, 2019), degpt.de
  • Merck & Co., Inc .: Post-Traumatic Stress Disorder (PTSD) (accessed: August 27, 2019), msdmanuals.com

ICD codes for this disease: F43ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: Treatment Options for Post-Traumatic Stress Disorder PTSD (August 2022).