Post-Traumatic Stress Disorder

In everyday language we use the word trauma very broadly. A separation, criticism, failure, disappointment, or an embarrassing moment is sometimes called trauma. These experiences can certainly affect a person deeply, but in the clinical sense trauma refers to a more specific domain.

In mental health, when we say traumatic event we generally mean situations in which a person's own life or someone else's life was seriously endangered, severe injury occurred, sexual violence took place, or a person directly witnessed such an event. Traffic accidents, earthquakes, floods, physical assault, sexual assault, torture, war, explosions, grave violence, and similar events fall within this scope.

Sometimes trauma does not happen directly to the person, but learning that someone very close to them was exposed to such an event can also have a traumatic effect. People in professions that continuously face severe injury, death, and human suffering, such as healthcare workers, search and rescue teams, police officers, soldiers, and disaster-zone personnel, can also experience secondary traumatic effects.

Not every painful event is trauma. But the fact that an event does not meet the clinical definition of trauma does not mean it has not caused the person pain or created a need for support.

After a severe event, the mind and body remaining on alert is often an expected response. The person may recall the event repeatedly, see it in dreams, startle easily, lose their sense of safety, and want to keep away from places and people associated with what happened. In the early period these can be natural stress reactions to trauma.

The first month in particular is a sensitive time in which the mind is trying to make sense of what happened and place it into memory. During this period it is not right to interpret every symptom immediately as a sign of a lasting disorder. Just as grief brings sadness, longing, and remembering that are natural, after trauma a certain degree of re-experiencing, avoidance, and startling can also be natural.

The key thing to watch for is whether these symptoms continue instead of fading over time, whether they intensify, and whether they begin to noticeably narrow the person's life.

In post-traumatic stress disorder, symptoms generally appear in four main areas. The first is re-experiencing symptoms. The person may see the event in dreams, have sudden intrusive images of it during the day, or feel as though the event is happening again.

The second is avoidance. The person may try to stay away from places, people, news, images, conversations, and sometimes even their own feelings that remind them of the trauma. Being unable to get into a car after a traffic accident, or fearing people with similar physical features after a sexual assault, are examples of this.

The third is hyperarousal symptoms. Excessive startling at sudden sounds, being constantly on edge, outbursts of anger, difficulty sleeping, trouble concentrating, and a persistent bodily state of alarm can appear. The fourth area is changes in emotions and thoughts. The person may blame themselves, see the world as entirely unsafe, withdraw from others, feel numb, or experience intense shame and anger.

Traumatic memories often do not settle the way ordinary memories do, as a story with a beginning, middle, and end. They can return in the form of smells, sounds, images, bodily sensations, and brief fragments of scenes. In therapy, the aim is often to make safe sense of this scattered material.

The impact of trauma cannot be explained by the severity of the event alone. Whether the event was caused by another person, how the person interpreted their freezing response during the event, what kind of reactions they received from others afterward, prior traumas, existing depression or anxiety symptoms, and the presence of social support and a safe environment all shape the course of recovery.

In traumas caused by other people, such as assault, abuse, torture, or sexual violence, shame, anger, guilt, loss of trust, and the shattering of basic assumptions about other people enter the picture alongside fear. Victim-blaming responses from others can, regrettably, make recovery harder.

Freezing during a traumatic moment is not a sign of weakness of will. It is one of the nervous system's automatic survival responses. Questions that come later, such as "why didn't I shout," "why didn't I run," "why couldn't I help," can lead the person into a heavy sense of guilt. In clinical work, these interpretations need to be carefully addressed.

Immediately after trauma, the primary goal is to ensure safety, meet basic physical needs, move the person away from danger, and let them feel that someone is present. Forcing people to talk, making them recount the event in detail, pathologizing every symptom, or trying to suppress everything immediately with routine medication is not always the right approach.

If the person wants to talk, listening is valuable. If they do not want to talk, pressing them is not right. Sometimes the best support is simply being able to sit quietly beside someone. A hand on the shoulder, a glass of water offered in a safe room, and the felt sense of "you are safe right now" can be more healing in the early period than long pieces of advice.

Psychological support after trauma is very valuable when given at the right time and in the right way. But not every intervention in the early period is healing. For this reason, professionals working in the field of trauma need to act in accordance with current guidelines and ethical principles.

In post-traumatic stress disorder, the strongest evidence points to trauma-focused psychological treatments. Trauma-focused cognitive behavioral therapy, cognitive processing therapy, prolonged exposure, and EMDR are among the most widely used approaches in this field.

The aim of these treatments is not to hurt the person again. The aim is to process the traumatic memory within a safe therapeutic relationship, to understand the changes that trauma has produced in beliefs about the self, the world, and other people, and to reduce the life-narrowing effect of avoidance.

Medication may be considered for some people for accompanying symptoms such as intense anxiety, depression, sleep difficulties, or other concerns. However, the treatment decision must be made through individual clinical assessment and by a physician.

If symptoms have not decreased despite passing the one-month mark. If avoidance of situations that recall the trauma is noticeably limiting life. If sleep, anger, relationships, work, or academic functioning are seriously affected. If there is intense guilt, shame, self-blame, or emotional numbness.

If there are thoughts of self-harm, thoughts of suicide, or any safety risk, urgent support is needed.