PTSD flashbacks disappear

Post Traumatic Stress Disorder (PTSD) - Causes and Symptoms

A Post-traumatic stress disorder occurs after trauma - it usually begins in the first six months after the incident. Impotent anger, fear of death, and grief go hand in hand with emotional emptiness. The victim remembers the traumatic experience as if he were experiencing it in the moment. In this case, experience is also physical: sweating, tremors, nausea, shortness of breath or racing heart accompany the flood of images of the catastrophe.

On the one hand, the person affected experiences flashbacks, i.e. particularly extreme flashes of memory 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” set off the memory waves, be it a smell, a sound or a person that the brain associates with the trauma. In the case of a traumatized person from the Balkan Wars, this can be a scrap of sentences in Serbo-Croatian, or, in the case of a raped person, a drunk with long hair who reminds her of the perpetrator.

Malcolm Mackenzie, who was discharged from the British Army with a stress disorder, says: “I drink too much and use too many drugs. I have difficulty concentrating and have flashbacks. Sometimes I step away. After that I don't remember anything. Other returnees have heart problems, ulcers and rashes. "

He describes triggers that allow him to relive the war: “During fireworks, I reached next to my bed and looked for my weapon, which of course wasn't there. Sometimes I have difficulty breathing and have 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

The psychiatrist Emil Kraepelin named the behavior of accident victims with shock neurosis. Soldiers with this syndrome were called "soldiers hearts" in the American Civil War. During the First World War, terms such as grenade shock, grenade fever and war neurosis were circulating. The English spoke of breaking points with soldiers who were no longer operational. So medical professionals already knew in 1918 that it was a pathological syndrome. However, these traumatized people were generally regarded as cowards and 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 World War II still suffer from trauma today. Almost half of the generation experienced at least one traumatic event. Four percent suffer from clear PTSD.

The traumatized Tolkien

J.R.R. Tolkien founded modern fantasy with the myth of Middle-earth. Frodo, the ring bearer, cannot go back to his beloved Shire after the war for Middle-earth; memories of nightmarish Mordor haunt him. He also suffers from 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 were to 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 scorched country and the wet cold wore him down. The writers of the war generation found different ways to process their experiences: Ernst Jünger glorified murder in his "steel thunderstorms"; Erich Maria Remarque's realistic novel “Nothing New in the West” relentlessly showed the cruelty of mass extinction - Tolkien took refuge in the imagination.

The incomprehension

Post-traumatized people have trouble sharing their suffering. They often avoid emotional ties with friends, family, or love partners. Even among friends and at work, they can hardly participate 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 if they tell about their experiences - and this fear is often true. People without such experiences quickly feel overwhelmed, even if the person concerned does not expect any help, but only tells what happened. As a consequence, post-traumatized people seek closeness to people who have had similar experiences and can therefore understand them. This is sometimes helpful, for example when those affected come together in self-help groups. Often the sufferer gets into a vicious circle - from the ex-soldier who works as an errand boy in the red light district to the torture victim who drowns in alcohol together with the child of a violent criminal. The massive problems of gaining a foothold in civil society are becoming common normality. Both experience feelings like depression and deep despair and cannot save each other from the abyss.

Post-traumatized people cannot finish their experience and therefore find it difficult to cope with civil life. Not only do you have flashbacks, you keep thinking about what happened. They often feel guilty and ashamed.

Post-traumatic stress disorder: causes

Apparently, not all people are at risk of developing PTSD. The way people store memories makes the difference. PTSD patients store catastrophic events intensively.

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

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

PTSD and the trigger event are sometimes years separate. Sometimes the symptoms are therefore not associated with the trauma. In addition, traumatizations mean 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, just a few decades ago, PTSD was regarded as a sign of a lack of (self-) discipline, and soldiers affected in particular were ridiculed as slackers.

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

Post traumatic stress disorder: symptoms

The following points to a trauma experience: sleep disorders, infections, emotional outbursts, low resilience, fear and nervousness, increased irritability. Traumatized people often develop a cynical worldview. Psychological and physical neglect, alcohol and medication abuse, relationship problems and avoidance behavior also play a role.

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 risky.

Post-traumatized people suffer from persistent memories of the stressful experience. They feel pressured in situations that they associate with it. They avoid circumstances that might remind them of the trauma. They are unable to fully recall the incident. You are sensitive. You have trouble sleeping and are on constant alert. You can barely concentrate and are prone to outbursts of anger.

You avoid conversations that have to do with the trauma and suppress feelings that are related to it. Often they go to the psychological place of horror but intoxicated like the traumatized ex-soldier who is drunk watching YouTube videos of atrocities of war. Some also compensate for the trauma with bizarre interests such as backyard wrestling, in which the participants pull clubs wrapped with barbed wire over their skin. Post-traumatized people also lapse into speechless horror when they think of the trauma. They cannot tell how they feel about what happened.

The depression of those affected causes them to give up their social contacts and lose interest in hobbies. As with other types of depression, they also get into a downward spiral. The less social contact they have, the greater the pointlessness. Some post-traumatized people are acutely suicidal in such phases.

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

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

The damaged accuse themselves. Due to the trauma, they have lost their basic trust in other people and themselves. They doubt themselves and see themselves as weak. Be it that they think they should have come to terms with the events long ago, be it that they blame themselves for what happened. Looking into the past also obscures the future; Plans seem utopian; society is racing towards an abyss in the view of the traumatized. The negative moods can lead to the person concerned 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 hadn't gone to the army, that wouldn't have happened to you”, sprinkle salt on the wounds of the soul. 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 at the time. PTSD is recognized in the US, and therapists accompany the affected soldiers returning from Afghanistan and Iraq.

Bundeswehr soldiers today also suffer from PTSD; In 2014 there were 431. Probably only one in five openly admits PTSD. On the one hand, they fear being considered “wimps”, and 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 armed forces and in civilian life. Many traumatized people stop working; back in society, however, many therapists do not dare to work with war invalids. The ex-soldier Malcolm Mackenzie says: “Nobody has been able to help me so far. I'm afraid of ending up in the closed institution or in jail. "

Who is at risk?

Regarding PTSD as a disease is true of the symptoms, but strictly speaking it is not correct. Rather, PTSD is the body's healthy response to coping with threatening situations. For example, those affected are less sensitive to physical pain than those not affected.

There is no such thing as a “typical” post-traumatized person, but people who have previously had psychological problems are particularly at risk. The same goes for people without stable and long-lasting relationships. People who work professionally in disasters such as police officers or paramedics are proportionally less likely to suffer PTSD than lay people.

Social circumstances prior to the event also have an impact on whether PTSD develops: fragmented families, criminal parents, mentally ill parents and poor contact with peers.

A study of traumatized Vietnam veterans found the following risk factors: pre-combat depression, harshly punishing parents, and unstable families. After the combat, there were also: illnesses, divorces, death of relatives and new trauma.

There were also factors that dampen trauma: a close relationship 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, it was significantly less, namely between 2.1% and 13.8%.

Loss of security

According to Maslow, human needs are staggered. Only when basic needs are satisfied do higher needs come on the agenda: Security follows sleep and eating, so it comes before the need for social contact, recognition and self-realization. Most people learn that their environment is safe. Trauma calls this certainty into question. The world becomes a threatening place, order chaos.

PTSD in partnerships

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

The family can help the affected person with flashbacks: Reliving what happened again instills fear in the injured person - the horror is there again. The relatives can give him the feeling of security here: No matter what happens, we are there for you. You shouldn't be pestering him with questions, you should be around.

Such “flashbacks” are associated with heartbeat, rapid breathing, nausea, muscle tension and sweating. Deep breathing helps against this: The injured person should breathe in deeply 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 also generally feel safe: Discussing the future with him, showing that it is open, keeping promises and creating routine are essential points.

The relatives must know that the injured party 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 important to them before. This is hurtful, but should not be taken personally.

Affected people think badly of themselves and paint their situation in black colors. Conveying love to them is just as important as positive ideas. Relatives can also relieve the outbursts of anger. If the person concerned “gets going” his friends can go with him to the next room or go for a walk. It also helps encourage those affected to keep diaries. Writing channels the feelings and thus dampens the outbursts. In addition, the person concerned becomes so clear about his feelings.

One should deal with a person affected with fingertips. Traumatized people are often over-sensitive and tense to the extreme. You should therefore avoid jerky movements, inform him if you make a noise and report when you get home.

Post traumatic stress disorder: treatment

Many psychotherapies have been specially developed for trauma. When 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 not directly related to it. If the memory bursts are less intense, the therapist and patient can address the trauma directly. Usually the patient first has to stabilize before the trauma therapy methods are used. Then it can be a question of changing the patient's behavior and living conditions.

Cognitive behavioral therapy is also used to treat trauma. Above all, exposure therapy is successful. The patient should remember the traumatic experience here, in a protected setting.

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

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

In addition, there is dream work to invalidate side effects such as nightmares. The person concerned imagines that a recurring nightmare has a happy ending. This procedure also reduces the memory surges.

PTSD can also be treated with medication, in Germany with sertraline and paroxetine, among others. 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 take place in four phases. First of all, it's about safety, i.e. teaching the patient to rebuild trust. The therapy should therefore offer a clear framework and the therapist should show himself to be a reliable partner. To do this, he discusses the goals and duration of the therapy with the person affected. He explains the symptoms and causes of PTSD and suggests different therapies to the patient.

In addition, the patient and therapist discuss the person's social relationships. If it turns out that acquaintances have a bad influence on his problems, or he seeks relationships that harm him, the question is how the affected person can deal with it.

In order to restore inner security, the therapist and client go through the “mental 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 horror explode.

In addition, the patient should now learn to build relationships that strengthen him and to part with relationships that harm him. This is very important for many traumatized people, as they often look for an environment that reflects their trauma experience. Now it is a matter of structuring everyday life again.

The “inner dialogue” method helps to regain and understand parts of the self that have been split off as a result of the traumatic process. The imagination, i.e. calling up healing images, complements the inner dialogue. With the mentally stable, these methods can easily be used in everyday life; In traumatized people with severe dissociations, however, the inner images are so “torn” that this phase can last for years.

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

Inner distance means that split off affects, feelings and perceptions move into consciousness and are integrated into the personality. At the end there is integration. Therapist and patient look back at the time of the trauma and put it aside in the past. As an encapsulated memory, it loses its horror. The therapist and the person affected develop new goals in life. Ideally, the therapy proves itself in the practice of a self-determined life. (Dr. Utz Anhalt)

Author and source information

This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
  • 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), informedhealth.org
  • 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

Important NOTE:
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.

ICD codes for this disease: F43ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work.