My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.
Contrary to popular misperceptions, post-traumatic stress disorder, PTSD, and acute stress disorder, or acute stress reaction, are not typical responses to prolonged abuse. They are usually the outcomes of sudden exposure to severe or extreme stressors, stressful events.
Yet some victims whose life or body have been directly and unequivocally threatened by an abuser do react by developing these syndromes. Post-traumatic stress disorder, PTSD, therefore, is typically associated with the aftermath of physical and sexual abuse in both children and adults.
This is why another mental health diagnosis, C, PTSD, complex PTSD, has been proposed by Dr. Judith Herman of Harvard University to account for the impact of extended periods of trauma and abuse. Someone else's looming death, one's violation, personal injury, or powerful pain, are all sufficient to provoke the behaviors, cognitions, and emotions that together are known as PTSD.
Even learning about such mishaps may be enough to trigger massive anxiety responses in listeners and viewers.
The first phase of PTSD involves incapacitating an overwhelming fear. The victim feels like she has been thrust into a nightmare or a horror movie. She is rendered helpless by her own terror. She keeps reliving the experience through recurrent and intrusive visual and auditory hallucinations. This is what we call flashbacks.
Some patients experience the same distress in dreams. In some flashbacks, the victim completely lapses into a dissociative state and physically reenacts the event while being thoroughly oblivious to her whereabouts, sometimes during sleep.
In an attempt to suppress this constant playback in the attendant exaggerated startled response, jumpiness, the victim tries to avoid all stimuli associated, however indirectly, with a traumatic event.
Many develop full-scale phobias, agoraphobia, claustrophobia, fear of heights, aversion to specific animals or objects, to specific modes of transportation, to certain neighborhoods, to buildings, to occupations, to the weather, and so on.
By avoiding these triggers, they are trying to avoid the recurrent flesh lips.
Most PTSD victims are especially vulnerable on the anniversaries of their abuse. They try to avoid thoughts, feelings, conversations, activities, situations of people who might remind them of the traumatic occurrence. These are the triggers that I've aforementioned.
This constant hyper-vigilance, this repeated arousal, the sleep disorders, mainly insomnia, the irritability, short fuse, and the inability to concentrate and complete even relatively simple tasks erode the victim's resilience.
Utterly fatigued, most patients manifest protracted long periods of numbness, automatism, and in radical cases near catatonic posture. Response times to verbal cues increase dramatically in PTSD patients.
Awareness of the environment decreases, sometimes dangerously so.
The victims are described by their nearest and dearest as zombies, machines, or automata. The victims appear to be sleepwalking, depressed, dysphoric, unhedonic, not interested in anything, and they find pleasure in nothing.
PTSD patients report feeling detached, emotionally absent, strange, and alienated.
Many victims say that their life is over and they expect to have no career, family, or otherwise meaningful prospects or future.
The victim's family and friends complain that she is no longer capable of showing intimacy, tenderness, compassion, empathy, or of having sex.
This kind of post-traumatic emotional and sexual rigidity is typical of PTSD sufferers.
Many victims become paranoid, impulsive, reckless, and self-destructive. Others solidify their mental problems. They develop psychosomatic disorders, complain of numerous physical ailments. They all feel guilty, shameful, humiliated, desperate, hopeless, and in extreme cases hostile.
PTSD need not appear immediately after the harrowing experience. It can and often does take a long time. It is delayed by days or even months. It lasts more than one month, usually much longer.
Sufferers of PTSD report subjective distress. The manifestations of PTSD are egodystonic. People don't like themselves. And they're functioning in various settings, like their job performance, grades at school, sociability. Their functioning deteriorates, marketeers. They're no longer the same person, so to speak.
The diagnostic and statistical manual criteria for diagnosing PTSD are far too restrictive. PTSD seems to also develop in the wake of verbal and emotional abuse, providing it is acute and loner, and in the aftermath of drawn-out traumatic situations such as a nasty divorce.
Hopefully the text of the diagnostic and statistical manual will be adopted to reflect this sad round.