PTSD and Quality of Life: New Research

Thanks to @ssanquist I recently read ScienceDaily’s article describing new research about the impact of PTSD (post-traumatic stress disorder) on quality of life.

PTSD at its core is defined as a response to trauma. It is diagnosed based on the existence of symptoms that are divided into 3 categories: re-experiencing the traumatic event, avoidance of stimuli associated with the trauma and numbing of general responsiveness, and increased arousal.  NIMH elaborates on the symptom categories as follows.

Re-experiencing symptoms include:

  • Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating
  • Bad dreams
  • Intrusive, frightening thoughts

Avoidance symptoms include:

  • Staying away from places, events, or objects that are reminders of the experience
  • Feeling emotionally numb
  • Feeling strong guilt, depression, or worry
  • Losing interest in activities that were enjoyable in the past
  • Having trouble remembering the dangerous event.

I find it interesting that avoidance symptoms describe dissociation (numbing, memory problems for traumatic event) but that term is not used. Too bad the diagnostic criteria have yet to catch up to research supporting a dissociative PTSD subtype.

Hyperarousal symptoms include:

  • Being easily startled
  • Feeling tense or “on edge”
  • Having difficulty sleeping, and/or having angry outbursts.

This study asked people with PTSD which symptoms adversely impacted their quality of life:

Distressing recollections of a traumatic event and avoidance of certain activities and thoughts — both commonly conceived of as dysfunctional behaviors — had little correlation to a patient’s reported sense of well-being, according to the study.

However, symptoms tied to heightened arousal — such as trouble sleeping, irritability and vigilance — were associated with lower quality of life among PTSD patients. Anxiety and depression were also associated with lower quality of life.

I can understand this finding regarding avoidance and have written about how dissociation can be adaptive short-term. But I am surprised that re-experiencing symptoms like flashbacks and nightmares were not correlated with reduced quality of life. This is not what I hear reported in my practice.

What do you think? Do these research findings fit with your experience?

Kathleen Young, Psy.D.

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19 Responses to PTSD and Quality of Life: New Research

  1. Java Princess says:

    I wonder if “distressing recollections” is the same thing as intensive and recurring flashbacks. Personally, even when I have had more somatic or “feelings” flashbacks on a regular basis, it through me off my balance, and often led to feelings of hyperarousal, anxiety and depression. The saddest thing about this article was the fact that participants would take an average of 13.6 years off their lives if it meant not having PTSD. That just broke my heart……

  2. Flannery says:

    Yes. This has been my experience.

  3. Shimon Cohen says:

    Doctor, you’re right- flashbacks have a definitely bad impact on the quality of life- i often found muself frozen, hardly aware of what was going on around me- just being able to do enough so no one would notice.
    but in some cases at least, I was asked by concerned people if I was ok. I couldn’t talk about what was happening, so I either lied or left the situation

  4. C says:

    Nightmares & flashbacks are causing me fear and extreme anxiety, even though I know this is “old stuff” not related to the present. In addition it’s something one needs to hide from being noticed as people would not understand anyway which makes it even more stressful. I wonder how being raped, abused and assaulted over and over again – even though it is JUST MEMORIES does not have an impact on the quality of life, to be honest. Makes me wonder once again if I am indeed not normal and overreacting to the past events and should just ‘forget about it and get a life’ as I have been told before.
    Besides this, the avoidance of doctors and dentist visits due to the extreme fear those are causing due to the past events, has a huge impact on the quality of life.

    • You are completely in the norm in my experience! That is why I found these results puzzling. In my 20 years of experience with trauma survivors, flashbacks are reported as very disruptive and overwhelming. You are in no way overreacting if you can’t just “forget about it”. That just plain does not work!

  5. mia says:

    No, that is not my experience.
    I responded just like you. At first I was quite surprised about that outcome.

    Then I realized… If I had not followed a billion clues myself, read and studied all aspects of these phenomenas, I would never have known where to place my own experiences either.
    I would not have had any idea of where to look for pathways to the origin of my reactions and respondings. First of all, I saw them clearly in past events. A little by little, in retrospective – everything that happened to me, during the years since this sort of major “disaster” struck.
    Later on I have gotten closer to the situation with my “reasoning”.
    Earlier, I instinctivly fled. I avoided without thinking. Well, I still run away – as it is no problem to shut out the world so good, one day there are no ties left. Suppose that is a fact so hard to get around, I am now aware of my response but without finding better alternatives. Really.

    Guess one could say that I lived through more than a decade, without being fully present. For many years I did not accept this new situation as being something “permanent”.
    And because of all the trouble it has caused me to respond like that – not knowing so at the time, of course – with dissociation and avoidance? As I am here today, experiencing and looking at all the huge irreversible damage, the consequenses I suffer at present, here and now?

    Dissociation (as described in your sub-category of PTSD) and avoidance of the most extreme kind, was never discovered by anyone within the healthcare system. I was diagnosed with depression and anxiety, noone listening to me beginning to know the coherence.
    I would not hesitate, but blame dissociation and avoidance, for having such trouble with hyperarousal and all other known PTSD-symptoms today.
    Not least, because my life as a whole today, is so broken and – I guess one could say: shockingly different from anything I could ever imagine.

    Now, I ought to add that medication took over when I believe dissociation would otherways have had a chance to ease. And it was not until I ended that in a hasardious manner (even if I knew better -) I found myself being back on planet Earth again. In all ways and in every sense, I felt present.

    After such a long time away, though, it was not a pleasant experience to take a look around. Nothing to be “feeling great” about, my life and me today.
    Along with several “unaviodable matters” – proceeding in the worst ways, for anyone as voulnerable as I then was – I had to face further complications.
    The grief and loneliness I am going through because of all the losses – at the same time as I continue to realize how everything turned out and changed over the years… It is simply so overwhelming, it is devestating all by itself.

    As if my life had turned into a runaway train.
    Kind of. ;)
    And I am not enjoying thrillers like I once did.

    I would welcome a sub-category of PTSD. Also I would like it to become a lot more awareness of the impact from human made, deliberately caused, terror and harassment of pure psychological nature.
    Adults all of a sudden living in the midst of a somewhat invisible war, maybe without a clue why or what is going on. Incomprehensible cruelty. Inhuman behavior without any reason whatsoever, according to humanity as one is capable to understand it.

    That was one long comment, Dr. Kathleen Young.
    Please excuse me for taking this much space in your blog. It might help if we could look at it as 20-1. The first of what should have been lots.
    By the way, I have this saying that came naturally from this dissociative state of being, at one point. “There is a first time for everything, a second time.”
    Sure is.

  6. mia says:

    I am convinced our expectations for all things to prove efficient, demands of results and improvements, collide with our brains defence system quite often.
    And if we are not given the time and space – preferrably not left all alone, though – to sort it out…? I am afraid we give in to the strength of our own nature. It makes us withdraw and close, as we should get to open up – slowly as we become safe.
    The problem is, we never get to be. Everyone is in such a hurry.
    Instead of helping, it adds to the problem of insecurity.
    Makes the train go faster when it needs to slow down.

    Who would believe, I love travel by train… Real trains.
    Those on time & track – also I prefer, in the right direction. :)

  7. Lothlorien says:

    I would say that flashbacks diminish my quality of life, but I wouldn’t cast them as the straw that breaks the camel’s back for me. I guess because, as bad as they are, for me they have come in waves. They are horrible when they are occurring. They disrupt my life and can interfere with my functioning and sense of presence depending on how severe and long lasting they are. However, for me, they are not a constant, and through therapy, I have learned to manage and cope with them, process what they bring up for me, and move past them. Therefore, I wouldn’t say that they are a strong contributor of my life dissatisfaction. Avoidance of reminders of the trauma wouldn’t rank that high either.

    I would be more inclined, personally, to agree with the study, but everyone is different. There was almost certain variance within the sample even though the majority resulted in the data that emerged.

    For me, the number one factor that has contributed to life dissatisfaction has been lack of appropriate attachment from birth. Attachment and depression together are the top issues that contribute to life dissatisfaction for me. They are a constant struggle, they make navigating life difficult, and deaden the whole life experience. I guess for me it is the deeper issues, not the “on the surface” symptomotology that really hurt me most.

    My two cents,
    Lothlorien

  8. Pingback: Best Tweets for Trauma and PTSD Survivors (week ending 03/18/11) « Third of a Lifetime

  9. J. E. Nolan says:

    As a partner of a child abuse survivor, I have trouble to agree with those findings. My partner is very distressed when there are ‘those images’ (as she describes it) popping up in her head at unpredictable moments. Certain sounds can set those off, the unanticipated (loving) touch of our kid and a lot of innocent appearing things. It is heartbreaking for me to see how she suffers. The fear and anxiety which she tries to cover up, are hard to hide. Her hands clenched, her knuckles white and shaking all over her body and rapid breathing reveal her inner struggles even though she tries so hard to put up a smile in those situations and pretend she is perfectly fine.
    Childbirth became a utmost traumatic experience, there was no way she could manage to avoid it (and mainly the exams, exposure, etc) and was related to many flashbacks, nightmares etc which decreased her quality of life significantly.
    Her efforts to avoid her past memories made her going this path of recovery alone so far (I am on her side but have limited possibilities to help her). She has been avoiding therapy because she wants to avoid being forced to reflect on her past and remember even more than the pieces that came up during those flashbacks and nightmares (in how far are nightmares accurate?)
    I can imagine that with successful therapy this statement might be partially true, however, people that suffer from acute PSTD most likely do not yet have learned the techniques that will help them to assure those symptoms do not affect their well-being.
    BTW, on another note, I found this website while looking for some therapy options /therapists as my partner is thinking about taking a first step to acquire techniques that will help her through current distressing situations and help her reduce anxiety and fears (though she is not yet willing to address the past directly – I hope this is generally a process with that particular step to come next). Do you happen to recommend any (preferably female) therapists in the Chicago downtown area (Streeterville / (South)Loop) who specialize in anxiety/child abuse?

  10. Dorothy says:

    J.E Nolan, I would highly recommend the book “Allies in Healing”.
    While it is true that you cannot know what the experience of your partner is, there are ways to be supportive and take care of yourself while you do it. It has been my experience that avoiding the symptoms or the triggers cannot be done successfully and sometimes getting help is a faster path to recovery.
    I would also recommend the book “The Courage to Heal”.
    Good luck to you both.

    Kathleen, I think the study makes sense to me. Hyperarousal triggers cortisol level, whereas memories, not necessarily. The memories can themselves cause hyperarousal and then be highly distressing, but perhaps the study is saying that the memories themselves do not cause harm to the body, while hyperarousal does (as we know, stress reduces life expectancy).
    Maybe i misunderstand, but that’s how I interpreted it from reading your post.

  11. OneSurvivor says:

    I am not sure where I fit into this pattern of experiences. Some things I notice that are different about me are:

    First…when it comes to avoidance…I will “sense” or “see” things coming up that I consciously push away. It is difficult to remember things because of the automatic pushback. I have to really force myself to find the time and place where I can be “safe” enough emotionally to allow the memories to come. I consider that to also be part of PTSD. Perhaps I am wrong?

    Second…flashbacks, for me, are in the form of overwhelming emotional pain that seems to come out of nowhere…although I do recognize that SOMEthing had to have triggered it. Or maybe it just could not be contained any longer? It is extremely rare that I can get a handle on the trigger or the initial event to which the emotional pain is related/connected.

    Third…I can be out and about and I suddenly need to go home. I just suddenly feel kind of overwhelmed and like I need to be home. It is difficult to explain.

    Anyway…although the first one does not really affect my quality of life…the other two definitely do. It varies. I will go through periods where it is better and periods where it is worse.

    I don’t know if that answers your question.

  12. Freemartin says:

    This finding that the re-experiencing symptoms were not correlated with reduced quality of life seemed surprising to me too. At first. Then I realized that my life could perhaps have been an example of just that. I don´t represent “the classical form” of PTSD – my unofficial diagnosis is complex PTSD with structural dissociation. In my life it ment, among other things, that I “had multiple lives”. I really had the feeling of leading two separate lives. One was “normal” (apparently normal) and contained no re-experiencing whatsoever. I went to school, hung around with friends and was quite a successful academic-to-be. The other life I led was quite the opposite. It was filled with re-experiencing stuff and messing up those things the other life tried to sustain. I had flashbacks, self-destructive behavior and misuse of different substances. In some weird way these two lives really were separate from each other. They both felt like “the whole story”. And in that “normal life of mine” I would not have consider my quality of life being reduced by any re-experiencing symptoms. “What are those?”

    I figure this phenomenon could in part explain the lack of decrease in the quality of life in some trauma survivors. If a person has more than one life, so to speak, one or a few of them can be free from those symptoms. The answer that you get to questions about life depend on which life these questions are asked in.

    I know this multiple lives -thing may sound funny or unbelievable, but I assure you, it was very real to me. Nowadays I have this one life the quality of which is decreased by re-experiencing symptoms to varying extent. I certainly prefer having only one life, but the cost is, I guess, that these symptoms really degrease its quality. On the other hand, the total quality of My One Life is constantly improving, and in this exhausting struggle I have had the priviledge of seeing and feeling things that really fill me with gratitude.

    I definitely agree with those people who think that recovering from trauma can lead to great places. A couple of years ago I couldn´t stand people trying to convince me that ” every cloud has a silver lining”, and I still don´t believe in it – there certainly are clouds that only bring horrible things and no precious metals whatsoever. But, in my case, the unification of these separate lives and really facing the almost unbearable past has led to things that I had no idea of. Really, really good things.

    Freemartin

  13. Marty says:

    From a lay person with complex childhood PTSD without any symptoms currently, I would say dissociation four times. PTSD fuels when we leave the awareness of now to give duration and power to our thoughts. In my mind, if you dissociate into the past or future, then as Rick Hansen says in Buddha’s Brain, What fires together wires together. It grows and we spend more time manipulating it.

    I believe many of our symptoms would integrate if we only practiced to be without thought in this moment. The nervous system would settle and the cortisol dumping would slow down.

    PTSD is a con game of the brain. Actually nothing concrete or solid exists just old judgments and attachments not yet integrated. If you can stay present and bring awareness to your fear and thoughts they will fade. Without the cortisol and stressor drugs our trauma loses interests for us.

    Just an opinion. I am not a therapist just one who has figured out how to grab my life back and fins happiness.

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