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?