Acute Stress Disorder and Posttraumatic Stress Disorder

Table of Contents

What is the role of trauma in the creation of anxiety?

This question raises complicated, far-reaching, and deeply compelling issues. Asking one question in this area raises even more questions than it provides definite answers.

However, both acute trauma (e.g. being in a car wreck or another near-death situation) and longer-term, lower-grade strain trauma (e.g. living over time in an abusive household) can serve as points of departure in beginning to answer this question. Both acute and strain traumas can lead to acute stress disorder or the creation of an anxious personality style.

Acute stress disorder and posttraumatic stress disorder can look the same, although they differ in their time frames. Technically, any acute trauma that leads to the symptoms of hyperarousal (including palpitations, racing heart beat, and sweating), reexperiencing (where one experiences flashbacks), or avoidance of anything associated with the trauma within thirty days is called acute stress disorder.

Those whose symptoms persist beyond thirty days qualify for diagnosis of posttraumatic stress disorder. These distinctions are both interesting and meaningful from a clinical perspective. However, anyone in the midst of these symptoms knows that sensitivity to one’s perspective, attempted understanding of one’s distress, and the provision of a safe haven to rest are more important than any diagnostic time frame parameters.

a worrisome man

Exploring emotional reactions related to the trauma in any longer-term healing way happens over time as the sufferer feels safe enough to begin this process. If you wish to learn more about these topics, start with Dr. Judith Herman’s Trauma and Recovery5or Dr. Leonard Shengold’s Soul Murder.

In cases of torture, we find overwhelming, ghastly, seemingly unspeakable consequences. James Bond may (unrealistically) be tortured on film and recover to a high level of functioning, almost making the notion of torture glamorous via Bond’s superherolike defiance of human fear.

Examples of torture are unfortunately all too common among military personnel, prisoners of war, or seekers of political asylum from dictatorial societies. Several major components characterize this torture.

First, the physical creation of pain is inter-spersed by design with caretaking, as well as with an overt, calculated plan to control the victim’s thoughts, to dominate one’s thinking, or to brainwash the mind’s total functioning. These tactics systematically disintegrate human mental functioning and sense of personal self, a process that has been called “soul murder.”

Child abuse, rape, or other sexual crimes might, likewise, result in acute or posttraumatic stress. The example of sexual abuse and the histories of its victims serves as one, among many, example that illustrates general principles of anxiety that stems from trauma. Victims of sexual abuse, whether disorders from incest or from another perpetrator, often feel particularly unprotected and vulnerable. Their overwhelming secret and the sense of shame they carry in keeping the abuse secret make symptoms even more uncomfortable.

Understanding the roots of this shame proves as individual a pursuit as the sufferer is an individual, with his or her own complex life history. Keeping an abuse history secret helps to avoid the perceived fear or humiliation one expects if he or she were to reveal his or her sexual involvement with a forbidden mentor, teacher, relative, or parent.

Sharing such histories of abuse might mean reexperiencing feelings of vulnerability or memories of being taken advantage of; or it might mean exposing what feels like an illegal yearning or hunger for affection. Often, victims struggle when revealing that they enjoyed part of the sexual attention they received by their perpetrators, perhaps knowing that such attention felt better than being alone.

It takes immense courage to speak aloud of the secrets of sexual abuse. Often, men and women wait decades— suffering privately—before coming forward with their secrets. This courage then allows for repair and safety to take root, both of which can encourage the shame and its attached discomfort to diminish.

In sexual abuse, as in all kinds of torture, an absolute violation of a human boundary occurs such that the world may no longer feel like a safe place. Instead, an actual blurring of the boundary between fantasy and reality emerges.

Whereas a normal child may fantasize being sexually involved with his significant caretakers or other adults around him, normative development allows a child to differentiate between fantasy and reality. However, sexual abuse may leave a child not knowing where reality ends or where fantasy starts.

This history can make the very nature of fantasy traumatic and invite the possibility that even sexual fantasies could become dangerous inasmuch as they might feel like crossing a forbidden boundary.

Sexual abuse can trigger many different types of anxiety. Patients with phobias, such as needle or tunnel phobias, panic disorder, or eating disorders may have experienced sexual abuse, as may have 50% of those diagnosed with borderline personality disorder. Patients with pain disorders and medical syndromes such as vaginismus (a contracting of the vaginal muscles making penetration of the penis impossible) may have been victims of sexual abuse.

Drug abuse, suicide, sexual inhibitions, promiscuity, and sadistic and masochistic personalities also come to mind in contemplating the myriad effects sexual abuse can have in the shaping of a personality.

The anxiety of regular sexual abuse or of regular screaming, yelling, fighting, or witnessing of physical abuse at home can create chronic feelings of insecurity. A man may fear that he will never grow out of being a boy, or a woman may feel trapped as a girl in her adult life. It is not uncommon for patients in the context of trauma to feel both a physical sense of numbness and an emotional lack of reactivity.

Numbness, or not feeling things in the body as someone otherwise might, could manifest itself as a loss of genital sensation or as decreased sensation in one’s hands. Alternatively, someone may notice that he has a decreased ability to identify his mood, which might actually serve a protective function. Anyone who has read Albert Camus’s book The Stranger or who has seen the emotional blunting of the abused character in the movie Mystic River can appreciate the haunting and deadening of mood that characterize survivors of sexual abuse and posttraumatic stress disorder.

What is Xenophobia?

In this current climate of war, the fear of strangers has reached a new peak. A major U.S. national concern has unfolded since September 11, 2001, involving anyone belonging to a Middle Eastern culture. In this case, a real trauma did occur, and our nation, rightfully, is anxious about another attack.

However, this anxiety can magnify into xenophobia, a fear of anyone foreign—Middle Easterners, in this case. It can also make people question whom we can trust when we cannot see the enemy. The nation’s response has paralleled that of someone who experiences an individual trauma; expecting the worst outcome in any situation inasmuch as a stimulus associated with trauma might lead to the fear of another attack.

Fear of strangers provides an excellent way of letting the mind split the world into good and bad, safe and dangerous. It also allows us to forget or deny that we, too, might be doing something bad. Many individuals who have endured a trauma exercise hypervigilance, mentally reexperience the trauma, or sense chronic numbness.

In reaction to the terrorist attacks, the nation has done that through its code orange alerts, its repeated images of planes crashing into the World Trade Center, and a wish to avoid the memories of what has happened.