Following is an example of how post-traumatic stress disorder (PTSD) can develop after a single traumatic incident.
Tony had a somewhat stable childhood. Though his parents divorced when he was 8, he, his mother and siblings stayed in the same house and he regularly saw his father, who remained in the same town. He had some difficulty with learning in school, and as a result often felt discouraged. His grades reflected this. However, he found success and acceptance in athletics, and always had a lot of friends.
Tony joined the Army when he was 18, looking to see some different parts of the world, serve his country, and perhaps one day go to college. For the most part, he enjoyed being in the Army — he found camaraderie with his “brothers,” stable pay, and he enjoyed training in communications.
While deployed in Afghanistan, he was riding in a convoy when his vehicle drove over an improvised explosive device. The others riding with him were killed and he was grievously wounded. He recuperated in Bethesda, mostly recovered but for the loss of one eye.
Tony is on partial disability and misses his former career, friends and the future he’d imagined. It has been two years, and he is working as a tattoo artist and finds his trauma symptoms are interfering with his life. He and his girlfriend have been fighting a lot, and recently, during an argument, he threw a glass at her. It missed, but it scared him that he could lose control like that.
While some of Tony’s symptoms present as classic PTSD material — he is having flashbacks, is very jumpy, and avoids thinking and talking about events surrounding his trauma whenever possible — there are others that make it more difficult for him to get support. Hypervigilance results in an overall elevation of the system, making the survivor extremely reactive to his surroundings.
Tony finds that he has rages that come out of nowhere and finds it impossible to predict what will set him off. He wants to be alone a lot more than he used to and even when he is around other people, he feels an isolation that is new to him. He is constantly distracted and worries about his memory, since he seems to be forgetting things that just happened to him.
Tony was initially worried about telling anyone what was going on, so he found an online chatroom for other veterans. He found a lot of participants not only didn’t think he was crazy, but they had a lot of the same feelings and symptoms. A couple of guys had worked with therapists and found it helpful, so Tony reached out to the VA. He was able to work with a therapist who used CBT with exposure. His therapist provided him with psychoeducation about trauma and how it affects someone’s body and brain. He learned to recognize triggers that upset him and how to tolerate discomfort with his symptoms.
Because Tony remembered that he used to really connect with drawing, his therapist had him draw frames from his traumatic event, from some times prior to the event, to the explosion and immediate aftermath, to afterward. Tony told his therapist the story several times until he found that the memories did not come on their own anymore, and when he thought about them they weren’t nearly as upsetting or vivid.
Tony found almost immediate relief in his trauma symptoms. He also found that he liked feeling more in control of his moods. He continued to see a therapist for a few months to continue to work on his anger and relationship issues. He and his girlfriend broke up, but he found that he was able to get through it better than he’d imagined. He also didn’t want other veterans to feel ashamed of their symptoms the way that he did and decided to volunteer to be a mentor to returning veterans.