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It is very common for someone who experiences a traumatic event to have a strong emotional reaction, but not everyone goes on to develop PTSD. Most people who develop PTSD do so either immediately after experiencing a traumatic event, or within weeks or months of the event.
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Nightmares and Flashbacks
People with PTSD find themselves reliving the event that triggered the disorder through flashbacks and nightmares. These episodes can seem so real that it feels like the event is happening all over again, with flashbacks of sounds, smells, physical sensations, and emotions.
Waking flashbacks can be triggered by ordinary every-day objects and events. A trigger might be a sound or smell associated with the event, a location, a word, or a physical sensation.
Why does someone who has experienced a traumatic episode relive it over and over? It is thought that this occurs because the mind is forcing the person to keep thinking about the episode so that he or she will be better prepared if another crisis occurs. Sometimes, the person might relive events in flashback and think about what he or she could or “should" have done to make things turn out differently.
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Numbing and Avoidance
Constantly reliving the traumatic event through nightmares and flashbacks is extremely upsetting for someone with PTSD, and he or she will generally try to avoid these episodes with distractions or by trying to become emotionally numb.
Avoidance and numbing strategies can take many forms, such as overwork or becoming deeply immersed in a hobby, or by drug or alcohol abuse. Often, someone with PTSD will avoid close friends and relatives in an effort to avoid talking about the trauma.
Numbing and avoidance is the mind’s way of trying to manage the additional trauma of flashbacks and nightmares by reducing them to a level that the person can cope with.
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The third of the key signs of PTSD is called hypervigilance. This is a state in which the person with PTSD is continually alert and unable to relax, as though constantly on the lookout for signs of danger and dangerous situations. Often the hypervigilant state is accompanied by anxiety and insomnia.
In psychological terms, it is thought that the purpose of the hypervigilant state is that the person can react quickly in the event of another traumatic incident. Hypervigilance acts as a type of reassurance that this time, the person will be able to react in a way that helps keep him safe. Hypervigilance tends to be accompanied by chronic adrenaline production, which helps keep the alert state going and ensures there will be enough energy to spare if a crisis occurs.
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Other Signs and Symptoms of PTSD
There are many other physical, emotional, and behavioral signs of PTSD that might develop. In contrast to the three key signs outlined above which are present in most people with PTSD, the pattern of additional signs varies from person to person and might include:
- Digestive upset such as chronic diarrhea or stomach pains
- Muscle pain or aching
- Irregular heartbeat or palpitations
- Anger, irritability, aggressive behavior
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National Institute of Health MedlinePlus: Post-Traumatic Stress Disorder Topic Pages
National Institute of Mental Health: Post-Traumatic Stress Disorder
Royal College of Psychiatrists: Post Traumatic Stress Disorder (PTSD)
United States Department of Veterans Affairs: Common Reactions after Trauma