Post Traumatic Stress Disorder (PTSD): What is it?
Updated: Jun 29
By Jesslyn Ch’ng
Content Warning: The following content contains discussions on trauma that may be distressing to some. For support, please contact email@example.com or 018-9003247.
Unexpected and distressing incidents such as a serious car crash, natural disasters or atrocities like robbery or sexual assault may lead to traumatization. This includes recent events such as the Kelana Jaya LRT collision and the ongoing COVID-19 pandemic.
Traumatic experiences can lead to depressed moods, difficulty in focusing, changes in appetite as well as disturbed sleeping habits. These experiences also lead to intrusive thoughts like “Why did this happen to me?” and hypervigilance, where those who are traumatised are constantly on high alert in fear of the re-occurrence of the traumatic incident.
These behaviours and thoughts are natural after a traumatic experience. We all need time to digest and process them. However, if these symptoms persist for more than a month, you may be presenting symptoms of Post Traumatic Stress Disorder (PTSD).
PTSD was first recognized and diagnosed in World War I, where many soldiers suffered from headaches, dizzy spells, amnesia or memory loss, and hypersensitivity to noises even after the war had ended. At that time, medical professionals assessed these symptoms as a part of their physical health without consideration of their mental health. They believed that these were caused by the poisonous gas and vibrations from artillery shell explosions. Hence, they coined the term “Shell Shock” to describe these symptoms.
Curiously, it was later found that even without experiencing artillery shell explosions, some soldiers still reported similar symptoms. Therefore, associating these symptoms to shell explosions would not only be too simplistic, but perhaps inaccurate.
It was only during World War II that medical professionals considered these symptoms to be a result of psychological distress, rather than a physical health issue. Since then, these symptoms were associated with the term that is now widely recognized as PTSD.
The criteria of PTSD includes at least one of the following experiences:
Life threatening situation (E.G. war, severe car crash, abduction)
Traumatic incident leading to sustained physical injuries or mental distress
Living with chronic illnesses and distressing situations such as domestic violence or bullying can also be considered as traumatic incidents. Occupations with extreme working conditions such as medical personnels, first aiders, military personnels, or police forces that experience high exposure to death, injuries, and violence are also more vulnerable to traumatic experiences. These incidents can be just as traumatic and increase the likelihood of PTSD.
These experiences may not necessarily be personal experiences. In fact, even just witnessing these traumatic experiences, or learning that a relative or a close friend was exposed to a traumatic incident can increase your risks of developing PTSD.
Since March 2020, Malaysia has been on high alert as we fight against the COVID-19 pandemic. Just as the situation began improving, we experienced another surge of COVID-19 cases in mid-April of 2021. On May 29th, 2021, the number of confirmed cases reached a new high of 9,020 cases. As Malaysia continues to see a rise in the death and spread of COVID-19, medical staff and frontliners continue to experience high levels of exposure to the traumas of the pandemic.
6.3% of medical personnel who provided for COVID-19 patients reported PTSD symptoms. However, this study was conducted on June 30th, 2020, when the highest total daily cases were only in the hundreds. If we were to conduct the same study in the present moment, the rate of PTSD amongst these frontliners would be significantly higher than previously reported.
Patients who survived COVID-19 are also at risk of experiencing PTSD. This is especially true for those who had severe COVID-19. Thoughts of uncertainty on whether they would recover haunted them as they were admitted into the ICU, requiring intubation and support from ventilators to assist their breathing. There are still long-lasting symptoms such as breathing difficulties and reduced attention span even after recovering from COVID-19, which further adds to the uncertainties on their quality of life.
Thus, not all wounds are visible, such as those of psychological distress.
The main symptoms of PTSD include:
1. Intrusive Memories
Even though the traumatic incidents have passed, individuals can still relive these experiences through intrusive recollection of the incidents.
For example, a COVID-19 survivor diagnosed with PTSD can still relive their experiences through flashbacks and/or nightmares of being admitted into the ICU, as though they had never left the ICU.
Reliving these experiences can be highly distressing, leading to a heightened sense of awareness that would subsequently affect their lifestyle and quality of life.
The amygdala is like an alarm system in the brain. When we are under distress or feeling threatened, it activates a “fight-or-flight” response that further activates the sympathetic nervous system (SNS). This system then prepares the body to fight against the threat (fight) or to flee for safety (flight). During these moments, our heartbeat increases and we feel nervous.
On the other hand, the prefrontal cortex (PFC) is the rational part of the brain. It responds to situations with good and sound judgement. However, during times of distress, the amygdala takes over the role of the PFC, where it activates the “fight-or-flight” response to protect the body.
For individuals who experienced trauma, the PFC is on constant activation, which leads to hypersensitivity to our fight-or-flight responses whereby our “alarm system” is over-sensitive and goes off too frequently. Traumatic experiences also impairs the PFC to have decreased function and activation, where individuals may not be able to recognise triggers for their trauma efficiently to deal with the situation. Consequently, these individuals become overly frightened even by the slightest stimulation (triggers) that brings back memories of the traumatic experiences, inducing panic within them.
For example, on May 24th of 2021, one of the worst railway collisions in Malaysia occurred on the Kelana Jaya LRT line. It severely injured 47 passengers and lightly injured 166 others, all of whom are likely to be traumatized by the incident. These passengers may even develop a fear of using public transport in the future as they are afraid of going through a similar experience once more. This incident could also be triggering to those who have only witnessed the collision through the news since it was widely covered by the media.
These experiences will have long term impacts on their lifestyle.
3. Avoidance and Negative Changes in Behaviour
Most trauma survivors could grow avoidant of activities or locations that remind them of their traumatic experience. For example, a car crash survivor may avoid driving or returning to the site of the incident in order to prevent recollecting the overwhelming memories of the incident.
Some trauma survivors can even show symptoms of selective amnesia (memory loss), where they might not be able to recall important details about the traumatic incident.
Some may become emotionally numb to their experiences. When narrating or recalling the incidents, they would narrate it in a way as though they had not personally experienced the incident. Instead, it would simply seem as though it was just a nightmare or someone else’s experience.
As we all do our best to recover from COVID-19, we should be vigilant in caring for our physical health, as well as our mental health. This is equally important for all of us, including medical personnel, frontliners, COVID-19 survivors, as well as anyone who has been heavily impacted by the pandemic. However, it’s important to be aware that PTSD symptoms do not necessarily occur immediately after traumatic incidents. In some cases, these symptoms can occur months or even years after the incident.
Therefore, even if we have managed to physically defeat the pandemic, the battle of COVID-19 continues. Frontliners and survivors should receive mental health screenings and have access to mental health support to support them through their post-pandemic battles.
After a traumatic experience, we need to allow ourselves time to properly process these experiences. It is important to remember the physical and mental impacts of trauma and to take proper measures to address them. If these impacts continue to persist and greatly affect our regular lifestyles, it is important to seek help from mental health professionals.
After all, mental health is just as important as one’s physical health.
Arnsten, A. F., Raskind, M. A., Taylor, F. B., & Connor, D. F. (2015). The effects of stress exposure on prefrontal cortex: Translating basic research into successful treatments for post-traumatic stress disorder. Neurobiology of stress, 1, 89-99. https://doi.org/10.1016/j.ynstr.2014.10.002
Bezdek, Kylie Garber; Telzer, Eva H. (2017). Have No Fear, the Brain is Here! How Your Brain Responds to Stress. Frontiers for Young Minds, 5(), 71–. https://doi.org/10.3389/frym.2017.00071
Bryant, Richard A. (2018). The Current Evidence for Acute Stress Disorder. Current Psychiatry Reports, 20(12), 111–. https://doi.org/10.1007/s11920-018-0976-x
Chew, N. W., Ngiam, J. N., Tan, B. Y. Q., Tham, S. M., Tan, C. Y. S., Jing, M., ... & Sharma, V. K. (2020). Asian-Pacific perspective on the psychological well-being of healthcare workers during the evolution of the COVID-19 pandemic. BJPsych open, 6(6). https://doi.org/10.1192/bjo.2020.98
Crocq, M. A., & Crocq, L. (2000). From shell shock and war neurosis to posttraumatic stress disorder: a history of psychotraumatology. Dialogues in clinical neuroscience, 2(1), 47. https://doi.org/10.31887/DCNS.2000.2.1/macrocq
Hughes, K. C., & Shin, L. M. (2011). Functional neuroimaging studies of post-traumatic stress disorder. Expert review of neurotherapeutics, 11(2), 275-285. https://doi.org/10.1586/ern.10.198
Jaapar, S. Z. S., Abidin, Z. Z., & Othman, Z. (2014). Post traumatic stress disorder and its associated risk factors among trauma patients attending the orthopaedic wards and clinics in Kota Bharu, Kelantan. International Medical Journal, 21(6), 1-3. Link: https://core.ac.uk/download/pdf/219463758.pdf
Janiri, D., Carfì, A., Kotzalidis, G. D., Bernabei, R., Landi, F., Sani, G., ... & Post-Acute Care Study Group. (2021). Posttraumatic stress disorder in patients after severe COVID-19 infection. JAMA psychiatry, 78(5), 567-569. https://doi.org/10.1001/jamapsychiatry.2021.0109
Jones, E., Fear D Phil, N. T., & Wessely, S. (2007). Shell shock and mild traumatic brain injury: a historical review. American Journal of Psychiatry, 164(11), 1641-1645. https://doi.org/10.1176/appi.ajp.2007.07071180
Marek, R., Strobel, C., Bredy, T. W., & Sah, P. (2013). The amygdala and medial prefrontal cortex: partners in the fear circuit. The Journal of physiology, 591(10), 2381-2391. https:doi.org/ 10.1113/jphysiol.2012.248575
Miao, X. R., Chen, Q. B., Wei, K., Tao, K. M., & Lu, Z. J. (2018). Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research, 5(1), 1-7.https://doi.org/10.1186/s40779-018-0179-0