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Never-ending Trauma

“What happens after a person suffers from sexual, physical, or emotional trauma?” This was one of the questions posed to the audience during our psychiatry conference.

It was a relevant question. We may not know it but any trauma can leave behind not just scars, but also pain, horror, depression, and impairment long after the experience.

In a way, the devastation is never isolated. It stays during and long after the dust settles. Really unfortunate!

Let me give you a hypothetical story of Helen. She is an accountant who had a traumatic past that she kept to herself. At age 15, she was grabbed by a masked man while jogging in a park. The man threatened to kill her with a knife and brutally raped her. She screamed but nobody heard her plea for help.

A few months after the incident, Helen has developed nightmares about being chased, raped, or killed. She has suffered from flashbacks. Also, each time she watches TV shows that remind her of the incident, she gets scared, overwhelmed, and agitated. At times, she develops anxiety attacks, palpitations, sweating, and restlessness.

Since the attack, Helen can hardly trust people and avoids friends and relatives. As a result, her relationships have markedly suffered. More recently, she’s been depressed and hopeless. She hasn’t been sleeping and eating well. Her inattention has negatively impacted her work.

Based on her symptoms, Helen is most likely suffering from Posttraumatic Stress Disorder (PTSD). What exactly is PTSD?

PTSD is a psychiatric disorder characterized by avoidance, hypervigilance, emotional difficulties, and recall behavior (for instance flashbacks and nightmares) after a traumatic event such as rape, war, vehicular accident, or natural disasters.

Recent researches have shown that after a trauma, biochemical changes develop in the brain that can result in serious psychological signs.

If left untreated, some individuals experience emotional difficulties such as depression associated with inability to concentrate, sleep, and eat. Occasionally, they become hopeless and suicidal.

What is the treatment for PTSD?

The combination of individual psychotherapy and medications helps. For long-term treatment, antidepressants including serotonin-reuptake inhibitors (SSRIs), for instance citalopram or sertraline, or serotonin-norepinephrine reuptake inhibitors (SNRI), for instance venlafaxine, have been tried with some success.

Other medications are successful in addressing associated symptoms. Anxiety and agitation can be treated with benzodiazepines. The latter should be restricted to short-term use because of their addiction potential. Trazodone is a preferred drug for insomnia.

For those with significant suspiciousness and agitation, a trial of atypical antipsychotics such as risperidone or quetiapine, may be warranted.

Psychotherapy or “talk therapy” is a crucial part of treatment and recovery. The traumatized individual should be able to express the fear, the frustration, the guilt, and the blame in a secure and safe setting. Moreover, his or her therapist should provide ample support and empathy.

It is not unusual to meet PTSD individuals with associated alcohol or drug problem. Apparently, they try to cope and self-medicate using the accessible substances they know. If alcohol and drug problem exists, address this issue through appropriate agencies such as Addiction Services, AA, and detoxification or rehabilitation programs.

by Michael G. Rayel, MD -

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Dr. Michael G. Rayel — author, game inventor, and psychiatrist — has created the Oikos Game Series to promote emotional health and has provided EQ Webinar for parenting, personal, and career success. For more info, visit or