(PTSD)
The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides definitions of mental-health problems. It explains that PTSD triggers include exposure to actual or threatened death, serious injury or sexual violation. The trauma, regardless of trigger, causes significant distress or impairment to a person’s social interactions, and their ability to work or function in other normal ways.
PTSD is most commonly understood to be seen in soldiers after combat – recorded throughout history during the American Civil War as ‘heart shock’, in the First World War as ‘shellshock’, and then in the Second World War as ‘combat fatigue’.[31] But it’s now known to affect those who have experienced sexual assault, violence and accidents, traumatic childbirth and disasters. Symptoms of PTSD include repeated thoughts of the assault or incident, nightmares, avoiding thoughts and situations related to the trigger; feeling unsafe, panic attacks, and difficulty sleeping and concentrating. According to NHS figures, PTSD is estimated to affect about one in every three people who have a traumatic experience, though it’s not known exactly why some people are affected and others aren’t.[32]
Sufferers don’t just experience the trigger clearly, they can also relive the experience through flashbacks, where a word, smell or noise might make a person think the trauma they endured is happening again. Understandably, those with PTSD will often go out of their way to avoid anything that might provoke a flashback – changing their routines or restricting their movements. They will be hyper-vigilant, watching for danger at every turn. This can provoke huge anxiety because of the constant mental pressure to be alert.
Further types of PTSD have since been defined, to better reflect the different experiences of it. They include:
Delayed-onset PTSD. If your symptoms emerge more than six months after experiencing trauma, this could be described as ‘delayed PTSD’ or ‘delayed-onset PTSD’.
Complex PTSD. This encompasses chronic and prolonged trauma or abuse. For example, if a person suffered from years of domestic violence, they might be said to have ‘complex PTSD’.
As with all mental-health problems, sufferers can live with the symptoms for years before diagnosis. Nicola was diagnosed with PTSD as an adult, having been sexually abused by her father as a young teenager. She only sank into a depression after leaving her job in the RAF and returning to civilian life. Even though she was offered counselling, Nicola found it hard to talk about what had happened to her, partly because a therapist wouldn’t ‘know what it is like to experience it’.
A fear of stigma is common in people who suffer with PTSD. For those who’ve been sexually abused like Nicola, victim-blaming attitudes and a fear of not being believed can prevent people from seeking help as early as possible. This is compounded by feelings of shame and guilt that many with PTSD experience.
I’ve been lucky not to experience this awful disorder in any real sense, though I am familiar with hyper-vigilance. After being stalked a few years ago, I was advised by the counselling service provided by Victim Support that I might experience some symptoms of PTSD. I didn’t think I was likely to, given that my troubles weren’t as serious as I thought those suffering from the disorder face, but I certainly did feel hyper-vigilant – looking for and sensing danger everywhere. I repeatedly checked under the bed, locked and unlocked doors, tested my alarm and felt on edge – prone to fright at every noise and movement. I was also just feeling highly anxious, with all my usual symptoms dialled up to eleven. As with all anxiety illnesses, it can therefore be hard to decipher which one you are experiencing. If PTSD seems like it might be something you’re suffering from, there are many resources available to you – starting with your own GP; but also including the mental health charity Mind, Combat Stress (for veterans’ mental health), the Royal College of Psychiatrists, and PTSD UK. Links are to be found at the back of the book.
Generalised anxiety disorder (GAD)
Hello old friend! Generalised anxiety disorder is sort of exactly what it sounds like – a free-floating but excessive level of worry which can’t be shrugged off. Nearly six people out of 100 are thought to suffer from generalised anxiety disorder in this country,[33] and DSM-5 (the fifth edition of the most popular diagnostic system for mental disorders in the US) says the period of time a person suffers for before diagnosis is important – it puts it at at least six months, to highlight the difference between those with worries based on something specific in life, and those for whom worries will not pass no matter what happens. This kind of anxiety means you worry even when there’s nothing actually wrong, or in a way that’s disproportionate to any actual risk. When you get on top of one worry, another will pop up – and your mind always races to the worst possible scenario in each case.
These worries will nearly always have a physical effect too. You may ‘feel’ a sense of doom, have headaches, suffer from insomnia or feel tired or rundown all the time. Other fun results of GAD that I’ve experienced include a terrible short-term memory; difficulty concentrating on anything; and a massive sense of irritation, directed at myself and others. There are countless other symptoms, which I still sometimes look up on dubious medical sites as a special treat (I’m kidding: I do it to tick off any weird pains I have). The disorder affects women more than men, and it’s a contributing factor in some cases of depression too, hastening the need for treatment.
Much is written about stress in the modern world. The Office for National Statistics says an estimated 137.3 million working days were lost due to sickness or injury in the UK in 2016, and that a third of those days were lost to mental-health issues.[34] We’re constantly told that our lives are full of worry – about money, work, family and relationships. These very real issues can make the most relaxed person feel anxious. GAD means you might worry frantically about these issues – as well as a whole host of other ones which seem to tack on to the initial one. I can easily spend hours worrying about money, which seems like a rational focus, but my mind will immediately take me to a place where I’m stranded, bankrupt and chased by debtors. On top of that, I’ll suddenly feel besieged by anxiety about illness, about whether I might have offended someone at work, about whether I remembered to blow out a forgotten candle, or maybe I’ll start thinking I’m getting a serious illness. One worry ushers in another, and another, until your mind is swarming with them and you feel almost despairing. It’s a tangled web that happens in warp speed – you don’t know where to begin trying to tackle the mess.
David suffers with GAD, having lived with anxiety for as long as he can remember. ‘When it’s at its worst, it manifests itself in both physical and emotional ways. Physically, I always feel tense, have sweaty palms, am quite restless and unable to concentrate for long periods. If something is on my mind I get full-blown stomach aches, palpitations, sweating. Mentally and emotionally it manifests itself in constant worrying, racing thoughts – the inability to rationalise things or live with uncertainty. For instance, if I am unsure of how a meeting at work might go, I will obsess about it all day, and be unable to focus on anything else until it is resolved. I have phobias of certain things – flying, food poisoning/general health problems. It’s exhausting all round, really.’
Exhausting, because your whole body is trying to expend excess adrenaline. The adrenaline that comes with GAD is extraordinary. My default position is lying down in bed, snoozing away. But at my most anxious, I have the energy of a young gazelle. I could do star jumps for hours if I wasn’t so busy feeling like shit and biting off the skin around my nails while I tap my feet and fail to concentrate on anything for more than thirty seconds. It comes in like a violent wave to the shore, knocking over anything in its wake, and shocking you with its force. You wake up to it rushing into your belly, pushing up into your throat, telling you that danger is near. Adrenaline – great in a real crisis, terrible when there’s nothing to worry about. It feels way too real to be ignored, so you don’t.
