Writing PTSD

I'm writing something that takes place during a war, and as consequence, there are some characters who have developed PTSD to varying degrees. I've researched the topic, and know some basic symptoms and effects (Nightmares, being affected by triggers, etc.) and I was wondering if anyone on here has had any experience with this at all. (I don't mean just military-caused PTSD) I'd very much prefer to be able to write this realistically.

In terms of military-related stuff, I'll give some of what I've picked up from talking to people and reading on the subject.

Increasing sloppiness is one of the first signs someone is coming apart, particularly when they're sloppy in ways that would materially affect their likelihood of survival; inattention to maintaining their weapon, poor fieldcraft, bad teamwork. It's often combined with heightened aggression, but not always.

Adrenaline from actual contact with the enemy can temporarily mask PTSD symptoms, even advanced ones like shaking or a breakdown. This can lead to sufferers feeling that "everything will be all right" if they can just get into the action again. (It won't be, and neither will they; even with the symptoms masked they'll still perform noticeably badly in comparison to someone without.)

Are your characters still in active combat situations or not?

I've spent five years working as a phone counselor on rape crisis hotlines, and thus have extensive experience with PTSD. Ask me anything.

Most of these characters are out of combat. Some of these characters haven't been in combat. Some have just witnessed some really messed up stuff. (Watching their families and friends getting killed, have been tortured, etc.) One has survived a rape attempt. It's not exclusively military PTSD.

edited 7th Aug '12 11:14:44 AM by TheMuse

Actually I'd like some description as well for PTSD victims. Do they have nightmares? Do they overreact to noises and sounds? Do they have paranoia problems (need to look over shoulder)? Do they heavily prefer to be in the company of someone or animal companions or is that more individual?

So what particularly do have questions about?

PTSD has a huuuuge range of symptoms and severity. It can be triggered by anything reminiscent of the event, from a scene in a movie to a particular smell. The person may or may not be aware of why that makes them feel so uncomfortable. Symptoms could be almost anything.

A better idea of what you're trying to do with it might help. It's a really broad subject and I could go on all day about it.

One character witness his parents getting murdered and as a result, has problems getting emoitionally close to people. Another fought in combat, got tortured and scarred, and is now not in combat. (A pretty long time has passed and he's somewhat all right now, I just don't want to comepletely ignore how it affected him mentally) There are others, I just can't think of them off the top of my head.

"Actually I'd like some description as well for PTSD victims. Do they have nightmares?"

Many do, but not all.

"Do they overreact to noises and sounds?"

Many do, but not all.

"Do they have paranoia problems (need to look over shoulder)?"

Many do, but not all.

"Do they heavily prefer to be in the company of someone or animal companions or is that more individual?"

Every single person has a different response to PTSD. Many but not all is a pretty safe answer to any PTSD symptom. Some would prefer to never be alone, but I have worked at least as often with people who isolate themselves instead.

Even the "common sense" ones like paranoia are just as likely to go in the other direction - it might also manifest as a reckless disregard for your own safety, engaging in extremely dangerous activities or putting themselves in situations where danger is likely - though they usually won't actively seek out the same thing that caused the initial trauma.

I think the jumping at shadows and loud noises paranoid type is a cliche that isn't necessarily the most accurate - it does happen, but more data on PTSD has shown that survivors are just as likely to exhibit - well any behavior. Basically the strongest symptom is a change in behavior, but it could manifest in almost any way. Likewise triggers are very individual.

PTSD is one of the most personal of disorders - no two people are the same and no two traumatic events are the same. Since this is an almost entirely psychological disorder (no genetics or chemical issues really come into play) brought on by a unique person's response to a unique event, it's not surprising that responses are so varied.

edited 7th Aug '12 11:42:18 AM by Cthulboohoo

"One character witness his parents getting murdered and as a result, has problems getting emoitionally close to people."

This is entirely reasonable. I'm sure s/he would have other effects as well, but this is a very common effect. Emotional distance in general is one I've seen a lot of.

"Another fought in combat, got tortured and scarred, and is now not in combat. (A pretty long time has passed and he's somewhat all right now, I just don't want to comepletely ignore how it affected him mentally)"

Even with extensive treatment, PTSD symptoms can last an incredibly long time; usually they never vanish completely. Chances are he will still feel the effects of it, though he might not always be aware of why he's feeling such things.

Some googling revealed a list of commonalities in PTSD survivors. It's quite short, and I agree with it:

Re-experiencing the traumatic event

Avoiding reminders of the trauma

Increased anxiety and emotional arousal

You'll always have those. Just remember that it could manifest as almost anything.

Side tracking a bit.

As much as PTSD is a pain, it can also have a few benefits.

Some may experience a heightened sense of awareness and greater strength, general disregard for pain and manic resistance to fatuige.

There may even be inexplicable attacks of euphoria, a sense of well being and inability to be troubled by normal concerns like the possibility/fear of dead, and agonizing pain.

As stated above, PTSD is highly individualistic so the pros may differ as much as the cons.

In most portrayals of Post-Traumatic Stress Disorder, some stimulus (a sound, something you see, maybe even a smell) acts as a trigger, and the person momentarily believes he's back in the traumatic situation. IE hearing gunfire in a video game making an ex-soldier think he's back on the battlefield.

What you describe, I believe, is called a flashback. It can happen with a trigger or occur spontaneously with no obvious trigger. Reliving the trauma is one of the features typical of PTSD; be it flashbacks during the day or nightmares during sleep.

Specific to the gunfire example above, things such like a tires bursting, fireworks, thunder or any other sudden, loud noise can likewise trigger a flashback. More importantly, one thing that happens is that individuals suffering from PTSD, upon identifying these triggers, will deliberately go out of their way to avoid them - be it avoiding cars altogether, secluding themselves, becoming socially withdrawn, etc.

edited 7th Aug '12 9:34:26 PM by peasant

Although they won't always know what triggered the flashback.

Hence the caveat of them first identifying said triggers.

Sorry! Didn't see that!

So mostly I'm looking for the most common problems that arise due to PTSD, unless the variance between different problems is basically zilch.

Physically visible manifestations? (Such as hand shaking, zoning out)

Mentally visible manifestations? (Nightmares, hallucinations, paranoia)

And I see you've mentioned a lot about behavioural shifts is there some that are more common than others?

If you're looking for lists, I'd suggest looking up the DSM-IV and/or ICD-10 criteria. Personally, I'd lean more towards DSM-IV as it's designed specifically for mental health where as ICD-10 is the classification system used by the WHO for all diseases; though both are pretty good, especially for your purposes. Just depends which country you're from. If I'm not mistaken, the U.S. prefer DSM-IV.

The links are as follows:

1.DSM-IV criteria

2.ICD-10 criteria

edited 10th Aug '12 9:12:08 PM by peasant

Wow that's really useful, thanks.

I'll just leave this first person account here.

http://www.reddit.com/r/AskReddit/comments/nnsrf/redditors_who_have_killed_in_selfdefense_or/c3akqtw

edited 11th Aug '12 9:00:52 PM by sonofkong

There's a song from a film that was popular a few years ago (won't say which, as it'll just be damned embarrassing if you know which one) that I can't listen to. Or, at least, couldn't for a long time. I can just about hold it together now.

It's the strangest thing, as the song itself is a very cheerful pop song, completely unrelated to anything, but there's a line in the chorus that reminds me of words someone said to me in the middle of a deeply unpleasant situation.

Every time I heard it I froze up. I mean completely. I would sometimes involuntarily stop breathing. If I wasn't in company I'd allow myself to cry. Even today I feel like throwing up if I hear that song.

There's also the whole 'ducking when you hear a firework' thing. I sometimes freeze if I hear one going up, but that's just a conditioned response, as some fireworks sound just like short-duration illumination flares and staying still is the best way to avoid being seen when one of those goes up.

There was an advert on TV last year that used the sounds of various weapons and equipment used by the British armed forces to symbolise a 'war against allergies'. I thought it was pretty cool, actually, but it turns out that the sound of a GPMG firing makes me a bit twitchy.

I don't know if that's any help or not. Hell, it's not even proper PTSD, but it is a bit flashbacky.

If you want to know what it looks like there was a sergeant attached to us from the REME who was involved in an incident where one of the trucks in a convoy ended up on fire and the driver was trapped inside.

They tried and tried to get him out, but his legs had sort of 'become one' with the mangled truck. In the end this sergeant had to inject the guy with half a dozen ampoules of morphine and leave him to burn.

I remember his eyes when he told me about that. He was normally such a vital person, you know? Very much in the here and now (or, like a few folk have said of me: 'just so...real...) and fairly easy going, but when he talked about that his face went slack and his eyes looked...sad, of course, but...almost as if he wasn't behind them anymore.

edited 12th Aug '12 12:52:57 AM by InverurieJones

[expunged]

edited 1st Feb '15 11:28:18 AM by TigerwiseVillain

On the much milder end of things than some of what's been posted here, my girlfriend has a case of PTSD from a car crash she was in a few years back. Now any time somebody honks a horn at her, or clatters a glass (let alone actually breaks one) she ends up having a panic attack and flashbacks the severity of which vary. She's also been set off by thunderstorms, slamming doors, and almost any other loud, sudden sound which her brain can confuse for cars hitting each other.

I'll also recommend Season 2, Episode 10 "Noel" of The West Wing to you. In it, Josh, one of the President's staffers, gradually suffers a nervous breakdown as his PTSD from an earlier shooting eats away at him.

edited 1st Feb '15 11:35:48 AM by AmbarSonofDeshar

Quick question: how realistic would it be to have a character who has experienced trauma but is otherwise fairly optimistic in outlook? I'm not saying that the character is "happy" but at least compelled to try new things and appreciate things in spite of it? I'm having some difficulty because the trauma really did hurt my character, but by the time the story begins a few years has passed since then and she's been at least holding on and keeping herself busy. She reacts to triggers and has flashbacks but it's at a manageable level, and I need to figure out how much time to give her.

That would depend on the character's circumstances and how strong the trauma inducing event was.

If s/he is from an environment where mental help is more accessible or have supportive people around, it wouldn't take too long to get back into everyday life, albeit with trigger reactions here and there.

Even with prolonged trauma? I should have clarified in that she had suffered parental abuse for a very long time. She's gone from them now but I'm still trying to figure out how to show that she's put it behind her. She does have some social support (although it's not so much a support group as it is a few scattered people she can talk to) but even then she's not really spending a lot of time opening up about her past.