Post Traumatic Stress Disorder (PTSD) is a condition that causes anxiety attacks, and occurs when someone experiences extreme duress, such as physical harm, life threatening situations. At a later time, when the immediate danger has passed, the stress comes out in anxiety attacks when it's triggered. PTSD is very common among people who've been in a warzone, disaster or accident. It's also one of the more common conditions of people who've experienced childhood sexual abuse.

The sufferer of PTSD has frightening thoughts and memories of what they went through, but feel emotionally numb. They may experience sleep problems, frequent nightmares, emotional numbness and flashbacks. This often causes a lot of problems in their daily life. The numbness can create relationship difficulties, the flashbacks and anxiety can be so great that the victim decides to avoid triggers (things that remind them of the situation) altogether, causing them to withdraw.

When you've been to a war, quite often, the situation you were in is vastly different from your present day. This makes the incidence of triggery situations a little less likely than with childhood sexual abuse. After all: the perpetrator may be family or a trusted adult. He/she may still be around you. But triggers also include things like: your child reaching the age your abuse started, seeing a father and child walk hand in hand, the smell of sex, or someone being taller than you. These things are readily available in most peoples lives and getting triggered by such every day things can be very disruptive to having a 'normal' lifestyle.

There are roughly two ways in which people react when they have PTSD: Avoidance and Hyperalertness. Avoiding triggers means you withdraw into your own (scary) world, whereas being hyperalert makes you overly aware of your surroundings, usually with a smathering of paranoid distrust in the mix.

Signals of avoidance

• Staying away from places, events, or objects that are reminders of the experience
• Feeling and acting emotionally numb
• Strong feelings of guilt or worry, laying awake at night
• Stopping activities that you enjoyed in the past
• Having trouble remembering the event that caused the trauma
• Drinking or using drugs to forget the traumatizing events

All of these signals or symptoms are very detrimental to a persons mental and emotional health. When you stop doing the things you love because you have fear and anxiety about them, your world shrinks. Feelings of guilt and worthlessness, combined with a lack of emotional involvement with the world around you can be the cause a full fledged depression.

Signals of hyperalertness

• being easily startled, being jumpy
• feeling a lot of tension
• having difficulty sleeping, difficulty trusting the sleeping process (also due to nightmares)
• sometimes getting angry suddenly and seemingly unprovoked

Being hyperalert is usually a constant sense of tension, not triggered by some event, but more a state of being. The hyperalert person is feeling constantly stressed and angry. This makes it difficult to do your normal every day stuff. You're having trouble concentrating, you're on edge all the time, constantly on the lookout for danger. This too can lead to substance abuse, most likely presciption drugs to quell the panic attacks and keep life tolerable.

Isn't some stress natural?
When someone goes through an accident or has a rough time, some stress is normal and appropriate. Sometimes people who've been through an ordeal experience these symptoms right away and for several weeks. This is called Acute Stress Disorder, although some would argue that, since it's normal to have some stress after going through an ordeal, calling it a disorder is overdone.
When the symptoms last for over 6 weeks and are severe disruptions of daily living, it's called PTSD. Some people start having symptoms right after the stressful experience, some people don't have any symptoms for years and only start displaying the PTSD symptoms after years of seemingly normal behavior.

There are many reasons why some people are more affected by traumatic experiences than others. The age is an important factor: the younger the child who suffers from sexual abuse, the greater the chance at PTSD. Another factor is the social situation: a child who have a healthy and supportive home environment and is confronted with childhood sexual abuse is more likely to be able to cope at a later age than the child who is confronted with the abuse in the childhood home.
Alcohol, drugs and psychiatric illness in one or both parents seem to also have a contributing effect on the incidence of PTSD among the children growing up in such a situation.

It's important to remember though, that while all these factors add up, the PTSD wouldn't occur, if there was no trauma. Childhood sexual abuse is a traumatic event, which causes PTSD in quite a few children. Sometimes the symptoms start occuring at a very early age. Some reports even speak of suicidal toddlers: children who repeatedly and appearantly on purpose put themselves in harms way. Teenagers who's stress builds so high that they take a knife to themselves to relieve it. Youngsters becoming so disconnected from their bodies that they think nothing of selling it for a few grams of their favorite poison. Runaways and drop outs, but also the children who don't run away: the ones that stay in abusive homes and families.

Sometimes the child doesn't show many, or even any of these signals. About half of the children who suffer from childhood sexual abuse grow up to be fairly happy and well adjusted adults (or at least are able to fake it) The other half is not so lucky.
50% of the survivors experience serious difficulty in their life as a direct result of the childhood sexual abuse. This includes PTSD, but also severe depression, relationship difficulties, suicidal ideation and dissociative identity problems. With PTSD the trauma often goes underground for many years, only to resurface when some trigger awakens the memories. Suddenly the adult becomes the traumatized child. Re-experiencing the incidents of their childhood and feeling the full impact of the pain they suffered. A pain for which they had no words as a child, and sometimes don't even have words for to this day. A pain so deep and pervasive that it's a small miracle that the child lived through it in the first place. A pain so great that reliving it is a bridge too far for some survivors. They sometimes opt for actual suicide, living a half-life of not being present in their bodies (dissociate), which to me is tantamount to soul-suicide.

There are many ways of working with PTSD in a therapeutic setting. I've outlined some types of therapy for childhood sexual abuse in day 14, 15, 16 and 17. In addition to those writing therapy and talk therapy are known to be effective with PTSD, at least where veterans of war are concerned. Healing from childhood sexual abuse is particularly difficult though, because there's usually nothing to go back to. The personality of the child is not fully developed when the abuse happens and as a result of the abuse the growth is stunted or twisted. The adult who is triggered into re-experiencing the abuse and wants to heal the past, it's as if the past is happening all over again. Usually it's best to undertake the descent into the hell of one's childhood with the help of an experienced counsellor or therapist.