Why It's Important to Treat PTSD at Any Age
Many people live through decades of suffering without treatment for trauma
To cope with panic attacks, depression and sleep problems, Ginger Mercer kept busy — very busy. “I’d go-go-go all the time and never stop … it wore me down through the years,” she says.
As Bill Talbott watched the movie Saving Private Ryan, he found himself reliving his time in the Vietnam War, though he hadn’t been in combat. He knew his self-control problems, which had led to job loss, bankruptcy and suicidal thoughts, were related.
Nina Whittam had been sexually abused by a boss in her 20s, but didn’t link it to her decades of terrible nightmares until a nurse asked a routine question about her health history.
Like these three people, many others live with symptoms of post-traumatic stress disorder (PTSD) for years before seeking help in later adulthood — a decision that these three found so useful they shared their stories with About Face, a support resource of the National Center for PTSD.
With past names like “shell shock” (World War I), “battle fatigue” (World War II), and “post-Vietnam syndrome,” PTSD has long been linked with the military. Yet, most cases have non-combat origins.
“It doesn’t happen to everybody, but it can happen to anybody,” says Paula Schnurr, executive director of the National Center for PTSD.
PTSD is a constellation of symptoms that arises when the mind’s and body’s natural recovery process from stress is interrupted. It can follow any shocking, scary or dangerous event. In the U.S., close to half of cases are caused by physical or sexual assault. As many as 30% to 40% of natural disaster survivors suffer from PTSD. So do many intensive care unit patients, cancer survivors, car crash survivors and witnesses to traumatic events.
Decades of Suffering
Many victims suffer without realizing their problem has a name and a cure. They may rely on crutches like alcohol, drugs or workaholism. Or they dismiss symptoms until a marital or health crisis happens and their condition becomes impossible to ignore. Retirement and aging can upset longtime coping mechanisms, causing flare-ups.
“An average of four and a half years pass between first symptoms and treatment, but it can be 40 years,” Schnurr says.
In older adults, PTSD is often underrecognized and undertreated, says Joan M. Cook, who studies trauma and geriatric mental health at the Yale School of Medicine.
The first step in identifying PTSD, she says, is appreciating why it’s often a hidden problem in older adults:
- Many victims don’t think of their experiences as trauma. “It’s partly the culture and society many older adults grew up in,” Cook says. One woman told Cook she’d never been raped, “but my husband used to force himself on me against my will.” Among older women who sought help at a mental health center in one study, not one reported a history of trauma — until during therapy, 85% described childhood abuse, marital domestic violence or both.
- Sufferers feel too ashamed or guilty to tell anyone. It’s common for long-married couples to have never told their spouses about childhood abuse or rape. Some people consider their stress response a personal failing.
- Symptoms get written off as something else. Cook sees older adults with PTSD label their emotional distress as “headaches” or “stomachaches.” Families often say a chronically cranky, angry or withdrawn loved one is “just being difficult.” PTSD can also look like depression or anxiety.
- Screening is uncommon in older adults, especially civilians. Health care providers seldom use their limited office time to assess for PTSD, a problem some don’t even recognize exists in older patients, Cook says. Because PTSD wasn’t recognized as a diagnosable condition until 1980, some sufferers were never diagnosed.
How PTSD Is Treated
Trauma-focused psychotherapy, or talk therapy, is the most highly recommended treatment for people with PTSD. There are many types of psychotherapy used for PTSD, including “prolonged exposure therapy,” which basically helps people face their memories of the trauma and learn to effectively block reminders from triggering fear and anxiety. Another type is “cognitive processing therapy,” in which people learn to reconsider and reframe negative thoughts about their trauma.
Some people also respond to anti-depressants in addition to counseling, and social support from family, friends and professionals figures hugely in treatment, Schnurr says.
If you suspect PTSD in a loved one, or yourself, watch for these four types of signs/symptoms:
- Reliving the event. Memories play out as nightmares, flashbacks or being distracted. Constantly staying busy or substance abuse may be attempts to blot out such thoughts.
- Avoiding certain activities. Someone who was in a car accident may avoid driving. Others avoid open spaces or woods or pick night jobs that avoid people.
- Having excessive negative thoughts and feelings (sadness, fear, anger, apathy). These include feeling bad about yourself (“I’m no good.” “I’m crazy. “I’m lazy.”), feeling bad about other people (“They can’t be trusted.”), or feeling bad about the world (“It’s a scary, dangerous place and I can’t protect myself.”).
- Feeling on edge. This can show up as trouble sleeping, being easily startled, irritability or overprotection (always “on guard” for something bad to happen).
Any time these behaviors interfere with everyday life to any degree, “it’s not too early to reach out,” Schnurr says.
Triggers for PTSD Symptoms
Experts caution people to watch for an uptick in PTSD signs or symptoms, especially following retirement or loss. Retirement can mean less structure, therefore more time to ruminate.
Changes in physical abilities also can cause PTSD flare-ups, Cook says. For example, she treated a wood worker who spent hours in his garage, “like a bunker,” she says. Then, he developed arthritis and had to give up his pastime. “There goes the coping strategy, while a flood of memories comes in,” Cook says.
“PTSD can wax and wane,” Schnurr says, adding that many things can be triggers: The death of a spouse or dear friend can reawaken old distress. News headlines about events similar to what a person with PTSD experienced, as well as anniversaries of traumatic events, can also bring up old feelings.
Depression, anxiety and substance abuse are common in people with PTSD. Even if you aren’t sure whether it’s PTSD or another issue, seeking help can untangle it and lead to the right treatment, experts say.
Helping Someone Talk About It
If you know someone who you think might have untreated PTSD, you can try helping by gently bringing up the topic. Phrases like, “I just read this article...” or “I was wondering...” can act as door-openers to helping someone consider their symptoms through the lens of PTSD, especially if they’re prone to insisting, “I’m fine.”
“Families are often reluctant to broach the subject, but we often hear people express relief and gratitude when they do, because it normalizes what they’re experiencing,” Schnurr says. The National Center for PTSD offers resources for families.
As you talk, avoid saying things like, “Oh, that happened so long ago.” or “Why aren’t you over that by now?” Avoid judgements, too (“I don’t think you should worry about that any more.”), says University of Oregon psychologist Jennifer Freyd, who offers “good listener” tips.
Self-Screening Tool for PTSD
The National Center for PTSD offers a Self-Screen for PTSD on its website. Even if the traumatic event happened many years ago, you could still be suffering from PTSD. Also, reach out to your doctor, a mental health provider (like a therapist) or, if you’re a war veteran, the local Veterans Administration. If you’ve tried PTSD treatment before, try again, because treatments are much better today, Schnurr says.
“It’s really important to know: It’s never too late to put those pieces together and heal from trauma,” Cook says.