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When trauma begets new trauma

A group of children walk down a hallway in school. After the latest threat to Columbine High School, Victor Fornari, MD, discusses ways to relieve post-traumatic stress disorder

Recent traumatic events like the shooting threats to Columbine High School shed light on a silent killer — post-traumatic stress disorder

The recent suicides of two Parkland students and a Sandy Hook parent in addition to a new threat to Columbine High School open a window into the dark room that can be post-traumatic stress disorder (PTSD). Similar to the way mass shootings and other tragedies horrify and seem beyond our comprehension, the effects and symptoms of PTSD can also often shock us and feel beyond our understanding. It’s all the more reason for us to try and shed light on illness that often times remains hidden from those who are in the best position to help identify it.

People may say an individual “suffers from PTSD.” But is there a true understanding of what that means? Has the label become almost too convenient leaving us content with a surface knowledge of a complicated illness that prevents a deeper understanding that might mitigate further tragedy?

The truth is, when it comes to PTSD, there is much more that we don’t know than we do; more that we can’t see than we can. It is why unspeakable and desperate acts like the recent suicides, spurred by prior trauma, shake and frighten us. Our instinct may be to bury traumatic events, to leave them tucked away in the dark fearing that any discussion will re-open a wound. Yet the reluctance to speak of such things can have devastating consequences.

Every one of us experiences varying degrees of trauma during a lifetime. Most people are resilient in the face of such events. Even in the most horrific situations — combat, the September 11th attacks, mass shootings — the vast majority of people adapt and recover. But some are more vulnerable. Some have mitigating factors that put them at increased risk. No two people respond the same way even to a shared event.

It’s why we need to ask the simple, but conversation-starting question of those who’ve experienced a traumatic event: how are you doing?

Family members, friends, teachers and primary care providers are in a unique position to know if an individual has experienced a trauma and need to have the courage to ask simple questions about a person’s well-being even if that person does not outwardly appear to be acting any differently than normal. It’s also important to remember that people who have a history of depression, anxiety or prior substance abuse issues possess risk factors most commonly associated with PTSD, and should have periodic check-ups to assess how effectively they may or may not be coping.

Identifying PTSD symptoms

An individual with PTSD suffers from repetitive, debilitating thoughts reliving the trauma over and over again. The condition can often be coupled with depression, which can lead to self-medication and grow into substance abuse or other addictive and destructive behaviors. All of these conditions need to be treated. An initial response to a severe trauma that includes loss (death of a loved one or friend, for example) is often followed by shock and disbelief. The individual can feel numb or unreal for a period of time. However, if those initial symptoms dissipate, that does not mean PTSD has been mitigated. There is no incubation period, no timetable for it to appear.

For example, following the 9/11 attacks, there was a group of Holocaust survivors who had been going about their lives uneventfully, who after the attacks were afraid to take the Long Island Rail Road because they thought the trains would take them to their deaths. That shows us that even 60 years after an initial trauma those traumatic memories can be rekindled by a subsequent event. An anniversary or other reminder can trigger a reliving of the trauma causing intrusive thoughts, flashbacks and disturbing nightmares that appear with increasing frequency.

Relieving this anxiety

Many times, all a person needs to get on the road to recovery is an opportunity to share what they are experiencing. That can open the door for referrals to a proper psychiatric evaluation and cognitive behavioral therapy. Interventions such as cognitive processing therapy (CPT) or trauma focused-cognitive behavioral therapy (TF-CBT), the use of selective serotonin reuptake inhibitors (SSRIs), antidepressants used to treat depression and anxiety, and eye movement desensitization and reprocessing (EMDR), which has gained increasing international attention and has been found useful in treating military personnel, have all been effective in treating PTSD.

In the aftermath of these recent tragic events, the questions naturally come. Are we doing enough? What can we do differently? How do we prevent more senseless tragedy from occurring after tragic events? The first question we need to ask of each other is: how are you doing? It is the most important step in beginning treatment for an illness that has become an all too frequent companion of the often unspeakable tragedies in our modern world.

Victor Fornari, MD, is the director of child and adolescent psychiatry at Zucker Hillside Hospital and Cohen Children’s Medical Center and professor of psychiatry and pediatrics at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.