Nuclear Symptomatology of PTSD

The Reexperiencing Phenomenon (Intrusion)

One of the cornerstones of PTSD is the inability to leave the trauma in the past. The patient suffers recurrent and involuntary flashbacks; it is not that he or she chooses to think about the event, but rather that the event "assaults" his or her mind.

This manifests itself in distressing nightmares or flashbacks, where the person may act and feel as if the event were happening again in the present, losing momentary contact with reality.

In addition, there is intense psychological discomfort and physiological reactivity (tachycardia, sweating) to any internal or external stimulus (a noise, a smell, a date) that symbolizes or resembles the original trauma.

Avoidance and Blunting Strategies

To protect him/herself from the pain of reexperiencing, the individual develops persistent avoidance behaviors.

This includes avoidance of thoughts or feelings associated with the trauma (internal avoidance) and avoidance of external places, people or objects that arouse memories (external avoidance).

In parallel, "affective blunting" or restriction of emotional life occurs.

The person may feel disconnected from others, unable to experience positive emotions such as love or joy, and lose interest in activities previously enjoyed.

It is a defense mechanism that seeks to "shut down" the system so as not to feel pain, but ends up shutting down vitality as well.

Hyperarousal and Negative Cognitive Disturbances

The nervous system remains in a state of constant alertness, known as hypervigilance.

The patient scans the environment for dangers, is exaggeratedly startled by unexpected noises, suffers irritability or fits of anger, and has difficulty sleeping or concentrating.

At the cognitive level, persistent and exaggerated negative beliefs about oneself ("I am broken", "I am guilty") and about the world ("no one can be trusted") are consolidated.

These distortions, coupled with inappropriate guilt for what happened, maintain the disorder by preventing a realistic and compassionate view of the lived experience.

Summary

Re-experiencing is the inability to leave the trauma behind. The patient suffers intrusive memories, nightmares and flashbacks, reacting physically and emotionally as if the event were happening again in the present.

To protect himself, the individual develops a persistent avoidance of associated stimuli. This is accompanied by affective blunting, disconnecting from emotions and losing vital interest in order not to feel the pain of the memory.

The nervous system remains in constant hypervigilance, scanning for dangers. Cognitively, exaggerated negative beliefs about oneself and the world are consolidated, together with an inappropriate guilt that prevents a realistic view of the experience.