It has been a little over one year since COVID 19 made its world debut. In that time we have all seen reports of horrendous deaths from the disease, the toll it has taken on our healthcare professionals and the tremendous changes it has brought to every society in the world:

• constant mask wearing
• hypervigilance around health and contagion
• decreased movement around our communities and world
• elimination of cultural group activities from rock concerts to political events to pubs
• the constant background fear of death or long term disability

In addition to these profoundly stressful changes in our lives, we have seen brutal killings on live TV by people who are supposed to protect us, as well as by mass murderers; social and political uprisings, the polarization of politics and the death of cooperation between political parties. These changes have left people all over the world uncertain about their future, about their safety, and about their financial survival. 

Many people understand that they are chronically traumatized. And many deny that these events affect them, even while acting out their fears and angers on their loved ones and those around them (itself a trauma symptom).

In the current Diagnostics and Statistical Manual on PTSD we have a list of criteria that apply to our collective experience of COVID and mass unrest. I have paraphrased some of these criteria; the ones that are verbatim from the DSM are in quotes.

1. “Exposure to actual or threatened death” by one of these four means: “directly experience the traumatic event(s)”, “witnessing in person, the traumatic event(s) as it occurred to to others, “learning that the traumatic event(s) occurred to a close family member or friend, and/or experiencing repeated or “extreme exposure to aversive details about the event(s)” as part of one’s work. 

Check. We would have to be very isolated indeed to not have experienced at least one of these criteria. As for the fourth criteria, that is officially listed as being “part of one’s work”, I disagree as a trauma therapist. Exposure is exposure. Just because the DSM says your exposure doesn’t count because you were not ‘on the job’ doesn’t mean that you were not traumatized. There is research showing that repeated viewings of traumas on TV or other media create a trauma response in viewers. I believe this criteria may be changed in future versions of the DSM.

2. Presence of one or more of these disturbing intrusive symptoms: uncontrollable recurrent memories and perseverations around the event(s); nightmares related to either the content of the event or the emotions around the event (loss, sickness, contagion, fear of the future etc.); flashbacks, or other dissociative reactions around the event(s), which for children can include repetitive play of the trauma or event; “intense or prolonged psychological distress at exposure to internal [your own memories] or external [in the environment] that symbolize or resemble an aspect of the traumatic event.

Translation: You cannot stop thinking about COVID, COVID related losses (school, travel, etc.) or other traumatic events related to COVID or social unrest. You cannot stop the feels that keep coming, and you feel depleted because of this. It is hard to focus on daily routines and feel ‘normal’ again. You may take extraordinary precautions that are not strictly necessary or none at all as a rebellion to these feelings.  You may have insomnia as the mind unconsciously avoids dream content related to COVID or social unrest and pops us out of sleep as we approach REM phase, where memories are processed.

3. Avoiding anything that reminds you of the traumatic event(s) in one or two of these ways: “Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about  or closely associated with the traumatic event(s) and/or “ [making] efforts to avoid external reminders (people, places, conversations,  activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)”. 

In other words, you don’t want to think about it and you don’t want to talk about it anymore. Even reading this blog may be a trigger. (Did you make it this far?) You may avoid shows about: illness, contagion, disasters etc. that you previously enjoyed. Or you may avoid discussing COVID with friends and family, or avoid talking about your feelings about it. Denial is another way our minds practice PTSD-related  avoidance. We may minimize COVID or say we are not at risk, or refuse to take precautionary measures. All of these are trauma responses, in other words,  our mind unconsciously and automatically protects us through avoidance.

Some of these behaviors make other people very angry and are themselves a stimulation of the trauma. You may be very reactive to people who minimize the risk of COVID to themselves and others. Both of these reactions are traumatic in nature. We do not, necessarily, choose our defense (which is a whole other blog topic). Some people intellectualize and want to learn everything about the event; others want to know nothing or deny reality. Both groups are avoiding their feelings, although intellectualization is preferable to denial. Avoiding feelings, in general, is a traumatic response, as well as a cultural one (some cultures value feelings more than others). 

4.  Negative alterations in cognitions and mood associated with the traumatic event(s), as evidenced by two (or  more) of the following: 

• Loss of memory around the event(s) [one of the more extreme reactions]
• “Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world”
• “Persistent, distorted cognitions about the cause or consequences of the traumatic  event(s) that lead the individual to blame himself/herself or others.”
• “Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).”  
• “ Markedly diminished interest or participation in significant activities.”  
• “Feelings of detachment or estrangement from others.”  
• “ Persistent inability to experience positive emotions (e.g., inability to experience  happiness, satisfaction, or loving feelings).” 

What strikes me about this section is how real it is socially, except for the loss of memory bit. 

(Also how much the word “persistent” is used.)

 “Persistent exaggerated negative beliefs or expectations about oneself, others or the world” Check.

“…lead the individual to blame himself/herself or others”

Check.

“Persistant negative emotional state”

Check. It’s like a nightmare we cannot get out of, which then becomes a trigger for all of our other unresolved traumas from this (and other, if you believe in that) lifetimes.

“Markedly diminished interest or participation in significant activities”. 

Check. But in a weird way. COVID prevents us from participation and maintaining interest. Double check.

“Persistent inability to experience positive emotions”. 

Check and Checkmate. We all feel depressed. We are all grieving. It is hard enough to maintain hope in the persistence of COVID, never mind the persistence of our collective trauma around COVID. Ugh.

5. Unpleasant behavioral changes as a result of the event that include two or more of the following: Insomnia or other sleep disturbance, inappropriate emotional outbursts that are out of character, hypervigilance, exaggerated startle response, and/or difficulty focusing and/or concentrating. 

Well, yes. Most of these for most folks. One only has to venture online to see the reactivity happening. Nearly everyone I know either as a friend or patient has struggled with sleep this year. You can check in with yourself as to whether you are still washing your hands 10 times/day or wearing your mask when you really do not need to (hypervigilance), or if you jump when someone comes up behind you unexpectedly. 

Many people came into this period of time with PTSD, either diagnosed or not. They have been suffering tremendously because their systems were already sensitive to traumatic stress. The rest of humanity may now suffer some level of PTSD. I say “level” because although PTSD is by definition a very unpleasant condition, it can have levels of severity beyond baseline. If you are having dissociative symptoms such as depersonalization (“feeling as though one were in a dream; feeling a sense of unreality of self or body  or of time moving slowly”)  or derealization (the world around you feels “unreal, dreamlike, distant,  or distorted”) you may have a more severe situation that needs attention. Technically it is called PTSD with dissociative symptoms. 

Oh yes. And these symptoms need to have gone on for more than one month. 

Check.

Please, dear reader, remember: I would not write this blog if I did not feel you or your loved ones could be helped. There are many resources available to help you heal from PTSD. My book, The Trauma Tool Kit: Healing PTSD From the Inside Out is available in libraries all over the world, and has a rating of 4.6/5 stars on Amazon where it is available on Kindle and Audible (in my own voice).

Be well and stay safe, Susan PB

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 E-Kindle Book 5th Edition (p. 308). Indephent. Kindle Edition.