What is post-traumatic stress disorder and what are its symptoms? Read about the effects of earthquake trauma, normal stress reactions and ways of recovery.
If you flinch when a door slams, if windows rattling as a heavy vehicle passes remind you of that night, or if the event you went through will not leave your mind months later, your mind and body may still be reacting as though you were in danger. Post-traumatic stress disorder (PTSD) is a long-lasting mental health problem that can develop after events that threaten a person's life or physical integrity, or in which they witness serious injury or death. In Turkey, the 6 February 2023 earthquakes meant that millions of people faced such an experience directly or indirectly. In this article I look at the usual reactions to trauma, the symptoms of PTSD, the particular features of earthquake trauma, and how the recovery process can unfold.
What Is Post-Traumatic Stress Disorder?
Trauma is an experience that exceeds a person's capacity to cope and creates intense fear, helplessness or horror. Examples of traumatic events include natural disasters such as earthquakes, floods and fires, traffic accidents, violence, assault, sexual abuse, war and migration experiences, or the sudden and unexpected death of someone close. Witnessing an event, or learning that someone close has been through it, can be as traumatic as experiencing it directly. People who are repeatedly exposed to traumatic details, such as search and rescue teams, healthcare workers and those working in a disaster zone, are also at risk.
After a traumatic event, many people experience intense stress reactions for a while. A large part of these reactions ease by themselves with time and support from those around them. Post-traumatic stress disorder is spoken of when symptoms last longer than a month, markedly affect the person's daily life, and continue rather than easing on their own. A diagnosis can only be made through a comprehensive assessment by a specialist.
Normal reactions to trauma
The emotional and physical reactions that follow a traumatic event are ordinary reactions to an extraordinary event. In the first weeks, the following are entirely understandable:
- Sleep problems and nightmares,
- Images of the event coming to mind involuntarily,
- Being constantly on guard and startling at the smallest noise,
- Bouts of crying, sadness and anger,
- Numbness, or perceiving the event as if it were not real,
- Difficulty concentrating and forgetfulness,
- Guilt at having survived.
These reactions are part of the mind's effort to make sense of what happened and to rebuild a sense of safety. What matters is to watch whether the intensity of these reactions lessens as time passes.
Reactions to an extraordinary event are often ordinary reactions; the mind is simply trying to make sense of what happened.
What Are the Symptoms of PTSD?
The symptoms of post-traumatic stress disorder are generally grouped under four main headings:
Re-experiencing
- Images, sounds or smells of the event coming to mind involuntarily and vividly,
- Recurring nightmares about the event,
- Moments when the person feels as though they are reliving the event,
- Intense physical reactions when encountering situations that remind them of the event: palpitations, sweating, trembling.
Avoidance
- Trying to stay away from thinking about, talking about or feeling anything related to the event,
- Avoiding places, people and activities that remind them of the event,
- For example, after an earthquake, avoiding entering enclosed or tall buildings, or avoiding going to certain cities.
Negative changes in thoughts and feelings
- Persistent negative beliefs such as "Nowhere is safe" or "I could have done something,"
- Constant fear, guilt, shame or anger,
- Loss of interest in activities previously enjoyed,
- A feeling of detachment and alienation from others,
- Difficulty experiencing positive emotions.
Hyperarousal
- Being constantly on guard and scanning for danger,
- Excessive startle at sudden noises,
- Difficulty falling asleep or staying asleep,
- Irritability, outbursts of anger,
- Problems concentrating.
In children, symptoms can look different. Changes such as replaying the event again and again in their play, difficulty separating from a parent, bedwetting again, or temper tantrums may be seen. Experiencing some of these symptoms does not by itself mean PTSD; but if they last a long time, a specialist assessment is important.
Earthquake Trauma and the Shared Experience in Turkey
The 6 February 2023 earthquakes left a deep mark not only in the directly affected regions but across the whole country. Many people lost their loved ones, homes, jobs and the life they were used to. Those who had to leave the region faced additional difficulties, such as adapting to a new city, longing for what they had left behind, and coping with uncertainty.
Earthquake trauma has some particular features:
- Triggers being everywhere: Small aftershocks, the passing of heavy vehicles, tall buildings or enclosed spaces can be constant reminders.
- A shaken sense of safety: The home is normally seen as a safe refuge. Because the earthquake shakes this basic trust, a person may not feel at ease even in their own home.
- Loss and grief intertwined: Experiencing close losses together with trauma can make the grieving process more complicated. I have dealt with this separately in the article on the grieving process.
- Indirect trauma: Even people who did not experience the earthquake directly, but watched images of the rubble for days, waited for news of relatives, or took part in relief work, experienced intense stress reactions.
- Anxiety about a possible new earthquake: Especially for those living in big cities, anxiety about an expected earthquake can keep the effects of trauma alive.
Suppose someone who moved to another city after the earthquake still keeps their shoes by the bed at night months later, runs outside at every small tremor, and does not want to talk to anyone about those days. These behaviours are a way the mind tries to protect them; but when they continue for a long time, they can narrow the person's life.
The anniversaries of the earthquake can also be hard for many people. As the calendar approaches that date, it is common for sleep problems to increase, anxiety to rise or sadness to become pronounced again. These "anniversary reactions" do not mean recovery is going backwards. Noticing these periods in advance, giving yourself more room to rest and being with people you trust can help you get through anniversaries with less strain.
Why Does PTSD Occur? Risk and Protective Factors
Not everyone who experiences the same event develops PTSD. Some factors increase the risk, while others play a protective role.
Factors that can increase risk:
- The severity, duration and repetition of the trauma,
- Being injured or losing someone close during the event,
- Previous traumas,
- Pre-existing anxiety or depression problems,
- Lack of social support after the event,
- Additional life stresses: housing problems, job loss, financial difficulties.
Protective factors:
- Strong social support and a sense of belonging,
- Safe relationships in which feelings can be expressed,
- Reaching a safe and orderly living environment after the event,
- Effective coping skills and being able to ask for help when needed.
How Can You Support Yourself After Trauma?
The suggestions below can support the recovery process, but they are no substitute for professional support.
Rebuild your sense of safety
Creating as regular a daily routine as possible, and sleeping and eating at the same times, gives the mind a sense of predictability and safety. Preparing for disasters, for example by putting together an earthquake bag and making a family plan, can also strengthen a sense of control.
Calm your body
Slow, deep breathing, lengthening the out-breath, muscle relaxation exercises and light physical activity help calm a body that is constantly on guard. Grounding exercises, such as feeling your feet on the floor and counting five objects around you at a triggering moment, can also bring you back to the "here and now."
Stay connected
Spending time with people you trust, and sharing what you have been through to the extent that you feel ready, is an important part of recovery. If you are not ready to talk, that is understandable too; even just being together can help.
Limit exposure to news and images
Constantly watching images and news about traumatic events can keep stress reactions alive. It is especially important to protect children from these images.
Look after your sleep
In the post-trauma period sleep is often disrupted, and lack of sleep can worsen other symptoms. Staying away from screens and the news before bed, keeping the room dark and calm, and going to bed and getting up at the same times help sleep settle again. When you wake from a nightmare, turning on the light, reminding yourself where you are and what the date is, and breathing slowly can help your body return to the present.
Make room again for meaningful activities
After trauma many people move away from the activities and people they love. Returning, even in small steps, to activities that give you meaning, such as taking up a hobby again, joining a voluntary project or helping a relative, can reduce feelings of helplessness and make you feel that life has begun to flow again.
Give yourself time and compassion
Recovery has no timetable. Instead of thinking "It should be over by now," try approaching yourself with patience. Trying to suppress feelings with alcohol or substances may seem relieving in the short term but makes recovery harder.
When Should You Seek Professional Support for PTSD?
If one or more of the following applies, it is important to see a mental health professional:
- If symptoms last longer than a month or are getting worse,
- If your work, school, family and social life are markedly affected,
- If nightmares and sleep problems are wearing you out,
- If avoiding everything that reminds you of the event is narrowing your life,
- If you have turned to alcohol or substances to cope with your feelings,
- If you notice long-lasting changes in your child's behaviour and emotions.
If you are having thoughts of harming yourself or ending your life, please do not try to carry this alone; in an emergency, call 112 (Turkey's emergency services) or go to the nearest emergency department. When sleep problems or accompanying depression are marked, whether medication support is needed is determined by a psychiatrist's assessment.
How Is PTSD Addressed in Therapy?
One of the research-supported approaches in the therapy of post-traumatic stress disorder is trauma-focused cognitive behavioural therapy. In this approach, the aim is not for the traumatic memory to be forgotten, but for it to be processed as a memory belonging to the past and for its effect on the person's daily life to lessen.
The therapy process generally includes the following stages:
- Trust and stability: First, a safe therapeutic relationship is established and coping skills are developed so that the person feels more balanced in daily life.
- Psychoeducation: The effects of trauma on mind and body are understood; the person realises that the reactions they are having make sense.
- Processing the traumatic memory: The traumatic memory is worked with in a controlled way, to the extent the person is ready. This process is carried out with a specialist, respecting the person's pace.
- Reappraising thoughts: Beliefs that develop after trauma, such as "It was my fault" and "Nowhere is safe," are addressed.
- Gradual confrontation of avoided situations: Avoidance behaviours that narrow life are reduced step by step with a safe plan.
- Reconnecting with life: The person is supported in reconnecting with their values, relationships and goals for the future.
When working with children, age-appropriate methods such as play and drawing are used; the involvement of parents in the process is also very important. You can find information about work with children on the child and play therapy page, and about work with adults on the individual therapy page.
Frequently Asked Questions
Does everyone who experiences trauma develop PTSD?
No. Many people who experience a traumatic event show intense stress reactions in the first weeks but recover over time and with social support. PTSD comes into question when symptoms continue for a long time and markedly affect life.
A long time has passed since the earthquake. Is it normal that I am still affected?
Yes, the effects of trauma can sometimes continue for a long time, or become pronounced again with triggers such as anniversaries, aftershocks and news of new earthquakes. This is not a weakness; but if the effects are limiting your life, getting support can be helpful.
Do I have to talk about the trauma again and again in therapy?
In therapy nothing is done by force. Working with the traumatic memory is approached in a controlled and planned way, when the person feels ready and safe. You always have a say in how much you share throughout the process.
My child has changed a lot since the earthquake. What should I do?
It is important to help your child feel safe, to keep their routines, to answer their questions honestly and in an age-appropriate way, and to keep them away from disaster images. If the changes last longer than a few weeks, talking to a child and adolescent mental health specialist can be a helpful guide. If you or your child are struggling in this process, it is important to know that support is available.
Bu yazı genel bilgilendirme amaçlıdır; tanı veya tedavi yerine geçmez. Yaşadığınız güçlükler için bir ruh sağlığı uzmanına başvurmanız önerilir. Acil bir durumda lütfen 112'yi arayın.
Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
Eğitimler