Poles with post-traumatic stress disorder. You don’t have to go through a war to have this.

Alexandra Zalevskaya-Stankevich, “Wprost”: Thinking about post-traumatic stress disorder (PTSD), I have in front of my eyes the film “Saving Private Ryan” by Steven Spielberg. Today, the name “Private and personal” with post-traumatic stress disorder is increasingly found among the so-called. civilian population. What can be a stressor?

Bow. Marta Svenchak, psychiatrist: You don’t have to be in a war to experience PTSD. For the average Kowalski, this cover could be a layoff, a divorce, a natural disaster, the death of a child, or a bank debt. PTSD also affects people who have been subjected to violence, including sexual violence, or who have witnessed another person being harmed, such as through armed conflict or an accident.

How does PTSD manifest?

Recurring intrusive memories and dreams that turn into nightmares. It is characterized by flashbacks, i.e. short-term sensations of a sensory nature. The patient feels or behaves as if he is really re-experiencing traumatic experiences, which are accompanied by fear, feelings of fear and anxiety, irritability, tantrums. Such a person may blame himself for what happened, all the while insisting that he could have prevented it. Another symptom may be indifference to the world, to loved ones, as well as apathy or lack of appetite.

Post-pandemic stress syndrome is also a worrying trend. Is this a common name or a medical term?

This is a colloquial concept. This term is not included in international classifications.. People who experience this type of syndrome have lost a loved one during the pandemic, or have experienced hard times themselves with COVID-19, or have seen firsthand how the coronavirus is taking its toll. We have all been subject to restrictions, our freedoms to socialize and conduct daily activities have been severely curtailed. For some people, returning to a normal life has proven too difficult. Apart from personal experience, some people are just very sensitive. Anxiety can be a character trait. One person is able to distance himself from matters on which he has no influence, while the other will look for analogies in his environment, take care of the matter to such an extent that he cannot function normally.

We usually talk about these people as nervous. Did the war in Ukraine and the pandemic cause a surge of neuroses?

I often see patients who claim to have neurosis, although we no longer use that term in medical parlance. In the United States, the term was removed from the DSM-III (Diagnostic and Statistical Manual of Mental Disorders) in the early 1980s. In Poland, the term has not been used in medical jargon since the 1990s, when the ICD-10 (International Statistical Classification of Diseases and Health Problems) classification was introduced, and with it the broad concept of anxiety disorders. The war in Ukraine, the pandemic and even the current economic situation in the country, of course, have greatly affected the well-being of the Poles.

The data suggests that thirty percent of the population will experience an anxiety attack at least once in their lifetime. Also remember that we are still in the process of breaking mental health taboos. It’s not that ten years ago people weren’t afraid. Our parents, grandparents were also worried, they were scared. They just rarely admitted it, did not seek help from specialists. Until recently, when someone suffered a mental breakdown—whether due to “neuroses” or depression—they were automatically labeled “geeks.”

Why do we have so much fear and so many neurotics? We cannot blame everything on the pandemic and the war.

To date, research shows that anxiety disorders have a complex basis, both environmental and biological. Genetic factors, neurotransmission disorders, functional and structural changes in the brain play an important role in the etiology of anxiety disorders. The style and pace of our life, of course, contribute to this in many ways. We are burdened with stress and professional obligations - working overtime, chasing deadlines, afraid that we will fall out of circulation, and then struggling with professional burnout. Our condition is negatively affected by excessive stimulation of information coming from media messages or social networks.

We are all afraid of something. How do we know if it’s a disorder or just anxiety?

The symptoms of anxiety can vary. Most often, anxiety takes the form of experiencing fear and feeling threatened without a clear objective cause. The position of our body can change. A person experiencing fear begins to stoop, shrink in himself, take a defensive position. A trifle can throw her off balance, and the reaction is disproportionate to the event. The patient begins to overload family and professional life - he feels overworked. The prospect of getting up for work, maintaining a routine, terrifies him.

What about bodily symptoms?

They can also accompany anxiety. Patients in the doctor’s office very often complain of palpitations, overflows of cold or heat, pressure or pain in the chest. It is difficult for them to breathe, they may sweat profusely, experience pain, for example, in the head or abdomen. Often, due to somatic symptoms, patients seek help from other specialists. The general practitioner refers the patient to a cardiologist, endocrinologist, gastroenterologist, rheumatologist. Unfortunately, it takes some time before someone finally suggests seeing a psychiatrist.

Most of the symptoms listed above can also indicate depression.

Anxiety disorders often accompany depression, but also other diseases, such as cardiac or hormonal. They can occur in acute poisoning with a psychoactive substance. Anxiety also often accompanies drug addicts, for example, with withdrawal symptoms. Anxiety by itself is not a symptom of depression. Chronic anxiety often leads to a bad mood and vice versa.

What happens in the brain when we tremble with fear?

Neurotransmission is disrupted in the nervous system, resulting in impaired physiological regulation of anxiety and mood. I will explain this using the example of a patient who is addicted to gambling in the stock market. When he is heavily burdened with stress, his system becomes unregulated. He starts playing again to regulate his emotions in order to bring relief. However, this relief lasts only a moment. But in the days that follow, the urge to play increases - it’s easy to lose yourself. The patient feels even more disturbing symptoms. A snowball effect is created.

Can a former neurosis manifest itself as social phobia?

Social phobia can be classified as a group of anxiety disorders. Then the patient realizes that certain social situations cause him more fear, so he begins to avoid them. It is difficult for him to break through and function in certain social situations. In the doctor’s office, I quite often meet people who, during the pandemic, are used to working remotely, meeting online, talking through video recorders. The vision of a live meeting with colleagues overwhelms them - causes fear, reddening of the face, increased sweating or trembling of the voice. Sometimes the phobia takes an extreme form, then the person isolates himself and cannot go out, for example, to go shopping.

Do anxiety disorders only affect shy people?

Not necessary. People who experience anxiety often “put on a mask”, are able to mobilize in front of family or friends, create the appearance of cheerful or sociable people.

Can anxiety disorders be completely cured?

Yes, although their trouble is that they convert. Therefore, in addition to pharmacological treatment, psychotherapy is of great importance. Medicines can help the patient stop anxiety attacks, sleep better, have more energy. But you always need to think about conducting medical procedures. Determine why such problems occurred. And tame fear by learning to live with it daily.