PTSD Awareness Month: A Lived Experience Q&A with Amy Brundle of NAMI NC

A lot of people have traumatic experiences. From your perspective of lived experience, what distinguishes PTSD? How is living with PTSD different from someone having some trauma in their background?

There’s nothing that really warns you ahead of time that your traumatic experience is going to lead to PTSD. The difference is the length of time and the severity of the symptoms.

Mine was triggered by a severe car accident that happened 20 years ago. While a lot of people have car accidents, a lot of people don’t necessarily have recurring nightmares two years after the accident or drive on a highway five years later and still have flashbacks to the point where they can smell the airbag deploying in their own car just by a visual reminder.

I think that in cases of people having PTSD, speaking from personal experience, sometimes the brain does not let itself let things go. It’s almost like new pathways are carved into the brain. That is, you had one huge reaction to a trauma that carved its way into your brain, so now this is how you respond to trauma or to reminders of it.

I think there’s a difference between gradually getting over a bad or traumatic experience and being able to work through that with resilience versus, instead, having it come up at inopportune times years later because your brain has rewired itself to respond to certain stimuli in this dramatic fashion.

What are common symptoms or indicators that someone has PTSD?

Some of the most common ones are things like nightmares and flashbacks. Small things—like smells or sounds—can bring things back really strongly.

A lot of times it shows up in your nervous-system responses, which can look like an inability to sleep, rapid heart rate, panic attacks, or shortness of breath. The kind of physical symptoms that you would attribute to an active panic attack can happen with PTSD, when you’re triggered by a memory or by some sort of external stimulus that promotes a memory.

Your body is constantly taking small things—small stimuli throughout your day—and using them to remind you of the traumatic event.

A lot of people have that experience in the few weeks after a traumatic event, but we’re talking months and sometimes years. It took me a decade to get rid of most of the resounding symptoms of PTSD.

Sometimes it seems like the months afterward hold the most severe recurring symptoms. But then years later, someone might be starting to move on, and then something happens and it all comes back.

You have to work through that. That tends to happen less and less as you go through different therapies and treatment, but it still takes a while for it to completely go away.

People also make behavioral changes to avoid triggers, in a way that can alter someone’s life. For example, it took me a while to be able to drive comfortably again. I was the one behind the wheel when my accident happened. I saw the person coming to hit me.

I remember distinctly having a massive panic attack on the road three months after the accident. I had to pull over. A friend met me where my car was and then coached me—for over an hour—through getting back behind the wheel, so that I could drive home without my entire nervous system just being shot.

People also sometimes have self-harming tendencies. I think that’s just a response to the overwhelming anxiety that you can experience. For me, I had this impulse to cause another accident, because my PTSD told me that another accident was inevitable. So instead of waiting around for it, I had an impulse to cause it, because I felt that I knew it was going to happen and I didn’t want to have it hanging over my head all the time.

That’s not a healthy response. But that was a response to a constant feeling of not feeling safe in my car anymore.

Amy, what are the biggest misconceptions about PTSD?

I think one is that it’s only a wartime disease—that it only happens to active-duty personnel. In fact, when I got diagnosed and told people I had PTSD, they sometimes would accuse me of trying to co-opt a military illness for my own purposes.

Most people are still learning a lot about what kinds of traumas can cause PTSD. But there was definitely this idea that PTSD was only for people who have gone through the kind of soul-crushing trauma that being in an active war zone or in combat can cause.

Yes, that is primarily how we learned about PTSD—through the experiences of people in combat. Theirs can be some of the most complex and hardest to treat experiences out there.

But PTSD can come from any kind of trauma, whether it’s instantaneous, like a car accident or a natural disaster, or it’s chronic and prolonged, like child abuse. It can come from a variety of different kinds of traumas.

PTSD is really more based on what your brain does when it experiences that trauma, how long it holds on to that trauma, and how difficult rewiring your responses to future events, experiences, and traumas can be.

Another misconception that has come up in the past several years is that we’ve gone from not understanding what PTSD is and kind of negating its existence to, instead, using it in a lot of different contexts where it doesn’t belong. There’s a tendency to either joke or make facetious comments about attributing any small inconvenience or bad day to PTSD.

We’ve all heard somebody say something like, “Oh, I just waited in traffic for hours, or someone took my parking space, or someone was mean to me, and I now have PTSD about it.” No, you don’t. 

When we joke about it, we minimize the real experiences people have. That is its own form of stigmatization. Because then when people who have experiences like mine—someone whose trauma is not what someone would necessarily consider a conventional cause for PTSD—then it’s easy to disbelieve that person’s experiences, because you’ve minimized PTSD into this reaction to a mild inconvenience.

For people like me—who went for months driving relationships away, not being able to sleep, not being able to drive, having panic attacks in the middle of the night, still having nightmares 20 years later—that minimization and disregard can make them feel like they don’t deserve to get treatment, because if everybody has it, nobody has it, if that makes sense.

It makes you feel overdramatic. It makes you feel like you’re making a big deal out of nothing or that this is a normal response, when it’s not.

There are treatments out there that can help get people to where they’re able to have a normal life and actually even be around some of their triggers.

Understanding that PTSD can be caused by any form of trauma, what are some of the more common “unconventional” causes of PTSD—ones that many people don’t associate with the disorder?

We’re starting to recognize prolonged abuse, including in childhood, as one of the common causes. There are studies happening to consider what PTSD looks like if you’ve been in a long-term abusive relationship.

Natural disasters can be a cause and even more so if one happens when you’re young. So, that includes surviving a hurricane, a tornado, an earthquake, or a fire—the kind of event that threatens your safety.

Another cause is being the victim or close to the victim of some sort of violent crime. For example, with school shootings, a lot of those kids will sometimes experience PTSD. 

It can also be something like mine, where it was an accident. I think my traumatic experience was exacerbated by the fact that I saw her coming, so I watched myself get hit. All those memories and sensations are burned into my brain.

I think it can be something awful that you witness, too.

So, there’s a wide range of different possibilities of causes of PTSD, and it really gets down to any kind of traumatic event that forms a pivot point in somebody’s daily life in a negative way—something that they can mark and say, you know, after this event my life was very different.

That’s powerful, Amy. For you, what has living with PTSD been like?

It took me a while to recognize that I even needed treatment, because I just thought it was my fault that I was dealing with the accident so poorly. I remember it took me a couple of days after getting out of the hospital to break down and have an emotional response. I assumed that the way I was supposed to be dealing with this was to have a brave face and push through the pain. 

I broke four bones and couldn’t walk for three months. Whatever—be strong. It’s fine. Keep going on with life.

So, it took me a while to get treated, because I was just assuming that this was my failure for not pushing through a negative experience to get back to normal as quickly as possible.

For me, PTSD feels like being on edge all the time, because I am never sure what exactly is going to set something off. I remember there was a series of TV ads that featured people talking in a car and then, out of nowhere, a car slams into them from the side. It was to advertise the car’s high safety rating and safety features. I remember being at a sports pub having dinner with my friends, and that commercial was on TV. I saw the car hit the other car in the commercial, and that’s all it took. I had a full-blown meltdown. I felt every single piece of my accident in that moment. 

You’re never quite sure what’s going to be triggering.

It also became very difficult to regulate my own emotions. Mood swings can be a big part of PTSD. It can be very difficult to keep yourself regulated enough to enjoy things like normal social interactions or to complete normal activities.

There was a lot of hypervigilance, feeling like I always had to be on guard because something else was going to happen to me. I needed to be ready. It’s like feeling amped up all the time.

That feeling fades. But even years later, if I was triggered by something, it would take an effort to tamp that immediate threat response back down. My body overreacted to normal stimuli.

We all have a threat response, right? It’s what keeps us alive. We evolved into being able to assess threats and respond accordingly, with adrenaline and fight-or-flight response. But this is that turned way up—overreacting to things that really shouldn’t spur a threat response.

The biggest part of my therapy is self-awareness and being able to remind myself that the way I’m feeling is not a standard response.

From there, I recognize something must be triggering my PTSD symptoms. I then step away from the situation and find a grounding tool or something else, because I am out of whack at the moment. I need to do something to bring myself down. 

Does PTSD frequently go undiagnosed? If you think you have PTSD, what steps should you take?

People might still be under a misconception that it is solely for active military members and veterans, so people might not seek treatment. Even for military members and veterans, some people don’t get treated for PTSD because of military culture and ongoing stigma within that community about seeking mental-health treatment. I think that’s starting to get better, but it’s not all the way there.

Also, various subpopulations tend to discourage getting mental-health treatment because of different cultural stigmas.

But there are ways to recover. I know that it can be difficult sometimes for people to decide to get mental-health care, but if you get a clinical perspective—well, then, even if a clinician says that something doesn’t qualify as PTSD, you can settle that in your mind. And maybe that’s a good opportunity to talk about other things you are experiencing.

You also don’t need to be on the verge of a crisis before you get assessed. Just as we go to a primary doctor for a physical or just to ask questions, we should think about our mental-healthcare providers in the same way and ask for a consultation about whether or not something is worth pursuing. Go to your primary-care doctor and get a referral for a therapist or psychiatrist who might be able to help you.

What are some common treatments for PTSD? Are they effective?

What is going to be effective depends on the person. As with a lot of mental illnesses, it’s going to be a journey that you walk through together with your providers to find the right treatment.

Medications, sometimes including antidepressants, can be a helpful way to go about it. Just because a provider prescribes something doesn’t mean it’s going to work for you. A lot of finding the right mental-health treatment involves trial and error. People have to know that going in.

A lot of times PTSD can be managed with and recovered from through talk therapy, especially cognitive behavioral therapy (CBT), which is a method of therapy that gets you to think through your responses and try to reframe them. Basically, you use certain behaviors and habits to train your brain out of negative emotional habits or spirals.

Sometimes exposure therapy may be appropriate, where you’re slowly being exposed to your triggers in order to desensitize yourself and turn off some of those negative reactions.

EMDR, or Eye Movement Desensitization and Reprocessing, is becoming more popular and showing benefits. The basic idea is to go through memories objectively, try to look at them from the outside, and reframe the way your brain responds to those memories while engaging in eye movements. There’s a special certification that you go through as a therapist to be able to do EMDR.

So, there are lots of approaches that can work. I can’t speak to the efficacy of treatments for everybody. That’s very individualized work to do with a clinician. 

I can say that, for me, a mix of antidepressants, talk therapy, CBT, time, patience, and a good support system has made it so that I rarely experience the symptoms of my PTSD anymore.

What are some general ways people can support loved ones who have or may have PTSD?

I think educating yourself about PTSD is always very helpful.

Then, respectfully and kindly encourage loved ones to consider getting treatment. Honestly, my friends and family telling me I was not handling things well and we might need to get some outside help—well, that was the catalyst that I needed.

Be there to support your loved ones in making whatever lifestyle changes they might need in order to temporarily avoid their triggers until they’ve come to the other side of it.

Understand that their mood swings or their changes in behavior are not your fault. They’re not triggered by you.

But, largely, it’s patience and understanding, and then also creating your own boundaries. I think that family, friends, loved ones, and caregivers have to make sure that they’re creating healthy boundaries around themselves, so that they’re not unnecessarily hurt by somebody’s actions when they’re not being treated—or not being treated effectively—and they’re kind of out of their own control.

Practicing self-care is important when caring for someone with PTSD. 

What else do you want people to know?

One other important thing is that PTSD can very often be co-diagnosed with other mental-illness conditions.

For me, I was already carrying some level of depression, and going through this traumatic experience spiked the depression symptoms.

Some people could manifest their anxiety after trauma in some other sort of compulsive behavior. They could show signs of OCD. They could try controlling things through how they control their eating, for example, which might then turn into another disorder.

So, a lot of these conditions tend to interlace together.

Is there a final message you’d like to share, Amy?

PTSD is treatable.

I basically consider myself in remission. I remember what the symptoms feel like, but I don’t really suffer from them anymore. 

You can get to a point where that traumatic event is not going to keep defining your life. It takes work. But there’s so much help out there now—so many resources and so many different treatment options that can help.

PTSD is something that can be gotten through. You can get to the other side.

No matter what you’ve experienced, recovery is possible.