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PTSD Questions & Answers
Joyce Boaz & Dr. Frank Ochberg, M.D.

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PTSD Symptoms: Re-traumatization.

Q: Dear Frank, What do you say to your clients when they feel they have been re-traumatized? What does it mean and what can someone do about it?

A: Dear Joyce, Re-traumatization is the opening of old emotional wounds and the anxious anticipation of such re-wounding. This second episode may be worse than the original trauma because it implies a string of "bad luck" - a sense of endless travail rather than one bad experience that has come and gone. Survivors tell me it feels like the old trauma plus a new trauma plus a loss of psychological safety. Psychological safety may be a myth (the thought that everything will eventually turn out right) but it is a helpful myth. It lets us live denying death. It saves us from the searing reality of biological truth.

Trauma therapists deal with re-traumatization all the time. In treating traumatic stress, we try to avoid opening a wound that is still too painful to be explored. Clumsy interviewing, bad timing, getting to a memory before rapport is developed - is bad therapy because it reinjures and destroys trust.

When my patients call, sometimes years later, to describe a recurrence of PTSD, they usually feel unlucky, unable to cope, and they say, "I'm back to square one." It as though all they learned about overcoming traumatic stress has vanished. The cause is usually a second trauma, but it may be a physical illness or a prolonged misfortune that falls short of the kind of trauma that causes PTSD. I review the progress they made before this happened. I search with them for sources of self-confidence. I remind them of their skills in surviving and coping. And I let them know that PTSD is real and it cannot be wished away. They may need more therapy. They may need medication, but I never assume that. They always need understanding and supportive friends.

If you are a successful survivor but your personal hurricane hits again, and PTSD returns, what should you do? First, make sure you are safe. Physical safety requires effort, friends and may require experts in security, law, or health. When the risks are high, you don't need psychoanalysis. You need a safety net. Second, when physically safe, but full of fear, flashbacks, numbing and self-isolation, remind yourself that you are better off than a rookie who knows nothing about emotional trauma. PTSD destroys your time sense and fools you into thinking that every bad thing is happening now. It isn't. These are aftershocks. Practice what you have learned. Get your conscious mind telling you what you know is good for you: PTSD passes. You are worthwhile. People can understand. There is no shame being human, having fear or deep sadness or confusion. Finally, Reach out to those you know are trustworthy. Tell them you have PTSD (or anxiety, depression or whatever term you can use). Don't wall yourself off. If you need professional help, get professional help. The return of PTSD seems to be worse, but usually it isn't. You have conquered it once. The skills kick in after the first shock wears off.

Webcast: What do you say to your clients when they feel they have been

Being re-traumatized does not necessarily mean you will not be capable of
dealing with PTSD symptoms that may reappear.

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