When the past continues to hurt in the present

You don't have to have been through a war to live with PTSD. Car accidents, domestic violence, childhood abuse, the sudden loss of a loved one, a serious medical diagnosis, a natural disaster – any event that has threatened your life or safety, or that has left you facing total helplessness, can leave deep marks on the way your brain functions.

Approximately 3.51% of adults experience PTSD each year, and the lifetime risk of developing the disorder is about 8-101% in the general population. You are not alone, and you are not „overreacting.” What you are feeling has a name, an explanation, and, most importantly, a treatment.

1. What is PTSD and how does it differ from ordinary stress?

After a traumatic experience, it's normal to feel scared, sad, or anxious for a while. The brain needs time to process what happened. But sometimes this process "gets stuck": traumatic memories aren't filed away normally, but instead remain active—like a file permanently open in the background—and continue to generate intense physiological and emotional reactions.

PTSD sets in when symptoms persist for more than a month and significantly interfere with daily life. It's not an exaggerated response – it's a normal response to an abnormally overwhelming experience.

Diagnostic reference: DSM-5 Criteria for PTSD – American Psychiatric Association

2. What types of events can cause PTSD?

Any event that is perceived as threatening or overwhelming can trigger PTSD. It doesn't matter if others think it "wasn't that bad" - what matters is the impact it had on you.

• Accidents: Road accidents, industrial accidents or other types of serious accidents
• Violence: Physical or sexual violence, including within a couple or within the family
• Childhood abuse: Emotional, physical or sexual abuse in childhood – often produces C-PTSD (complex trauma)
• Traumatic grief: The sudden and unexpected loss of a loved one, especially through suicide or accident
• Medical trauma: Serious medical diagnoses – cancer, chronic diseases, invasive medical procedures
• Disasters: Natural disasters, fires, earthquakes, floods
• Community violence: Street violence, robbery, physical assault
• Vicariate trauma: Repeated exposure to the traumatic events of others (doctors, nurses, firefighters, psychologists)

Research shows that cumulative trauma (repeated exposure to adverse experiences in childhood – Access) significantly increases the risk of PTSD and other disorders in adult life.

Fundamental study: Feliaci et al. (1998) – Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death (ACE Study) – American Journal of Preventive Medicine

3. How do you know you have PTSD – Main symptoms

PTSD manifests itself in four main categories of symptoms. You don't have to have them all—the combination and intensity vary from person to person:

Involuntary re-experiencing of trauma

• Flashbacks – feeling like the event is happening again, even though you know you are safe
• Repetitive nightmares with the theme of the trauma or similar sensations
• Intense reactions (emotional or physiological) to things that remind you of the event – a smell, a song, a date

avoiding

• Avoiding places, people, or activities that remind you of what happened
• You don't want to talk or think about the event.
• Your world is getting smaller and smaller – you give up activities and freedoms to „feel safer”

Negative changes in thinking and emotional state

• Negative beliefs about yourself: "It's my fault," "I'm weak," "I don't deserve to be loved"„
• Persistent guilt or shame, even though you rationally know you were not wrong
• Emotional numbness – you no longer feel joy, affection, or interest in things you used to enjoy
• Feeling of alienation from others, as if there is a glass wall between you and them

Hyperactivation (Increased Arousal)

• You get scared very easily by sudden sounds or movements
• You are always on the alert, you can't relax, you are "on edge"„
• Insomnia, difficulty concentrating, irritability or outbursts of anger

4. What you feel – and why it matters

„"I feel like I'm not okay. I get scared of everything. I wake up at night and can't fall back asleep. People say I should get over it - and I want to, but I can't. I don't understand why I can't."”

If you find yourself in these words, we want to clarify a few essential things:

• You are not "overdoing it.". „"Getting over it" is not an option of the will – PTSD is a real biological change, not a weakness of character.
• Your reactions are the normal response of a brain overloaded by an abnormally difficult experience. Your survival system did exactly what it was supposed to do.
• Guilt and shame are symptoms of PTSD, not truths about yourself. The traumatized brain automatically produces these thoughts as a control mechanism.
• Isolation is understandable, but harmful in the long run. Human connection – even with just one trusted person – is part of healing.

5. Therapy – How it works and why it is effective

Modern trauma therapy doesn't mean recounting everything in detail until exhaustion. It means working with a trained professional who will guide your brain to process and "archive" the event—so that memories become just memories, not active urges.

EMDR (Eye Movement Desensitization and Reprocessing)

One of the most documented therapies for PTSD, recommended by the WHO and APA. It works by bilaterally processing traumatic memories, allowing the brain to "desensitize" them - remove them from active urgency and integrate them as part of personal history.

Study: Shapiro (2018) – Eye Movement Desensitization and Reprocessing Therapy: Basic Principles, Protocols, and Procedures

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT)

It works with distorted thoughts produced by trauma („I was wrong,” „The world is completely dangerous”) and avoidance behaviors that keep PTSD active. It is particularly effective in trauma in adults with childhood abuse and in relational trauma.

Study: Cohen et al. (2017) – A randomized controlled trial of trauma-focused CBT (JAMA Pediatrics)

Somatic Experiencing and body-oriented therapies

Trauma is stored in the body, not just in the mind. Somatic methods (Peter Levine) directly address traumatic tension in the nervous system and muscles, without requiring detailed verbalization of the event. Especially useful for people who cannot yet talk about what happened.

Reference: van der Kolk (2014) – The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma

The 4 steps of healing

• Step 1 – Safety and stabilization (20%): building a safe space, emotional regulation techniques, grounding
• Step 2 – Safe Distance (20%): learn to "look" at the memory without being absorbed by it
• Step 3 – Processing and Integration (45%): restructuring patterns of guilt and fear, integrating memories
• Step 4 – Reconstruction of life (15%): values, relationships, meaning, future projects

Estimated duration: significant reduction of symptoms in 6-8 sessions; complete integration in 12-16 sessions.

6. What you can do right now – 10 practical strategies

These techniques do not replace therapy, but they can reduce the intensity of symptoms during difficult times:

1. Physical Grounding: When you feel the flashback taking over, touch a cold object, clench your fists, and say out loud, „I am safe, I am home.” This brings your nervous system back to the present.

2. Prolonged breathing: Inhale for 4 seconds, exhale for 6 seconds. Exhaling longer than inhaling is the biological signal you transmit to the brain that the danger has passed.

3. Write down your triggers: Notice what triggers your moods (a smell, a sound, a date, a tone of voice). Identifying them reduces the surprise effect and helps you prepare.

4. Don't completely isolate yourself: Stay connected to at least one trusted person. Isolation fuels shame and reinforces the belief that you are "different" or "abnormal.".

5. Self-compassion: Talk to yourself as you would to a friend who has been through the same thing. Your reactions are not weakness – they are a normal body response to an abnormal experience.

6. Simple sleep routine: Keep the same hours, avoid news and screens before bed, avoid alcohol (amplifies nightmares and fragments REM sleep).

7. Journal: If it's too hard to talk, write. Put your thoughts on paper to get them out of the repetitive loop in your mind.

8. Mindful movement: Yoga, stretching, or walking with focused attention on sensations in the body helps release traumatic tension stored in the muscles.

9. Postponing major decisions: During acute periods, avoid radical decisions related to career or relationships – perspective is often distorted by fear.

10. Seek professional help: Trauma is extremely difficult to resolve on its own. Therapy with a trauma specialist can qualitatively and sustainably change the way you live.

7. Complex PTSD (C-PTSD) – When the trauma has been repeated

If the trauma was repeated and prolonged – childhood abuse, long-term domestic violence, captivity, human trafficking – the clinical picture can be more complex than „classic” PTSD. C-PTSD includes, in addition to the symptoms of regular PTSD, also:

• Severe difficulties in emotional regulation (oscillations between "numbness" and intense outbursts)
• A deeply negative self-image and persistent feeling of being „broken,” „at fault,” or „different”
• Major difficulties in relationships – hypervigilance towards signals of abandonment or aggression

C-PTSD requires a slower therapeutic pace, with a strong emphasis on the stabilization phase before addressing the processing of the actual trauma.

Reference: Herman (1992) – Trauma and Recovery – the fundamental concept of complex trauma

8. Clinical Notes for Professionals – Essential Aspects in Psychotraumatology

This section is aimed at psychologists, especially those just starting out in working with trauma.

Window of Tolerance: Trauma work must take place within the client’s „window of tolerance” (Siegel, 1999) – neither too close to the material (risk of retraumatization) nor too far away (no processing occurs). Striking this balance is one of the core skills of the trauma therapist.

Stabilization before processing: Beginning therapists often make the mistake of beginning trauma processing before the client has acquired sufficient internal resources. The rule of thumb: the client must be able to „move in and out” of the traumatic material without being overwhelmed. If he cannot, continue stabilization.

Transference and countertransference in trauma: Clients with C-PTSD will systematically test the safety of the therapeutic relationship. Reactions of abandonment, idealization, or devaluation are predictable and must be worked on in therapy, not avoided. Regular supervision is essential for therapists – especially those who are new to the profession.

Professional supervision: Elena Pap – Psychological Supervision Constanta

Dissociation in session: If the client „gets lost,” becomes absent-minded, or freezes in their gaze, do not continue processing—bring them back to the present with grounding techniques. „Where are you now? What do you feel standing up? What color is the chair you are sitting on?” Dissociation in session indicates that the material has exceeded the window of tolerance.

Additional validated resources: ISTSS (International Society for Traumatic Stress Studies) publishes updated treatment guidelines. EMDR Institute offers accredited training. For assessment, use PCL-5, IES-R, or CAPS-5 as appropriate.

ISTSS Guidelines: ISTSS – PTSD Treatment Guidelines (2018)

Conclusion – Healing is possible

Trauma doesn't define who you are—it defines what you experienced. With proper therapy, your brain can relearn that the danger is over. The memories will remain, but the intense emotional reaction, panic attacks, and nightmares can diminish until they disappear.

It's not an easy road. But it's a real road, traveled every day by thousands of ordinary people who decided it was worth living differently.

„"When you go through a traumatic event, time doesn't heal everything on its own. PTSD therapy helps you process those moments so that they become simple chapters in your past, not shadows that control your present."”