Although great strides have been made researching the health implications of HIV/AIDS for long-term survivors (LTS), the main focus of these studies has been on physiological issues such as virologic and immunologic concerns, the long-term impact on immune function and other body systems, and HIV pathogenesis. Largely absent from these studies is detailed, solution-focused research on the psychological impact of long-term survival, particularly post-traumatic stress disorder (PTSD).
There have beenstudies on the general psychological impact of HIV/AIDS, such as an overall higher suicide rate, high rates of anxiety and depression, cognitive impairments, increased risk for addictive and high-risk behaviors, and greater social isolation. While these represent an enormous burden for LTS, it is important to highlight PTSD, a specific disorder with distinct symptoms and treatments, and one for which LTS are at greatly increased risk.
For LTS, trauma can include an HIV diagnosis at a time when that represented a "death-sentence;" a foreshortened sense of survival or even having a future; multiple losses of friends and family members (sometimes entire circles of friends); years of life-threatening illnesses and clinging to survival waiting for the next drug to be released; and rejection by families and friends due to the stigma of HIV/AIDS.
I see signs of PTSD among LTS everywhere in my practice and among my friends. Like soldiers returning from war, many of us who survived the 1980s and 1990s are reluctant to talk about those times, choosing instead to avoid painful memories. Many others isolate, or continue to experience anger, fear or grief out of scale with a triggering event. PTSD is caused by the unexpressed and unprocessed feelings resulting from trauma, and these emotions continue to bubble up in support groups, in workshops focusing on LTS issues, and in indirect ways such as social isolation or avoidance of relationships, and therefore potential loss. It should not be assumed that all LTS experience PTSD, but it is incumbent upon health care providers and the community to recognize it and, when identified, provide assistance.
Signs and Symptoms of PTSD
Trauma causes PTSD, and to diagnose it properly a person must have symptoms from each set of criteria below. While almost everyone can relate with some of these symptoms, PTSD is very specific and can only be diagnosed by a health care professional.
- Re-experiencing the traumatic event(s).
This can take many forms, including intrusive thoughts (involuntary and involving unwelcome memories or images that are upsetting or distressing), nightmares, flashbacks, and experiencing unwanted psychological or physiological reactions from internal or external stimuli that trigger memories of the trauma. This re-experiencing can lead to emotional numbing and dissociation (detaching from an emotional experience).
- Avoidance of (or efforts to avoid) stimuli representing the trauma.
These include steering clear of memories, thoughts and feelings associated with the traumatic events, and avoidance of reminders that reawaken unwelcome memories about the trauma. This avoidance can directly compound the social isolation of LTS who attempt to escape the emotional pain of loss by not getting attached to people again.
- Negative thoughts and moods.
These include an inability to remember events or details; persistent negative beliefs about oneself (such as "I am damaged goods" or "the world is unsafe"); persistent negative emotional states such as fear, anger, guilt or shame; and a detachment from activities and other people.
- Marked alteration of arousal and reactivity associated with the trauma.
Signs can include angry outbursts or hopelessness out of scale to the current circumstances; reckless or self-destructive behavior; hypervigilance (constantly being alert to potential dangers in one's environment); poor concentration; and an exaggerated startle response.
While these symptoms of PTSD can be overwhelming, there are a variety of treatment interventions for which effectiveness has been well-documented. PTSD can be diagnosed by any medical professional but mental health professionals typically have more expertise with various interventions. Most treatments are short-term and include:
- Cognitive behavioral therapy (CBT) and cognitive processing therapy (CPT).
CBT is practiced by many mental health workers and involves changing patterns of thinking or behaviors and thereby changing the resulting feelings. CPT is a version of CBT that is more specifically focused on trauma and PTSD.
- Prolonged exposure therapy.
This is another form of CBT characterized by re-experiencing the traumatic event in a safe setting with a trained professional. It involves remembering and engaging with the trauma rather than avoiding it. Various forms of prolonged exposure therapy have proved to be effective for PTSD.
- Eye movement desensitization and reprocessing (EMDR).
This technique helps the brain "file" traumatic memories so that the emotions associated with the trauma do not reawaken every time a memory is triggered. EMDR involves stimulating the connection between both sides of the brain simply by looking from left to right, or through methods of stimulation like holding small disks that alternately vibrate left and right, while at the same time becoming aware of and verbalizing feelings with a trained professional. This process helps the brain resolve traumatic memories that are "stuck" in place and which create negative feelings and behaviors when triggered, even years after the event.
- Alternative therapies.
A variety of other techniques can help reduce symptoms of PTSD. These include releasing the "fight or flight" mechanism that can become frozen at the time of the trauma with techniques such as somatic experiencing or [heart-centered hypnotherapy - http://www.wellness-institute.org/why-heart-centered-hypnotherapy]], which involves working with a client in a relaxed state of consciousness to identify and change self-sabotaging patterns of behavior resulting from trauma (it is effective at resolving childhood conflicts and trauma, as well).
The lives of many people living with HIV/AIDS have been shaped by traumatic events, some of which occurred 30 years ago. As a result, many remain locked in the painful and crippling emotional states characterized by PTSD. There are solutions, and with awareness and treatment, PTSD need not create even more casualties among long-term survivors.