Think of a broken arm. It's easy to see the problem, the solution, and often the mechanism of injury. Now think of a fever. The fever isn't the actual injury but rather a symptom whose cause isn’t always clear; It might be a bacterial infection, a reaction to medication, or a symptom of rheumatoid arthritis and if you address the fever as though it were the problem, you'll miss the actual cause.
Like a physical affliction that causes fevers, migraines and gastric problems (depending on an individual’s physiology), PTSD doesn’t show in only one vague symptom, but in many.
And inside the symptoms-within-symptoms nature of PTSD, there are 2 main manifestations:
- Externalization, which is the projection of one’s thoughts, feelings, or perceptions onto the external world. Here, we aren’t talking about what someone feels physically as a result of their inner thoughts but rather we mean how their behavior reflects their inner trauma. Externalizing behaviors can include low self-constraint, a feeling of alienation from others, aggressiveness, and substance abuse (to name a few).
- Internalization is the identification with one’s thoughts and feelings combined with the difficulty in separating oneself from them. Someone who is in the throes of internalization may direct themselves inward and become more anxious, introverted, listless and depressed (to name a few).
What complicates the matter is that people with PTSD can have an equal mix of internal/externalization, or one can be dominant over the other. Some days symptoms may be more internal while the next day, more external. And the lines dividing the internal and the external aren’t always clear cut.
Thinking back to the first paragraph, it's not always clear what the cause of a fever is, just like it's not clear what the causes of anxiety, depression, substance abuse, or aggression are, and a treatment for any one of those is not adequate (alone) to treat the underlying PTSD.
Comments