Delayed Posttraumatic Stress Disorder

Introduction and Clinical Features of Delayed-PTSD

In Delayed PTSD, the original trauma is automatically repressed and stored in the unconscious mind. Each time there is a flashback, nightmare, or intrusive thought, it is added to the already-stored information related to the original trauma.

We protect ourselves from unpleasant or painful thoughts by forcing them out of our conscious awareness and closing the door on them.

This is an automatic process and takes place largely without our thinking about it. It is the same as the instinctive reaction of withdrawing our hand from a hot stove. It is an automatic process that causes us to block out anything that produces physical or emotional pain.

For this reason, we forget nightmares soon after they occur. We push away flashbacks and intrusive thoughts and avoid anything reminiscent of painful or terrifying experiences.

Flashbacks and nightmares are not eliminated completely from the mind; they are stored in a separate area, loosely described as part of the unconscious mind. For simplicity, let’s call this area an “abscess” of the mind. It contains all our repressed thoughts related to the trauma. The partition that contains them and keeps them out of conscious awareness is the “wall” of the abscess. The enormous force of repression accumulates, layer upon layer, year after year, to form this defensive wall.

In such cases, the person cannot return to full heath. Instead, s/he becomes more distant, does not socialize, and avoids anything reminiscent of the original trauma. Keeping the original trauma in checks also requires a massive amount of emotional energy.

Then one day, years or even decades after the trauma, an event occurs which is so intense and similar to the initial terrifying experience that it pierces the defense wall and stirs the unconscious material in the “abscess” of the mind. This is followed by a volcanic eruption and surfacing of the original trauma and all that it has become in the unconscious mind. The eruption, or surfacing of the walled-off/repressed material, announces the beginning of delayed posttraumatic stress disorder.

Delayed posttraumatic stress disorder surfaces sometimes many years after the original trauma. Until recently, the longest delay I had ever seen occurred in a man who was drafted into the army in 1944 while not fully recovered from meningitis.

His infirm state left him feeling quite vulnerable because he knew he did not have full control of his faculties. When asked to crawl under live machine-gun fire during basic training, he was terrified because he knew he would not be able to keep from standing up. A sergeant helped by going through the course with him and holding him down. He was so terrified that he developed angioneurotic edema, a condition in which his lips and throat swelled. It was so severe that he had to force his fingers down his throat in order to breathe.

Upon discharge from service, he married and found work in a stock brokerage firm until one day, forty-four years later, he was in a car crash, was rushed to a hospital, and placed in an MRI scanner.

As soon as he heard the loud clicking sound of the scanner and was told not to move, he began hallucinating tracer bullets flying overhead—with eyes open and with eyes closed. Even the angioneurotic edema returned, causing him to thrust his fingers down his throat once more in order to breathe. From that point forward, he was 100 percent disabled with delayed posttraumatic stress disorder.

In the year 2001, a bank executve topped the veteran’s record for length of delay in delayed posttraumatic stress disorder. This man’s wife reported a particularly strange behavior in him. he would awaken five minutes after falling asleep, go directly to the refrigerator to eat something sweet, return to bed, and repeat this throughout the night. In the course of one year, he gained nearly one hundred pounds.

History revealed that he had a successful knee replacement and was happy with the results; but one year later, he fell and tore his knee badly, destroying the repair. He became scared of more operations, but had to endure one after another. This caused great fear, stress, and anxiety; and he thought he might lose his leg. The strange behavior and the hundred-pound weight gain started after he became fearful of more operations and losing his leg.

As commented by the narrator, his awakening, putting something in his mouth, and returning to sleep is similar to the patter of infants when they awaken, cry, and the mother puts something in their mouth. He noted that when he was born, fifty-five years earlier, his country was in civil war.

Babies, being sensitive to the fears of the mother, often awaken with anxiety and cry. Ordinarily, a mother places something the baby’s mouth, and it is comforted. This is what was happening.

Fear of operations returned him to the original fear, causing him to awaken throughout the night; and each time, he followed the earlier pattern of putting something in his mouth to fall asleep.

This remarkable example illustrates three things:

1. The delay can be more than half a century.
2. it can be limited to a very narrow band of feelings, reality, and behavior.
3. Its origin can be from early infancy, long prior to conscious memory.

In this case, only it is delayed posttraumatic stress disorder from infancy, and the symptoms more closely match the realty and behavior of the infant. The original trauma usually is not even recognized as being traumatic, and few associate the resultant behavior as belonging to an infant in the first two years of life.