Monday, March 7, 2016

PTSD: post traumatic stress disorder - what it is, what it's like, what helps, what doesn't help

PTSD is one of the mental health conditions that tends to get tossed around in political circles more than any other, simply for the fact that it's so prevalent in the lives of returning servicemembers.

One of the greatest misconceptions about PTSD is a direct result of this politicized discussion: it is the idea that PTSD only occurs in veterans who have seen physical combat, and that it simply cannot exist in the absence of physical combat.

Both are patently untrue and do a vast disservice to anyone suffering from the condition.

PTSD can arise as the result of any type of trauma, physical trauma being only one type. It can be caused by emotional trauma, psychological trauma, sexual trauma. It can be triggered by brief episodic traumas or by long term traumas. It occurs in men and women, and most of the people living with PTSD have never stepped foot onto a battlefield.

What PTSD is
Though my definition is far from an official one based on my professional credentials, I like to think of PTSD as a coping mechanism that turns on you. Essentially, you cannot both survive and process the trauma at the same time, so your body opts first for survival. As you are enduring whatever the source of the trauma is, you aren't adequately processing it, which results in the trauma never becoming a permanent part of your past. It is not and cannot be categorized and stored in your long term memory, instead taking up residence in the instant recall portions of your mind. It isn't in the past, it doesn't feel like it is in the past, it can resurface at any time and can feel as threatening and as real as when you were actually involved in the traumatic event.

- PTSD can occur to any person as the result of experiencing or witnessing any trauma.

- 1 in 5 veterans of Iraq and Afghanistan suffer from PTSD, though that number is likely even higher due to underreporting.

- PTSD occurs in all categories of the population. It affects up to 10% of women in their lifetimes.

- The trauma behind PTSD can be physical, emotional or psychological. There is no requirement of physical harm or danger.

- PTSD can be triggered by combat or injuries in the military population, but neither is required for the symptoms to present. There could be some other trauma involved wholly unrelated to the deployment. The military and media are both guilty of suggesting that combat is required to develop PTSD, and they are just plain wrong.

- PTSD can be co-morbid with other mental health conditions.

- The diagnosis of PTSD is not, as the military has tried to suggest here, a complicated one. If a person has the symptoms, they fit the diagnostic criteria. Period.

- Diagnosing traumatic brain injury (TBI) is more complicated, and can exist at the same time as PTSD. They can exist separately as well, neither requires the other.

The Symptoms of PTSD
The symptoms of PTSD can occur immediately after the trauma occurs or can show up later on. The symptoms vary in severity and occurrence in each person, not all who suffer will have all the symptoms. For example, if you have insomnia and triggers, but not flashbacks, you could still be suffering from PTSD. As a general rule, if a person has at least some of the symptoms, they fit the diagnostic criteria. There is no sophisticated testing to determine if an individual is suffering from this condition.
  • the symptoms begin to interfere with daily life
  • flashbacks
  • triggers - something innocuous will bring up memories of the trauma
  • insomnia
  • nightmares
  • irritability
  • avoidance of things that could serve as triggers
  • isolation
  • altered memories
  • feeling emotionally flat or overreacting
  • feeling like you are always on guard
  • aches and pains that aren't connected to other injuries
  • depression - feeling hopeless at the situation in particular
  • problems with family or friends
  • difficulty controlling emotions
Complex-PTSD is a subcategory of the condition that results from long term traumas, often abusive relationships with family members or partners.

What It Is Like
In one word, it's hell. It's like hell. 

Of all the things I've endured in my life as far as mental health issues go, this one is hands down the worst. The longer it went on, the worse it got up until the point that almost everything in my life was a trigger for something. I wasn't sleeping hardly at all, and when I was sleeping, I was awakened every night with vivid nightmares. I withdrew almost completely from everyone in my life and isolated myself. I started suffering physically as a result of the lack of sleep and everything else, ended up having several panic attacks, a few of which landed me in the emergency room. It was to the point that I was having a hard time leaving the house, and was absorbing almost everything around me as some kind of threat.

Left unchecked, it can and will often get progressively worse.

It's hell and I wouldn't wish it on my worst enemy.

PTSD is especially difficult to endure when your reality means that you currently are surrounded by either the person or situation that inflicted the trauma in the first place, or reminders of that event. Interaction with the person who may have caused some or all of the damage is a struggle, particularly if they refuse to own any degree of responsibility for what they have done. 

What Helps
There is treatment for PTSD. It should be considered an injury, not simply a mental condition, certainly not one that is automatically permanent. The treatment may include medication to treat symptoms and usually involves intense therapy. I have personal experience with EMDR.

PTSD will not go away on its own.

I've learned that though PTSD can be treated, I don't think it will ever completely disappear. I am still triggered occasionally now, but it isn't the disabling event that it used to be. I think it is just a part of who I am now, and will forever remain that way.

Having said that, I want anyone out there reading this to understand that there is hope. You can get better. It doesn't have to be like this and it doesn't have to stay like this. You aren't broken. This isn't your fault. The only way it gets better is to admit you need help to get there. Please get help.

  • Medication - there are many different medications used to help mitigate the symptoms of PTSD, and they can be quite beneficial, especially if you are in crisis mode. Anti-depressants, anti-anxiety medications and medications to help people fall asleep and stay asleep tend to be the most commonly used. Individuals may need to use medication only episodically or daily, they may need them short term or long term. It is important to remember, though, that these medications and the general treatment of the symptoms may not be enough to address the actual issue causing the PTSD in the first place - the underlying trauma. Medication is not a sign of weakness in any way. I actually see it quite the opposite - an acknowledgement and acceptance that you are needing help and willing to ask for it.
  • Tapping/distraction techniques - these are strategies used so that a person can remind themselves to stay in the present. The root of PTSD is the reminders of the trauma which occurred in the past. The threat, whatever it was, is not actually happening right now. Tapping, snapping a rubber band on the wrist, patterned distraction of any kind can both get someone to not focus on the reminder, and pull them back to the current time. 
  • Assistance animals - therapy dogs can be of tremendous help, but are quite expensive. Ordinary pets can also help in many ways, without the specialized training. 
  • Distancing from the source of the trauma - this one is often quite difficult, particularly if you are in a situation where a person who might have caused the trauma is still present in your life and you are forced to interact with them, magnified even more if they refuse to admit their role in your injury. Firm establishment of boundaries is important to safeguard your well being. It may become necessary to cut ties entirely with people, even family members, at times. None of this is easy, and generally would only be something to do as a last resort.
  • Therapy - there are many different types of therapy, in many different types of settings from individuals to groups. The most important thing here is to find a therapist who is specifically skilled in the treatment of PTSD. Addressing the trauma is vital to the treatment of PTSD.
    • EMDR - standing for eye movement desensitization and reprogramming, EMDR is a specific type of therapy targeted at PTSD. Every professional has slightly different methods, but it basically forces you to relive the trauma repeatedly while those methods are being employed until you have been able to process it completely. My therapist used a TENS machine. I have to be completely honest and tell you that this process SUCKS. It absolutely gets worse before it gets better, and there is a hangover-like recovery time following every appointment. You have to be in a safe place emotionally to even consider going through this process and be entirely committed to powering through it in order for it to work....but it will. You really have to trust the process, which is hard to do when you're living with a condition like this one that tells you not to trust anything.
  • Supportive family and friends - loving and living with someone suffering from PTSD is not easy. We can be irrationally moody, and if we withdraw at times, it is often because our minds are playing tricks on us. In our own way, we may be trying to protect you from our thoughts, but that suppression is actually likely to make things worse. If someone you love is dealing with this condition, remind them that you love them, that you are there for them, that you are a safe place for them to come with their thoughts. Encourage them to talk to a doctor about symptoms, to not be afraid to take medication if needed, to seek therapy. If it is possible to help them reduce exposure to triggers, that may be beneficial as well - for example, if someone is triggered by loud noise, make an effort to reduce the occurrence of them.
What Doesn't Help 
- Stigma. Stigma is damaging and dangerous. Educate yourself about this condition before you say anything to or about anyone living with it. Understand that the media is notorious for providing false information and perpetuating the stigma.

- Our condition (usually) isn't about you, so please don't take it personally. If it is about you, please own your responsibility in that.

- People with PTSD, literally, cannot just "get over it". Don't tell them to. It will not go away on its own. Time will not fix it. Ignoring it can often make it worse.

- Don't try to impose some arbitrary time limit on their recovery. You don't get to decide how long this takes, particularly if you had a hand in causing the trauma.

- PTSD in its most severe form does not have to be permanent. It does not mean a person is irretrievably broken. It does not mean a person will become violent, though it can go that direction if left untreated in some people. Do not assume that anyone with PTSD is dangerous.

- PTSD is not a sign of weakness in a frail person. It is what happens when a person's brain becomes overloaded due to trauma (whether the trauma is one episode or ongoing) and loses the ability to process those experiences as it is supposed to. Instead of categorizing and storing the information, it stays on the surface and is easily accessed. Do not act as though those who develop the condition are weak. They've been through something awful. Period.

- When someone with PTSD is triggered, the fear, pain, emotions of the memory are as real to them as they were when the experience actually occurred. Do not mock them or try to minimize their feelings. 

- Once they seek help, people with PTSD need a system in place that offers what they need - in particular they need their situation treated as legitimate, and they need resources well equipped to treat PTSD. The military in particular focuses on "soldiering on" and "resiliency", neither of which will help someone fighting these battles in their own mind. The treatment of this condition is often lengthy and emotionally exhausting.

If you or someone you love is suffering, please get help. Things can absolutely get better.


  1. I was hit by a car -- I was a pedestrian. I mentioned to a friend (who I thought was sympathetic to such things) that I thought I had PTSD. Her reply was, "Really? It's not like you were in a war, or anything." That hurt so badly. I'm doing better, but now I consider these symptoms just part and parcel of my whole being, with all my other anxieties and depression.


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