What is Post Traumatic Stress Disorder?
Peace and Healing will approach this diagnosis from two definitions. The first definition is from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which this author takes issue with. The second definition which I would like to characterize as a more functional, clinical diagnosis.
The DSM-IV is a manual that targets diagnoses for labeling and insurance reimbursement, a psychologist, psychiatrist, social worker cook book if you will. The clinician must be able to label a certain amount of criteria in order for the diagnosis to be met and subsequently for the therapist to get paid from the insurance company, and if the individual is a veteran to obtain benefits from the armed services. The DSM-IV states, the individual must experience an extreme stressor involving personal experience with threatened death, or injury or a threat to their physical integrity. This event must involve fear, helplessness, and horror. There also is a numbing, or avoidant behavior that ensues after the stressor. * The full symptom constellation, must be present for a minimum of one month, and the disturbance must cause significant clinical distress in the person’s social, occupational areas of functioning. (How do we measure significant?) ( What if the symptoms are less than a month?)
The traumatic event is often revisited in the patients memory. There can be triggers of all sensory stimuli. Smell, taste,sight,hearing and touch. Recurrent dreams are very frequent, and it is not uncommon to dissociate at times when one has this flash back. An individual may be avoidant or distant even if they are in the same room with you. It is not uncommon to see brief episodes of agitation, distorted thinking patterns, and their conversation does not flow with the topic. Anniversaries,weather, automobiles, and anything that was associated with the trauma can exacerbate an anxiety state, or an emotional upheaval, which in turn inhibits functioning and current relationships.
Stimuli from the traumatic time are avoided at all costs. Patients make a conscious effort to avoid thoughts, feelings, and conversation about the past. (1) Other common criteria are; amnesia, feeling detached, inability to feel emotions, decreased libido and intimacy, and a want to not participate in social events.One also can be hyper vigilant to the point of paranoia, have an exaggerated startle response, and frequent nightmares.
Peace and Healing would rather define Post Traumatic Stress Disorder with a more liberal catch all criteria. As clinicians we must stop putting people in boxes, and label them with strict criteria. This mechanism runs the risk of missing the boat on certain individuals, and over diagnosing others. What happened to treating each patient as individuals for who they are, and their unique experience? We all handle trauma differently, and we all have different support networks.
Anybody who experiences a traumatic life event has an emotional reaction to this event. The direct effect is directly dependent on a few factors; the emotional development of the person at the time of the event, the duration of the event, does the person have a good, reliable support network, is there a mechanism for the person to escape from the traumatic event, and how devastating does this event impact their every day life. There should not be a one month criteria, their should not be some check list criteria, and if one meets the right amount of checks they are the winner of the diagnostic label. If they do not meet the criteria, …well off they go, possibly without treatment due to an insurance company not covering their diagnosis. Our medical profession and political system MUST make changes if we are going to make a positive impact in treating patients who are hurting from life trauma.
What are the DSM-IV criteria for Post Traumatic Stress Disorder?
A. The person has been exposed to a traumatic event in which both of the following have been present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person’s response involved intense fear, helplessness, or horror.Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor
What are the symptoms of Post Traumatic Stress Disorder?
Above are the symptoms of the DSM IV, they are cut and dry and meant to pigeon hole a specific individual. As if all individuals experience the same constellation of symptoms. There are similarities and studies do revel commonalities,however they do not take in account the individual differences. For those fans of Peace and Healing I wrote a book about my personal experience of being sexually abused by my cousin. “Above His Shoulders” was released in 2008 by Outskirts Press and is available through www.amazon.com. In this autobiography I speak extensively of my trauma, the effects and the road of hope and healing that empowered me to my position now.
Initial feelings of guilt, depression, and insecurity led to poor grades, acting out among family members and becoming lost within my own peer group. The effects of sex abuse are long reaching. As an adult I did not realize how the need to satisfy, the insecurity in relationships, and the inability to maintain any semblance of my life. I consistently searched for inner happiness but could not find it, and did not understand where it went and was it ever there? Some of my symptoms met the criteria for the DSM IV, however not all. I would not of met the criteria at the time. This is my point, clinicians must treat each person as an individual, and use all their tools available to arrive at a treatment plan.
What is the treatment of Post Traumatic Stress Disorder?
There are numerous treatment options to treat patients with this diagnosis. There is not one modality that works well. Treatment must be tailored to the type of trauma, the severity, and the patients willingness for treatment. All research over the years that I have scoured do have one commonality. You cannot resolve the past trauma without acknowledging it, talking about it, and moving through the emotional pain. Many individuals say they have dealt with it because they have shared their trauma or event with a peer. This is “venting” NOT working through your issues. Others rationalize their way through their trauma, dancing in conversations to avoid at all costs the specific events. these individuals just are not ready to disclose. This author has not seen much success with behavioral modification and PTSD. Psycho dynamic approaches, and pharmaceuticals have had a higher efficacy rate then just one treatment modality. Remember to never close your mind to different treatment options. Hypnosis, individual therapy with one who specializes in life trauma, are all beneficial. Do not be closed off to anti-anxiety medication and sleep medication, for the short term. Insomnia can be an exacerbation to any stressful event.
There is hope, all events in our life happen for a reason. that reason may not be readily available to us. Life trauma introduces us to new individuals and others who have experienced similar events. Winning in life is the struggle to find continuous happiness. Professional sport teams who get in a losing streak just do not know how to win. They have to experience winning for it to be contagious and learn how to accomplish that task. When one is pessimistic, and complains the majority of the time, that is what they know, they will never get out of the pessimistic rut if they do not try something different. We all must risk, and dump our old baggage. Before we dump our baggage, we need to go through it and find out what we want to keep and what we want to dump. Then and only them can we walk across the bridge leaving the traumatic past behind. I am not naive here. There will always be lingering effects, however you do not need to dwell and ruminate, for you know the cycle of winning.
There is hope, you must believe it, be prepared to fail many times, and re frame a given situation for the positive instead of harboring on the negative. One of the most disheartening voices is one who touts their trauma for years to come, “poor me” syndrome. I was abused, I was raped, I have a bad life, everything always happens to me. These statements will continue to get you what you are stating, more pessimism, more sadness, and there will be no sunny days even on the brightest of days.
We do make the day what we want out of it, despite the every day stressors. Only you can take the responsibility to change the outcome. It takes time, failure, and then success to overcome any life trauma. When you do, I guarantee you will be stronger and happier than before.