Post Traumatic Stress Disorder (PTSD)

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Post Traumatic Stress Disorder (PTSD): Diagnosis

Post Traumatic Stress Disorder (PTSD) is an anxiety disorder that sometimes develops in people who have been exposed to a traumatic event. In recent years, it has become a fashionable label that has been used loosely by many therapists and patients.

As a therapist practicing short-term, cognitive behavioral therapy, I have a problem with this watered down use of the term PTSD. Proper treatment depends on a proper diagnosis.

The information on this page may help you decide whether you truly suffer from post traumatic stress disorder (PTSD) versus some other problem. I've described the disorder using the accepted, strict, criteria put put into plain language.

Please remember that self-diagnosis is never completely reliable. If this description of post traumatic stress disorder matches you, even loosely, you should probably get treatment sooner rather than later. Even if your problems don't seem to meet the full criteria for PTSD, a trained professional can help you get much needed relief.

You may also want to look up my pages on:
Generalized Anxiety Disorder (GAD),
Panic Disorder & Agoraphobia, and
Obsessive Compulsive Disorder (OCD).

Diagnostic Criteria for Post Traumatic Stress Disorder / PTSD

Post-Traumatic Stress Disorder (PTSD) occurs after a truly terrifying event in which physical harm occurred or was threatened. It can happen either to the person directly harmed/threatened or to someone who witnessed the event.

People with Post Traumatic Stress Disorder / PTSD re-experience the traumatic event in one or more of the following ways:

  • repeated and intrusive memories
  • recurring dreams
  • acting or feeling as if the traumatic event were happening again (flashbacks)
  • intense psychological pain when exposed to things that resemble or are symbolic of some aspect of the event
  • physiological (bodily) reactions when exposed to things that resemble or are symbolic of some aspect of the event
Re-experiencing the event is painful. People often feel emotionally numb afterwards. They attempt to avoid this painful re-experiencing the traumatic event. For the diagnosis of Post Traumatic Stress Disorder / PTSD, three or more of the following forms of avoidance must be present.
  • efforts to avoid thoughts, feelings, or conversations about the traumatic experience
  • efforts to avoid people, places, or activities that bring it to mind
  • inability to remember important aspects of the event
  • reduced interest or lack of participation in activities that are apparently unrelated and were previously enjoyed
  • emotional distance or alienation from others
  • the inability to feel a full range of emotions (eg love)
  • the inability to imagine having a normal future or the belief that one will die early (despite current good health)
Finally, people diagnosed with full-blown Post Traumatic Stress Disorder / PTSD experience two or more of the following signs of hyperarousal (being keyed up, wired, or tense):
  • insomnia or difficulty staying asleep
  • irritability or angry outbursts
  • difficulty concentrating
  • hypervigilance
  • an exaggerated startle response
To be Post Traumatic Stress Disorder / PTSD, these symptoms must last for at least a month. They can start to appear immediately after the traumatic event or much later. The symptoms of Post Traumatic Stress Disorder / PTSD can be somewhat different in children who have survived trauma.

Most people think of Post Traumatic Stress Disorder / PTSD as something that happens as a result of war, 9-11-2001, sexual assault, or being held hostage. However, severe traffic accidents are the most common cause. Survival of natural disasters such as Hurricane Sandy or Hurricane Katrina with sudden loss of home and possessions, and with dislocation from family, friends, job or school can result in many symptoms that are very similar to post traumatic stress disorder / PTSD though it does not meet the accepted diagnostic criteria. This undefined disorder can be treated similarly though I am unaware of clinical studies on the efficacy of this treatment.

Only a small minority of people who are exposed to a traumatic event will ever get Post Traumatic Stress Disorder / PTSD. Many more people will experience Acute Traumatic Stress Disorder. This disorder is similar to PTSD. However, it begins within a month of the incident and resolves itself less than a month later. The two disorders are frequently confused, especially when someone has been repeatedly exposed to separate traumatic situations as happens with soldiers in a war or emergency service workers. The real difference is whether the symptoms go away by themselves or persist.

Short-term Therapy for Post Traumatic Stress Disorder / PTSD

At one time, Post Traumatic Stress Disorder / PTSD was thought to be nearly impossible to cure. Today, most cases of PTSD are successfully treated with short-term therapy. Tougher cases may involve longer-term treatment, but patients should feel significantly better within six months.

Effective, short-term therapy for Post Traumatic Stress Disorder / PTSD has become possible through the development of a cognitive behavioral therapy protocol. Cognitive behavioral therapy (CBT) focuses on alleviating symptoms and building up the person's ability to cope. It is an active therapy for Post Traumatic Stress Disorder / PTSD that involves specific exercises and homework that is done between sessions.

The key to treating Post Traumatic Stress Disorder / PTSD is to focus on the patient's avoidance symptoms. Most of the other symptoms of PTSD are maintained by the avoidance symptoms.

Let's look at normal recovery from a traumatic incident. It's only natural for people to feel very distressed and disturbed after a traumatic event. The memories and the fear can't just be turned off. The first days after are often marked by nightmares, recurrent thoughts, and sometimes numbing, hyper-vigilance and anger. But our minds are capable of adapting to these things, most of the time. Over the course of a few difficult weeks or months, we heal.

Post Traumatic Stress Disorder / PTSD is caused by a failure in the healing process. This is almost always caused by avoidance. When we force ourselves not to think about a traumatic event, when we refuse to dwell on the memories, and we don't allow ourselves to experience the emotions, we also deprive ourselves of the ability to adapt.

Actually, it's a bit worse than that. We can't really force traumatic memories out of our minds. They keep coming back. The harder we try to push them away, the more we regard the memories themselves as something to be feared. We monitor ourselves, constantly. It's a bit like the kid's joke about trying not to think about a pink elephant in a green tutu, dancing in the living room. The more you try not to think about it, the more you do.

In order to successfully treat Post Traumatic Stress Disorder / PTSD, I have to start by teaching patients to relax. This is done using breathing exercises, guided visualizations, and secular forms of meditation.

Once a patient feels capable of taking control of their upset, I begin to explore the particular memories, thoughts, and other forms of re-experiencing that disturb them. Often we'll create a list of disturbing thoughts and memories, ranking them from the easiest to handle to the most difficult.

Starting with the easiest ones, patients are then asked to consciously think about them. The therapist asks them to allow themselves to become upset and to stick with it until the upset subsides.

Instead of avoiding their emotions, they experience them fully. Instead of pushing thoughts and memories of trauma out of consciousness, they deliberately expose themselves to them. The amazing thing about our minds is that through this process, we adapt. We become less sensitive. The things which were so distressing before carry less of a charge.

When each disturbing thought or memory is mastered, we take on the next. We work on them until even the most difficult material has lost its ability to make us fearful.

I also ask patients to explore the meanings they attach to these traumatic events. We try to develop more helpful ways to put them into context.

At the same time, I try to work with patients on all the places, people, and situations they may be avoiding. Again, exposure is the key to desensitization.

This is all hard work. It requires a great deal of commitment from the patient and support from the therapist, but it is extremely effective.

Sometimes Post Traumatic Stress Disorder / PTSD seriously disrupts a patient's life. There may be marital problems, divorce, estrangement from children, or job loss. Sometimes the trauma itself has left someone disabled, as in spinal chord injury or the loss of a limb. Short-term therapy for Post Traumatic Stress Disorder / PTSD sometimes needs to be longer term, as a compassionate therapist helps a patient to readjust and rebuild their life.

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