What you Need to Know about Post-Traumatic Stress Disorder (PTSD)
Living with Post-Traumatic Stress Disorder (PTSD) ripples into all areas of our lives. After a trauma, we think the battle is over, but really it has just begun. What they don’t tell you about charging up the hill to the battle zone is that the images and emotional imprints of that single moment will live within us and color the way we view the relationships we have with the innocent people we love who didn’t sign up for the war. The same can be said of the formative years when we abuse our bodies and put ourselves in situations and relationships that damage us. We do not yet realize that the damage we face is more than the bruise, hang over, dirty moment in the shower. With PTSD we live in a world that feels threatening and unpredictable and as a survival response we live in the defensive. This is exhausting mentally and emotionally, it is hard on our bodies, and it takes a tole on our closest relationships. Somewhere along the line, when we can take no more, we must capitalize on the moment of this frustration and take hold of the hand of someone who can guide us out of the dark.
This comprehensive guide aims to be the beginning of just that. Let’s talk about PTSD and start the process of creating a foundation of knowledge on which to make a plan to move into a new chapter. We will begin with the most basic concept of what PTSD is, how it is diagnosed and what other conditions are often seen concurrently (ie. alcohol abuse and depression). We next explore the ways it is treated and the cutting edge science emerging about complex PTSD, psychedelics, and,couples therapy for carrying trauma.
When you have finished reading this guide, you should have a basic understanding of PTSD and enough insight the unspoken questions we all have to move forward into therapy and/or have a good conversation with your loved one about getting help. If you have additional questions after reading this, please feel free to contact us at admin@grottopsych.com or give us a call or text (877) 292-6020. We always answer 24 hours, rain or shine.Now, we begin.
What is PTSD?
Post Traumatic Stress Disorder which we will refer to from this point forward as PTSD is a condition in which we experience or fear experiencing something that is so emotionally significant that our brain cannot adequately process the information and place it neatly in the series of memories of our lives. In essence, when we feel in danger in a way that we are horrified or overwhelmingly afraid combined with feeling powerlessness to stop the danger, our brain glitches. The brain’s survival mechanism imprints the importance of this moment so strongly that it gets stuck on the conveyor belt of memories. Normally, each moment we live simply floats down the conveyor belt of memories. When we experience trauma, we live that danger as if it is the last memory the brain made. The memory is so heavily fused with emotions, we cannot release it and let it drift into its relative place amongst all the memories of our past. It is no wonder that we basically live our lives readying for the danger. We do this in three primary ways:
- We are physically and mentally readying for the danger; our bodies are tense, our survey of a room is looking for potential threat, and we are living defensively
- We have intrusive thoughts, dreams, or triggers. We may smell a smell that takes us back or have an intensively emotional response to a scene in a movie, or perhaps we wake up in a lurch or have chronic nightmares.
- We try to avoid people, places, thoughts, and memories that remind us of the danger. We may do this by isolating, we may avoid crowds, we may drink or smoke a little too often to release us from the angst that we feel.
This state of existence causes us a great deal of distress. This can often be seen most clearly from the angle of a loved one or child that lives with us. When we are in the thick of it, sometimes we lose sight of all of the compensatory techniques we use to make life manageable. We forget that not everyone needs to sit back against the wall in a restaurant. We don’t realize that not everyone feels the ever presence of a predator close by.
What is a Traumatic Event?
When we experience a dangerous situation, we often minimize its importance or even try to forget or deny that it happened so that we can avoid that felt sense of living in a dangerous world. This is the brain’s attempt to stop the PTSD scenario described above, however, the downside of this is that we often downplay our trauma.
Everyone I have ever treated as a trauma therapist knows someone who had it worse or failed to realize how impactful an experience was. I hear: “Yeah but I lived” or “Yeah maybe I was drugged and didn’t want to have sex but he didn’t hit me”. This takes away our ability to simply call it like it is and seek help. So, let’s describe it.
A traumatic event is anything that causes intensive horror, fear, disgust AND powerlessness or helplessness to change it. The terror we feel waiting for the danger is often worse than the actual danger itself. The terror we feel watching or knowing a loved one is going to be hurt, tortured, abused, or compromised also falls in this category. I’m going to repeat this, trauma is any moment that results in psychological terror or anguish!
These events can vary widely, encompassing situations where individuals have experienced or witnessed life-threatening incidents, serious accidents, natural disasters, combat, or physical or sexual assault. The intensity and severity of the trauma significantly influence the likelihood of developing PTSD. For the most common traumatic events, please reference this self-report: The LEC-5 the standard for the VA PTSD assessment.
When traumas span lifetimes, the situation can be much more complex. In this circumstance, the way we describe trauma and how we treat it shifts slightly. For instance, when our baseline is traumatic, it is more challenging to connect with and understand life peace. This may happen in a scenario of living with a parent who has mental instability or substance use problems, managing poverty, living in an emotionally cold home, living in a community with a culture of violence, or being bullied or picked on. Even when the traumatic event is not actively happening in these types of environments, they feel like the danger is right around the corner. For instance, the kid who hears gunshots every Friday on the westside of Chicago may not necessarily need to be shot to feel the fear of being in danger. This impacts the way we walk through life indefinitely. This is enough to cause PTSD. In a nutshell, anything that threatens the safety or dignity (as in sexual assault or physical maiming the body) of self or someone we love in a way that causes us great angst, horror, intense fear, and a sense of powerlessness is enough to echo into the PTSD symptoms later. However, every trauma does not necessarily lead to PTSD and many people who experience trauma do not develop PTSD. We will discuss complex PTSD in the coming sections.
Reference: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
What Causes of PTSD? Vulnerability Factors
So, does everyone who experiences a traumatic life develop PTSD? The answer is no. Not every traumatic experience results in PTSD and some folks can endure tremendous amounts of trauma and not experience PTSD. Understanding the causes of PTSD can help us better support people who have endured trauma. In this next section, we explore the key factors contributing to the development of PTSD, providing valuable insights into the nature of trauma and the path towards healing.
Not everyone exposed to trauma develops PTSD. So, what predisposes us to develop PTSD? Brewin and colleagues (2000) performed a meta-analytic summary of the research available regarding the risk factors that make one more likely to develop PTSD. They collapsed all of the research across available studies to understand what the bigger picture is across studies. The factors include: pre-existing mental health condition, family history of mental health issues, lack of social support, and personality characteristics. Let’s dive deeper.
1. Pre-existing Mental Health Conditions
The research indicates that individuals with pre-existing mental health conditions may be more susceptible to developing PTSD after exposure to trauma. These conditions may include anxiety disorders, depressive disorders, or other psychiatric disorders. The presence of a pre-existing mental health condition can amplify the impact of trauma, making individuals more vulnerable to the development of PTSD symptoms. The way I view this finding is that when we are already using life energy to manage moods, emotions, and thoughts, this colors the amount of energy and the way in which we internally narrate a traumatic event. Also, this may limit available resources to manage a trauma.
Wellness Tip: If someone you love has experienced a trauma, encourage them to talk about it. If someone has a pre-existing mental health condition, hopefully they have a relationship with a mental health provider. Processing the trauma with a therapist can help reduce ongoing symptomology.
2. Family History of Mental Health Issues
A family history of mental health issues emerges as another notable risk factor. Individuals with a genetic predisposition or familial history of psychiatric disorders may have an increased susceptibility to PTSD following trauma exposure. There is an interplay in family history of mental health between potential genetic and social factors. First, our genetics may more strongly predispose us to feeling distress more strongly or seeing the world in a way that is blue or anxious. Secondly, there may be limited family resources or availability to absorb and support a traumatic experience when the family is struggling with mental health challenges. For instance, if a parent is depressed, they may have less energy to be present and support a child post traumatic event.
Wellness Tip: If we know that our family members are struggling with their own walk in life, finding other communities of support is integral. This may be done by joining an organization such as a religious or social group, a gym, or a campaign. This may also be done more formally through a support group or pursuing friendships through Bumble BFF or Meet Up.
3. Lack of Social Support
This leads into the most important of the risk factors. The Brewin et al (2000) meta-analysis demonstrated that a lack of adequate social support is a significant risk factor in terms of developing PTSD. More importantly, appropriate social support is a protective factor and actually reduces the risk of PTSD. In effect, this means that having a social circle that we can confide in and allowing ourselves to express the need to a loved one in our hour of need makes our long haul life healthier. This was echoed by the later Ozer and colleagues (2003) meta-analysis.
Wellness Tip: Friendships matter. Isolation is something that has become so normalized during the pandemic, but, when bad things happen in life, friendship can be a life raft. It is a good rule of thumb to attempt to leave the house once daily and to connect with another human on non-work related topics once daily even if it is a quick run to your corner store.
4. Neuroticism and Pessimism
Neuroticism refers to the tendency to experience negative emotions and emotional instability; people who are highly neurotic are often more detail-oriented and better capable of predicting realistic outcomes. However, these individuals high in neuroticism are also more likely to experience feelings of anxiety, worry, fear, anger, frustration, sadness, and other negative emotions. On the contrary, those low in neuroticism tend to be more emotionally stable, calm, and less prone to experiencing intense negative emotions.
Though neuroticism may drive long work hours and perfectionism in performance, it is associated with:
- Anxiety: Neurotic individuals often experience heightened levels of anxiety, including feelings of worry, nervousness, and tension.
- Moodiness: There is a tendency for mood swings and fluctuations in emotional states. Individuals high in neuroticism may have a less predictable emotional baseline.
- Tendency to Focus on Negative Aspects: Neurotic individuals may be more likely to focus on potential threats or negative aspects of situations, leading to increased worry and pessimism.
- Stress Reactivity: High neuroticism is associated with increased reactivity to stressors. Minor stressors that might not affect others significantly can lead to more intense emotional responses.
- Low Self-Esteem: Individuals with high neuroticism may be more prone to self-doubt, feelings of inadequacy, and lower self-esteem.
- Susceptibility to Mental Health Issues: High neuroticism is a risk factor for various mental health conditions, including anxiety disorders and depression.
In addition, neuroticism and a tendency towards negative affectivity, are identified as risk factors for PTSD. Individuals with these traits may find it challenging to cope effectively with traumatic experiences, increasing the likelihood of persistent distress and the development of PTSD.
Wellness Tip: Practicing reframing life and monitoring our inner dialogue can protect us in so many ways. Start your day with a podcast or speak wellness to yourself in the mirror. We cannot change our traits, sometimes it takes a little more work to maintain calm and stable and that’s ok.
5. Brain Chemistry and Neurobiology
The neurobiological impact of trauma plays a significant role in the development of PTSD. Traumatic events can alter the brain’s structure and function, particularly in areas responsible for emotional regulation and memory processing. The dysregulation of neurotransmitters, such as serotonin and norepinephrine, may contribute to the persistent symptoms of PTSD.
6. Dissociation
During a traumatic event, we sometimes distance ourselves from the moment by focusing on other things in the environment. If you have ever been driving, gotten lost in thought and had no idea how you got from Point A to Point B, you have dissociated. In trauma, this experience can be even more profound. Sometimes emotions are so great, we literally leave our conscious mind and the ability to actually make memories is lost for a period. People talk about dissociation in different ways, it can feel like you are in a movie theatre watching what is happening inside of your head or it can feel like you leave your body and enter a dot on the ceiling or that time has passed without your awareness of what happened. Dissociation is simply a state of detachment from reality. This dissociation can interfere with the normal processing of the traumatic experience, potentially contributing to the development of PTSD.
Wellness Tip: If you have or are dissociating, there is a great deal of work we can do to get back in touch with our body and begin being in the moment and healing. Working with a therapist who specializes in dissociation in relation to trauma can be helpful.
7. Vivid Dreaming
There is an interesting role between vivid dreams and PTSD. Folks that have vivid dreams may be more prone to nightmares, sleep disruption, and re-experiencing trauma in sleep which all effectively worsen PTSD symptom severity. In a study of Veterans, the worse the vivid nightmares, the more symptomology is reported the following morning in sleep studies (Miller et al, 2018).
Vivid dreaming, especially in the context of nightmares, is often associated with Posttraumatic Stress Disorder (PTSD). Individuals with PTSD frequently experience intense and distressing dreams related to their traumatic experiences. The relationship between vivid dreaming and PTSD is complex and multifaceted, involving various psychological and neurobiological factors.
Vivid Dreaming as an Intrusive Symptoms: Individuals with PTSD often experience intrusive symptoms, where distressing memories or flashbacks of the traumatic event intrude into their waking and sleeping hours. Nightmares can be a manifestation of these intrusive symptoms, leading to vivid and emotionally charged dreams.
Vivid Dreaming as Re-experiencing Trauma: Vivid dreaming can serve as a form of re-experiencing the trauma during sleep. These dreams may replicate the sensory and emotional aspects of the traumatic event, contributing to the overall distress experienced by individuals with PTSD.
Hyperarousal and Sleep Disturbances: PTSD is associated with hyperarousal, which can lead to difficulties with sleep, including insomnia and frequent awakenings. The disrupted sleep patterns can contribute to an increased likelihood of remembering and being disturbed by vivid dreams.
Dream State and Emotional Processing: Vivid dreaming in PTSD may be linked to difficulties in emotional processing. Traumatic memories may be encoded and consolidated during sleep, influencing dream content and emotional intensity.
Nightmares and Fear Conditioning: Nightmares in PTSD may be a result of fear conditioning, where the brain associates sleep with the traumatic experience, leading to heightened arousal and the manifestation of distressing dreams during the sleep cycle.
Dreams and Neurobiological Mechanisms: Research suggests that alterations in the neurobiological mechanisms involved in sleep and dreaming play a role in the relationship between vivid dreaming and PTSD. Dysregulation of neurotransmitters, such as serotonin, and changes in sleep architecture may contribute to the occurrence of nightmares.
Do I have PTSD? PTSD Diagnostic Criteria
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Posttraumatic Stress Disorder (PTSD) is a mental health condition that can develop after exposure to a traumatic event. The DSM-5 outlines specific diagnostic criteria for PTSD, and these criteria are organized into four main clusters:
Criterion A: Exposure to Traumatic Event
– Direct exposure to actual or threatened death, serious injury, or sexual violence.
– Witnessing the traumatic event occurring to others.
– Learning that the traumatic event occurred to a close family member or friend.
– Experiencing repeated or extreme exposure to aversive details of the traumatic event (e.g., first responders).
Criterion B: Intrusive Symptoms
– Recurrent, involuntary distressing memories of the traumatic event.
– Intense and prolonged psychological distress or physiological reactions to cues that symbolize or resemble an aspect of the traumatic event.
– Distressing dreams related to the traumatic event.
Criterion C: Avoidance
– Avoidance of distressing memories, thoughts, or feelings associated with the traumatic event.
– Avoidance of external reminders (people, places, conversations) that evoke distressing memories, thoughts, or feelings associated with the traumatic event.
Criterion D: Negative Alterations in Cognitions and Mood
– Inability to recall an important aspect of the traumatic event (not due to head injury or substance use).
– Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
– Persistent, distorted cognitions about the cause or consequences of the traumatic event that lead to self-blame or blame of others.
– Persistent negative emotional state (e.g., fear, horror, anger, guilt, shame).
– Markedly diminished interest or participation in significant activities.
– Feelings of detachment or estrangement from others.
Criterion E: Alterations in Arousal and Reactivity
– Irritable behavior and angry outbursts.
– Reckless or self-destructive behavior.
– Hypervigilance.
– Exaggerated startle response.
– Problems with concentration.
– Sleep disturbances.
Criterion F: Duration of Symptoms
– Symptoms persist for more than one month. this duration criterion helps mental health professionals differentiate between acute stress reactions that may naturally resolve over time and more persistent and impairing symptoms that characterize PTSD. It’s also a way to ensure that the diagnosis is not applied to individuals experiencing a normal and expected reaction to a recent trauma.
If an individual continues to experience symptoms for more than a month and meets the other criteria outlined in the DSM-5, a diagnosis of PTSD may be considered. However, only a qualified mental health professional can make a definitive diagnosis based on a comprehensive assessment of the individual’s symptoms and history.
Criterion G: Functional Significance
– Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Criterion H: Exclusion
– Symptoms are not due to medication, substance use, or other illness.
It’s important to note that a qualified mental health professional should make the diagnosis based on a comprehensive clinical evaluation. Additionally, cultural considerations and individual differences should be taken into account.
How is PTSD Diagnosed?
PTSD can be diagnosed by a licensed mental health provider. This is typically done through the use of a series of self-report questionnaires, a review of relevant medical records, and a 60 to 90 minute clinical interview to better understand the information reported and the felt sense of being in the room with the person reporting the symptoms. It is not typical that people fake PTSD, we are looking for the experience of the symptoms reported while we are connecting in session. We may ask for examples of real world experiences to better
Differential Diagnosis
Clinicians also engage in a process of differential diagnosis, considering whether the observed symptoms may be better explained by another mental health condition. This involves ruling out other disorders that may share similar symptoms but have different underlying causes.
Cultural Considerations
Clinicians need to consider cultural factors that may influence the expression and interpretation of symptoms. Different cultures may have varying ways of coping with trauma, and symptoms may be expressed differently across cultural groups.
Collaboration and Multidisciplinary Approach
In many cases, the diagnosis of PTSD involves collaboration among different healthcare professionals. This multidisciplinary approach may include psychologists, psychiatrists, social workers, and other mental health specialists working together to provide a comprehensive assessment and treatment plan.
Do I Have PTSD or COMPLEX PTSD?
Complex PTSD introduces additional complexities. to the conventional symptoms. It can be viewed as a variant of PTSD with similar symptoms but it is not quite the same. This section helps readers differentiate between PTSD and CPTSD through informative content and self-assessment tools.
The 17 Symptoms of Complex PTSD
Complex Posttraumatic Stress Disorder (C-PTSD) is a condition that may develop as a result of prolonged exposure to traumatic events, particularly in interpersonal relationships where there is an element of captivity or entrapment. The symptoms of C-PTSD are often more varied and pervasive than those of PTSD. While the DSM-5 does not officially recognize C-PTSD as a distinct diagnosis, many mental health professionals use the term to describe a set of symptoms that go beyond the criteria for PTSD.
Here are 17 symptoms commonly associated with Complex PTSD:
- Difficulty regulating emotions: Intense and fluctuating emotions, including difficulty managing anger, sadness, or frustration.
- Problems with self-perception: Persistent feelings of shame, guilt, and a distorted self-image.
- Distorted perception of the perpetrator: Idealization or preoccupation with the abusive person, even when they are harmful.
- Preoccupation with the abuser: Intrusive thoughts about the perpetrator and difficulty focusing on other aspects of life.
- Difficulties with relationships: Struggles in establishing and maintaining healthy relationships, including fear of intimacy or excessive dependence.
- Loss of faith in humanity: A pervasive negative view of others and a diminished capacity to trust.
- Changes in identity: A sense of a fragmented or disrupted identity, with a lack of a coherent sense of self.
- Chronic feelings of emptiness: Persistent feelings of inner emptiness and a lack of fulfillment.
- Difficulty with attachment: Challenges forming secure and healthy attachments with others.
- Impaired memory: Problems with memory, including difficulty recalling certain aspects of the traumatic events.
- Dissociation: Experiencing episodes of dissociation, where one feels disconnected from reality or their own body.
- Somatic symptoms: Physical complaints without a clear medical cause, such as chronic pain or gastrointestinal issues.
- Impaired self-esteem: Low self-esteem and a sense of worthlessness.
- Difficulty with boundaries: Struggles in establishing and maintaining appropriate personal boundaries.
- Hypervigilance: Heightened state of alertness, always anticipating potential danger.
- Difficulty with self-care: Neglect of one’s own physical and emotional well-being.
- Reenactment of trauma: Engaging in behaviors or relationships that recreate aspects of the traumatic experience.
It’s essential to note that the symptoms of C-PTSD can vary widely among individuals, and not everyone with a history of trauma will experience all these symptoms. If you or someone you know is struggling with these symptoms, it is crucial to seek support from a qualified mental health professional who can provide a comprehensive assessment and appropriate treatment.
PTSD EVALUATION FOR SERVICES
The interesting thing about PTSD is that we have often spent so much time normalizing what we are experiencing or just dealing with the symptoms that it can take some time to even realize that we may actually have a diagnosable condition. Sometimes days or years pass without this realization coming into focus. PTSD is a chronic medical condition. It requires care in the same way that any other chronic condition might. By the very definition of a diagnosable mental health condition, distress and/or functional challenges must be present. For this reason, a formal evaluation and diagnosis are often important to assure that people with this condition have access to the care they need. A formal evaluation is different than traditional therapy as it requires the clinician to take a questioning role as opposed to a supportive role. The evaluator is tasked with fidelity to the truth, not the benefit of the client or the agency that may be petitioned for support. Therefore, a therapist cannot simply provide this evaluation for the client and an evaluator cannot be the client’s therapist. If you feel you have a diagnosable case of PTSD, you may be eligible for work related compensation if the trauma happened during a time of employment or the condition was worsened by the employment. You may also be eligible for a disability insurance and Family Medical Leave that allows time to gain treatment while receiving a portion of your typical earnings. This is not the case with all jobs, so, please check carefully with your employment paperwork, paystubs, and/or HR department. Worth noting, the condition does not have to be caused by the current position of employment to petition for leave and disability. The Grotto team is equipped to provide PTSD evaluations as well as therapy. The three most common evaluation requests that we have received are as follows:
PTSD Evaluation for Medical Cards
Individuals seeking support for PTSD often wonder about the evaluation process for medical cards. Medical cards, often associated with health insurance or government assistance programs, can significantly facilitate access to therapy for individuals dealing with PTSD. These cards may cover various mental health services, including therapy evaluations, psychotherapy, and medications. The specific coverage depends on the type of medical card and the policies of the insurance provider or assistance program.
For those without insurance, government-funded programs like Medicaid or Medicare may provide financial assistance for therapy services. These programs aim to make mental health care more accessible, ensuring that individuals with PTSD can receive the necessary evaluations and ongoing treatment without facing insurmountable financial barriers.
PTSD Evaluation for Service Connected Disability (VA Rating)
Veterans dealing with PTSD and depression often navigate the VA rating system. Here, we provide clarity on the process, criteria, and potential benefits associated with VA ratings for individuals facing these challenges. Learn more about how to apply with the VA the rating levels.
PTSD Evaluation for Fitness to Return to Duty for First Responders
First responders face unique challenges that demand specialized treatment approaches. We explore tailored interventions and support mechanisms designed to address the distinct needs of this group.
A Fitness for Duty (FFD) evaluation is a comprehensive assessment aimed at determining an individual’s ability to perform their job responsibilities effectively and safely. Employers may request these evaluations when concerns arise about an employee’s physical or mental capacity to fulfill their professional duties. FFD assessments are not limited to addressing mental health issues; they encompass a broad range of factors that may impact an individual’s job performance.
These evaluations typically involve a thorough examination conducted by qualified professionals, including medical practitioners, psychologists, or psychiatrists. The process may include a review of the individual’s medical history, interviews, psychological assessments, and observations relevant to the specific job requirements.
Employers play a crucial role in recognizing the signs of PTSD and providing avenues for employees to seek help without fear of judgment or reprisal. Establishing a workplace culture that encourages open communication about mental health and ensures confidentiality in the evaluation process is essential for creating a conducive environment for seeking help.
Navigating Legal and Ethical Considerations
Fitness for duty and PTSD evaluations in the workplace must adhere to legal and ethical standards to protect the rights and privacy of the individuals being assessed. Employers should ensure that the evaluation process is fair, unbiased, and conducted by qualified professionals. It is important to strike a balance between the organization’s need to maintain a safe and productive work environment and respecting the rights and dignity of the individual undergoing evaluation.
Challenges in Accessing PTSD Evaluations
Despite the importance of therapy in PTSD treatment, many individuals face challenges in accessing timely and affordable evaluations. Stigma, financial constraints, and limited mental health resources can act as barriers, preventing individuals from seeking the help they need. This is where medical cards become instrumental, breaking down financial barriers and ensuring that individuals can access the necessary evaluations and ongoing therapy.
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