When I tell people that I suffer from complex PTSD as a result of various traumas and my abusive marriage, I often get blank stares or questioning looks. So, in hopes of somewhat enlightening those who are fortunate enough to be unfamiliar with PTSD, here is a brief explanation. If you wish, you can, of course, google it and there's a plethora of information available. However, I'll try to give you a sort of 'Reader's Digest Condensed Version' to save you some time.... Honestly, I DID try to keep it short .... REALLY! Portions that are highlighted in red and bolded are things that I can personally relate to and am now experiencing or have experienced in the past.
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Q: What is PTSD, who gets it, and what causes it?
A: Post-traumatic stress disorder (PTSD) is a condition that has both emotional and physical components.
Although it has likely existed since human beings have endured trauma, PTSD has only been recognized as a formal diagnosis since 1980. Before then it was known by a variety of names (usually in connecting with various wars, etc.): soldier's heart, combat fatigue, post-Vietnam syndrome, battle fatigue, and shell shock.
Virtually any event that is (or is perceived as) life-threatening or that severely compromises the physical or emotional well-being of an individual may cause PTSD. Examples include things such as:
(*) experiencing or witnessing a severe accident or physical injury,
(*) being the victim of kidnapping or torture,
(*) exposure to military combat or a disaster (hurricane, plane crash, etc.),
(*) being the victim of rape, mugging, robbery or assault; or
(*) enduring physical, sexual, emotional, or other forms of abuse.
Q: Does everyone who experiences trauma develop PTSD, or are some people more at risk than others?
A: Not everyone who survives traumatic events will develop PTSD. Issues that tend to put people at a higher risk for developing PTSD include:
(*) the individual experienced trauma as a child,
(*) the individual experienced trauma over an extended period of time,
(*) the individual experienced very severe physical and/or emotional pain,
(*) the individual had an emotional condition prior to the trauma (low self-esteem, anxiety, depression, etc.), or
(*) the individual was isolated and had little social support in the form of family or friends.
Q: What are some of the symptoms of PTSD?
A: The three groups of symptoms that are required to assign the diagnosis of PTSD are:
RE-EXPERIENCING, AVOIDANCE/NUMBING, and HYPER-AROUSAL.
Symptoms that fall under re-experiencing are:
• Recurrent and intrusive distressing recollections of the trauma -- including images, thoughts, and/or perceptions
• Body memories (not a conscious recollection of what they are re-experiencing but they will often experience the same physical pain).
• Recurrent distressing dreams of the trauma (nightmares).
• Acting or feeling as if the trauma were recurring (includes a sense of reliving the experience, dissociative flashback episodes, especially upon first awakening from sleep).
• Intense psychological distress at exposure to triggers (internal or external cues that symbolize or resemble an aspect of the trauma). Fear, anxiety, depression, etc. • Intense physical reactions upon exposure to triggers. (Difficulty breathing, pain, nausea, headache, dizziness, numbness/tingling, heart racing, etc.)
Symptoms that fall under avoidance/numbing are:
• Make an effort to avoid thoughts, feelings, or conversations associated with trauma.
• Make an effort to avoid activities, places, or people that arouse recollections of the trauma (for example: avoiding going to the doctor, a former place where the person lived, certain types of clothing, certain rooms, sounds, smells, etc.)
• Inability to recall an important aspect of the trauma.
• Markedly diminished interest or participation in significant activities.
• Feeling of detachment or estrangement from others.
• Restricted range of affect (able to have loving feelings but unable to express anger or vice versa; feeling emotionally numb or "robotic").
Symptoms that fall under hyper-arousal are:
• Difficulty falling or staying asleep.
• Irritability or outbursts of anger.
• Difficulty concentrating. (this is a BIGGIE for me)
• Hyper vigilance (walking on eggshells/always being 'on guard').
• Increased or exaggerated startle response.
In addition, the following groups of symptoms MAY occur in some individuals with PTSD (most commonly seen in response to added stress):
• Impaired ability to regulate emotion.
• Ambivalence.
• Self-destructive and/or impulsive behavior.
• Increased need to be around others.
• Re-enactment of past traumas.
• Dissociative symptoms.
• Feelings of ineffectiveness and incompetency.
• Shame.
• Despair or hopelessness
• Feeling victimized.
• Feeling permanently damaged.
• Loss of previously sustained beliefs.
• Hostility.
• Social withdrawal and isolation.
• Feeling constantly threatened or unsafe.
• Impaired relationships with others.
• Addictions - may try to self-medicate PTSD symptoms with a substance or constantly occupy oneself with activity (work lots of overtime, take on extra projects, etc).
Q: How is one diagnosed with PTSD?
A: At least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or functional impairment in order for the diagnosis of PTSD to be assigned. PTSD is considered of chronic duration if it persists for three months or more.
Q: You say you have complex PTSD. What is that?
A: Complex post-traumatic stress disorder (C-PTSD) is a more complicated/chronic type of the condition that usually results from prolonged exposure to trauma and is characterized by long-lasting problems with many aspects of emotional and social functioning. Basically think of it as PTSD on steroids!
In addition to the symptoms associated with "normal" PTSD, symptoms that tend to be associated with C-PTSD include: significant problems expressing and/or regulating feelings; a tendency to forget the trauma or feel detached from one's life (dissociation) or body (depersonalization); persistent feelings of helplessness, shame, guilt, or being completely different from others; and severe change in those things that give the sufferer meaning (such as a loss of spiritual faith or an ongoing sense of helplessness, hopelessness, or despair).
Q: How is PTSD treated?
A: Since PTSD affects both the body and the mind, effective treatment approaches will generally have both psychological and medical components. Professional help is usually required and one or more of the following may be used:
(*) Education - teaching individuals about what PTSD is, that it is caused by extraordinary stress rather than weakness, how it is treated, and what to expect in treatment. This education thereby increases the likelihood that inaccurate ideas the person may have about the illness are dispelled, and any shame they may feel about having it is minimized. Teaching people with PTSD practical approaches to coping with what can be very intense and disturbing symptoms has been found to be another useful way to treat the illness.
(*) Relaxation - helping sufferers learn how to manage fear & anxiety, improve their communication skills, and use relaxation techniques can help individuals with PTSD gain a sense of mastery over their emotional and physical symptoms.
(*) Cognitive behavioral therapy - helps people with PTSD recognize and adjust trauma-related thoughts and beliefs by educating them about the relationships between thoughts and feelings, exploring common negative thoughts held by traumatized individuals, developing alternative interpretations, and by practicing new ways of looking at things. This treatment also involves practicing learned techniques in real-life situations. (I personally haven't found this to be too helpful as some of my symptoms are bodily responses that just don't seem to respond to this type of therapy.)
(*) Somatic Trauma therapy - In development since 1992, Somatic Trauma Therapy is not a single method, but an integrated system of psychotherapy and body-psychotherapy that continues to evolve as new theory and techniques emerge in the field. Somatic Trauma Therapy addresses all aspects of trauma's impact -- on thinking, emotions, and bodily sensations -- bringing them into sync, and relegating trauma to it's rightful place in the past. So, I guess you could call it a "combo" approach to PTSD. (My own experience with this type of therapy is that it's gut-wrenching, pain-staking work that involves processing the trauma itself, a bit at a time, and re-experiencing it in "real time." This can be excruciatingly painful and exhausting, both emotionally and physically.)
(*) Eye-movement desensitization and reprocessing (EMDR) is a form of cognitive therapy in which the practitioner guides the person with PTSD in talking about the trauma suffered and the negative feelings associated with the events, while focusing on the professional's rapidly moving finger. While some research indicates this treatment may be effective, it is unclear if this is any more effective than cognitive therapy that is done without the use of rapid eye movement. (This technique didn't help me all that much using eye movements. My therapist instead had me close my eyes and she gently tapped the tops of my outstretched hands alternately in a rhythmic manner. This seemed to be a bit more effective for me.)
(*) Directly addressing sleep problems - not only helps alleviate those problems but also helps decrease the symptoms of PTSD in general. Specifically, rehearsing adaptive ways of coping with nightmares (imagery rehearsal therapy), training in relaxation techniques, positive self-talk, and screening for other sleep problems have been found to be particularly helpful in decreasing the sleep problems associated with PTSD. (I currently take a prescription medication to help me get to sleep and stay asleep. Without it, I cannot sleep. I also utilize several relaxation and meditation techniques to help "destress" before bedtime.)
(*) Medications - in some cases medication can help PTSD sufferers by decreasing the physical and emotional symptoms associated with condition. SSRIs are the first group of medications that have achieved approval by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD. These medicines have been found to help PTSD sufferers modify information that is taken in from the environment (stimuli) and to decrease fear. Research also shows that this group of medicines tends to decrease anxiety, depression, and panic. (I'm currently taking prescription medications for anxiety, depression, and insomnia.)
The following quote explains fairly well how PTSD can potentially develop when a person becomes overwhelmed by trauma:
"The human response to danger is a complex, integrated system of reactions, encompassing both body and mind. Threat initially arouses the sympathetic nervous system, causing the person in danger to feel an adrenaline rush and to go into a state of alert. Threat also concentrates a person's attention on the immediate situation. In addition, threat may alter ordinary perceptions: people in danger are often able to disregard hunger, fatigue, or pain. Finally, threat evokes intense feelings of fear and anger. These changes in arousal, attention, perception, and emotion are normal, adaptive responses. They mobilize the threatened person for strenuous action, either in battle or in flight...Traumatic reactions (such as PTSD) occur when action is of no avail. When neither resistance nor escape is possible, the human system of self-defense becomes overwhelmed and disorganized. Each component of the ordinary response to danger, having lost it's utility, tends to persist in an altered and exaggerated state after the actual danger is over....Traumatic events produce profound and lasting changes in physiological arousal, emotion, cognition, and memory. Moreover, traumatic events may sever these normally integrated functions from one another. The traumatized person may experience intense emotion without clear memory of the event, or may remember everything in detail but without emotion."
(From p. 43 of Judith Lewis Herman's book "Trauma and Recovery").
Hope that helps! I welcome any further questions or comments.
