Defining PTSD

Post Traumatic Stress Disorder is a mental illness with a number of symptoms.

In this section I will lay out diagnostic criteria and other signs and common symptoms of PTSD first, and then other trauma based responses. The following information about PTSD is taken directly from a site called HelpGuide.org.  I am using it rather than the DSM 5 because it is the clearest explanation I could find. It is based directly on the DSM 5 criteria.[1]

Notice in particular that there are four clusters of symptoms: re-experiencing trauma, avoidance and numbing, hyperarousal, and negative thoughts and mood changes.

The text below is taken verbatim from: HelpGuide.org) Accessed Dec 29, 2017

PTSD vs. a normal response to traumatic events

The traumatic events that lead to post-traumatic stress disorder are usually so overwhelming and frightening that they would upset anyone. Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD. When your sense of safety and trust are shattered, it’s normal to feel crazy, disconnected, or numb. It’s very common to have bad dreams, feel fearful, and find it difficult to stop thinking about what happened. These are normal reactions to abnormal events.

For most people, however, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift. But if you have post-traumatic stress disorder (PTSD), the symptoms don’t decrease. You don’t feel a little better each day. In fact, you may start to feel worse.

A normal response to trauma becomes PTSD when you get stuck

After a traumatic experience, the mind and the body are in shock. But as you make sense of what happened and process your emotions, you come out of it. With post-traumatic stress disorder (PTSD), however, you remain in psychological shock. Your memory of what happened and your feelings about it are disconnected. In order to move on, it’s important to face and feel your memories and emotions.

Signs and symptoms of PTSD

PTSD develops differently from person to person because everyone’s nervous system and tolerance for stress is a little different. While you’re most likely to develop symptoms of PTSD in the hours or days following a traumatic event, it can sometimes take weeks, months, or even years before they appear. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell.

While everyone experiences PTSD differently, there are four main types of symptoms.

Symptoms of PTSD #1: Re-experiencing the traumatic event

  • Intrusive, upsetting memories of the event
  • Flashbacks (acting or feeling like the event is happening again)
  • Nightmares (either of the event or of other frightening things)
  • Feelings of intense distress when reminded of the trauma
  • Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating)

Symptoms of PTSD #2: Avoidance and numbing

  • Avoiding activities, places, thoughts, or feelings that remind you of the trauma
  • Inability to remember important aspects of the trauma
  • Loss of interest in activities and life in general
  • Feeling detached from others and emotionally numb
  • Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)

Symptoms of PTSD #3: Hyperarousal

  • Sleep problems
  • Irritability or angry outbursts
  • Hypervigilance (on constant “red alert”)
  • Feeling jumpy and easily startled
  • Aggressive, self-destructive, or reckless behavior

Symptoms of PTSD #4: Negative thought & mood changes

  • Guilt, shame, or self-blame
  • Feeling alienated and alone
  • Feelings of mistrust and betrayal
  • Difficulty concentrating or remembering things
  • Depression and hopelessness
PTSD symptoms in children
In children—especially very young children—the symptoms of PTSD can be different from adults and may include:
Fear of being separated from parent
Losing previously-acquired skills (such as toilet training)
Sleep problems and nightmares
Somber, compulsive play in which themes or aspects of the trauma are repeated
New phobias and anxieties that seem unrelated to the trauma (such as a fear of monsters)
Acting out the trauma through play, stories, or drawings
Aches and pains with no apparent cause
Irritability and aggression

PTSD causes and risk factors

While it’s impossible to predict who will develop PTSD in response to trauma, there are certain risk factors that increase your vulnerability.

Many risk factors revolve around the nature of the traumatic event itself. Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.

Other risk factors for PTSD include:

  • Previous traumatic experiences, especially in early life
  • Family history of PTSD or depression
  • History of physical or sexual abuse
  • History of substance abuse
  • History of depression, anxiety, or another mental illness
  • High level of stress in everyday life
  • Lack of support after the trauma
  • Lack of coping skills

(From HelpGuide.org) Accessed Dec 29, 2017

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The Importance Of Avoidance Symptoms

A major factor to consider is that the second category of the disorder are symptoms that are around avoidance and numbing, that is, finding ways to avoid acknowledging or dealing with trauma. This is crucial to our cultural predicament.  We all know we are-as a species- we are  out of control, but yet we can’t seem to stop ourselves.  I believe this is in large part because  avoidance symptoms that are part of individual PTSD.  I believe that these same avoidance symptoms show up in Cultural PTSD.

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Trauma based symptoms that do not rise to the level of PTSD can include a variety of things that range in seriousness. People often function well enough to lead productive enough lives and just learn to live with the symptoms. Other people will come in to counseling because they are having difficulty in specific areas such as:

  • Trouble being close with others-Not able to feel close to anyone
  • Social anxieties- afraid of people, can show up as aloofness as well
  • Arguing, not able to get along
  • Low self esteem, feelings of inferiority
  • Picking partners that will not be suitable in some way
  • Picking irresponsible or dangerous partners
  • Domestic Violence
  • Control issues
  • Being overly critical
  • Being easily irritated/defensive
  • Being overly protective
  • Unwillingness to set or achieve goals
  • Problems with sex
  • Anxiety levels that are unwarranted about a variety of things
  • Anxiety about the safety of family and friends
  • Anxiety about personal safety in general
  • Distrust of others
  • Worries about job security, finances, the future in general
  • Worries about social standing
  • Problems with or inability to enjoy relaxation
  • Depressive symptoms
  • Sense of hopelessness
  • Sense of despair
  • Suicidality
  • Concentration issues
  • Not able to care about others or be interested in life
  • Feeling numb, vaguely down
  • Problems setting goals
  • Low levels of ambition
  • Substance abuse issues
  • Legal problems
  • Problems sleeping

Trauma Informed Care

If a person has just one or two of these symptoms by themselves, and they come in for help, sometimes they get misdiagnosed.  For example take a person functioning well enough, but comes in because “I feel sort of numb, I’m not really enjoying life.” Up until recently, most clinicians wouldn’t think about trauma immediately when diagnosing. And some still don’t. But a growing number in the helping fields are becoming aware of the wide ranging effects of trauma on people.

In addition to individual practitioners becoming better able to perceive and treat trauma based responses (TBRs), many agencies in the helping fields have become aware of TBRs and how people coming into their agencies might be responding to the agency policies. This awareness is called Trauma Informed Care.[2]  Basically, it’s an organizational level awareness to make sure agency policies and services don’t accidentally trigger TBRs, or re-traumatize people. In light of this awareness, agencies strive to make their processes and policies more helpful to those dealing with trauma based symptoms. This will be a useful model for creating Trauma Informed Governance Models.

More About Symptoms

As mentioned earlier, trauma based responses are incredibly common when dealing with people in mental health settings. It is also very common for clinicians to notice trauma based responses or symptoms in people, bring the subject up, and have the person (initially) deny or minimize the impact of trauma on their current behaviors and coping skills.

Trauma Is Often Unrecognized As A Catalyst

A good percentage of people have no inkling that their anxieties, depression, relationship issues, or other issues can be traced back to or triggered by trauma that happened -often times- many years ago. It’s not uncommon to have a person flat out say no, they did not have any major traumas as a child, only to find out later that they had lived through situations that were clearly traumatic.

Often people don’t want to believe trauma events affected them in the long term. They will attribute their trauma responses to outside factors. They do this because it is very painful and frightening to think about or deal with trauma.

This is understandable. No one likes to think about traumatic events. Even thinking about fictional trauma can be painful and change our autonomic systems. You can observe changes in your own body as you read a suspenseful book. If our autonomic systems can be triggered by simply imagining a fictional scene, think about how people’s systems respond when they are faced with having to think about real trauma experiences.

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[1] The DSM 5 is written for professionals in technical language.  We use it in the US, but most of the rest of the world uses the ICD10, and, in fact, all US insurances require ICD10 diagnoses for reimbursement, not those from the DSM. The DSM 5 added an entire category called Trauma and Stressor Related Disorders to its classification system which brings it more in line with the ICD 10. Both classification systems use very similar symptoms for diagnosing.  see also The DSM 5 changes explained by the VA

[2] Trauma Informed Care addresses organizational issues, such as impersonal intake systems that frighten or alienate people with TBRs.  It is sometimes used interchangeably to also describe and individual practitioner’s level of knowledge about TBRs. This is SAMHSA’s PDF on the topic. http://www.traumainformedcareproject.org/resources/SAMHSA%20TIC.pdf