Monday, April 6, 2009

PTSD Healing: Symptom Overview

OK, let’s set the record straight. The more widely known it becomes and the higher profile it has the more those 4 letters P, T, S, D get tossed around and misapplied. I read around online a lot. I often come across blog posts and articles where people are saying things like, “I have PTSD from taking this class,” or, “By the time I quit this job I’m going to have PTSD.” There’s a big difference between not liking your boss and surviving a car wreck.

Before PTSD becomes so ubiquitous everyone forgets that it actually applies to people who have survived extraordinary life-threatening and overwhelming circumstances, let’s lay out the ground rules: You do not have PTSD if you just feel agitated about your course load. You do not have PTSD if your career is in a shambles or you’re experiencing stress in the face of some great existential angst.

The following list of symptoms (provided by Sidran Institute) is the official list of what PTSD looks like. If you recognize yourself in this list, or if you recognize the reflection of someone you love, it’s time to get some professional help, learn what you need to know about your situation, and begin mapping out a strategy to find relief.

The journey to healing begins with recognizing the problem. Here it is, plain and simple:

In the immediate aftermath of trauma – say, the first month or so – many people suffer from Acute Stress, which includes the following symptoms:

Behavioral disturbances
Avoidance of memories related to the trauma

All of these symptoms are part of the normal steps of how trauma survivors process the recent event. However, if these symptoms persist for more than one month (and begin to functionally impair and significantly upset the survivor), then the diagnosis is changed to Post-Traumatic Stress Disorder. According to the DSM-IV Classification this means the subject meets the following six criteria:

A. The person has been exposed to a traumatic event in which both of the following were 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.

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

2. recurrent distressing dreams of the event

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 on awakening or when intoxicated)

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

1. two (or more) of the following:

2. difficulty falling or staying asleep

3. irritability or outbursts of anger

4. difficulty concentrating

5. hypervigilance

6. exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Got it? Good. Now go spread the word. PTSD is a serious emotional response to an incredibly traumatic event. The more we work together to learn what PTSD is and how it presents – the more we educate ourselves – the more quickly all PTSD experiencers will be diagnosed and set on the healing path.

(Photo: jennytrucano)


Anonymous said...

I agree with all of this. PTSD is a serious disorder. It is one that many people confuse with depression, anxiety, and bi-polar disorder.
Complex PTSD is even harder to recover from.
"The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment" by Babette Rothschild is a great resource about somatic memory.

Marj aka Thriver said...

Dang! I realize, with this reminder, that I still deal with a lot of the symptoms of PTSD. Ah well, the climbing of Mt. Everest consists of a series of small steps. At least I'm past the days of DAILY flashbacks and nightmares. Thank goodness!

But, you're right. The acronym is being tossed about way too carelessly these days. Threatens to become a "generic term" like when people say, "I'm depressed."

Michele Rosenthal said...

@anonymous -- What a great comment! I love when we discover new things from each other. I'm unaware of that book -- will pick it up ASAP. I believe very deeply in the memory of the body. Always so much more to learn...

@Marj - As always, love your perspective: in a moment that could have been disturbing, you see the path already accomplished behind rather than the sloping work of the path to come. You are such a sage presence. So glad to have you here.

Donetta said...

You taught me something more about it.I had not thought that the issues of irritability and most all of the "d" section well that relieves some stress to know that it is just no wonder:) I was one of the early trail blazers. Before they knew a lot. It is possible to overcome folks Be courageous.
I have a supportive blog
A life restored.

Michele Rosenthal said...

@Donetta -- Wonderful to have your voice here. It's always good to know others are healing. The more we remember healing is possible the closer we get to making it happen!

Elizabeth Stanfill said...

Great post Michele,

Although, I do believe acute stress disorder can last up to 6 months, it is frightening to know the symptoms of PTSD can truly become who we are, if not treated.

What I mean by become who we are is that we can live with these symptoms everyday and forever if we don't get help.

Also, even though people are self diagnosing themselves with PTSD and over abusing the acronym, there are still many out there who are not diagnosed and are unaware that they may have PTSD. That is why I am so grateful for posts like this.

If someone reads this and recognizes their signs and symptoms they can seek help.

Have a great week.


Michele Rosenthal said...

@Elizabeth - You're so right: PTSD can become who we are because we get so used to living with it. And also, because we believe we have no other choice, which we do!

Just to clarify, Acute Stress Disorder is, actually, relegated to a short period of time specifically to delineate the lines between it and PTSD. Here's an explanation from

Definition -

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms that occur within a month of a traumatic stressor. It is a relatively new diagnostic category and was added to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994 to distinguish time-limited reactions to trauma from the farther-reaching and longer-lasting post-traumatic stress disorder (PTSD). Published by the American Psychiatric Association, the DSM contains diagnostic criteria, research findings, and treatment information for mental disorders. It is the primary reference for mental health professionals in the United States.

Description -

ASD, like PTSD, begins with exposure to an extremely traumatic, horrifying, or terrifying event. Unlike PTSD, however, ASD emerges sooner and abates more quickly; it is also marked by more dissociative symptoms. If left untreated, however, ASD is likely to progress to PTSD. Because the two share many symptoms, some researchers and clinicians question the validity of maintaining separate diagnostic categories. Others explain them as two phases of an extended reaction to traumatic stress.

Anonymous said...

great blogpost.

Michele Rosenthal said...

@sparkling amber - Glad you stopped by. If you find a way to continue Mental Health Camp on the net - another conference online?? - let me know. I wanted to participate but live too far away. But I think community is so important in helping all of us heal...