With my therapist thinking PTSD is causing more problems for me right now, I wanted to refresh my memory on the disorder. Thought I would share some of the info I am reading with you. The more we know, the more we can help ourselves and/or others.
The following three groups of symptom criteria are required to assign the diagnosis of PTSD in the context of an individual who has a history of being exposed to an actual or perceived threat of death, serious injury, or sexual violence to self or others that does not involve exposure through media unless that is work related:
Recurrent re-experiencing of the trauma (for example, troublesome memories, flashbacks that are usually caused by reminders of the traumatic events, recurring nightmaresabout the trauma and/or dissociative reliving of the trauma): In children, this may include repetitive play about the trauma.
Avoidance to the point of having a phobiaof places, people, and experiences that remind the sufferer of the trauma, or a general numbing of emotional responsiveness.
Negative changes in thinking and trouble remembering important aspects of the trauma, holding negative beliefs about him or herself, a tendency to blame oneself for the trauma, a persistently negative emotional state, inability to have positive emotions, low interest or participation in significant activities, and feeling detached from others
Significant changes in arousal and reactivity related to the traumatic event(s), includingsleep problems, trouble concentrating, irritability, anger, poor concentration, blackouts or difficulty remembering things, reckless or self-destructive behavior, increased tendency and reaction to being startled, and hypervigilance (excessive watchfulness) to threat.
The emotional numbing of PTSD may present as a lack of interest in activities that used to be enjoyed (anhedonia), emotional deadness, distancing oneself from people, and/or a sense of a foreshortened future (for example, not being able to think about the future or make future plans, not believing one will live much longer). At least one re-experiencing symptom, one avoidance symptom, two negative changes in mood or thinking, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or impairment in functioning in order for the diagnosis of PTSD to be assigned.
A similar disorder in terms of symptom repertoire is acute stress disorder. The major differences between the two disorders are that acute stress disorder symptoms persist from three days to one month after the trauma exposure, and a fewer number of traumatic symptoms are required to make the diagnosis as compared to PTSD.
In children, re-experiencing the trauma may occur through repeated play that has trauma-related themes instead of or in addition to memories, and distressing dreams may have more general content rather than of the traumatic event itself. As in adults, at least one re-experiencing symptom, one avoidance/numbing symptom, 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. When symptoms have been present for three days to one month, a diagnosis of acute stress disorder (ASD) can be made.
Symptoms of PTSD that tend to be associated with C-PTSD include problems regulating feelings, which can result in suicidal thoughts, explosive anger, or passive aggressive behaviors, 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, feeling the perpetrator of trauma is all powerful, and preoccupation with either revenge against or allegiance with the perpetrator, and severe change in those things that give the sufferer meaning, like a loss of spiritual faith or an ongoing sense of helplessness, hopelessness, or despair.
My personal traumas include sexual abuse as a child by a friend/neighbors older brother, repetitively taken advantage of sexually during the years I had serious drug addiction problems and was at my worst mentally, a five year physically & psychologically abusive relationship, and during 2013 I was "date raped".
I have dealt with severe anxiety, depression, suicidal thoughts (and attempts), self harm, self loathing, blackouts, rage, insomnia, sexual issues, and more.
What's seems strange to me is I seem to have more issues overcoming what happened during the five year abusive relationship than the sexual abuse I have endured... I still fear my ex. The thought of him causes me panic. The hateful things he said to me still ring in my ears... and it all makes me feel helpless... he still has power over me...
Individuals with PTSD may present with a history of making suicide attempts. In addition to depression and substance-use disorders, the diagnosis of PTSD often co-occurs (is comorbid) with bipolar disorder (manic depression), eating disorders, and other anxiety disorders like obsessive compulsive disorder(OCD), panic disorder, social anxiety disorder, and generalized anxiety disorder.
At age 15 I was diagnosed with Rapid Cycling Bipolar 1 Disorder with Psychotic Tendencies (the P.T. has since been removed from the DX), PTSD, Social & Generalized Anxiety Disorders, and OCD Tendencies.
Treatments for PTSD usually include psychological and medical interventions. Providing information about the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms of PTSD, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness. Education of PTSD sufferers usually involves teaching individuals about what PTSD is, how many others suffer from the same illness, that it is caused by extraordinary stress rather than personal 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. This may be particularly important in populations like military personnel that may feel particularly stigmatized by the idea of seeing a mental-health professional and therefore avoid doing so.
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. Specifically, helping sufferers learn how to manage their anger and anxiety, improve their communication skills, and use breathing and other relaxation techniques can help individuals with PTSD gain a sense of mastery over their emotional and physical symptoms. The health-care professional might also use exposure-based cognitive behavioral therapy by having the person with PTSD recall their traumatic experiences using images or verbal recall while using the coping mechanisms they learned. Individual or group cognitive behavioral psychotherapy can help people with PTSD recognize and adjust trauma-related thoughts and beliefs by educating sufferers 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.
Eye-movement desensitization and reprocessing (EMDR) is a form of cognitive therapy in which the health-care professional 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.
Helping PTSD sufferers maintain their employment and other tasks of their daily lives is an important part of treatment. Occupational therapy (OT) is an important treatment modality in that regard, in that it focuses on rehabilitation and recovery through participation in activities. This can range from assisting helping people with PTSD regain independence in basic self-care to helping them reintegrate into previously held work and community roles. Another potentially powerfully positive activity-based intervention for individuals with PTSD can be the use of a service dog. Particularly toward the completion of more conventional treatments, service dogs have been found to be effective in improving PTSD suffers' sense of safety, responsibility, optimism, and self-awareness.
Families of PTSD individuals, as well as the sufferer, may benefit from family counseling, couples counseling, parenting classes, and conflict-resolution education. Family members may also be able to provide relevant history about their loved one (for example, about emotions and behaviors, drug abuse, sleeping habits, and socialization) that people with the illness are unable or unwilling to share.
Directly addressing the sleep problems that can be part of PTSD has been found to not only help alleviate those problems but to thereby help 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.
Medications that are usually used to help PTSD sufferers include serotonergic antidepressants (SSRIs), like fluoxetine (Prozac), sertraline(Zoloft), and paroxetine (Paxil), and medicines that help decrease the physical symptoms associated with illness, like prazosin(Minipress), clonidine (Catapres), guanfacine(Tenex), and propranolol. Individuals with PTSD are much less likely to experience a relapse of their illness if antidepressant treatment is continued for at least a year. SSRIs are the first group of medications that have received approval by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD. Treatment guidelines provided by the American Psychiatric Association describe these medicines as being particularly helpful for people whose PTSD is the result of trauma that is not combat related. SSRIs tend 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. SSRIs may also help reduce aggression, impulsivity, and suicidal thoughts that can be associated with this disorder. For combat-related PTSD, there is more and more evidence that prazosin can be particularly helpful. Although other medications like duloxetine (Cymbalta), bupropion(Wellbutrin), venlafaxine (Effexor), anddesvenlafaxine (Pristiq) are sometimes used to treat PTSD, there is little research that has studied their effectiveness in treating this illness.
Other less directly effective but nevertheless potentially helpful medications for managing PTSD include mood stabilizers like lamotrigine(Lamictal), tiagabine (Gabitril), and divalproexsodium (Depakote), as well as mood stabilizers that are also antipsychotics, like risperidone(Risperdal), olanzapine (Zyprexa), quetiapine(Seroquel), aripiprazole (Abilify), asenapine (Saphris), and paliperidone (Invega).Antipsychotic medicines seem to be most useful in the treatment of PTSD in those who suffer from agitation, dissociation, hypervigilance, intense suspiciousness (paranoia), or brief breaks in being in touch with reality (brief psychotic reactions). The antipsychotic medications are also being increasingly found to be helpful treatment options for managing PTSD when used in combination with an SSRI.
Benzodiazepines (tranquilizers) such asdiazepam (Valium) and alprazolam (Xanax) have unfortunately been associated with a number of problems, including withdrawal symptoms, and risks of overdose and addiction, and have not been found to be significantly effective for helping individuals with PTSD.
To date we really haven't addressed or treated my PTSD. The focus has always been my Bipolar & Anxiety Disorder diagnosis and symptoms.
My current therapist is trying Seeking Safety Therapy, Dialectical Behavioral Therapy, Individual Therapy, and has mentioned wanting to try EMDR.
Some ways that are often suggested for PTSD patients to cope with this illness include learning more about the disorder as well as talking to friends, family, professionals, and PTSD survivors for support. Joining a support group may be helpful. Other tips include reducing stress by using relaxation techniques (for example, breathing exercises, positive imagery), actively participating in treatment as recommended by professionals, increasing positive lifestyle practices (for example,exercise, healthy eating, distracting oneself through keeping a healthy work schedule if employed, volunteering whether employed or not), and minimizing negative lifestyle practices like substance abuse, social isolation, working to excess, and self-destructive or suicidal behaviors.
Right now I'm stuck in a mixed depression - mania episode with extremely high anxiety so I am just trying to do my best each day. Trying to not be ineffective; haven't cut again, but have drank. Trying to focus on the positive step. And I'm doing a lot better at not drinking than when previously in situation I am in.
One breath at a time. One step at a time. One day at a time.
I must get started on my "homework" for therapy. Hope this info helped someone out there, and maybe sharing some of my story helped too.
Until next time,
Live. Laugh. Love.