Thursday, January 21, 2010
Post Traumatic Stress Disorder, Part 1
I've been thinking about the fact that I specialize in treating Post Traumatic Stress Disorder (PTSD) but have never written about it on my blog. I'm not sure why that is exactly. I think partly because I'm afraid that once I get started talking about it, I won't be able to stop! I also worry that I will begin to get long-winded and technical in my discussion of PTSD and lose many of my readers. I think it's important to begin my discussion on this and trust my ability to rein myself in as needed. Thank God for "edit posts" option. Here goes...
What is PTSD?
Well, first of all, for any of you who are unfamiliar with PTSD, let me define it for you. I'm going to define it according to "professional standards," but will put it in everyday terms. A traumatic event is one in which you fear that either yourself or another person is going to be seriously injured or killed. Many people face events like this but do not develop PTSD. Post-Traumatic Stress Disorder develops when, after the traumatic event is over, you continue to feel like you are still experiencing it. You may re-experience it through intrusive memories or flashbacks of the trauma. You may have nightmares of the event or at times literally feel in your body as if the event were happening right now. Also with PTSD you will go to extreme lengths to avoid situations or people that remind you of the trauma. It is common that we sometimes experience these types of symptoms immediately after a traumatic event, such as losing a loved one. The difference between a normal stress reaction and PTSD is that in a normal stress reaction, these symptoms tend to dissipate after one month. Also, in a normal stress reaction, you tend to maintain some level of control over your response and your life is not shattered irreversibly after the event. For example, you may face a horrifying event and be really shaken up about it for weeks afterward. Over the course of the next few months you find that you are able to leave your home, continue with work, and the anxiety does not rule your life. With PTSD, it is not uncommon for people to not experience any symptoms until months or years after the event occurred.
These are the technical criteria for PTSD:
1. A person is exposed to a traumatic event and has a response of intense fear, helplessness, or horror.
2. The traumatic event is persistently re-experienced (i.e., intrusive memories, flashbacks, nightmares, intense distress when exposed to cues or reminders of the trauma, etc.)
3. Persistent avoidance of people/situations related to the event (i.e., unwillingness to discuss the event, inability to recall details of the event or maybe extremely sharp memories of detail, withdrawal from everyday living and people in general)
4. Increased arousal, that is, "hyped-up" behavior-- you may be hyper-alert, on edge, on the watch, difficulty falling asleep or staying asleep, irritable/angry, difficulty concentrating, exaggerated startle response
5. The duration of these symptoms last longer than one month and cause "clinically significant distress or impairment in social, occupational, or other important areas of functioning."
How Does PTSD Happen?
Our brain is an intricate road map of neural pathways. There are happy and pleasant pathways in our brain and then there are some terrifying (though life-saving) pathways as well. An example of this is the fight or flight response. We've all most likely experienced having our fight or flight pathway being activated. Your heart rate accelerates. You go into survival mode. You may freeze up and feel unable to speak. You can feel every hair all over your entire body stand on end. Or you may turn into someone you don't recognize and display tremendous strength or ferocious aggression and fighting back. It's a critical part of our human make-up that we have this response. It keeps us alive in many terrifying situations and has for eons now.
Things go awry if this fight or flight response gets activated when there is not actually any terrifying event occurring. Someone with PTSD who has a history of physical abuse from a parent may be triggered into fight or flight years later when someone in the grocery store bumps into them roughly by accident. A child who was sexually abused in a bathroom may continue to experience intense anxiety about going to the bathroom years later. A war veteran who saw a friend killed in combat may continue to experience a feeling of hypervigilance and anxiety at the sound of loud trucks or booms. When someone has PTSD, their brain continues to categorize many events as "danger," when, in reality, there is no present danger. This categorization is not under control of the person and happens too quickly to be stopped many times. Once the woman in the grocery store was bumped by a stranger, the brain quickly perceived this event as life-threatening and activated a neural pathway of "high alert." Once the neural pathway is activated, it's like a loop with no end. She's driving on this pathway that just goes around and around with no exit.
As you can imagine, this is a miserable way to live. Often people with PTSD are going through their everyday living being triggered by voices, scents, perceived threats or sounds. These people are unaware themselves what is happening within them, not understanding what just triggered intense anger or anxiety. Many people with PTSD have no clue that they symptoms they are experiencing have anything at all to do with a traumatic event that likely occurred years ago. Or, if they do have some suspicion that their present anxiety is related to event(s) from the past, they are not fully aware of the extent to which their very personality is being shaped by fear and a need to avoid.
There Is Hope
PTSD does not have to be a life-long disorder. There are good and effective treatments for PTSD that are backed by research. The most effective treatments for PTSD aim to help people access helpful and positive neural pathways in the brain, when triggered, rather than falling into the fight or flight loop. This is what is being done in narrative and cognitive behavioral therapies that create positive and helpful pathways then, through repetition, link them with the traumatic event and triggers of the event. Eye Movement Desensitization and Reprocessing (EMDR) is a type of therapy that literally retrains the brain through the use of eye movements to access helpful networks in the brain. I love EMDR and use it often in my practice. It often brings immediate relief to those suffering with PTSD. I have personally seen countless children and adults suffering with PTSD go bravely through treatment and lose their diagnosis. I have watched these people begin to experience relief from symptoms within weeks and months of treatment. If you have PTSD, you do not have to suffer or self-medicate for relief (this is another blog post!). There is treatment available to help you. I believe the human mind wants to heal itself and sometimes it just gets stuck. It is good to seek the assistance of a trained professional to help the broken record get un-stuck and get you back on the right track.
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