What is PTSD?

What is PTSD?
Clinical description followed by personal description and assessment tests.

PTSD stands for post traumatic stress disorder and can be quite frightening, overwhelming and debilitating. As I am not a licensed mental health practitioner, I have borrowed the following official descriptions and terms as excerpts from a few websites (their sites are listed afterwards). I will follow these technical descriptions with my own writings describing my take on PTSD and what it was like for me, and at the end I will include a standardized test I took to determine whether or not I had PTSD. It's my hope that if you too have PTSD, these descriptions and tests can help you to understand yourself and your reactions better, and if you don't have PTSD then perhaps you will understand, connect and help give those who do courage, support and an ear to listen or an arm to hold.


Post-traumatic stress disorder is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death.

PTSD can occur at any age. It can follow a natural disaster such as a flood or fire, or events such as:
Assault
Domestic abuse
Prison stay
Rape
Terrorism
War

The cause of PTSD is unknown. Psychological, genetic, physical, and social factors are involved. PTSD changes the body's response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters).
It is not known why traumatic events cause PTSD in some people but not others. Having a history of trauma may increase your risk for getting PTSD after a recent traumatic event.

Symptoms

Symptoms of PTSD fall into three main categories:

1. "Reliving" the event, which disturbs day-to-day activity
Flashback episodes, where the event seems to be happening again and again
Repeated upsetting memories of the event
Repeated nightmares of the event
Strong, uncomfortable reactions to situations that remind you of the event

2. Avoidance
Emotional "numbing," or feeling as though you don't care about anything
Feeling detached
Being unable to remember important aspects of the trauma
Having a lack of interest in normal activities
Showing less of your moods
Avoiding places, people, or thoughts that remind you of the event
Feeling like you have no future

3. Arousal (I hate this term- a much better term would be "on edge"- there is nothing "arousing" about it!)
Difficulty concentrating
Startling easily
Having an exaggerated response to things that startle you
Feeling more aware (hypervigilance)
Feeling irritable or having outbursts of anger
Having trouble falling or staying asleep

You might feel guilt about the event (including "survivor guilt"). You might also have some of the following symptoms, which are typical of anxiety, stress, and tension:
Agitation or excitability
Dizziness
Fainting
Feeling your heart beat in your chest
Headache

Expectations (prognosis)
You can increase the chance of a good outcome with:
Early diagnosis
Prompt treatment
Strong social support

Complications
Alcohol abuse or otherdrug abuse
Depression
Panic attacks

Although traumatic events can cause distress, not all feelings of distress are symptoms of PTSD. Talk about your feelings with friends and relatives. If your symptoms do not improve soon or are making you very upset, contact your doctor.
Seek help right away if:
You feel overwhelmed
You are thinking of hurting yourself or anybody else
You are unable to control your behavior
You have other very upsetting symptoms of PTSD
You can also contact your doctor for help with problems such as repeated upsetting thoughts, irritability, and problems with sleep.

Excerpts taken from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/
This website seems to be totally spot on with much of what PTSD is like, so I copied quite a bit of their definitions and descriptions. Hopefully this can help you a lot to understand PTSD and how it affects people.

On a side note it's worth mentioning that the symptoms associated with PTSD must exist for longer than 30 days- an excruciating amount of time- in order for the diagnosis to be PTSD. There are other diagnosis that are more accurate if this is not the case. It's important to receive a correct diagnosis as physical makeup and biochemistry is affected differently with different disorders. Symptoms can last for years. It's also common for symptoms to manifest long after the actual traumatic event.


Posttraumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event that results in psychological trauma....overwhelming the individual's ability to cope. As an effect of psychological trauma, PTSD is less frequent and more enduring than the more commonly seen acute stress response. Symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning.

Posttraumatic stress disorder is classified as an anxiety disorder, characterized by aversive anxiety-related experiences, behaviors, and physiological responses that develop after exposure to a psychologically traumatic event (sometimes months after). Its features persist for longer than 30 days, which distinguishes it from the briefer acute stress disorder. These persisting posttraumatic stress symptoms cause significant disruptions of one or more important areas of life function. It has three sub-forms: acute, chronic, and delayed-onset.

PTSD is believed to be caused by either physical trauma or psychological trauma, or more frequently a combination of both. According to Atkinson et al. (2000) PTSD is more likely to be caused by physical or psychological trauma caused by humans — such as rape, war, or terrorist attack — than by trauma caused by natural disasters. Preliminary research suggests that child abuse may interact with mutations in a stress-related gene to increase the risk of PTSD in adults.

PTSD displays biochemical changes in the brain and body that differ from other psychiatric disorders such as major depression... Translating this reaction to human conditions gives a pathophysiological explanation for PTSD by a maladaptive learning pathway to fear response through a hypersensitive, hyperreactive and hyperresponsive HPA axis.

Recently, it has been found that several single-nucleotide polymorphisms (SNPs) in FK506 binding protein 5 (FKBP5) interact with childhood trauma to predict severity of adult PTSD. These findings suggest that individuals with these SNPs who are abused as children are more susceptible to PTSD as adults. This is particularly interesting given that FKBP5 SNPs have previously been associated with peritraumatic dissociation (that is, dissociation at the time of the trauma), which has itself been shown to be predictive of PTSD.

Although most people (50-90%) encounter trauma over a lifetime, only about 8% develop full PTSD. Vulnerability to PTSD presumably stems from an interaction of biological diathesis, early childhood developmental experiences, and trauma severity. Predictor models have consistently found that childhood trauma, chronic adversity, and familial stressors increase risk for PTSD as well as risk for biological markers of risk for PTSD after a traumatic event in adulthood.

These excerpts were taken from http://en.m.wikipedia.org/wiki/Posttraumatic_stress_disorder
This site is terribly interesting and goes into scientific detail (which I tried hard not to post here) on what PTSD does from a biochemical, genetic and psychological perspective. I find it delightfully fascinating!



Over the years I've written many different types of writings that effectively describe different points along the spectrum- varying degrees- of PTSD by describing thoughts and emotions, essentially showing the mindset of a person with PTSD. These writings will be scattered throughout my blog (possibly as I locate them). Below is my own description I've used in various correspondence to help people in a more business mindset try to understand (if they cared to) what PTSD has been for me and my own personal challenges associated with it. I've mostly used this writing to validate my experience in an attempt for employment with the federal government or as supporting evidence as to why I need to be allowed access to my support network when necessary.

PTSD is a storm, a hurricane of ancient memories (many of which you didn't know were there as during trauma they are buried), ancient feelings, ancient thoughts, many of which don't make sense anymore as you thought they were already dismissed, already over. They don't feel like they are your own. They don't belong anymore, if they ever belonged at all (even just admitting something like that happened to you makes you a victim- who wants to acknowledge themselves as a victim???). You are not the same person as 10 years ago, the act of rape itself has no origins in you- it is a foreign thought that once perpetrated against you produces foreign thoughts, emotions, and physical responses.

It's trying to understand and deal with thoughts, feelings, emotions, and physical responses that are not understandable, let alone unthinkable to most people. It's trying to make sense of the non-sensical. To a rational person not guided by emotions, the storm that is PTSD is alien, does not exist in a rational world dictated by science and reason, and is therefore an inescapable nightmare. (And from a militaristic perspective, how can you control or defeat something that defies the very laws of existence, of reason?). Everything, all the pent up emotion over the years, comes flooding back out- the wound is continuously re-opened, the pain re-experienced to compounding degrees.

PTSD is an overtaking of the mind. It's a full on siege to your thoughts, emotions and physical responses. It is unrelenting even in sleep and activities that under normal or desirable circumstances would produce a hypnotized or catatonic effect (like movie watching for example). It causes one to remain tiringly aware of all surroundings- all people and their actions, all things and their actions or inactions, at every place you happen to be. It often creates enough anxiety to pressure a person to plan a daily schedule on this anxiety often leading to seclusion and separation from life and society. It creates social roadblocks as the only thoughts and images in your mind are not those that originate with you, but with the experience of the traumatic event and the direct results of it. Often you find yourself socially awkward with no one to understand you which produces more thoughts of complete isolation leading to more depression and anxiety. When another remotely stressful or traumatic situation occurs, especially one that triggers similar thoughts, emotions or physical responses to the traumatic event, you can't handle it and find your responses to be completely inappropriate and at the very least, overreactive. Everything becomes overwhelming. Everything and everyone require so much out of you, and you're not there anymore. You are missing. Your day involves trying to find and keep tiny fragments that were once part of your whole. Were you ever whole once? You can't remember as all you know is suffering, pain, anxiety, and everything about the traumatic experience. That is your only daily reality.

PTSD is debilitating, terrifying, alienating, intense, aggressive, and out of control.

PTSD is also a definitive instigator of change. For better or worse it effectually wipes your old life away and creates an insanely turbulent existence that to calm requires massive change. Realization, admission, acceptance, learning, listening, watching, letting go- these are all elements that must happen for PTSD to subside. PTSD is change and produces change on a massive scale. Although you may not realize it for a while, things are changing on a massive scale for someone with PTSD. It allows a person to forget what was once enjoyable or desirable and to start anew on a voyage of self discovery in all areas of life. PTSD is an opportunity for positive change and massive personal growth that even of itself will produce even more change. It just takes a little buildup of speed and hopefully a nudge in a positive direction for the ball to get rolling.

"Who will tell whether one happy moment of love or the joy of breathing or walking on a bright morning and smelling the fresh air, is not worth all the suffering and effort which life implies."
Erich Fromm


What follows is a standardized assessment used by mental health practitioners to determine if you have PTSD or not.
*DISCLAIMER*
I am not a licensed mental health practitioner. The purpose of these standardized tests and measures is for your own peace of mind if you think you may have PTSD. If you believe yourself to have PTSD, or any other mental health issue, it's imperative you seek professional assistance from either your doctor or a licensed mental health practitioner. These are often found at community health centers at reasonable rates, sliding scale, or even free of charge. Please see the support tab above for more resources. Also keep in mind that symptoms may wax and wane- you may feel fine again for a while only to have symptoms flare up later. Please seek professional help and have a plan of action in mind for when symptoms become worse.


GAIN-SS

The first test is a GAIN-SS test. It is to determine if you need to see someone about your symptoms (could be PTSD, could be another issue). Each question is answered with a yes or no. A yes answer indicates your symptoms have persisted for more than 2 weeks, they keep coming back, they keep you from meeting your responsibilities or they make your life stop abruptly. They are all to be answered in the time frame of the past 12 months. There are 3 sections- each yes answer counts as a point for each section. The higher the score, the more imperative it is for you to see someone.

During the past 12 months have you had significant problems...
1. With feeling very trapped, lonely, sad, blue, depressed, or hopeless about the future?
2. With sleep trouble, such as bad dreams, sleeping restlessly, or falling asleep during the day?
3. With feeling very anxious, nervous, tense, scared, panicked or like something bad was going to happen?
4. When something reminded you of the past, you became very distressed and upset?
5. With thinking of ending your life or committing suicide?
Total your yes responses for this section.

During the past 12 months did you do the following things two or more times?
1. Lie or con to get things you wanted or to avoid having to do something?
2. Have a hard time paying attention at school, work, or home?
3. Have a hard time listening to instructions at school, work, or home?
4. Been a bully or threatened other people?
5. Start fights with other people?
Total your yes responses for this section.

During the past 12 months did...
1. You use drugs or alcohol weekly?
2. You spend a lot of time either getting alcohol or drugs, using alcohol or drugs, or feeling the effects of alcohol or drugs (high, sick)?
3. You keep using alcohol or drugs even though it was causing social problems, leading to fights, or getting you into trouble with other people?
4. Your use of alcohol or drugs cause you to give up, reduce or have problems at important activities at work, school, home, or social events?
5. You have withdrawal problems from alcohol or drugs like shaking hands, throwing up, having trouble sitting still or sleeping, or use any alcohol or drugs to stop being sick or void withdrawal problems?
Total your yea responses for this section.

If you scored high in any section you should see someone. The higher you scored overall, the more imperative it is to see someone, however if you think you have a problem and still didn't score high, you should still see someone.


PTSD Symptom Scale (PSS)

This next test is to help determine what if any traumatic events you may have witnessed. The more traumatic events you have survived, the more likely these experiences have compounded to produce a stress response. The more there are, the more varied your responses to stress could be (triggers), and the more layers you may have to dig through. This list is not at all comprehensive, and after stress responses begin to compound simplistic things can become potential stress triggers- this form is just a starting point, a way to produce dialogue between therapist and client to lead to more revelations. This form is here to help open your eyes to the vast possibilities of traumatic events and to help you identify possible origins within you as a starting point for dissection.

Below is a list of traumatic events or situations. Please mark YES if you have experienced or witnessed the following events or mark NO if you have not had that experience.

1. Serious accident, fire, or explosion
2. Natural disaster (tornado, flood, hurricane, major earthquake)
3. Non-sexual assault by someone you know (physically attacked or injured)
4. Non-sexual assault by a stranger
5. Sexual assault by a family member or someone you know
6. Sexual assault by a stranger
7. Military combat or a war zone
8. Sexual contact before you were age 18 with someone who was 5 years or more older than you
9. Imprisonment
10. Torture
11. Life-threatening illness
12. Other traumatic event
13. If "other traumatic event" is answered with a YES above, please write what the event was
14. Of the questions you answered YES, which was the worst
15. Which of the above incidences specifically is the reason for which you are currently seeking treatment

If you answered NO to all of the above questions, STOP this questionnaire (you may or may not actually have PTSD)
If you answered YES to any of the above questions, please complete the rest of the form

Please answer YES or NO regarding the event listed in question 15
We're you physically injured?
Was someone else physically injured?
Did you think your life was in danger?
Did you think someone else's life was in danger?
Did you feel helpless?
Did you feel terrified?

This part of the form is to evaluate how severe your PTSD may be. It is to monitor and re-evaluate what progress is made. It doesn't matter how bad the PTSD, if you have PTSD you should see a professional to discuss possible treatment options and understand what's available to you.

Below is a list of problems that people sometimes have after experiencing a traumatic event. Please rate on a scale from 0-3 how often or how much these following things have occurred to you.

0 Not at all
1 Once per week or less/ a little bit/ once in a while
2 2 to 4 times per week/ somewhat/ half the time
3 3 to 5 or more times per week/ very much/ almost always

1. Having upsetting thoughts or images about the traumatic event that come into your head when you did not want them to
2. Having bad dreams or nightmares about the traumatic event
3. Reliving the traumatic event (acting as if it were happening again)
4. Feeling emotionally upset when you are reminded of the traumatic event
5. Experiencing physical reactions when reminded of the traumatic event (sweating, increased heart rate, etc)
6. Trying not to think or talk about the traumatic event
7. Trying to avoid activities or people that remind you of the traumatic event
8. Not being able to remember an important part of the traumatic event
9. Having much less interest or participating much less often in important activities
10. Feeling distant or cut off from the people around you
11. Feeling emotionally numb (unable to cry or have loving feelings)
12. Feeling as if your future plans or hopes will not come true
13. Having trouble falling or staying asleep
14. Feeling irritable or having fits of anger
15. Having trouble concentrating
16. Being overly alert
17. Being jumpy or easily startled

Please mark YES or NO if the problems above interfered with the following...
1. Work
2. Household duties
3. Friendships
4. Fun/leisure activities
5. Schoolwork
6. Family relationships
7. Sex life
8. General life satisfaction
9. Overall functioning


PTSD Checklist- Civilian Version (PCL-C)

Below is another test designed to gauge and monitor symptoms of PTSD.
Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully and rate them using the scale below to indicate how much you have been bothered by that problem in the last month.

Rating Scale
1 Not at all
2 A little bit
3 Moderately
4 Quite a bit
5 Extremely

Rate these responses using the scale above...
1. Repeated, disturbing memories, thoughts, or images of a stressful experience from the past
2. Repeated, disturbing dreams of a stressful experience from the past
3. Suddenly acting or feeling as if a stressful experience were happening again (as if you were reliving it)
4. Feeling very upset when something reminded you of a stressful experience from the past
5. Having physical reactions (eg. heart pounding, trouble breathing, or sweating) when something reminded you of a stressful experience from the past
6. Avoiding thinking about or talking about a stressful experience from the past or avoid having feelings related to it
7. Avoiding activities or situations because they remind you of a stressful experience from the past
8. Trouble remembering important parts of a stressful experience from the past
9. Loss of interest in things that you used to enjoy
10. Feeling distant or cut off from other people
11. Feeling emotionally numb or being unable to have loving feelings for those close to you
12. Feeling as if your future will somehow be cut short
13. Trouble falling or staying asleep
14. Feeling irritable or having angry outbursts
15. Having difficulty concentrating
16. Being super alert or watchful or on guard
17. Feeling jumpy or easily startled


Untitled test

Indicate how much you have been bothered by each symptom during the past week, including today, by writing a numerical equivelant to how you've been feeling. There are four general categories for severity with a window of numerical values corresponding to each category to refine severity of symptoms.

Rating Scale
Not at all 0-7
Mildly (it did not bother me much) 8-15
Moderately (it was very unpleasant but I could stand it) 16-25
Severely (I could barely stand it) 26-63

Choose a category and pick a numerical value corresponding to symptoms for each of the following...

Numbness or tingling
Feeling hot
Wobbliness in legs
Unable to relax
Fear of the worst happening
Dizzy or lighthearted
Heart pounding or racing
Unsteady
Terrified
Nervous
Feelings of choking
Hands trembling
Shaky
Fear of losing control
Difficulty breathing
Fear of dying
Scared
I digesting or discomfort in abdomen
Faint
Face flushed
Sweating (not due to heat)

Add up a total from the numerical values recorded.

Score
Minimal= 0-7
Mild= 8-15
Moderate= 16-25
Severe= 26- 63