Do I have PTSD??
“I thought I was going to die!”
“I can’t believe I am still alive and survived that!”
This is what I have heard countless times in my clinical practice from military Veterans to children and adult survivors of physical and sexual abuse.
The Diagnostic and Statistical Manual of Mental Disorders 5 definition of trauma requires “actual or threatened death, serious injury, or sexual violence”  (p. 271).
That being said there are degrees and shades of trauma in most of our lives:
Natural disasters, accidents, illness and injuries for example. All of which can and do fall on a spectrum of how bad was it that happened to me, and what was the context and circumstances of that really really horrible and “oh God I am going to die” event.
These are the categories and types but the other facets of trauma and whether you suffer knowing or unknowingly from Post-Traumatic Stress Disorder (PTSD) require a careful and thorough assessment and trauma-informed care approach for not only a diagnosis but for what’s most important, treatment and moving forward.
How can someone unknowingly have PTSD? Simply stated? Ours defense mechanisms and the minimizing of the event as well as the denial that we are mortal, finite, and dust in the wind, as the song goes. These three factors either separate or in concert with one another has kept the post trauma’s effect unaware undiagnosed and untreated.
Signs and Symptoms of PTSD –
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more)
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
B. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
C. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest or participation in significant activities.
6. Feelings of detachment or estrangement from others.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
D. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
1. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behavior.
4. Exaggerated startle response.
5. Problems with concentration.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
Source: APA, 2013a, pp. 271–272.
What Is Not Talked Out Is Often ACTED OUT
The irritability, poor sleep, avoidance and hypervigilance are all signs of unprocessed thoughts, feelings, meaning and interpretations of “why did this happen to me” and in some cases the survivor’s guilt.
From Post-traumatic Stress Disorder to GROWTH!
People get better, I have seen and been a humbled participant in that healing, reconciliation and growth! I get chills just writing and remembering my clients.
Here’s what might work for you and your healing:
#1 Meeting you right where you are in how far you’ve come since your trauma and the resilience that got you there
#2 Joining up with you in a safe, secure and welcoming setting be it face to face of via tele-health and determining if this will be a good fit for you.
#3 Recommending an evidenced based practice (EBP) as we discuss what those might be and what work they entail: Cognitive Processing Therapy, (CPT) or Prolonged Exposure (PE), or one we devise together. You are the expert on you.
Click below for an appointment!
I have found a lot of unexpected fun and humor as well as a steep steep learning curve coming back to independent clinical social work/counseling. It has been a time of stepping out of comfort zones. This post my 1st on my website and LinkedIn inspired by a new client scrolling through the profiles on www.psychologytoday.com/ looking for a therapist to help them. We meet and its always a job interview with a potential client. Right fit and therapeutic alliance is a big part.
As our session comes to and end, he asks to share some of the text conversations he was having with the therapist friend:
“Sonny Hatfield, don’t know him, quite the Kentucky name, I wouldn’t be surprised if he talks like Fog Horn Leghorn!” It doesn’t get any funnier than that! And it was a right fit. The journey with the client begins.