Trauma

What happens when terrible things happen to us?

We frequently help people with PTSD, so let's review some of those experiences.

During a traumatic experience, a person may feel like they are going to die and lack power and control over their situation. During this, a toxic amount of chemicals are released into the brain and can create damage if these elevated levels are sustained over a significant period.

This is a critical crossroads. Not all people who experience trauma or the same level of trauma develop PTSD. Trauma plays an important role but is not the whole story. Consider soldiers. Often, a group of soldiers will experience the same or similar trauma; out of that group, a small number may develop PTSD from that experience. It is believed that there is a physical and psychological resiliency that some individuals have to help them resist the development of PTSD. What we frequently see in soldiers is some soldiers who did not initially develop PTSD developed PTSD eventually after multiple tours of combat. This indicates that numerous prolonged exposures to the above toxic effects of elevated fight or flight hormones play a role in developing PTSD.

There is something that we now hear frequently brought up, and that is a non-DSM term called complex PTSD. Complex PTSD was a term brought about in the discussion of soldiers, explicitly acknowledging the significant difference in experience. PTSD, as frequently described in civilian life, is a single trauma even. PTSD for soldiers can often be multiple, repeated, prolonged events. Complex PTSD specifically can occur in civilians but may be overused.

Let's clarify something up front regarding PTSD and treatment. PTSD is a disorder that implies a current deficit in functioning secondary to the disorder. PTSD is not incurable and doesn't have to be lifelong. The first thing we always assess is, "how is this trauma affecting you now?"

Let's walk through a simple case of PTSD. A person has a single trauma event and develops PTSD from that trauma. PTSD is a combination of emotions and memories. Anything that triggers a memory related to the trauma, consciously or subconsciously, can elicit an emotional response. Things that are not obviously related to the trauma may elicit an emotional response. There are many variations of this, but commonly, a person will start to avoid things. Avoidance is one of the most common coping skills (see the shrinking world phenomena). Hyper-vigilance is the next. Hyper-vigilance looks like finding seating in restaurants and waiting rooms that give you a full view of the room, shelter, and an easy exit. It often also includes an increased startle and jumpiness. Nightmares. Flashbacks.

Shrinking world: As avoidance is often the primary coping skill for many with PTSD, let's look at the shrinking world phenomenon. Initially, a person developing PTSD (after the acute phase of trauma) will start to avoid things they used to do. The list of things avoided will be relatively small, to begin with. However, a person will start to avoid things next to the things they are avoiding. For instance, if they avoid a particular place, they might avoid the roads next to it. Then avoid highways in that town, then avoid roads in general. Eventually, a person will not want to leave their home. The home will be locked, and the doors and windows will be closed. Curtains will be drawn. A weapon will be within arms reach. In severe cases, the person will not want to leave their room.

(Trigger warning, this section may upset some) Some of the politics behind PTSD and why there is conflict behind this diagnosis. PTSD is rare because it is one of the few diagnoses people seek as it validates their experience or provides financial gain. It is well known that many soldiers have PTSD; what is less well known is how few VA benefits you get w/o a service-oriented injury or how many benefits you can get with service-connected injuries. So specifically, in the VA, people are financially incentivized to be ill; the worse their condition, the higher their compensation (this is how it was when I worked for the VA). The second reason people seek out the PTSD diagnosis is that it validates their experience. A medical label for your injury encourages others to empathize with your painful experience.