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Written by Dr Bob
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PTSD is often misdiagnosed and misunderstood. Here we list the symptoms of post-traumatic stress disorder and what you can do to get help.
Symptoms of Trauma
- Difficulty in concentrating
- Changes in appetite or sleep patterns
- Erratic behavior
- Lack of enthusiasm for activities previously considered fun
- Irritability, lethargy, and the desire to stay away from people
These symptoms usually only last a month or so.
Symptoms of PTSD
- Re-experiencing traumatic events (ie, obsessive recollections, flashbacks, nightmares)
- Avoidant symptoms (fear of being with people)
- Signs of hyperarousal (easily startled, irritable)
PTSD usually sets in up to several months after the most recent trauma, and can last years or even a lifetime.
What's Needed
For PTSD, be sure to seek professional help. However, all trauma needs friendly support:
- Encouragement to be with people
- Encouragement to express feelings and fears
- Exchange of needs instead of second-guessing what will help
- Lots of safe exercise, such as walking, and preferably with friends
- Lots of safe exercise, such as walking, and preferably with friends
- Sticking to routines, especially social ones, at home and work
- Reality checks from friends especially around safety (money, job) issues
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Written by Dr Bob
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Over the years my wife, and fellow therapist, Alicia Fortinberry, and I have treated many people who were suffering from what is called post traumatic stress disorder or PTSD including a number of Vietnam veterans. In talking to the vets I noticed that a pattern was developing which caused me to widen my enquiries to veterans who went through the same experiences in Asia, but who did not have the symptoms of PTSD.
I have not had the time to do a formal study, but I have come to some very interesting conclusions regarding the disorder, which have been confirmed by some recent studies. I have become convinced of the strong link between PTSD and depression and between both of those and childhood trauma.
The Origins of PTSD
I have long been interested in the effect of childhood trauma in the development of a number of mood disorders such as depression and dysthemia (a milder form of on-going depression). I believe that depression childhood can be a form of dissociative disorder — a way the child escapes the harsh reality of his or her environment through a slowing down of mental activity. Almost all patients that I have seen who were depressed when they were children were the victims of some sort of abuse: physical, sexual or verbal in the form of criticism or implied threats of violence or abandonment. I am not saying that all depression is the result of childhood trauma or that all children who were abused become clinically depressed, just that in many children there seems to be a causal relationship between early abuse and depression.
In dealing with the vets I found the same sort of relationship -- those who were diagnosed with PTSD tended to have traumatic childhoods and those who were free of PTSD did not.
What is PTSD? Although traumatic events have long been known to cause psychological problems, the disorder itself was first formally characterized in the early 1980s. Even now it is the subject of controversy, with many psychiatrists and clinical psychologists saying a diagnosis of PTSD is meaningless (see articles in recent editions of the British Medical Journal). Personally I do not subscribe to this view, rather I believe the problem is one of inaccurate diagnosis.
Generally speaking PTSD is identified by the following three symptoms: 1) re-experiencing traumatic events (ie, obsessive recollections, flashbacks, nightmares); 2) avoidant symptoms (fear of being with people); and 3) signs of hyperarousal (easily startled, irritable). Traumatized people often suffer from a combination of PTSD, depression and other anxiety disorders.
Often the victims of PTSD are mis-diagnosed. For example, some patients will present more severe symptoms of hyperarousal with severe depression. The re-experiencing of events is often mis-diagnosed as "obsessiveness" within a depressive disorder. Hyperarousal symptoms may be mis-diagnosed as insomnia and anxiety within a major depressive episode. Other PTSD victims are mis-diagnosed with obsessive-compulsive disorder.
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Written by Dr Bob
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Nearly every researcher agrees that early childhood traumas (i.e. those that happen before the age of six) lie at the root of most long-term depression and anxiety, and many emotional and psychological illnesses. Severe traumas can even alter the very chemistry and physiology of the brain itself! Among mental health professionals, and even some childhood development specialists, there is sometimes a lack of understanding over exactly what constitutes childhood trauma.
A seminal 1992 American Academy of Pediatrics (AAP) report defines childhood abuse as "a repeated pattern of damaging interactions between parent(s) [or, presumably, other significant adults] and child that becomes typical of the relationship."
In addition to physical, sexual and verbal abuse, this can include anything that causes the child to feel worthless, unlovable, insecure, and even endangered, or as if his only value lies in meeting someone else's needs. Examples cited in the report include "belittling, degrading or ridiculing a child; making him or her feel unsafe [including threat of abandonment]; failing to express affection, caring and love; neglecting mental health, medical or educational needs."
The AAP also includes parental divorce in the list of potentially harmful events which can traumatize a child.
Many things on the AAP's list of factors leading to childhood trauma benefit from further definition. For example, what do "belittling" or "degrading" mean in terms of a child's development? What actions--or inactions--on the part of parents or child carers would lead little Tommy to feel degraded? Under this category I would include criticism, and even failure to praise him (for accomplishment, for effort as well as just for being a "great kid"), listen to his opinions, and take an interest in his activities or friends. Praise and encouragement are essential to a child's sense of competence and emotional security, and absence of positive feedback can be extremely damaging to a child's self-esteem.
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Written by Dr Bob
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OK so you feel stressed-out. You and most of humanity at some stage in their lives. You know when you feel stressed, you know the symptoms, right? Pulsating heart, sweat, shaking, you've seen them in all the movies. Yeah! You know stress!
Well the experts can't agree, despite the millions of words written on the subject and the billions of dollars spent on research, exactly what stress is, or what causes it, how much stress you need, or how to rid yourself of the stress you don't need. Modern research indicates that stress is a syndrome, a collection of diverse symptoms with multiple causes, biochemical, prenatal and environmental. On the most basic level researchers can't agree whether stress is reactive (e.g. you fail an exam so you get stress) or causative (e.g. you failed the exam because you were prone to stress) or a mixture of both (you weren't going to pass that exam anyway).
The most recent findings indicate that it can be both causative and reactive depending on the stressor and the individual's proneness to stress in general.
Unlike depression, stress does not seem to have an easily identifiable single neurochemical basis and, except in extreme cases, the most successful treatments are non-pharmaceutical. Yet stress and depression are linked in many intricate ways, as researchers are now finding. Maybe the propensity to some forms of stress is a symptom of an underlying depression. Maybe we should begin to see stress as a symptom of something else, not as a problem in itself. But a symptom of what?
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Anxiety & Panic