What are the symptoms of PTSD?

Well, here’s a “quiz” to see if you have classic PTSD symptoms.  This list is based on the diagnostic criteria of the American Psychiatric Association. So it may give you an indication of whether you might want to seek professional help.  However, only a mental health professional can diagnose PTSD, after interviewing you regarding your situation.

Also, if your situation is distressing to you and interfering with your ability to live your life, that’s what we usually call “clinically significant distress.”  Then you don’t necessarily need this “quiz”—you can just go ahead and call a mental health provider for some assistance.   If you are in Colorado Springs, I’ll talk with you for 15 minutes at no charge (719-377-4577).

[If the things you’re having trouble with happened to you as a child, then things might not look exactly like this. There’s a different set of criteria for what we sometimes call complex childhood PTSD.  You can read more about childhood trauma here.]

To have PTSD, each letter category below should apply to you.

A. Exposure

You were exposed to one of the following: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one the following way(s).

[This is “the traumatic event.”]

  1. It happened to you or you actually (physically) witnessed it happen to someone else.
  2. You found out that it happened to a close family member or close friend.
  3. You have been repeatedly exposed to details of these kinds of traumas, even if you didn’t know the people. This typically happens in war or to first responders—police, firefighters, etc., as well as with medical and mental health professionals.

B. Intrusion

At least one of the following things persistently continues to happen:

  1. You have unwanted distressing memories of the event (not just sadness).
  2. You have nightmares about it.
  3. You have flashbacks (you feel like you are re-experiencing some aspect of the event—visually, auditorially, emotionally—or the whole event).
  4. You feel distressed whenever you see or experience certain reminders of the event.
  5. You have unpleasant physical reactions when you are reminded of the event (body tension, nausea, sensations of heat or cold, agitation, elevated heart rate, etc.)

C. Avoidance

You avoid some of the following things that are related to the traumatic event:

  1. Thoughts or feelings related to the event, or
  2. Physical objects or events that remind you of it.

D. Negative changes in thoughts and emotions (you need two of these)

After the traumatic event, you

  1. have difficulty recalling important details of the event
  2. have more negative thoughts about yourself or the world
  3. inappropriately blame yourself or others for the trauma (even though you know it really doesn’t make sense to)
  4. feel bad emotions more often
  5. have less interest in doing things
  6. feel more isolated
  7. have trouble feeling good emotions

E. Negative changes in how you react to things (two of these also)

After the event, you

  1. became more irritable or aggressive
  2. engage in more risky or destructive behavior
  3. are always watching out for bad things (hypervigilance)
  4. are more easily startled
  5. have more difficulty concentrating
  6. have more difficulty sleeping

F. The symptoms above have lasted for more than one month.

The natural process of recovery after a traumatic event lasts a few weeks.

G. The symptoms are distressing to you or interfere with your functioning.

This is how we define mental health problems.  If it bothers you, it’s a problem.

H. The symptoms are not due to medication, substance use, or other illness.

So if you marked one in each of A,B and C, at least two in each of D and E, and F,G and H are also true, then your situation may fit the American Psychiatric Association’s definition of PTSD.  In this case, you might want to see a mental health professional to be sure.  That’s because the above list is simplified in some ways. You may also wish to seek treatment.  PTSD can be successfully treated—there are a number of good therapies available for it.

[Learn more about what we believe PTSD really is and how it works.]

How Trauma Therapy Works

What should I expect from trauma therapy?  How will trauma therapy work?  How will I feel?  Will it take long?  How do I know if it’s going well?

A thousand kinds of trauma

Because trauma can come in many different forms–physical, psychological, sexual, short-term or long-term–trauma therapy will look different for each person.  Some of it will depend on the symptoms you’re facing.  It will depend on your resiliency and your resources.  Yet, no matter what kind of trauma and exactly how it affected you, there are some themes and similarities.  (For a list of classic PTSD symptoms, read here.)

Safety first

The first thing that’s needed to address trauma is safety.  Without it, there can be no recovery.  Why should there be?  Trauma reactions are adaptive–they are actually helpful if you are under threat.  If you’re in the war zone, you’d better wake up at the slightest noise and grab your rifle without thinking.  If you’re in an abusive relationship, you’d better be hypersensitive to your abuser’s moods.  And if you’re being repeatedly beaten or raped week after week, then it’s best if your brain finds a way to just not be there.  Your mind checks you out of reality–it’s the only way to tolerate the intolerable.

But when it’s over, and the traumatic experience isn’t happening anymore, these things, these things that were so helpful while it was happening–they suddenly become symptoms.  You’re avoiding crowds and jumping at small noises, you’re hypersensitive to those around you and fly off the handle at tiny provocations.  Or you find yourself constantly checking out of work, checking out of your marriage.  You don’t feel like you’re there; and that’s because you aren’t.

So where are you?  Well, you’re back in the trauma.  You know it’s over, but your body doesn’t.  As Bessel van der Kolk says, “you have to somehow convince the body that it’s over.”  So it’s not enough for it to actually be over.  You have to somehow fully experience that.  That’s why we start with safety.

Safety means several things.  First, you have to feel safe with your therapist.  If you don’t, find a different one.  Second, you have to be safe in your life.  You can’t still be living with your abuser, you can’t still be tolerating their denial.  You also have to get free from toxic relationships that will trigger your abuse reactions.  For some reason, when we’ve been traumatized, we sometimes unknowingly seek out situations that are similar.  That’s got to stop.  You have to be in control of your life in order to heal.

Remembering

Next comes the heart of the trauma work.  There are many ways to do this.  In the past, it was done with talk therapy alone.  This can work, but it takes a long time (sometimes many years).  Nowadays, we have powerful techniques which are based on working with the body.  They’re often very effective, and usually shorter.  Sometimes a lot shorter.

The techniques of trauma therapy help your brain/body process the memory of the trauma.  Even though you may not remember it well, your body remembers it.  Your body remembers every blow, every word, every move your perpetrator made, and it remembers not only what happend and what you did to try to help and defend yourself, but also what your body wanted to do.  The problem is, this memory is stuck.  The brain hasn’t put it into place, the way it does with normal memories.  Once it has done this, the trauma goes from being something that is still happening to something that happened in the past.  A bad thing, for sure, but a bad thing that is finally over.

There’s a lot to do here.  The charge has to be let out of the body, and the sadness has to be let out of the soul. Trauma therapy work takes some time and effort.  You don’t feel better after every session.  Sometimes you feel a bit worse.  But gradually, as you go through the process, you begin to get relief.  You begin to feel lighter, more clear, more present, more confident and capable, more (dare we say) normal.  You begin to feel more like yourself.

Reconnecting

Once this happens, you can begin to rejoin your life.  You reconnect with others, build new relationships, engage in new activities (or dust off the old ones).  Love, work and play:  All the things that were on hold while you were suffering so much.

How long does it take?  No one can say.  But if it’s going correctly, there should be things happening at almost every step that are helpful to you.  And it can take a lot less time than it used to, if it’s done well.  Some of the modern therapies seem strange (actually, all of the ones that seem to work well seem strange), but they’re pretty powerful.  If you don’t feel anything is happening or changing after a few months, you might want to re-evaluate.  On the other hand, you can’t put a time limit on it, either.  It takes what it takes. Just keep walking downhill and you’ll eventually make it to the river.