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.]

Trauma and Resiliency

Trauma is an everyday occurrence in our world.  Everyone experiences it at some point or another.  Whether it’s something “normal” like an auto accident or surgery, or whether it’s something more unusual, like an attack, abuse, combat or seeing someone killed, it happens to a lot of people.  But most people recover fairly well, and don’t develop severe symptoms of PTSD.  Aftereffects are limited to a few days or weeks after the event, and people soon return to living their lives as before, at least mostly.  We say these people have more resiliency.

However, for many others, the effects last longer and are more disruptive.  They manifest as physical illnesses and sudden thoughts and feelings that can make normal functioning difficult, if not impossible. What makes the difference?  Why is it that two people who experience the same thing see such different results?

Differences that make a difference

Well, first let’s address that word same.  No two people are the same in terms of body chemistry, personality and life experiences or many other factors.  That means that no two people ever experience the same trauma in the same way.  Even if we’re sitting next to each other when the car goes into the pole, it’s not the same event for us.  And some of the differences can make all the difference in the world, in terms of resiliency.

First, there are differences in how things went down.  People who are able to do something about what’s happening, who are able to maintain some level of control, are not nearly as traumatized.  Perhaps you got away from one threat but succumbed to something else.  Maybe you were able to soften the blows somehow.  Perhaps someone came to your aid, or you were able to come to someone else’s.  These aspects of being in control are important.  The less control, the more severe the trauma.

Another thing that matters is how connected you are to other people.  The more positive personal and social relationships you have, the greater your resiliency.  Being able to call someone up, to share the burden of the event with others who care—this is important.  We are social animals, and social connections are a vital part of our mental health.  If you want to be able to survive the slings and arrows of outrageous fortune, stay connected.  (It’ll actually help you live longer, too.)

One more important thing—your history of previous unresolved trauma is important.  People who have experienced a lot of prior trauma seem to be more susceptible to being harmed by new traumas.  Things that might be a difficult bump in the road for someone with an ACE score of zero and a supportive group of friends and family can be overwhelming to someone with a score of four or five—especially if they are socially more isolated.  The bottom line is that life is very unfair in this regard.  People who’ve been badly hurt before are less resilient in the face of new traumatic experiences.

Getting in front of the problem

You can think of resiliency as PTSD pre-treatment.  It is preventative.  If we are more resilient we can do better regardless of what difficulties we face tomorrow.  So is there anything we can do about that?

The short answer is yes.  Let’s look at a few.

First, take control.  Perhaps we couldn’t avoid the car accident.  But what can you do now?  Finding a way to empower yourself in the situation is extremely important.  Regaining control helps us feel more normal after difficult events.  We can’t change the past, but we can do something to make today better.

Then, create and strengthen social connections.  This is extremely powerful.  Healing takes place in a context of social support.  And one of the unfortunate things about experiencing traumatic events is that sometimes they can interfere with our sense of security, and along with that, our willingness to trust others.  We also tend to isolate ourselves when we feel bad.  These reactions, while natural, just don’t help.  We need to find some people we can trust, we need to reach out for help.

One thing that can actually increase both of these (empowerment and connection) is to help others who have gone through similar circumstances.  Join a support group.  Volunteer. Collect donations.  Spread the word. This gives us a sense of control as well as connections with people we can relate to.  That’s a double-dose of resiliency right there.

Getting past the past

The last thing I’ll mention is also an important one.  We need to address the past traumatic events we have faced which have reduced our resiliency, our flexibility, our capacity to “bend in the wind.”  The past often isn’t really past, in terms of how it has impacted us.  If we’re functioning well, have some good times as well as tough ones, usually feel pretty happy with ourselves and our lives, that’s good—perhaps we can let sleeping dogs lie.  But many of us are far from that description.   Depression, anxiety, addiction, constant self-sabotage—these are signs that something is out of balance, even if we don’t have full-on PTSD.  It means that there is some work to do—not so that we dwell in the past, but so we can finally live free from its continuing harmful effects.

The goal of trauma treatment is just that—for the past to become the past.  A part of us, for sure, but a part that no longer frightens or paralyzes us.  The traumatic experiences become chapters in our story, just like all the other chapters, albeit not as sunny.  But once we[ve told the stories and written the chapters, once our bodies have really become convinced that the nightmare is over—then it’s time to get back to living a fulfilling life.  Work, love, serve and play.  That’s the point, right?

PTSD is not (exactly) an illness

Flashbacks.  Avoiding public places.  Hiding in the closet.  Jumping at sounds.  Nightmares.  Waking up shaking or screaming.  Yelling at loved ones for no reason.  Feelings of fear, anxiety, shame, rage.  These are some common symptoms of PTSD.  (Childhood trauma can manifest itself a bit differently.) There may also be depression, numbness, lack of ability to focus or concentrate and many similar symptoms.  People feel unreal, the world feels unreal.  But still, I’ll say that PTSD is not exactly an illness.  It’s not quite that simple.

How can anyone say that, especially when PTSD sometimes requires hospitalization?  Well, let me explain.  It starts with an understanding.  We are creatures with bodies and our brains are part of our bodies.  When bodies are injured, they immediately do several things.  First, they marshal protective resources.  If you are cut, the blood begins to clot.  The body may withdraw bloodflow back to your core (this is the physical reaction called shock).  Next comes inflammation—the body sends white blood cells to the site to fight any infection that may have intruded.  Finally, over the next few days or weeks, many restorative healing processes reconstitute the skin, the flesh and the blood vessels in the injured area.  Protection, then healing.  It’s what bodies do.

Protection

Traumatic stress occurs when our brains are overwhelmed with events that threaten us or those we are close to in some way.  The first thing we do under threat is fight or run.  If either of those works, then we’re usually pretty much ok afterwards.  But sometimes they don’t work.  Something is too much for our defenses.  The beating happens, the person is ejected from the car, the dog tears at the face.  When this happens, our brains protect us.  We dissociate, that is, we check out in some way.  Numbness, freezing, shutting down, forgetting, out-of-body experiences—these are the realm of the body’s defenses.  These are examples of defenses against threats that overwhelm our fight and flight responses.  If we can successfully fight, flee, or get help, we don’t need them. But when those strategies don’t work, our brains protect us from the too-intense experience of harm.

And as long as the threat remains active, the body (the brain) is in protection mode.  We do whatever it takes to survive.  But eventually the threat is gone (in cases of child abuse, domestic violence or imprisonment, this may take years).  Once we are safer, it’s time for the body to heal.  It’s time for the broken bone to mend, for the slashed skin and flesh to knit itself back together again.   So what does it look like when the brain is healing trauma?

Healing

In the last 50 years, we’ve begun to discover some answers to this.  We know, for example, that unhealed traumatic memory is very different from normal memory.  So the healing process must involve the brain constructing a normal memory of a situation that was unbearable at the time.  We also know that there is some kind of “charge” held in the body.  The body must somehow “ramp down” from its protective state back to a resting state.   This involves changes in physiology, in muscle tension, in the levels of stress hormones in the blood and many other things.

In the vast majority of people, the brain heals itself.  Some people are even stronger after the traumatic experience.  But some people do not quite heal on their own.  We don’t know completely why, but there are probably many reasons.  One is unresolved trauma from childhood.  Another is that the trauma might have been so massively overwhelming that the brain can’t heal just by itself.  There are other reasons and often we don’t know why.

So what then is PTSD?  A modern view is that it is nothing but a situation the brain’s attempts to heal that are stuck in one place–the brain is still trying to protect us, even though the event is over.  If you look at the PTSD symptoms, they are all about protection.  (The two major modes of protection involve being more agitated in some way, or checking out in some way.)  So there is nothing “crazy” or even wrong with a person who is suffering from PTSD, except for the fact that somehow, things are not healing (yet).  Like a scab that is constantly picked, like an unbandaged wound that keeps getting torn open, there is something that keeps the PTSD sufferer from healing naturally.  Some part of the brain doesn’t know that it’s over.

Supporting a natural process

The goal of trauma therapy is not fixing people who are broken.  It’s more like putting casts on broken bones, bandaging bad cuts, supporting immune responses with antibiotics.  We create a space for healing and facilitate the process.  Therapy puts a container around the wound and protects it.  Then we often jump-start the process, but then it unfolds of its own accord.  We try to keep from re-injuring it while that happens.

So in some important sense, PTSD isn’t quite an illness–it’s more like and unhealed wound–the body’s attempts at healing are stuck for some reason.   There are many things that can help—arts as simple as massage or as complex as acupuncture have been shown to be helpful.  And there are a number of therapies that can be very helpful in getting the process going.  But let’s be clear:  The therapy doesn’t completely heal the trauma, any more than the cast heals the bone.  The body heals, the brain heals, the person heals.

But sometimes, I have the privilege of helping.

The impact of childhood trauma

I’ve worked with a lot of people with addiction (and I’ve struggled with addiction myself).   At some point I realized that among the people I knew well with addiction, the only ones who hadn’t told me about awful things that happened to them as children were the ones who hadn’t told me anything about their childhood.  That thought got me interested in childhood trauma, and I began reading and trying to learn more, as well as listening (which I’d already been doing).  I then ran across the ACE Study.

ACE Study

ACE stands for adverse childhood experiences.  This study took the medical records of over 17,000 people and correlated them with the results of a survey.  The survey asked them questions about negative things that may have happened to them as children.  The negative things were actually categories of things.  They involved physical, verbal or sexual abuse, neglect, divorce, having a parent die, seeing your mother struck, living with a person who had a mental illness or substance abuse problem or who became incarcerated.  They counted how many categories (of the 10) that each person had experienced.  Then they looked at the medical records.

The results were a bit stunning.  The main finding was that higher the person’s ACE score, the more at risk they were for developing a host of physical and psychological problems as adults.   That’s right, physical problems.  Not only were the folks with higher scores more likely to fall into addiction, anxiety or depression, they were also more likely to develop heart disease and obesity.  Now, this data has been looked at very closely and many research papers have been written about it.  Problem after problem, condition after condition, including antisocial behavior–all are more likely to befall people who had painful and awful things happen to them as children.  It’s pretty shocking.

It’s also terribly unfair.  Unfortunately, we all often participate in making it more unfair.  Every time we think that addiction or overeating is about willpower, every time that we assume heart disease is all about diet, we are neglecting one major thing that (for many people) can cause or worsen all of them:  adverse childhood experiences.  Trauma and loss.  Bad stuff.

What to do?

We go to doctors to get better, to feel better, and they often give us pills.  Not just pills for heart disease, but pills for anxiety and depression and many other things.  But there’s often a missing piece–the unacknowledged and untreated pain and damage created a long time ago.  If there was ever an argument for the need for trauma treatment, this study is it.   (I’m not at all putting down the good work doctors do–and I should note that the principle investigator on the ACE study is a medical doctor.  Many of us get significant help through medical treatment.  But many of us also need more than that.)

Of course, not every child has a high ACE score.  But a lot of us have a few, and a few of us have a lot.  The impact of childhood trauma is something we should acknowledge, something we should look at.  It’s something we should try to address.

A Personal Story

How to do that?  Well, we can start by not blaming children for what happens to them.  Years ago, I was teaching high school, and I had a student who “gave me a lot of trouble.”  I sent him to the office a lot.  Over and over.  Then one day I was talking with the assistant principal about him, and I found out what had happened.  My student, 16, and his 15 year old brother had been abandoned by their parents.  Just left.  They were living with their 19-year old brother who was working and trying to keep it all together so his brothers could stay in school.  How’s that for an adverse childhood experience?  After I learned that, I had a bit of a different attitude about my student.  I started trying to connect with him a little more.  I was young and didn’t know a lot about how to do that, but it was something.  So things went a bit better after that.  I didn’t just stop enforcing rules, and he didn’t completely stop breaking them, but things got better.

If you want to find your ACE score and read about the study, there’s a great website here.

We’ll keep talking about this problem.  And about what can be done to address it.

 

 

Childhood Trauma

What is complex childhood trauma?

Childhood usually involves a few traumatic events: accidents or injuries, unintended separations, grief over minor losses, etc. Events such as these can have some long-term impacts, but often they don’t. However, some children experience things that are usually more serious: divorce, death of a parent, ongoing abuse or neglect, a parent with addiction or mental health problems, etc. These usually involve a disruption or difficulty with an important relationship. In these cases, we talk about complex childhood trauma (or developmental trauma). [Look forward to my talking about this regularly in later posts.]

Impacts

It turns out that these kinds of events or situations can have very damaging long-term impacts on a person’s health. They can increase your chances of developing things like heart disease, obesity and other physical problems as well as mental health issues like depression, anxiety or addiction. [More about the research on this.] In other words, some childhood events can create many different ongoing difficulties. Many people are unaware of this connection, including some in the health fields.

Why is this connection important? For a simple reason: treating the wrong health condition doesn’t always help. If you go to the doctor for a broken arm and she gives you antibiotics, well, your arm won’t get infected, but it also won’t heal correctly. This can happen in therapy. A person will try to get help for depression or anxiety, and they may get medication for it (which can be helpful) and may get some therapy or counseling to gain some coping strategies (which is also helpful). But if the underlying cause is childhood trauma, and that doesn’t get treated, problems often persist.

Treatment

Some people say, “well, you can’t change the past, so you might as well figure out how to live with it.” In my view, that’s both true and false. It’s true that we can’t change past events, and we can’t change the way we reacted at the time, or the effects it has had up to now. But there is a lot more that can be done than just “learning to live with it.” It turns out that we can actually change what has happened in our bodies as a result of trauma.

Our bodies? That sounds weird. But let’s think about it carefully. Heart disease happens in the body. Depression affects the brain and the chemistry of the blood. Anxiety is mostly physical—heart and thoughts racing, tightness in the chest, shaking, sweating.   And most PTSD symptoms are things we can’t consciously control—flashbacks, feelings of unreality, fear, hopelessness, intrusive thoughts about the situation, etc.

Working with the body

For this reason, many of the modern, cutting-edge approaches to trauma treatment are based in the body (we say they are “somatic”).   Things such as EMDR, Yoga, acupuncture and massage all have been found to be helpful. I work with a somatic trauma therapy called Trauma Dynamics. It targets the effects that events and situations have had on our nervous systems, particularly the parts we can’t control. This somatic PTSD therapy is only a few decades old, and is still developing. But there is evidence that it’s extremely powerful, even in cases of complex childhood trauma.

So it turns out that healing is possible. We can’t change the past, but we can change the effects it has had on us. That’s good, good news for everyone.