Part 1 – How do I know if I have PTSD?
We’re calling this series on PTSD “The Last Nerve”, because that’s what PTSD often feels like to the person, and his or her family. It feels like the last nerve has been reached and the person can do no more.
PTSD – Posttraumatic Stress Disorder – is often called the brain and body’s natural response to an unnatural situation. When we are in danger, it is natural to feel fear. Fear triggers the portion of our brain called the amygdala. If there is true danger, the amygdala triggers other parts of our brain to respond. This is our fight or flight response. But if the danger isn’t real, a part of our brain called the ventromedial prefrontal cortex (vmPFC) kicks in and says, “whoa, nothing to be worried about” and tells the amygdala to calm down. Another part of our brain, the hippocampus, also jumps in and helps calm the brain down. With those who have PTSD however, the amygdala is always kicking in and producing the intense anxiety symptoms that are common in PTSD. The brain just can’t easily be shut down. It’s always on alert.
In order to diagnose PTSD, there has to be a traumatic event that involves physical harm or the threat of physical harm. The person with PTSD may have been the one who was harmed, the harm may have happened to a person he knows, or the person may have witnessed an event that harmed a loved one or even a stranger. This is important to understand because we’ll hear, “He can’t have PTSD because he never saw combat.” However, being on a base where there was constant mortar fire can be a catalyst for PTSD. This is the threat of physical harm. Or having a buddy killed during combat, even if the person wasn’t there to witness it, can be the traumatic event.
Symptoms of PTSD may include:
- Nightmares, vivid memories, or flashbacks of the event
- Feeling emotionally cut off from others and avoiding the distressing memories, thoughts, or feelings about the traumatic event
- Feeling numb or losing interest in things you used to care about, including family and friends
- Becoming depressed
- Hypervigilance – constantly being on guard for danger, scanning your surroundings, patrolling your home
- Feeling anxious, jittery, or irritated
- Excessive anger or angry outbursts with little or no provocation
- Experience a sense of panic that something bad is about to happen
- Difficulty sleeping
- Having trouble concentrating, or with memory
- Reckless or self-destructive behavior
- Difficulty relating to and getting along with your spouse, family, or friends
- Fear, guilt, or shame
- Persistent avoidance of stimuli associated with the traumatic event such as avoiding the memories or avoiding the external reminders
- Exaggerated negative beliefs or expectations about yourself or the world such as I am bad, or no one can be trusted
- Blaming yourself for the cause of the event or the consequences of the event
For it to be considered PTSD, the symptoms have to last for more than 1 month and cause significant impairment in the person’s ability to function socially, in a job, or in other aspects of life. Not all of these symptoms listed have to be present for a person to have PTSD as each person responds to trauma in his or her own way. We will often see those with PTSD turn to consistent drinking or use of drugs to numb feelings, or to thoughts about harming themselves, including suicide. Pulling away from other people (putting up walls), and becoming isolated are also often present.
It is not uncommon for the vet with PTSD to be fine for a while and then experience a triggering event that can escalate current symptoms or bring about PTSD symptoms that the vet thought were under control. Fourth of July fireworks for example, may trigger flashbacks, anger, or anxiety in the vet with PTSD. Certain smells can also trigger negative reactions. Understanding triggers is important for the vet in learning to manage his PTSD.
I realize that having PTSD can be overwhelming. I hear from people who think that they will never get better saying, “I am always going to be messed up.” That is wrong. PTSD can be treated effectively. I won’t lie and say that it’s easy, but in essence, it’s learning how to control PTSD, versus PTSD controlling you. Some treatments involve medications to help with depression or anxiety, but therapists are using very effective means to treat PTSD. We will be discussing these treatments in our next blog. Just know help is available. Here are two resources for learning more about PTSD. The first is the VA website, which has a lot of information available to vets. The second is a page in which those with PTSD and their families, share what they are going through and receive support from their peers.
Department of Veteran Affairs, National Center for PTSD: http://www.ptsd.va.gov/PTSD/index.asp
Facebook: This is a great page, developed by veterans and their spouses who have PTSD that allows vets and spouses to talk about PTSD and get support from the community. https://www.facebook.com/MilitarywithPTSD