Shrink Rap: What is PTSD?

Shrink Rap: What is PTSD?

PTSD is Post Traumatic Stress Disorder. Dr. Susannah Smith speaks out on the subject.

In order to be diagnosed with PTSD, a person has to have “exposure to actual or threatened death, serious injury, or sexual violence….” (Diagnostic and Statistical Manual V). Exposure can be by way of direct experience; witnessing in person the events as they happened to others; learning that traumatic event(s) occurred to someone very close to you; having direct and repeated exposure to distressing and aversive details of traumatic events (as in first responders).

People with PTSD may experience only one of the following symptoms, some, or all: recurrent, involuntary and obtrusive distressing memories of the traumatic event; distressing recurrent dreams; dissociative reactions (such as flashbacks, experienced on a continuum of distress, from detaching all the way to a complete loss of awareness of current circumstance); intense, prolonged psychological distress when exposed to internal or external cues that remind or resemble any aspect of the traumatic event; and clear physiological reactions to internal and external triggers.

People with PTSD persistently avoid these upsetting memories and/or any place or person that may provoke upsetting memories and experiences. They experience declines in cognition and mood associated with the traumatic event(s) beginning after the experience occurred. They will experience two or more of the following: inability to remember certain details or aspects of the event (but not due to other factors such as head injury, alcohol or drugs); persistent strong negative beliefs about oneself; distorted cognitions about the cause and consequences, leading the person to blame himself or herself; continual negative mood and emotional state; diminished interest in people and activities; feeling detached and estranged; and/or inability to experience positive emotions.

PTSD sufferers also have very reactive systems following the traumatic event(s), such as angry outbursts and easy irritability, with little or no provocation, often expressed as physical or verbal aggression toward people or objects; reckless and self-destructive behavior; exaggerated startle responses (as to sudden or loud noises); very reactive nervous system, such as major anxiety and panic attacks (red face, heart beating fast, hyperventilating); hypervigilance (always looking over their shoulder; fearful that something or someone bad is ready to cause harm); sleep disturbance; difficulty concentrating.

The duration of these symptoms must have existed for more than one month; the symptoms cause significant problems with normal functioning in the areas of social, occupational or other; and the symptoms are not the result of other diagnostic considerations. Symptoms usually begin within about three months of the original trauma(s), although there may be a delay of many months or even years, called “delayed expression.” Some symptoms may appear immediately and never go away, or get worse, and more symptoms may occur as time goes on.

Not everyone gets PTSD after they experience a trauma. Also, we now know that PTSD can occur from less often recognized trauma, such as when a spouse has an affair (see the work of Julie and John Gottman on couples), and various types of prolonged litigation. Symptoms can range from mild to quite severe.

Some forms of treatment have helped people get relief, including psychotherapy, such as CBT and insight psychotherapy; PET or prolonged exposure therapy (which may or may not be indicated); and inner child work; medication treatment, such as certain type of anti-depressants; and new hopeful and somewhat surprising research with other drugs such as LSD, ecstasy, and mushrooms in a controlled setting.

Forms of deep relaxation are helpful too, such as helping the body learn a conditioned relaxation response through hypnosis or biofeedback. Yoga and meditation have helped to calm the nerves and get to a peaceful place when triggered. Relating to animals has proved to be therapeutic and calming too. There are also many chat rooms and support groups for PTSD.

About Dr. Susannah Smith:

Dr. Susannah Smith

Dr. Susannah Smith is a licensed practicing clinical psychologist and organizational development consultant, with offices in Telluride and Ridgway. She is licensed in Colorado, California, Louisiana, Mississippi, and Texas. Dr. Smith has conducted workshops on child sexual abuse, domestic violence, and sexual assault, and is a mediator and custody evaluator. If you would like to contact her, she can be reached;; or 970-728-5234.

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