PTSD – Symptoms

These are common symptoms of PTSD, but are not a diagnosis. If many of these statements are true for you then please take the next step to tell someone: family, friends or a professional.

A. The person has been exposed to a traumatic event in which both of the following were present:

1.the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
2.the person’s response involved intense fear, helplessness, or horror.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

1.recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. (daymares)
2.recurrent distressing dreams of the event.
3.acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and associative flashback episodes, including those that occur on awakening or when intoxicated).
4.intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
5.physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

1.efforts to avoid thoughts, feelings, or conversations associated with the trauma
2.efforts to avoid activities, places, or people that arouse recollections of the trauma
3.inability to recall an important aspect of the trauma
4.markedly diminished interest or participation in significant activities
5.feeling of detachment or estrangement from others
6.restricted range of affect (e.g., unable to have loving feelings)
7.sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

Early_pre_PTSD

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

1.difficulty falling or staying asleep
2.irritability or outbursts of anger
3.difficulty concentrating
4.hyper vigilance (always checking the locks, looking behind you, trying to sit in the far corner so you can see what everyone is doing etc.)
5.exaggerated startle response (someone touching you or phone ringing and you almost jump out of your skin)

E.Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

With Delayed Onset: if onset of symptoms is at least 6 months after the Stressor
A personal report. This is a long report that started out a a Stressor letter to the Department of Veterans Affairs. Its called “PTSD: Living with Personal Dragons” and I hope the experience of the letter will help others!

Outside the box PTSD symptoms:
Here are two that the government does not talk about BUT you should be aware of!
No longer wishing to go to church, if you went before
Are you running into difficulties within your unit? Like Articles 15’s, poor performance reviews, difficulty with authority?

How common is PTSD?

Associated Features:
Understanding the biology of Post-traumatic Stress.
Depressed Mood
Somatic/Sexual Dysfunction
Guilt/Obsession
Addiction

Differential Diagnosis

Adjustment Disorder; Symptoms of avoidance, numbing, and increased arousal that are present before exposure to the stressor; another mental disorder (e.g., Brief Psychotic Disorder, Conversion Disorder, Major Depressive Disorder); Acute Stress Disorder; Obsessive-Compulsive Disorder; Schizophrenia; other Psychotic Disorders; Mood Disorder With Psychotic Features; a delirium; Substance-Induced Disorders; Psychotic Disorders Due to a General Medical Condition; Malingering.

(www.mentalhealth.com) copyright © 1995-2005 by Phillip W. Long, M.D.

Check the symptoms below that you experience (that may or may not be related to a traumatic event) and make notes as needed:

I experienced or witnessed a traumatic event during which I felt extreme fear, helplessness, or horror.

The event happened on (day/month/year)_______________.

What happened?________________________________________.

1) I have symptoms of reexperiencing or re-living the traumatic event:

Bad dreams or nightmares about the event or something similar

Behaving or feeling as if the event were actually happening all over again (this is known as having flashbacks)

Having a lot of emotional feelings when I am reminded of the event

Having a lot of physical sensations when I am reminded of the event (e.g., my heart races or pounds, I sweat, find it hard to breathe, feel faint, feel like I’m going to lose control)

2) I have symptoms of avoiding reminders of the traumatic event:

Avoiding thoughts, conversations, or feelings that remind me about the event

Avoiding people, places, or activities that remind me of the event

Having difficulty remembering some important part of the event

3) I have noticed that since the event happened:

I have lost interest in, or just don’t do, things that used to be important to me

I feel detached from people; I find it hard to trust people

I feel emotionally “numb” and I find it hard to have loving feelings even toward those who are emotionally close to me

I have a hard time falling or staying asleep

I am irritable and have problems with my anger

I have a hard time concentrating

I think I may not live very long and feel there’s no point in planning for the future

I am jumpy and get startled easily

I am always “on guard”

4) I experience these medical or emotional problems:

Stomach problems

Intestinal problems

Gynecological problems

Weight gain or loss

Chronic pain (e.g., in my back, neck, pelvic area (in women))

Problems getting to sleep

Problems staying asleep

Headaches

Skin rashes and other skin problems

Irritability, a quick temper, and other anger problems

Nightmares

Depression

Lack of energy, chronic fatigue

Alcoholism and other substance use problems

General anxiety

Anxiety (panic) attacks

Again, if you think you have PTSD, or even just some of the symptoms, it is important for you to let your primary care physicians know. This information is invaluable for planning your medical treatment. It can also help your doctor provide you with appropriate referrals for other services (e.g., to a psychologist, a social worker, child abuse protective services, lab tests, etc.).

Down Range – To Iraq and Back

by Bridget Cantrell, Ph.D. and Chuck Dean

Courage After Fire:

Coping Strategies for Returning Soldiers and Their Families (Paperback)

The Symptoms of Post-Traumatic Stress Disorder:

Chronic and/or Delayed

Something to think about when you start to have adverse reactions!!

This section deals with understanding the symptoms of PTSD. Please note that since I’m a Vietnam Era vet, it states the information for my generation. This information is for all survivors of a traumatic event but is empathized for combat personnel.

You may change VC to insurgents, Vietnam with Afghanistan or Iraq, then change jungle into “Sandlot”. The results are the same, Trauma, Depression, Isolation, Guilt… and the list goes on!

Depression

They feel depressed; “How can I tell my wife, she’d never understand?” they ask. “How can anyone who hasn’t been there understand?”

Accompanying the depression is a very well developed sense of helplessness about one’s condition. Vietnam-style combat held no final resolution of conflict for anyone. Regardless of how one might respond, the overall outcome seemed to be just an endless production of casualties with no perceivable goals attained. Regardless of how well one worked, sweated, bled and even died, the outcome was the same. Our GIs gained no ground; they were constantly rocketed or mortared. They found little support from their “friends and neighbors” back home, the people in whose name so many were drafted into military service. They felt helpless. They returned to the United States, trying to put together some positive resolution of this episode in their lives, but the atmosphere at home was hopeless. They were still helpless. Why even bother anymore?

Many veterans report becoming extremely isolated when they are especially depressed. Substance abuse is often exaggerated during depressive periods. Self medication as an easily learned coping response in Vietnam; alcohol appears to be the drug of choice.

When someone has a major “Attack” of depression they start to think about the value of their lives. How much have they improved the standard of living, upheld family values, disappointment in wasting their lives and in many cases where the PTSD has been chronic, they have Wasted their lives by not reaching a “Higher standard of Living” or accomplishment. The outcome to this is a path to possible suicide. This is where counseling, group Therapy, and medications needs to be used! (Understand that when this depression “Hits” we are in pain, ended a relationship, lost another job, and we can’t see going on with the same routine. The idea of suicide becomes a tool for an easy out of all the combined pain! RN)

Isolation

Combat veterans have few friends. Many veterans who witnessed traumatic experiences complain of feeling like old men in you men’s bodies. They feel isolated and distant from their peers. The veterans feel that most of their non-veteran peers would rather not hear what the combat experience was like; therefore, they feel rejected. Much of what many of these veterans had done during the war would seem like horrible crimes to their civilian peers. But, in the reality faced by Vietnam combatants, such actions were frequently the only means of survival.

* Had many broken relationships/divorces?

* Desire to live life as a hermit?

* Experienced lack of social contact?

* Have few acquaintances and even fewer friends?

* A desire to seek refuge by moving away from the problem?

* Feel isolated or distanced from spouse, parents, children, brothers, peers or others?

Rage

The veterans’ rage is frightening to them and to others around them. For no apparent reason, many will strike out at whomever is near. Frequently, this includes their wives and children. Some of these veterans can be quite violent. This behavior generally frightens the veterans, apparently leading many to question their sanity; they are horrified at their behavior. However, regardless of their afterthoughts, the rage reactions occur with frightening frequency.

Avoidance of Feelings: Alienation

The spouses of many of the veterans I have interviewed complain that the men are cold, uncaring individuals. Indeed, the veterans themselves will recount episodes in which they did not feel anything when they witnessed a death of a buddy in combat or the more recent death of a close family relative. They are often somewhat troubled by these responses to tragedy; but, on the whole, they would rather deal with tragedy in their own detached way. What becomes especially problematic for these veterans, however, is an inability to experience the joys of life. They often describe themselves as being emotionally dead.

* Do you feel hollow inside?

* Do you feel emotionally numb?

* Do you feel detached, aloof, and emotionally dead?

* Do you seem to be cold, uncaring, and even ruthless at times?

* Are you unable to feel love or compassion for others?

* Are you unable to experience either the sorrows or the joys of life?

Survival Guilt

When others have died and some have not, the survivors often ask, “How is it that I survived when others more worthy than I did not?” Survival guilt is an especially guilt-invoking symptom. It is not based on anything hypothetical. Rather, it is based on the harshest of realities, the actual death of comrades and the struggle of the survivor to live. Often the survivor has had to compromise himself or the life of someone else in order to live. The guilt that such an act invokes or guilt over simply surviving may eventually end in self-destructive behavior by the survivor.

* Do you ever feel guilt for surviving the war, when others (who may have had more to live for) did not?

* Do you feel guilt that perhaps, if you had stayed a little longer, you could have made a difference?

* Do you feel guilt for acts committed or acts observed without making an effort to stop them?

* Do you feel guilt for returning to the safety of home and leaving friends behind who were still engaged in combat?

Anxiety Reactions

Many Vietnam veterans describe themselves as very vigilant human beings; their autonomic senses are tuned to anything out of the ordinary. A loud discharge will cause many of them to start. A few will actually take such evasive action as falling to their knees or to the ground. Many veterans become very uncomfortable when people walk closely behind them. One veteran described his discomfort when people drive directly behind him. He would pull off the road, letting others pass, when they got within a few car lengths of him.

War Enters Classrooms ~ Fear Grips Afghans

Intrusive Thoughts

Traumatic memories of the battlefield and other less affect-laden combat experiences often play a role in the daytime cognitions of combat veterans. Frequently, these veterans report replaying especially problematic combat experiences over and over again. Many search for possible alternative outcomes to what actually happened in Vietnam. Many castigate themselves for what they might have done to change the situation, suffering subsequent guilt feelings today because they were unable to do so in combat. The vast majority report that these thoughts are very uncomfortable, yet they are unable to put them to rest.

* Do you ever have flashback episodes?

* Do you have intense thoughts (of what might have been?)?

* Do you ever experience strong reaction to sights, sounds and smells?

* Have you ever had prolonged feelings of being somewhere other than where you are?

* Do your memories of traumatic events ever interrupt your routine thought patterns?

SLEEP DISTURBANCES

* Unable to remember dreams?

* Watch TV until late in the morning?

* Do you stay awake as long as possible?

* Wake up often during the night for no reason?

* Do you wake in the morning still feeling tired?

* Do you have nightmares, dreams of being shot or pursued?

RESTLESSNESS/LISTLESSNESS

* Numerous changes of addresses?

* Don’t know why you even exist?

* Ever drive about aimlessly when you’re angry?

* Do you have chronic job hopping/an unstable work history?

* Do you have no feelings of direction, meaning, purpose or significance in life?

* Have you lost interest in work or other activities that you used to enjoy?

* Ever feeling like nothings been going right and it’s been like that for a long time?

IDENTITY ISSUES

* Lack of confidence in your own abilities?

* Do you feel like a reject from society?

* Do you feel hollow inside, like an old man in a young man’s body?

REDUCTIONIST THINKING

* Do you give away material things easily?

* Are you able to easily strip away all non-essentials?

* Do you feel the need to get to the point in all conversations?

* Are you irritated easily by insignificant chatter (small talk) and all non-essential conversations?

* Do you hoard material and supplies that might be necessary for survival?

* Are you able to leave the area at the drop of the hat, knowing exactly what you will take with you and where you will go?

Avoid things that resemble(including uniforms, hotels, certain foods and drinks, etc.)

-bulimia
-IBS
-GERD
-agitation
-nightmares
-super vigilant
-cry too much
-don’t care about things
-bad self esteem
-go days without shower
-flashbacks
-get lost in what happened like living it again and my body hurts where they hurt me
-don’t care to do things that I used to do. anything to do with music is crap now.
-since music was a dream that was ripped away, it is a negative thing to me now.
-sometimes feel like I have lost time
-can’t read a book. read same pages over and over again and don’t remember what I read
-loud noises scare me
-check the doors at night. even though I can see they are locked I have to test
-had hysterectomy because period made me have flashbacks and cramps felt like I was being raped again
-sleep problems. even with CPAP. Wake at about the same time every night.
-divorce
-no relationship with sisters in 12 years
-new friends
-refuse to go to church and get angry when they keep bothering me
-dizziness
-sweat all the time
-tremors
-hearing loss
-tinnitis
-I wish/pray that I won’t wake up in the morning
-Nightmares several times per week, and so real it takes 10 minutes+ to separate the nightmare from reality
-Super vigilant all the time, driving, walking, cannot focus on TV, radio or conversation
-Claustrophobic
-Periods of feeling detached from my body and the environment around me
-Lost periods of time
-Scan area before I move
-Won’t go out at night
-Won’t drive to places I have never driven to before, always have a cell, map, clothing, food and flashlight
-Won’t go to a city because I get overwhelmed and lost, make as few trips outside as possible
-Don’t date
-No sex drive
-Can’t keep jobs for long periods of time due to anger issues, or not being able to focus and concentrate
-Moved into a shelter because I never feel safe, and right now I feel it is in my best interest to be monitored
-Cry often and for hours with no apparent reason
-Feel empty
-Don’t care about things that use to interest me sports, going out, getting dressed up
-Eating disorder
-Bad self esteem
-Flashbacks
-Easily lose focus and concentration
-Sleep problems, cannot go to sleep, stay asleep and wake up rested
-Loss of most relationships, boyfriend, family members, friends at school and work
-No friends because I cannot stand them telling me to smile, or be happy
-Refuse to go to church and get angry when people try to discuss church or religion with me.
-Occasional headaches, with no prior history of this
-Vision (unexplained light flashes in both eyes) during Migraines
-Need to control any situation I am in and the people around me
-Check all doors and windows all the time, even though I know they are locked
-Get mad from 1 to- 120 in 2 seconds
-Outbursts of Anger
-Fights with co-workers
-Get angry at customers at work, especially males
-Have episodes of loss of short term memory (can’t remember what I was doing or why)
-Excessive drinking to numb my emotions
-My vision is getting worse
-I tremble and freeze when under pressure
-Sweat all the time
-Wake up at the same time every night
-Go for days without a shower
-Loud noises scare me
-I am afraid of things I never used to be afraid of
-Avoid certain cleaning products because the smell triggers me
-I forget things like turning off the stove and oven, and don’t cook anymore because I am afraid I will burn down the house
-I don’t really care about anything, my life feels like I am just going through the motions for no reason

The Biology of PTSD

(Thank you Susan Avila Smith for breaking it down for all to understand)

There is a biological component to PTSD

Many people feel stigmatized when diagnosed with PTSD feeling as if they should just “get over it”. It is important to understand there is a biological component to this disorder. Additionally it is important to be aware of the biological aspect of PTSD because it is becoming increasingly popular to use medicine to help treat the symptoms of PTSD.

The brain changes

An individual suffering with PTSD actually experiences physiological changes. The autonomic and central nervous systems are both affected. Also, the hippocampus decreases in mass and the amygdala is over reactive. Memory is a key component to PTSD. The traumatic event is relived constantly via memory. Both the hippocampus and amygdala are key in human memory. It is believed that the amygdala is the “fear center” of the brain. It should not be surprising that PTSD sufferers have over reactive amygdala. The amygdala helps the brain establish a connection between fear producing situations from the past and because of this conditioning pairs them with a stimulus in the present that may be neutral. This incorrect conditioning helps the individual maintain a constant state of hyper arousal because the brain is telling the person that a “safe” situation is threatening even though the “safe” situation may have nothing to do with the prior trauma.

The hippocampus plays an important role in learning and memory. Research suggests that the hippocampus attempts to create expectations in situations that may offer rewards and punishments based on memory and past learning. Due to hippocampal damage in those with PTSD it may be difficult for the brain to learn new expectations for situations following the traumatic event.

PTSD and Stress Hormones

Those who have PTSD have abnormal levels of stress hormones. Studies show that individuals with PTSD have lower levels of cortisol than those who do not have PTSD and higher than average levels of epinephrine and norepinephrine. The above three mentioned hormones are responsible for creating the “flight or fight” response to stress. In turn, this means that the person with PTSD lives in constant “flight or fight” mode. Some of the side effects of long term stress are: hypertension, ulcers, and poorer overall health. Cortisol helps give the body energy while stressed and glucocorticoids help with post stress survival these are hormones that those with PTSD have lower than normally levels. Serotonin is believed to play a role in PTSD however research is inconclusive. It is thought that the lack of inhibitory signals to neurons may not “shut off” the stress responses. Additionally people with PTSD have higher levels of natural opiates after the trauma. These higher levels of opiates may condition the individual to re-experience the trauma in order to attain the opiate response. The neurotransmitter changes exhibited by those with PTSD are those opposite to the changes seen in people with major depression.

Terminology (Taken from Witipedia):
Amygdala

Cortisol

Hippocampus

Neurons

Epinephrine and Norepinephrine

Glucocorticoids

Neurotransmitter

Other questions that you may want to ask your doctor or counselor:
“What do people have to do to recover from PTSD?”

“Why do I have PTSD and other people don’t?”

“Does having PTSD mean that I’m crazy or mentally ill?”

“What will happen if I go for treatment?”

“How long will treatment last?”

“What will be the likely effects of treatment?”

“What should I tell my spouse/partner/other family members about PTSD?”

If medication treatment is discussed, you may want to ask some of these questions:

“How is this medication supposed to help me?”

“How will it affect my symptoms?”

“How long will I have to take it?”

“Can I stop it if I don’t like it?”

“How will we know if it is working?”

“What will happen if it doesn’t work?”

“What are the side effects of the medication?”

“How will it affect the other medications that I’m taking?”

“Why do I need to go for counseling if I’m receiving medication treatment?”

“How will medication treatment fit in with my PTSD counseling?”

“How will medication affect my substance abuse recovery?”

*All credit given to Susan Avila Smith

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