WHAT IS POST-TRAUMATIC STRESS DISORDER?
Post-traumatic stress disorder (PTSD) is the name for an illness that has been present since the beginning of recorded history. At the same time, its symptoms have been complex and confusing and have frustrated the countless people who have suffered from it as well as all those who have tried to help the afflicted. The goal of this book is to help you get a handle on just what this diagnosis means and to offer some suggestions on ways it can be treated.
What makes it so complicated?
Post-traumatic stress disorder is a relatively recent term for a constellation of symptoms that can be hard to organize neatly. PTSD must begin after a trauma, but the trauma might be a train wreck that happened last month or sexual abuse that occurred in early childhood. At the time of occurrence, the trauma must have immediately caused intense fear, helplessness, or horror, but these feelings might not even be remembered by the time the person seeks treatment; and, in children, the immediate response might be disorganized or agitated behavior rather than a feeling. Although the trauma must be "reexperienced," the recollections may take place in several ways. They might be in the form of clear memories, nightmares, physical feelings, reenactments, or distress when exposed to something that reminds them of the traumatic event (like a war veteran hearing the backfire of a car). In addition to reexperiencing the event in some fashion, people with PTSD must also avoid reminders of the trauma and numb their general responsiveness, and they must present symptoms of increased arousal. Each of these terms and the general categories of "avoidance" and "arousal" are simplified expressions that reflect wide-ranging symptoms in human beings.
As can be seen, there are lots of ways that this disorder can present itself. In addition, most people experiencing PTSD have another disorder as well, such as depression, severe anxiety, or substance abuse, which can sometimes mask the diagnosis of PTSD.
I think I might have PTSD, but I don't really understand what you're saying. If it's so complicated, how am I going to recognize it?
The goal of this book is to allow everyone to understand the basic concepts of the disorder and to consider treatment options.
Consider the following scenarios:
Jim is a Vietnam vet. He has difficulty falling asleep. When he does doze off, he is tormented by nightmares that are sometimes so vivid that he shakes and pushes his wife, terrified that he is back in Vietnam and that she is the enemy. He has complained about sleep problems for years, but his family doctor has quit giving him sleeping pills, saying that sleeping pills and alcohol don't mix. Jim knows this is true, but he also believes that beer helps him in several ways. According to Jim, a few cans of beer stop him from exploding at all the daily frustrations of life, help him get to sleep, and help squash the nightmares. People say he should just get over it, that it's been thirty years since he was in the war, but he is just feeling worse and worse. And now his wife says she can't stand the physical abuse at night (he has been known to assault her in his sleep, mistaking her for the enemy hidden in the jungles of Vietnam) and his irritability all day. His relatives think he's an alcoholic, and he is afraid that his wife may want a divorce. Jim wants to change, but he doesn't know where to begin.
While Lilly was walking home from work one night, she was wrestled into the woods and raped. She felt like a wreck afterwards, unable to sleep or relax. It's been six months, but she keeps thinking of the man's face. She never walks home anymore, but takes the bus, even though it's slow and out of her way. In fact, she gets very anxious at the thought of going anywhere near the woods. She quit her softball team, because all the games were held at a park, and the park reminded her of the woods. Her whole body shakes when she sees a stranger who reminds her of the man who raped her. She now has great difficulty going out on dates or being alone with men. She obsesses about what she should have done to prevent the rape.
Fred, a paramedic in a small town, was called to the scene of a terrible traffic accident during a blizzard. A school bus carrying nine children had skidded off a cliff and crashed into the rocks below. The children and the driver were killed. Fred felt his whole body go numb at the scene of the accident, but he was able to help remove the bodies from the wreckage. While he seemed to be doing okay immediately after the accident, images of the school bus preoccupied him for months. His whole body seemed to alternate between being numb and being sensitive to any little stress. He decided to quit working as a paramedic. This helped a little, but almost anything reminded him of the accident: children, buses, snow, the cliffs. He convinced his wife to move to Florida, to get a fresh start. This helped, but he knows he's still not the same.
Beverly started seeing a therapist last year because of persistent depression. She knew she should have seen the therapist sooner, but she'd never liked talking about herself. She'd finally relented because another of her boyfriends was complaining that she was uptight, spacey, and moody. As she and the therapist started talking about her difficulties with intimacy, a vague, nauseating sensation came over her, which then stuck with her for days. She'd never really enjoyed foreplay, but now she began to feel creepy whenever her boyfriend even touched her. She started to have terrifying dreams in which a giant rat was eating her. After a few weeks of these dreams and creepy feelings, Beverly had just about decided to stop therapy. She'd been depressed before, but now she was worse. Suddenly she began to have images of her first stepfather doing sexual things to her when she was a young child. The images seemed very clear, and there were lots of them, but they also seemed unreal, as if they'd happened to someone else. Could she possibly have forgotten something so major? That stepfather had disappeared when she was five. She'd never given him a second thought. How could he have done this? She began to feel dirty and contaminated and more depressed. She had lots of thoughts of hurting herself and a few, dim feelings of intense rage. She certainly wanted nothing to do with her boyfriend. And she wasn't so sure she wanted to continue with her therapy.
In many ways, Jim, Lilly, Fred, and Beverly may have little in common, yet each is suffering from PTSD. I've started hearing and reading a lot about PTSD. Is this condition something new?
While doctors have been studying and treating victims of trauma for centuries, the diagnosis of PTSD wasn't included in the psychiatric diagnostic manual until 1980. Prior to that time, people with PTSD symptoms were diagnosed and treated in a variety of ways; often their situation simply went unrecognized. How did PTSD get recognized in 1980?
Apparently the efforts of three separate groups forced a review of the diagnosis. Vietnam veterans, women, and therapists began to challenge the status quo.
What Is Post-Traumatic Stress Disorder?
Post-traumatic stress disorder (PTSD) is the name for an illness that has been present since the beginning of recorded history. At the same time, its symptoms have been complex and confusing and have frustrated the countless people who have suffered from it as well as all those who have tried to help the afflicted. The goal of this book is to help you get a handle on just what this diagnosis means and to offer some suggestions on ways it can be treated.
What makes it so complicated?Post-traumatic stress disorder is a relatively recent term for a constellation of symptoms that can be hard to organize neatly. PTSD must begin after a trauma, but the trauma might be a train wreck that happened last month or sexual abuse that occurred in early childhood. At the time of occurrence, the trauma must have immediately caused intense fear, helplessness, or horror, but these feelings might not even be remembered by the time the person seeks treatment; and, in children, the immediate response might be disorganized or agitated behavior rather than a feeling. Although the trauma must be "reexperienced," the recollections may take place in several ways. They might be in the form of clear memories, nightmares, physical feelings, reenactments, or distress when exposed to something that reminds them of the traumatic event (like a war veteran hearing the backfire of a car). In addition to reexperiencing the event in some fashion, people with PTSD must also avoid reminders of the trauma and numb their general responsiveness, and they must present symptoms of increased arousal. Each of these terms and the general categories of "avoidance" and "arousal" are simplified expressions that reflect wide-ranging symptoms in human beings.
As can be seen, there are lots of ways that this disorder can present itself. In addition, most people experiencing PTSD have another disorder as well, such as depression, severe anxiety, or substance abuse, which can sometimes mask the diagnosis of PTSD.
I think I might have PTSD, but I don't really understand what you're saying. If it's so complicated, how am I going to recognize it?The goal of this book is to allow everyone to understand the basic concepts of the disorder and to consider treatment options.
Consider the following scenarios:
Jim is a Vietnam vet. He has difficulty falling asleep. When he does doze off, he is tormented by nightmares that are sometimes so vivid that he shakes and pushes his wife, terrified that he is back in Vietnam and that she is the enemy. He has complained about sleep problems for years, but his family doctor has quit giving him sleeping pills, saying that sleeping pills and alcohol don't mix. Jim knows this is true, but he also believes that beer helps him in several ways. According to Jim, ...
