Anyone else have PTSD?

It troubles me how so many therapists bandy sp? about diagnoses when they don't even understand what the diagnosis is. OIY.
Note, I have also read too much of the DSM-III-R, and the DSM-IV over the years. You start to understand the differences of these disorders.

Back to the very strict delineation of an anxiety disorder such as PTSD, I think the term/disorder is overused. As sebastian said, the most common example of PTSD would be someone who has survived a battle in a war, someone surviving a terrorist attack, someone surviving a rape, an attempted murder, etc. Someone who got out of the WTC on 9/11. The firemen who were there, the cops, everyone.

The STRESSOR is VERY specific and horrendous and the reaction to it is dramatic. Example... I heard a Vietnam Veteran (at a NAMI conference) describe having flashbacks where he would drive through his neighborhood, a plane would fly overhead and he would be certain a bomb would drop -- very specific. He would see his whole neighborhood on fire. If a car backfired he would DROP TO THE GROUND.

There is a huge startle response. This guy's wife also said he was very agitated. She'd get up and find him mowing the grass at 4a.m. to get the rage/fear/stress "out of his system".

[ur]http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual/section15/chapter187/187e.jsp%3Fregion%3Dmerckcom&word=post&word=traumatic&word=stress&domain=www.merck.com#hl_anchor[/url]

Hope that link works. Just plug posttraumatic stress (not disorder) into the Merck Manual engine.

Section 15. Psychiatric Disorders
Chapter 187. Anxiety Disorders
Topics
[General]

- Panic Attacks And Panic Disorder
- Phobic Disorders
- Obsessive-Compulsive Disorder
-Posttraumatic Stress Disorder
- Acute Stress Disorder
- Generalized Anxiety Disorder
- Anxiety Due To A Physical Disorder Or A Substance

NOTE: PTSD is one of seven very specific anxiety disorders. Again it is a disorder. It is not a symptom. Also, to the best of my knowledge, those w/PTSD don't suffer from chronic DP/DR. DP/DR seem to be symptoms of other anxiety disorders. Correct me if I'm wrong.

FROM THE MANUAL: NOT DREAMER'S WORDS
"Posttraumatic Stress Disorder
A disorder in which an overwhelming traumatic event is
reexperienced, causing intense fear, helplessness, horror, and
avoidance of stimuli associated with the trauma.

The stressful event involves serious injury or threatened death to
the person or others or actual death of others; during the event,
the person experiences intense fear, helplessness, or horror.

Lifetime prevalence is at least 1%, and in high-risk populations,
such as combat veterans or victims of criminal violence, prevalence
is reported to be between 3 and 58%.

Symptoms and Signs
When terrible things happen, some persons are lastingly affected by
them. Afterward, the traumatic event is repeatedly
reexperienced, usually through nightmares or flashbacks. The person
persistently avoids stimuli associated with the trauma and has a
numbing of general responsiveness as a mechanism to control
symptoms of increased arousal.

Symptoms of depression are common. Sometimes the onset of symptoms is delayed, occurring many months or even years after the traumatic event. If posttraumatic
stress disorder has been present > 3 mo, it is considered chronic.
If untreated, chronic posttraumatic stress disorder often
diminishes in severity without disappearing, but some persons
remain severely handicapped.

Treatment
Treatment consists of behavior therapy, pharmacotherapy, and
psychotherapy. Behavior therapy involves exposure to safe
situations that the person avoids because they may trigger a
reexperience of the trauma.

Repeated exposure in fantasy to the
traumatic experience itself usually lessens distress after some
initial increase in discomfort. Preventing certain ritual
behaviors, such as excessive washing to feel clean after a sexual
assault, may also help. Antidepressant and anxiolytic drugs appear
to have some benefit but are generally less effective than for
other anxiety disorders. Selective serotonin reuptake inhibitors
(eg, fluoxetine, fluvoxamine, paroxetine, sertraline) and monoamine
oxidase inhibitors appear most effective.

Because the anxiety associated with traumatic memories is often
extremely intense, supportive psychotherapy plays an important
role. In particular, therapists must be openly empathic and
sympathetic in their recognition of patients' psychologic pain and
must validate the reality of the traumatic experiences. At the same
time, therapists must encourage patients to face the memories as
they undergo behavioral desensitization and learn techniques of
anxiety control in an attempt to modulate and integrate the
memories into their broader personality organization.

In addition to trauma-specific anxiety, patients may experience
guilt because they behaved aggressively and destructively during
armed combat or because they survived a traumatic experience in
which family members or close associates perished--so-called
survivor guilt. In such cases, psychodynamic or insight-oriented
psychotherapy aimed at helping patients understand and modify their
self-critical and punitive psychologic attitudes may be
helpful."

Best,
D
I don't think that many of us here have true PTSD. Forgive me if I am wrong in any circumstance. I don't know any of you, but PTSD is indeed related to a HUGE major trauma such as war, catastrophe, surviving a horrendous event.

Oh, HELL, I always want to clarify.

Say in the event of the WTC. An individual may have a certain predisposition to GETTING PTSD. I'll use the WTC as only one example.
It was an unprecedented event. It was HUGE. I'm thankful I wasn't there.

Note however:

There were people in the buildings, employees as well as rescue personnel. Some got out safely. Some never got out. Some were badly burned or injured and yet somehow survived. If you've seen the beautiful documentary 9/11 by Jules and Gideon Naudet (which is about firefighters) and some of the best footage from inside the towers, you hear the bodies of people crashing onto the overhangs. They were jumping out of the burning floors.... 90 stories up... I forgot.

Many fire and police officers heard this/saw this. They saw people on fire, literally on fire.

BUT: Not every person in those very specific horrendous circumstances got PTSD. Many were in shock. Many will never forget that day, those moments until the day they die, but NOT EVERYONE GOT PTSD.

Even in a horrific situation like that, evironment/specific events/support from other people/religious faith/helping others, etc., etc. affected how each UNIQUE individual dealt with that.

There is a strength in the human spirit.... SURVIVAL. That is the natural tendency. But our fear response, the fight/flight can go bad.

I had a very bad childhood. Not as bad as so many people, but I do not have PTSD and was never diagnosed with it. GAD and Borderline fit best. And I have the symptoms of DP/DR which I believe stem from anxiety and my personality. The way I dealt with things from childhood.

Children who live in war torn countries, children and adults who live in high crime areas are more likely to have PTSD.

This does not make personal trauma such as child abuse or rape or any trauma anyone here has experienced any less. IT IS DIFFERENT and has a different outcome.

OK,
End of lecture.
A sad one.
D

bright23 said:

"IT IS DIFFERENT and has a different outcome."

Hey Dreamer, could you explain how it's "DIFFERENT", and the nature of this "different outcome." I don't follow your argument.

Click to expand...

Dear Bright,

In simplest terms, and I don't know how to clarify this any better than in my posts above:

PTSD is a very specific disorder. Per the criteria one must have been a part of a horrendous, life threatening event. The outcome of such an event are symptoms that are different from other "trauma".

E.G. -- killing people in a war as a soldier, seeing a fellow soldier being killed or tortured, being robbed or raped at gunpoint, surviving an airplane accident .... these things are extreme forms of stress.

Death of a family member (unless they are murdered in front of one's eyes) to illness, etc. is not something that would bring on the clinical definition of PTSD.

What one gets instead would be other anxiety disorders, not PTSD.

Also, I am of a biological viewpoint which not everyone here is, that some of us would get DP/DR, anxiety no matter what -- from our own life experiences here. I have no knowledge that anyone here has experienced dramatic trauma which fits the criteria for PTSD.

Some of us came from backgrounds where our lives were happy, trauma was the everyday trauma that every human being experiences. Life/death/illness, etc. For some of us, such loss may result in anxiety/DP/DR/depression, but not PTSD.

Again, bottom line. PTSD is a very specific disorder that is brought on by a life-threatening incident that the average person doesn't experience -- war, observing someone getting shot to death, being raped at gunpoint, surviving a plane crash. That's pretty specific.

I'm not sure what isn't clear.
Sorry if I haven't been clear.
Man I cannot get to sleep tonight.
Got a lot of writing done... not just here either 8)
Can you rephrase the question?

And it really isn't my argument, it is what is commonly discussed in psychiatric literature and has been for some time. PTSD is described in the same way in psychiatric texts. My argument I guess is that the term is misused and overused and that most of us here don't have PTSD. Many therapists don't know how to diagnose our symptoms and hence use handy diagnoses that "seem to fit."

There are also many here that self-diagnose.
Does this make any sense?

Getting DP/DR after the death of your brother... I'm sorry to hear about that.... seems to have resulted in the onset of DP/DR for you. The symptoms of DP/DR are not Posttraumatic Stress Disorder. DP/DR are not commonly associated with PTSD, but with other anxiety disorders.

Best,
D
No sleep for the weary tonight.

cesart said:

wow i wasn't expecting so much response! thank you to you all for your theories..although im slightly confused its interesting to know people's views. i have done some reading up on PTSD, and it all points to some sort of traumatic event..ie. car crash, bomb etc. i try to understand why two highly professional pyschs would put me under this category..and the only thing i can think of is that maybe a 'traumatic stressor' can be different for each and every sufferer. for eg. someone who survived 9/11 may have been able to cope reasonably well, but the death of their child has left them completely devastated. or vica versa. surely if you haven't experienced an extreme trauma you have nothing to judge this by. i think what im trying to say is that as i have not been in any severe situation such as 9/11 i have absolutely no idea, and couldnt even begin to imagine, what this might feel like. however, the death of my nan and closest and best friend is something that has paralysed me to the extent that i cannot live my life as 'normal' (though what that is i have no idea!). i dont think im exlpaining this very well...except to me losing my nan (especially the way that she died) is the biggest 'trauma' ive ever had to experience in my 21 yrs on this planet. any thoughts anyone? once again thank you for your replies...hope everyones ok (or as 'ok' as possible!) cx

Click to expand...

Dear cesart,
And welcome. Sorry for my lectures, I give them on a regular basis, and this wasn't directed at you. Forgive me. I was in agreement with Sebastian about the definition of PTSD and wanted to discuss it further.

Yes, the death of a close relative, someone you love is a terrible stressor, and I believe in measuring overall life stressors, death of a spouse and/or a loved one is very high.

These stressors, however, are separate from disasters. They do happen to all of us. And again, the key is how each of us deals with it. All of humanity experiences "the circle of life", from death to birth, and though frightening and grief inducing these experiences usually do not render someone incapacitated for long periods of time.

I'm not sure why your therapist says you have PTSD, and it really isn't my business to say your therapist is wrong, I'm sorry, but per the definition of PTSD it doesn't fit. That is, your symptoms -- and I don't know all of them, but I assume you have DP/DR among them -- have led to some other form of anxiety disorder which includes DP/DR, perhaps depression, etc. Perhaps you already had GAD before the stressors and they brought out this predisposition you have.

What separates PTSD out from the other anxiety disorders is flashbacks and startle responses that are so extreme the person seems to be reliving the horrible experience.

Yes, it's a matter of semantics, when someone dies, we can "relive" the loss, the feelings. We can not stop thinking of the person. But we don't avoid thoughts of the person to avoid feeling worse, we may dwell on the person to an extreme. We don't "numb out" as in shock, but we may DP/DR out of extreme anxiety/disbelief.

I wish I could articulate this better.

I am not taking away from your losses at all. I'm just saying that PTSD is in theory reserved for those people who have been exposed to a threat to their own lives or the lives of others, such as in a plane crash, a terrorist bombing.

Also, oddly enough, the PTSD individual is TOO "awake" (and that is a poor metaphor). They startle at the drop of a hat, but I don't hear of a lot of DP/DR which I see as something completely different.

ACH, making no sense. But I do believe there is a very distinct difference.

Please believe me, I don't mean to take away from anyone's traumas or losses here. I'm simply trying to define a diagnosis that I think gets overused.

Then, I may be full of garbage, LOL.
Take Care,
D :?

poonanny said:

Acute Stress Disorder is usually the diagnosis for people who lose loved ones; and yes...symptoms are DP/DR. Look it up, cause im too lazy.

Click to expand...

poonanny you're a genius.

And a key thing here, Acute Stress Disorder can result in DISSOCIATIVE SYMPTOMS. PTSD in its pure form does not have DP/DR as part of the mix... at least not to this degree.... and no I'm not an expert, but there is a difference in the two syndromes.

http://www.merck.com/mrkshared/mmanual/section15/chapter187/187f.jsp

why don't my URLs work these days? ACH cut and paste. Sorry.

Acute Distress Disorder (Again from the Merck Manual, same as the DSM)

"Acute stress disorder resembles posttraumatic stress disorder in
that the person has been traumatized, reexperiences the trauma,
avoids stimuli that remind him of the trauma, and has increased
arousal.

However, by definition, acute stress disorder begins
within 4 wk of the traumatic event and lasts a minimum of 2 days
but no more than 4 wk. A person with this disorder has three or
more of the following dissociative symptoms: a sense of numbing,
detachment, or absence of emotional responsiveness; reduced
awareness of surroundings (eg, being dazed); a feeling that things
are not real; a feeling that he is not real; and amnesia for an
important part of the trauma. (This is not delineated in the symptoms of PTSD -- the dissociation from which we experience here.)

The prevalence of acute stress disorder is unknown but is
presumably proportionate to the severity of the trauma and the
extent of exposure to the trauma.

Many persons recover once they are removed from the traumatic
situation and given appropriate support in the form of
understanding, empathy for their distress, and an opportunity to
describe what happened and their reaction to it. Many benefit from
describing their experience several times. Drugs to assist sleep
may help, but other drugs are probably not indicated because they
may interfere with the natural healing process.

-----------------------------------------------

So yes, I stand corrected. There is a SPECTRUM of trauma. But again, the point is PTSD seems to be the result of HORRENDOUS, LIFE-THREATENING TRAUMA. This is what I've always read about.

On the other hand psychiatry keeps redefining itself. PTSD as a diagnosis has seeped into other types of trauma definitions. Mental Health Professionals are also unique in their diagnostic technique.

I had a very traumatic (long term verbal abuse/neglect type scenario) but I can't say a diagnosis of either PTSD or Acute Stress fits me. I'd gather it has to do with specific incidents again. Moreso than long term trauma.

This gets very confusing.

Best,
D :shock: Learn so many new things every day.

-Panic Attacks And Panic Disorder
-Phobic Disorders
-Obsessive-Compulsive Disorder
-Posttraumatic Stress Disorder
-Acute Stress Disorder
-Generalized Anxiety Disorder
-Anxiety Due To A Physical Disorder Or A Substance

Again, see the delineation of specific anxiety disorders which require DIFFERENT approaches to treatment. I guess that is my point. Proper diagnosis = proper treatment.

bright23 said:

Perhaps ask yourself why you are so insistant of your speculation that PTSD is currently over-diagnosed. You might come up with an interesting answer.

Click to expand...

Bright, I'm not sure what you mean by that. I love research. I am a mental health advocate. I have a mental illness and interact with many mentally ill people. I like to try to understand the workings of the mind. What's an old 47 year old woman to do? I enjoy the research. 8)

bright23 said:

My brother's death was a suicide. Does that make it more awful than Cesart's loss? I don't think so. The entire concept that "that's worse, THAT's worser, and THAT's the WORSTEST!" is illogical, flawed and leads to misunderstandings between people. I don't think its healthy to compare trauma this way.

Click to expand...

There is no competition here between a worse trauma than a lesser trauma. That's not what I'm saying and it's not what the DSM is saying. A heart attack is no less serious than a stroke, but when the patient comes into the ER in a coma, a doctor needs to know what happened. Heart failure or stroke? Then the proper treatment can be given.

I'm very sorry about your brother. My closest friend committed suicide last year... well... it was around this time last year that she was "finalizing her life plans".

It's very difficult for me to deal with. I am attending a focused Survivors of Suicide group for this. Her one year death will be 12/15.

I am simply saying there is a difference between death and catastrophe and the human mind deals with it differently. But everything is on a spectrum, and of course everyone is unique... have a look at my signature! 8) I keep stressing that.

I have been on this board and on the DP Board before this one. PTSD seems to come up more often as a diagnosis. Frequently people self-diagnose and say they have PTSD. Like sebastian, I wanted to look it up for myself to see what the difference was ... if I recalled it correctly.

Our suffering is not a competiton. Not at all. I'm glad cesart is also open to hearing different points of view. I'm not making it a competition. I'm simply expressing my understanding of the difference between PTSD and what is now called Acute Stress Disorder.

Folks know me here as the research maven and the biological reductionist. Many things made me that way in my life. It's who I am. No harm intended.

I don't know what your implying in your first statement. Can you clarify?
I don't have PTSD. I have GAD/Boderline/DP/DR and have since I was a kid. Long boring story. No one has diagnosed me as PTSD in all those years. I can't identify with the diagnosis myself.

And as I mentioned briefly, I attended a PTSD meeting at a NAMI convention. It was packed full of war veterans at the time. None of them knew what I was talking about when I described DP/DR. And their experiences and symptoms were very different from mine, and from reading the board, from many here.

I can't diagnose anyone here, I am just thinking out loud. I'm sorry if I offended anyone.

Best,
D