In the first of a two-part series, we’ll identify the 5 symptoms of PTSD and next week, we’ll talk about how healing occurs and what you can do to offer support to someone with PTSD - plus, what not to do!
The idea for this podcast episode comes from listener Phoebe Gavin of New York City. In addition to being an OIF veteran, Phoebe is a member of Iraq and Afghanistan Veterans of America (IAVA), the first and largest non-profit, non-partisan association for new veterans. Thank you, Phoebe, and all your fellow veterans, for your service. .
Let’s begin with two adapted-from-real-life stories to paint a more accurate picture of PTSD. Consider proceeding with caution if you’re a super-empathizer or a survivor yourself. A pleasant spoiler: both people I describe are doing fine now.
Two PTSD Test Cases
We’ll start with Kim. Kim is a 26-year-old former patient. As a child, her alcoholic parents neglected her, leaving her alone for long stretches of time. Even when they were present, they were often too drunk to notice anything. A male neighbor took advantage of the situation and molested Kim for several years. Each time Kim tried to speak up, her parents told her, beer bottle in hand, that she was lying. The abuse finally stopped when she reached puberty. Kim was functional, though promiscuous, through high school, but when she saw the neighbor at a local car wash several years ago, something snapped.
When Kim first started coming to therapy, she was having nightmares, flashbacks, and panic attacks almost every day. Seeing any unfamiliar man, even a grocery store checkout clerk, automatically triggered the thought that he was going to force himself on her. As a result, she had dropped all her college courses and stayed in the house as much as possible. Several of Kim’s friends were supportive, even if they didn’t always understand. Her mother, however, told her to snap out of it and said she was just trying to get attention.
Larry is another former patient. He has diabetes and was in a freak accident that left him locked in a self-storage unit for 48 hours. He was in ketoacidosis and in and out of a diabetic coma by the time he was found, and the emergency room doctors said he had the highest blood glucose levels they had ever seen. After two weeks in the ICU, he was released. Once home, Larry had a horrible time sleeping because every room in his house reminded him of being locked in the storage unit. To make things worse, going to sleep and waking up reminded him of passing in and out of his coma. He couldn’t make it through a day at work. His wife told him to pull it together.
Kim and Larry both had post-traumatic stress disorder, or PTSD, which is the only mental disorder that must be caused by an outside event.
What Is PTSD?
The trauma that sparks PTSD can be experienced directly, like combat, assault, being in a fire, or Kim’s or Larry’s experience. But witnessing something horrific is also valid, like watching someone drown or get shot. Similarly, repeated exposure to the aftermath of tragedy counts as well; this category might include child protective service counselors who deal with child abuse day in and day out, or the cleaning crews dispatched to mop up grisly crime scenes.
As of the most recent version of the diagnostic bible, the DSM 5, there are 4 groups of symptoms, plus one that occurs only in some cases:
Symptom #1: Intrusion. Also called re-experiencing, these are the memories that come rushing back, seemingly out of nowhere, and are so lifelike that you feel you’ve been sucked right back to the trauma. Re-experiencing makes you relive the worst moments of your life again and again.
Re-experiencing can include flashbacks, nightmares so vivid they feel real, or intense memories. The smell, the house, or the stretch of highway that re-ignites the traumatic memory is called a trigger. For example, every time Larry woke up in a dark room, the trigger of darkness sent him right back to the storage unit. Kim would get triggered whenever anyone looked her straight in the face, which is how she remembers her abuser. In other examples, a song that was playing during an assault might set off a flashback, as might the sound of fireworks for a traumatized combat veteran.
Symptom #2: Hyperarousal and reactivity. For some, hyperarousal (which has nothing to do with sexual arousal) means being terrified all the time. Constantly being on edge, jumpy, paranoid about perceived danger, or vigilant for threats leads to trouble sleeping and concentrating. For example, Kim was always on alert for men and literally ran away if a strange man approached her.
For others, hyperarousal may play out as feeling aggressive, impatient, irritable, or angry, or as self-destructive behavior like cutting, getting into fights for no reason, or promiscuity, all of which make sense when you think about it—powerful short term distraction must be a welcome, if dangerous, diversion.