Post Traumatic Stress Disorder

Today I am talking about PTSD. PTSD is Post Traumatic Stress Disorder; basically, PTSD derives from some source of trauma that occurs to an individual. It is your response to a trauma that has happened. Two people can experience the same trauma; one person might have PTSD afterward while the other does not. My goal and vision are to bring awareness to trauma and PTSD and let people know that this is common. PTSD is prevalent, and it is highly undiagnosed and goes untreated. I can't say what trauma is because what's trauma to me might not be trauma to you and vice versa.

PTSD, what are some symptoms?

The number one symptom of PTSD is detachment, withdrawing from relationships, and starting to unravel. You see that person detaching from a relationship before even verbalizing something happened. Detachment can be pretty much anything. It can be from depression, can be from anxiety, it can be from numerous different things. So when I say our traumatic event, it could be something as simple as a car wreck that you were involved in. It can be an assault that happens to you on your job. It can be sexual or physical trauma, all of these things, and it can occur in childhood. It can happen in adulthood. Plenty of different things and topics can cover incidents and events.

The trauma can be a vast majority of things. It can be something as simple as emotional or severe emotional abuse during childhood. So with that, as a symptom, you can have flashbacks. It can be during the middle of the day, and you have a flashback of someone bullying you at school, someone telling you you're worthless name-calling. Essentially, any flashbacks from events that have occurred.

Another symptom is having nightmares. Nightmares can be nightmares of the actual event that happened that traumatic event, or they can be nightmares unrelated to the trauma. So nightmares and flashbacks start to detach and withdraw.

Here's an example. Trauma happens at work. Somebody at work assaults you. You avoid wanting to go to work. You start avoiding the situation where it happened. Abuse occurs in the home and avoids going back to the house, wherever it happens.

Another symptom can be insomnia, having difficulty sleeping at night, and many times it can be from fear of not wanting to go to sleep because you're afraid. I was also jumpy, anxious, and paranoid that this event would happen again. So you're out in public and constantly on the alert and watching because you're afraid that this event will happen again. If you're out, and something happens like loud noises, a smell, or even somebody that looks like the person that might have looked like the person that abused you. Or like I said, you know, you witnessed somebody getting shot. So the sound of a firecracker going off is a trigger for a gunshot. It can start your mind to go back to that event that happened. And it can cause an anxiety attack. It occurs very frequently and is like a whole panic attack where sometimes patients have to be hospitalized because they're hyperventilating and unable to calm down.

Suicide is another symptom of PTSD. Once avoidance happens, then depression might set in. It exacerbates and worsens and could eventually lead to suicidal thoughts. So another thing with children, it's never a cookie-cutter thing. The most trauma we see with PTSD in children is the abuse, physical abuse, and sexual abuse. Often, they don't talk about it. So what ends up happening is that kids typically tend to recreate the traumatic event. They might act out a sexual behavior, or they might act out the things that they have witnessed. Those are things to look out for as well.

So what happens if nothing's treated?

PTSD does not happen until about a month after the traumatic event, and you cannot shake it. That's when it turns into a diagnosis of PTSD that we were first diagnosed as a stress disorder. You're having some stress. Let's see how you adjusted this because it does not mean you'll have PTSD when a traumatic event happens.

What happens if PTSD is not diagnosed?

Drug abuse and alcohol abuse are widespread. Look at our military population. The percentage of our veterans that have PTSD is astronomical. The Vietnam vets come back with all this exposure to death and watching people die, killing people, all this trauma, and they don't know how to handle it. They're told to readjust back into society. So we have had veterans for years who haven't gotten the help or services they need and live with trauma. They live with PTSD, and it destroys their lives. They end up using drugs and alcohol to cope. So that is something that can happen if it's not addressed correctly.

What are some risk factors?

Just because you have a traumatic event does not necessarily mean you'll have PTSD. Here are some risk factors that obviously could put you at a higher risk of developing PTSD if you witness a traumatic event. If you have a long history of already having a trauma of some sort, that can be a risk factor. If you have depression and anxiety, then having a traumatic event happen on top of that can also be a risk factor.

If you have a family history of depression and anxiety, that is a risk factor. If you have a job that's in the military, that's any first responders. You're at risk of developing PTSD. And I'll say this as a nurse, back at my core in the emergency room, nurses have a real crude sense of humor. They witnessed a lot of traumatic events happening. And I can't say that all have PTSD. That's not true, but they're at risk for PTSD. So substance use is a higher risk for developing PTSD, lack of support, not having support, someone to talk to, some people that you'd know that you can lean on, and trust that is a risk factor.

Treatment.

We can go over tons of different ways we could treat this. But the first thing first, we always want to go with therapy. You'll talk about coping mechanisms and methods to cope and deal with the stress you've experienced. So when we say coping mechanisms and coping skills and talking about, "Hey, when you see something or something triggers you, or you hear something, whatever, when you're triggered, what are you going to do at that moment?"

Sometimes the anxiety goes from low to high immediately, and there's no way of calming yourself down. One of the things that I am implementing is rounding techniques. It is when anxiety strikes, when the trigger happens, pushing your feet into the ground, grounding yourself back into reality, "Hey, this is where you are. You're not there."

Another thing is EMDR therapy. So Eye Movement is the sole purpose of EMDR therapy. It takes trauma from one part of your brain, where it is stored. Another aspect of the brain takes trauma from an open wound to a scar. You are triggered every day, too, you might get started now and then, but it's not impairing your lifestyle. EMDR is strictly for the reaction reactivity whenever you're exposed to trauma. It desensitizes. I highly recommend to them EMDR therapy for PTSD.

The third is medication. Often life gets so stressful, and they don't know how to deal with the emotions behind the trauma that depression, anxiety sets in, and sometimes suicide. So what do we do with PTSD? Antidepressants are the number one way. We treat it along with trauma-focused therapy, which is EMDR therapy. So, where medications come into play the most is treating the symptoms. With the EMDR therapy paired with medication, I have seen patients make a 100% turnaround. It's been pretty incredible with the EMDR therapy. It's a long process, and many times we have to constantly adjust medications because it's basically like exposure therapy to desensitize when triggers happen.

Typically am having to treat nightmares. I have to treat panic attacks. Many times I have to bump up doses because as EMDR therapy is being conducted, it increases panic attacks. It increases stress levels. It's very calm. So when I know, I have a patient with PTSD, the number one thing we talk about in therapy. Because many times, if you can get through the therapy aspect, nine times out of 10, you can get off medications because the reactivity is lower, and you don't have panic attacks anymore.

Do you sometimes not know or not remember the actual event but have extreme anxiety when faced with this situation repeatedly?

Yes, that happens. It's called suppressing. Many times what happens is primarily young. Below the age of five, traumatic events occur. And often let kids hide and learn how to stop their feelings. So when something happens in life, like rejection, just any kind of issue, you depress it, stiff it down, and eventually, things will start to make sense. It doesn't mean you'll ever maybe have a memory, but you typically develop that way of coping. I can't say 100% that I have an answer for that question, but as far as managing, that is always an alert.

PTSD it's often undiagnosed, especially with childhood trauma. Childhood trauma is typically a sexual or physical abuse trauma, like sexual abuse, and children who have at one point been sexually abused, whether rape or molestation, usually turn into a victim. Here are some more signs of abuse in a child. As far as sexual abuse goes, a child does not want to bathe, take care of themselves, want to look unattractive, not wash their hair. These are all signs of sexual abuse, and here's another way if it's ever diagnosed or suspected. For cases like such, they attend play therapy where they have the child via play therapy. During therapy sessions, a child may re-enact the traumatic event typically. So there are plenty of reasons a child won't disclose trauma; they've been threatened, scared, and the list can go on.

As a parent, be vigilant because most sexual abuse happens within the family, whether it be aunts, uncles, cousins, or step-parents. So be very attentive to your children and be their advocate. If you suspect, schedule play therapy and a forensic assessment.

How was their hope, and how do you help? Do you get them a schedule, an appointment, and have a psychiatric evaluation completed during their evaluation? They will have a thorough assessment done. Again, how we make that diagnosis is how long has this event, how long ago did this event happen? What are the symptoms? Are they having nightmares? Are they having depressive symptoms? Are they having flashbacks, et cetera? And then, from there, recommendations are made as far as medications. Medications aren't recommended, just depending on the severity of the situation. From there, you refer to therapy. EMDR therapy is what I always recommend.

So yes, how you help your significant other or anybody, for that matter, is simple. Get a psychiatric evaluation completed. Often, we have built rapport reports with therapists we know will be a good fit. And so we refer, and we'll recommend,

Are there levels of PTSD? How bad does it have to be before it's considered PTSD? With PTSD, it has to be over a month since the exposure to the traumatic event happened. We don't diagnose it before then because it can just be like a stress disorder and doesn't have to be PTSD but depends on the severity of the symptoms.

Are this life and pairing for this individual? Is this causing suicidal thoughts? Is this causing depression? Is this causing the nightmares, the flashbacks, et cetera?

So that is how we assess that. There are all factors in how many of these the patient has met. And it also will factor into the meeting that diagnosis.