Is This PTSD? And a Few Questions

[sigh]

Sort of. It wasn't to dissuade you so much as to remind yourself that life isn't looking things up. It includes other people, so many things. Reading about trauma can be triggering. I find that I would obsess over something, go to Barnes and Noble so I could read the books I couldn't buy, and buying the ones I could. I was in a Dissociative Identity Disorder group on line which also had a chat room. I met one of my (not any more) best friends ever. But too much time with so much grief (for me) made forget that I'm an artist, a musician, a writer, a lover of the ocean.

Actually I'm totally lying. I would totally obsess about it too. hrmp

the sensamela is talking.

 

[anthony]

Loqu, time frames are based only for theoretical purposes in order to try and get some sort of uniformity across diagnosis, which makes them far from correct.

When I first deployed, I can tell you that I had every symptom to fit PTSD, but I did not have PTSD. Knowing what I know now, I had ASD, even though I had the symptoms for about two months. The second time was a little longer, though what snapped me out of it was another deployment only 12 weeks after the second, for a duration of about 6 weeks, so that was the third. I had little fallout after that, as I was quite ok. Each deployment I had symptoms upto 6 months in duration, but then I recovered and got on with life once again.

I went into a war zone... snapped after that one, but still got better about 8 months after. All symptoms of ASD, because each time the symptoms disappeared completely and I did get better. At the time, they where severe each time, but disappeared. Any physician by the book would have diagnosed with me PTSD, though I recovered each time and became quite good. My last deployment raised a lot of issues with my previous, because I redeployed back to the same war zone, only now it was a UN peacekeeping zone and very different from the previous. No killing, no daily fear... Then I gave up smoking, and that was the thing that just overwhelmed me and from then on everything fell apart, mainly everything to do with the war zone deployed... I have never recovered to date. Now I have PTSD... everything prior I had ASD.

Again, if I knew then what I know now, I would have sought professional help after each, it was offered... but I thought I was fine, too big a man, etc etc. I was wrong, but now its too late.

You have done the exact correct thing through seeking professional help now... whilst it is preventable. Once you get to the point where your brain physically changes its chemical makeup, you're fu*ked from that point forward as there is no recovery.

So... clinician guides are just that, a guide. Every clinician should think outside the box and assess a person over a period of time, instead they just do one or two sessions these days and conclude you have an incurable mental illness, when in fact many don't have PTSD at all.

It is now being stated, and I watched this on the BBC the other night, about how PTSD is being diluted by society and clinicians. Even a reporter was diagnosed with PTSD from his combat time reporting with the military, though he recovered, and admits that PTSD by definition is incurable, but he recovered totally... so how could he have PTSD. After his own research he concluded he actually had ASD, even though he suffered for near a year with symptoms. These books really are a guide, and clinicians globally are diluting the term PTSD to suit themselves and society. ASD is rarely diagnosed... because clinicians make no money off that diagnosis... and being a clinician nowadays seems more about making money that helping people.

 

[loqu]

anthony,

Thank you for this insightful post describing your own experiences. I'm saddened but not surprised by the content. It is very unfortunate that the clinical judgement of this widespread disease remains ill-defined, or at least limited in its scope. I'm highly sympathetic to your plight, now having known for myself the symptoms of psychological trauma. I'm very thankful that you shared this because it has brought me reassurance that my case is within the treatable boundaries of ASD. I'm hoping that the ongoing improvement can be taken as a decisive sign that no irreversible damage was done.

One point that was as confusing to my therapist as it is to myself is why my symptoms were delayed for 11 months before being triggered. Again, this does not sound like the clinical description of ASD. Reading your post I realize that the clinician's guides like the DSM are insufficient in relating one's own experience with psychological trauma. The disease is simply to complex to definitively pin down and comes in many shapes and sizes.

 

[anthony]

One point that was as confusing to my therapist as it is to myself is why my symptoms were delayed for 11 months before being triggered. Again, this does not sound like the clinical description of ASD. Reading your post I realize that the clinician's guides like the DSM are insufficient in relating one's own experience with psychological trauma. The disease is simply to complex to definitively pin down and comes in many shapes and sizes.

Well... not really a disease, but a mental illness. Disease is something different again than mental illness. I understand what you're getting at though.

You really hit it on the head with onset... because it is also something where a rough guide is used, but it really just doesn't apply in real life. To clinicians, they think they got it right, but if you look at a [DLMURL="http://www.ptsdforum.org/thread275.html"]poll we started here in 2006[/DLMURL] about this exact thing, you will see that the actual majority do not fit the clinicians guide at all, and only about a third sit within the clinicians guide to onset and diagnosis. The rest sit at 3 months and longer, the majority at beyond 12 months before symptoms established themselves.

What makes clinicians guides typically are the statistical analysis from soldiers, nothing more. Because veterans are the largest obtainable group in one location, this is where clinicians do the majority of their research, study and calculations from. It is proven that soldiers are actually the minority of PTSD sufferers within society based on PTSD statistics, but they are the single largest entity in one easy to gather place for study. This is another reason why clinician guides are not exactly correct for all. Yes, clinicians do provide statistical data and metrics from practices around the globe, but these are also full of incorrect data and many do not provide it to the bodies who write the diagnosis standards... usually only public facilities, which is again, the minority of data within the mental health field.

The problem with veteran data is that it is very incorrect due to the nature of combat trauma, being it is placing a person within a prolonged situation/s and then removing them from that situation suddenly. The effects of just that alone produce symptoms of PTSD, let alone combat and traumatic events that occurred. It can take a soldier a month, two or three, even up-to six months to readjust to society again after prolonged exposure to a combat zone. So what you could construed as PTSD, may just be readjustment from an environment of constant alertness, sleep deprivation and more to suddenly civilian life, do what you want, when you want, no constant threats around you, no gun piquets, sleep all night without interruptions, etc.

Common sense really must prevail with mental health diagnosis, and more and more clinicians are starting to move towards this due to growing dissatisfaction from the public around the world. Still... these physicians are the minority, but can be found if you look hard enough.

When you put a physician within say a public mental health facility, they have their morals and ideas, their own personal ways and thoughts to help people, though then they become subject to policy and procedure of those facilities, where they are not allowed to use their own common sense and methods, instead are forced to use doctrine. This travels in many circles of life, not just health... then you have things like the burnout factor... how long a physician can last before they just accept they are banging their head against a brick wall. This can then taint them for life and they apply the same half arsed principle across all new patients, instead of where say they may off come from initially with ideas and methods that suit them. Very few follow those commonsense principles due to corporate doctrine and policy from employers.

All of these factors and more then makeup the global doctrine... which when you ask any really good physician who gives a shit about patient health still... the answer should always be, "they are a guide to diagnosis only, where experience, common sense and patient well-being must always come first".

 

[loqu]

I think I'm starting to see the bigger picture now. I shouldn't be surprised to google "ASD" and "delayed onset" and variations thereof and find zero results, because according to the party line (the doctrine on these disorders) delayed onset is a definitive sign of PTSD. Of course, when you gather data from war veterans fresh of the battlefield and then attempt to apply these statstics to every trauma-inducing event in civilian life you're bound to fail. This is all quite astonishing to me: who could know that the clinical canon is so far off, so completly skewed at its core? It's demoralizing. The pure notion of allowing data gathered from people who have been subjected to extended periods facing actual death and allowing this to become the framework for all diagnostic efforts is preposterous (incidentally, my therapist spoke of the very real difference of having been threatened with death, even if physical violence was involved, and actually seeing people being killed around you. It's simply not comparable).

 

[pegasus]

Anthony it is great to see the stastics challenged. They say only 8% of complex PTSD sufferers don't meet the current PTSD criterion. It seems that a prolonged abuse i.e. childhood would manifest much differently than an isolated PTSD suffer therefore the it theoretically would seem the symptoms and onset would differentiate. Lets hope in years to come the statistical evidence will become much more broadly studied.

 

[anthony]

I hope so too pegasus... I'm really quite tired of seeing all the studies from veterans, then attempting to provide a blanket statement for PTSD. I am a veteran and I can see the difference in PTSD from myself and other veterans with PTSD I personally know, compared to a civilian who was raped, abused, MVA, etc. Being prolonged trauma vs. one time event. PTSD comes out the same, but how it got there is vastly different to each person.

The problem is the same though across most medical industries, in that private practice which actually makes up the bulk of medical practices, do not provide their data because of privacy and just because they don't have too. Any private physician who I believe does a procedure within a public facility though, then their public facility work is added to the statistical data, but the rest of their private work is not. It changes around the globe from country to country, but typically all private practice do not provide such data unless its within a public practice.

Straight from the wikipedia, cited:

The DSM-IV doesn't specifically cite its sources, but there are four volumes of "sourcebooks" intended to be APA's documentation of the guideline development process and supporting evidence, including literature reviews, data analyses and field trials.

For those who do not know, the DSM is published by the American Psychiatric Association (APA) http://www.psych.org.

Don't get me wrong, the ICD and DSM are both good sources... where the ICD is more a global publication and the DSM was mainly for the US, though the DSM is more readily cited as the main publication for diagnosis around the globe today. There are many inherit issues with diagnosis, and really no physician can know everything about each one. This is why I always recommend people to really seek out a trauma specialist, and not someone who says they are, but when you ask lots and end up with often the same name from other industry specialists.

Diagnostic manuals have been designed for one purpose and one purpose only... an attempt to have uniformity across the world with diagnostic labels. 99% of physicians who read the diagnostic criteria for PTSD don't think outside the box, nor have the experience in PTSD to know really what is what with who. Any mug can pickup a book and read, if you fit it, then give it too you. Shit, I can do that as can every other person on this forum. But it takes a lot of skill to really know who is who with PTSD vs. someone with ASD. So many people fit the criteria for PTSD but don't actually have it... where it is given now and watering down PTSD itself as a result.

There is a very good recent story on the trauma industry surrounding PTSD going to court for compensation, and everything it says is true.

http://news.bbc.co.uk/panorama/hi/front_page/newsid_8166000/8166060.stm

This jumps out at me from that story, which is absolutely true, UK based:

According to a July 2005 report by the National Institute for Health and Clinical Excellence (NICE), the NHS is treating an estimated 250,000 people a year for PTSD.

That is twice the number of soldiers in the entire British Army. Professor David Alexander, a PTSD specialist, gives his assessment of the rise in diagnoses

"It's a money spinner, let's be blunt about it," Professor Alexander tells Allan. "If you've got at the end of the road the prospect of £100,000 by continuing to have headaches, flashbacks, insomnia - you can see why people may not find it easy to relinquish those symptoms."

Personal injury lawyers tell Panorama that the 'no win, no fee' way of doing business offers a legal voice to people who are suffering and who might otherwise not be able to afford to sue for compensation.

 

[anthony]

Added:

Something that I am finding more and more from people here today, is that PTSD is being diagnosed first, instead of last, as it used to be. There are some who fit it due to history immediately, but the majority should actually be diagnosed with the lesser first, as this was the standard practice years ago. Every physician I spoke with five years ago said to me that they 90% of the time they would diagnose with the lesser first, and instead watch a person over months to see whether improvement was made or not and the level of that improvement. Now... it is diagnosed in the first or second session, given medication and sent on your way, told to come back periodically for a med check and seek counselling.

If you have a bit of anxiety nowadays, physicians just go straight to PTSD instead of the other 20+ anxiety disorders available. The moment they here one traumatic incident... PTSD.

 

[pegasus]

Very good points Anthony. In some respect it is a very young diagnosis and it will unforntunately take some time to really get a good understanding to "get it right" (as much as that can be done).

 

[loqu]

I'm seeing a new therapist now (EMDR, with a guy who happens to be specialized in traumatology). I read this excellent post by anthony [DLMURL]http://www.ptsdforum.org/showthread.php?t=6764[/DLMURL] and so I had a few questions.

1. Since my condition seems to be ASD, I want to clear things up with my therapist and to find out where he stands on the issue of diagnosis. Apparently this is a difficult subject with conflicting viewpoints. anthony writes in his post that PTSD is by definition incurable (albeit treatable) while ASD, exhibiting many of the same symptoms, is curable. Who's made this distinction? Although to me this seems a reasonable clinical judgement, how does this comport with the notion of "acute" PTSD as it is currently put forward in the DSM? This is supposedly a condition where the symptoms of PTSD passes within three months. This doesn't sound like incurable, permanent damage. Is the DSM wrong, or have I misunderstood this description?

2. anthony wrote in an earlier post that he experienced several bouts of ASD before he came down with full blown PTSD. Again, this sounds reasonable in the sense that if damage is incurred a sufficient number of times the wound will eventually become permanent. But I'd like to make sure: if one has once suffered ASD, are you more suspectible to coming down with PTSD if you experience further trauma? What are the mechanism by which the chemical imbalance or whatever other physiological behavior that influence ASD/PTSD is affected by repeated trauma?

I know this is difficult stuff. Many of these questions I asked my first therapist, who both said that I had PTSD and that I would be completely recuperated. In other words, he had no idea what he was talking about. Since I'm with a new guy, I want to make sure we're on the same page. Also, I continue to dig deeper into this so I can understand what the ramifications are for the future. Many thanks!

 

[anthony]

anthony writes in his post that PTSD is by definition incurable (albeit treatable) while ASD, exhibiting many of the same symptoms, is curable. Who's made this distinction?

The doctors made this distinction. Once the chemical imbalance has taken effect within the brain, there is no current cure to reverse it. The only attempted method to rebalance it is through medication, however; many will know already that this is an attempt only, and does not balance the imbalance correctly.

Although to me this seems a reasonable clinical judgement, how does this comport with the notion of "acute" PTSD as it is currently put forward in the DSM? This is supposedly a condition where the symptoms of PTSD passes within three months. This doesn't sound like incurable, permanent damage. Is the DSM wrong, or have I misunderstood this description?

Duration of symptoms vary from person to person, which is why variations are defined. Some people can have an MRI, determined to have PTSD, though their symptoms may only last for short periods, ie. when they are under a lot of stress, many symptoms engage them at once, then they reduce again. The DSM does not refer to this as a one time event, but instead this is applied to how the symptoms affect the person each time they present. You will hear people here often say, good days, bad days. These can be good weeks and bad weeks, good months and bad months.

But I'd like to make sure: if one has once suffered ASD, are you more suspectible to coming down with PTSD if you experience further trauma? What are the mechanism by which the chemical imbalance or whatever other physiological behavior that influence ASD/PTSD is affected by repeated trauma?

Now you get into the area where many are still really unknown. There are so many studies on this exact thing, each showing differences, change and different statisical and medical data. Some are testing towards what genetics has to do with it, whether your family history tends to lean more towards a genetic component. Others are testing a range of stressor factors... the list is really just so long. You can just go through the world news section here to find such a vast range of studies, comparisons and outcomes on this exact topic / surrounding it.

It is hypothesised that prior traumatic events lead towards the effect of further life traumatic events. There have been many statistical facts showing this, but nothing actually medically proven. They have found that family history statisically shows the likelihood of stress within other members of the family, but once again, most of these studies are based on statistics, not so much medical. Some things though I guess can only be found through statistics for an approximation... other is medical, some both.

Since I'm with a new guy, I want to make sure we're on the same page. Also, I continue to dig deeper into this so I can understand what the ramifications are for the future. Many thanks!

This is exactly the problem with this diagnosis... therapists who are not qualified to actually give such a diagnosis are telling people they have it, without even fully understanding it. Physicians are doing the same at times... therapists are terrible for it though. A therapist should never tell someone they have something... they should only give clear speculation or their opinion, but send you for further professional testing by people who know what they're doing with trauma and PTSD.

There was a BBC show about how PTSD is now being diluted because of social pressures and inaccurate information about the diagnosis. It is the last resort of diagnosis, not the first, and should never be treated as such, yet many therapists are throwing the term around as though its a common phrase... It was even referred to due to society as "a cool thing to have." People actually think that having such a label is cool... being they obviously also do not understand what it is or when it should be given.

Hope that helps you out. There is a lot of information based on the science of the brain within the information sections already. Some within the chat PTSD forum, but mostly within the info sections. Dr Roerich is one the worlds leading experts on PTSD, and he has put some pretty good info in those areas.

 

[loqu]

I had misunderstood the DSM, how "acute" refers to a repeated pattern of triggered symptoms. Thanks for clearing that up, certainly makes things more navigable. Still, I'm befuddled by how the DSM misrepresents in particular ASD. Nowhere do they mention a delayed onset of this condition, which, I recon, should be one of the most common mental illnesses in our society today. Consider how often people are faced with life threatening situations where a freeze and the accompanying stress on the nervous system is present. For example, every time someone points at you with a gun. Of course, not all these situations will incur post traumatic stress for the individual. But they happen so often. I just can't believe they've completely missed out on delayed onset of symptoms that are not due to permanent brain damage.

In my case, I'm happy to say I'm experiencing continually diminshing symptoms. What started out at about a 7 SUD at worst is now down to a 3 or so. Again, in reference to ASD, it's confounding how I've never reached more than half of the criteria for either PTSD/ASD. I've certainly had a great deal of stress and pain, to the point where I've sought professional help. My point with this is that there should be plenty of people with the same experience that are within a "grey zone" of mental illness, whose pathology does not comport with the manuals. I suppose this has been your point all along, anthony. I'm just now starting to see the bigger picture.

I'm trying to ascertain whether this was a one time event or if there will be further triggers down the road. I've had no prior experience with traumatic stress, maybe trauma albeit nothing that stands out in my mind. Certainly no symptoms of the kind I've had for the last 4-5 months. I'll speak with my therapist on all these points and see where he stands now that I have an intellectual foundation on this issue.

I'll check out the information sections. Again, the most warmest thanks for your help.