• All donations and upgrades are manually verified and approved within 24hrs.
  • Upgrades are ongoing. Learn how to save your bookmarked posts.

Ptsd diagnosis

Thread starter #1
Posttraumatic Stress Disorder (PTSD) is a classified trauma and stressor related disorder which is often misdiagnosed with Bipolar. PTSD is treatable, yet has no medical cure to date. Saying that, PTSD can and does go into remission, similar to that of cancer. What is often referred to as Posttraumatic stress can in actuality be referring to PTSD, Acute Stress Disorder (ASD), Adjustment Disorders or simply having a few symptoms after a traumatic event that meet none of the above, and instead a combination of other disorders. One way to view PTSD is, "an abnormal response, to an abnormal situation, is normal behavior."

PTSD vs. ASD

Simplified, when the brain reaches the state of PTSD, it means the brain has physiologically broken through a neurological change that is yet to be specifically identified, hence the experts don't really know where PTSD exactly originates in the brain, or why. Whilst our brains chemical composition is related to anxiety, depression, behavior, mood and so forth, the old model of PTSD being a chemical imbalance is no longer accurate today, as no chemical balance is proven to state an imbalance. Medication attempts to replicate or replace this chemical model, which is hit and miss at best, to put it bluntly, though still a requisite for severe symptoms or even a requirement due to lifestyle choices / demands. Latest research brings much doubt upon the efficacy of Selective Serotonin Reuptake Inhibitor (SSRI's) and whether they are any longer suitable as an effective treatment with PTSD specifically.

ASD has very similar symptoms of PTSD, however; symptoms don't cause a permanent neurological change. ASD symptoms typically subside, thus the person recovers fully via treatment, with usually no ongoing mental health requirements. ASD fundamentally hovers more towards less severe / part thereof symptoms, where PTSD heads toward additional and often worse severity. ASD is often stated as a precursor for PTSD, however; more recent studies tend to disagree. You could technically have ASD for months, not fully meeting PTSD, and with time symptoms develop or lessen.

To use a simplified statement, think of PTSD like a broken bone. You can break it and it heals. Your age may depend on the time and quality of that healing process. If you break the bone again, whilst it will repair itself, this time it will not be as good as the last, as you have aged, the break is now twice in the same place, so you didn't start with an original bone to break, it was 'used' due to its first break and now carried scarring. The body heals faster the younger you are, yet the human brain tends to process emotion better with age, or life experience. Now continue to repeat the break with each trauma, and uniquely to each person, the bone will stop healing and cause permanent impairment to that persons life.

Self-Diagnosis

The worst view any individual can have towards a diagnosis is an attempt to self diagnose, or fit themselves within a diagnosis. Diagnosis does not work that way. The key you must know about diagnosis is that every diagnosis comes with assessment tools. These are a set of industry questionnaires that have been tailored to find specific responses across a range of emotional, individual and lifestyle aspects. There are practical components that can only be assessed face-to-face with a trained physician. Without these combined tools of assessment, a diagnosis is just words.

Risk & Prognostic Factors

Females are more prevalent than males to PTSD. Females in general experience PTSD longer than males. The increased risk for females is attributable to the greater likelihood of being raped or other form of interpersonal violence.

Suicide risk is increased within those exposed to childhood abuse.

There are three areas that determine risk for PTSD, which are pretraumatic, peritraumatic and posttraumatic. The following information outlines some areas of life that determine an increased risk for PTSD development.

PreTraumatic Factors

Temperamental: Childhood emotional problems by age 6 (traumatic exposure, externalizing or anxiety problems) and prior mental disorders (panic disorder, depressive disorder, PTSD or Obsessive Compulsive Disorder (OCD))

Environmental: Lower socioeconomic status, lower education, exposure to prior trauma (especially childhood), childhood adversity (economic deprivation, family dysfunction, parental separation or death), cultural characteristics (fatalistic or self-blaming coping strategies), lower intelligence, minority racial / ethnic status, and a family psychiatric history.

Genetic and Physiological: Female gender and younger at time of exposure. Certain genotypes may either be protective or increase risk of PTSD after exposure to traumatic events.

PeriTraumatic

Environmental: Severity (dose) of trauma (the greater the magnitude of trauma, the greater the likelihood of PTSD), perceived life threat, personal injury, interpersonal violence (particularly trauma perpetrated by a caregiver or involving a witnessed threat to a caregiver in children), and, for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy. Finally, dissociation that occurs during the trauma and persists afterward is a risk factor.

PostTraumatic

Temperamental: Negative appraisals, inappropriate coping strategies, and development of ASD.

Environmental: Subsequent exposure to repeated upsetting reminders, subsequent adverse life events, and financial or other trauma-related losses. Social support (including family stability, for children) is a protective factor that moderates outcome after trauma.

Diagnostic Features

Controversial for years, the non-medical diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) due to a failure within the PTSD diagnosis to adequately cover the dissociative symptoms experienced by those with complex trauma, often meaning prolonged childhood trauma, some combat veterans and prisoners of war. The experts have listened, as dissociation is now adequately covered within PTSD as a diagnostic feature in the broad set of symptoms, including two dissociative subtypes.

Individuals will exhibit prominent features in symptom sets, which means their primary concerns will focus closely in one of the following, yet may experience all symptoms or sets at lesser severity:
  • fear based re-experiencing, emotional and behavioral symptoms,
  • anhedonic or dysphoric mood states and negative cognition symptoms,
  • arousal and reactive-externalizing symptoms, and
  • dissociative symptoms.
One definition that should be defined here, is the use of 'persistent.' As defined by the DSM, persistent means "always or almost always." This removes ambiguity when reading diagnostic criterion or underlying assessment data and fitting yourself into 'persistent.'

Criteria A

Criterion A outlines events that are considered traumatic enough for a PTSD diagnosis, which include but not limited to, war as a combatant or civilian, threatened or actual physical assault (robbery, mugging, physical attack, childhood physical abuse), threatened or actual sexual violation (forced sexual penetration, alcohol / drug-facilitated sexual penetration, abusive sexual contact, noncontact sexual abuse, sexual trafficking), being kidnapped, taken hostage, terrorist attack, torture, prisoner of war, natural or man-made disasters, medical (waking during surgery, anaphylactic shock) and severe motor vehicle accidents.

Whilst every conceivable type of trauma is impossible to list, the DSM clearly outlines a pervasive pattern of extreme violence or abnormal event not considered normal within life. Normal death, life threatening illness, debilitating medical illness, relationship breakdowns and other stressors considered part of normal life, are not necessarily considered a traumatic event by definition for PTSD. These lesser events are covered under other diagnoses, such as Adjustment Disorders, where a single stressor is responsible.

Criteria B

Criteria B1 is focused on intrusive symptoms. A key focus in this criterion is that the intrusion is involuntary. The emphasis is on recurrent memories of the event that usually include sensory, emotional, or physiological behavioral components.

Criteria B2, a common re-experiencing symptom is distressing dreams that replay the event, part thereof, or thematically related to major threats from the trauma.

Criteria B3, dissociative states can last hours or days, during which components of the event are relived and the individual behaves as if the event where occurring at that moment.

Criteria B4 and B5 are about triggers and your reactions to them. They could be psychological or externally cued, such as a windy days after a hurricane, seeing planes after surviving a crash or seeing someone who resembles your perpetrator.

Criteria C

Criteria C is specifically about persistently avoiding anything related to your trauma, avoiding talking, feeling or having memories about the event. Distraction techniques are internal avoidance cues, avoiding places or people who arouse recollections of your trauma.

Criterion D

Persistent negative alterations in mood or cognitions refer to thoughts such as, "I have always had bad judgement" "People in authority can't be trusted" "It's all my fault my Uncle abuse me" and such thoughts.

These criterion also shift towards cessation of activities that you once enjoyed and looked forward to, such as team sport, exercise or social events. You were once a happy, outgoing person, and now you can't feel happiness, joy, satisfaction, tenderness or intimacy with your partner.

Criterion E

Criterion E is quite behavioral, such as suddenly yelling at people, getting into fights, reckless or self-destructive behavior (dangerous driving or a sudden urge for extreme sports) excessive drug or alcohol use, self-injurious and suicidal behavior. Criterion E also covers threat potential, such as thinking you will have a heart attack at any time, will die or other accident waiting to happen. You may be jumpy, hyper-aware of your surroundings, suspicious of others and have a difficult concentrating, remembering simple things or even doing multiple things at once like you once could. This all often leads into sleep problems, sleeping a couple of hours nightly or changing your sleep patterns completely.

Diagnostic Criteria for 309.81 (F43.10) Posttraumatic Stress Disorder

Note: The following criteria apply to adults, adolescents, and children older than 6 years. For children 6 years and younger, see corresponding criteria.

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
  1. Directly experiencing the traumatic event(s),
  2. Witnessing, in person, the event(s) as it occurred to others,
  3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent and accidental.
  4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure to electronic media, television, movies, or pictures, unless the exposure is work related.

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
  1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s) Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
  2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note:In children, there may be frightening dreams without recognizable content.
  3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
  4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
  5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidence by one or both of the following:
  1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
  2. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
  1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
  2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," "no one can be trusted," "The world is completely dangerous," "My whole nervous system is permanently ruined").
  3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
  4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
  5. Markedly diminished interest or participation in significant activities.
  6. Feelings of detachment or estrangement from others.
  7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
  1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
  2. Reckless or self-destructive behavior.
  3. Hypervigilance.
  4. Exaggerated startle response.
  5. Problems with concentration.
  6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of disturbance (Criteria B, C, D, and E) is more than 1 month.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Specifiy whether:

With dissociative symptoms: The individual's symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
  1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
  2. Derealization: Persistent or recurent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Specify if:

With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).

Diagnostic Criteria for 309.81 (F43.10) Posttraumatic Stress Disorder for Children 6 Years and Younger

A. In children 6 years and younger, exposure to actual or threatened death, serious injury, or sexual violence is one (or more) of the following ways:
  1. Directly experiencing the traumatic event(s).
  2. Witnessing, in person, the event(s) as it occurred to others, especially primary care-givers. Note: Witnessing does not include events that are witnessed in electronic media, television, movies, or pictures.
  3. Learning that the traumatic event(s) occurred to a parent or caregiving figure.
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
  1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: Spontaneous and intrusive memories may not necessarily appear distressing and may be expressed as play reenactment.
  2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note:It may not be possible to ascertain that the frightening content is related to the traumatic event.
  3. Dissociative reactions (e.g., flashbacks) in which the child feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Such trauma-specific reenactment may occur in play.
  4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
  5. Marked physiological reactions to reminders of the traumatic event(s).
C. One (or more) of the following symptoms, representing either persistent avoidance of stimuli associated with the traumatic event(s) or negative alterations in cognitions and mood associated with the traumatic event(s), must be present, beginning after the event(s) or worsening after the event(s):

Persistent Avoidance of Stimuli
  • Avoidance of or efforts to avoid activities, places, or physical reminders that arouse recollections of the traumatic event(s).
  • Avoidance of or efforts to avoid people, conversations, or interpersonal situations that arouse recollections of the traumatic event(s).
Negative Alterations in Cognitions
  • Substantially increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion).
  • Markedly diminished interest or participation in significant activities, including constriction of play.
  • Socially withdrawn behavior.
  • Persistent reduction in expression of positive emotions.
D. Alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
  1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression towards people or objects (including extreme temper tantrums).
  2. Hypervigilance.
  3. Exaggerated startle response.
  4. Problems with concentration.
  5. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
E. The duration of the disturbance is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in relationships with parents, siblings, peers, or other caregivers or with school behavior.

G. The disturbance is not attributable to physiological effects of a substance (e.g., medication or alcohol) or another medical condition.

Specify whether:

With dissociative symptoms: The individual's symptoms meet the criteria for posttraumatic stress disorder, and the individual experiences persistent or recurrent symptoms of either of the following:
  1. Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one's mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
  2. Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experiences as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts) or another medical condition (e.g., complex partial seizures).

Specify if:

With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immedicate).

To diagnose PTSD within children is extremely difficult for any trained professional, as there are psychological boundaries, maturity and associated factors against the diagnostician. Children will rarely meet all the criteria, as depending upon age, will depend upon the type of behavioral response they may have. An example in young girls, 11+ years of age and promiscuous with sex. An overwhelming majority are found to have endured sexual abuse / assault, thus a behavioral response is promiscuity, usually unknown to the parents.

It has been found within studies that when the assessment of a child take place for traumatic occurrence, the parent/s should always be present, interviewed individually and collectively as a family, as studies have conclusively proven, it is extremely rare to get a full snapshot of symptoms from just the one person.

Differential Diagnosis

Adjustment Disorder: In adjustment disorders, the stressor can be of any severity or type rather than that required by PTSD criterion A. The diagnosis of an adjustment disorder is used when the response to the stressor that meets PTSD criterion A does not meet all other PTSD criteria. A symptom pattern may be similar to that of PTSD, though not meet PTSD, so an adjustment disorder is diagnosed.

Other PostTraumatic Conditions and Disorders: Not all psychopathology that occurs in individuals exposed to an extreme stressor should necessarily be attributed to PTSD. The diagnosis requires that the trauma exposure precede the onset or exacerbation of pertinent symptoms. Moreover, if the symptom response pattern to the extreme stressor meets criteria for another mental disorder, these diagnoses should be given instead of, or in addition to, PTSD. Other diagnoses and conditions are excluded if better explained by PTSD (e.g., symptoms of panic disorder that occur only after exposure to traumatic reminders). If severe, symptom response patterns to an extreme stressor may warrant a separate diagnosis (e.g., dissociative amnesia).

Acute Stress Disorder: ASD is distinguished from PTSD because the symptom pattern is restricted to a duration of 3 days to 1 month following exposure to the traumatic event.

Anxiety Disorders and OCD: In OCD there are recurrent intrusive thoughts, but these meet the definition of an obsession. Additionally, the thoughts are not related to a traumatic event. Neither the arousal and dissociative symptoms of panic disorder nor the avoidance, irritability, and anxiety of Generalized Anxiety Disorder (GAD) are associated with a specific traumatic event. The symptoms of separation anxiety are clearly linked to separation from home or family, rather than a traumatic event.

Major Depressive Disorder: Major depression may, or may not, be preceded by a traumatic event and should be diagnosed if other PTSD symptoms are absent. Specifically, major depressive disorder does not contain any PTSD criterion B or C symptoms. Nor does it contain a number of symptoms from criterion D or E.

Personality Disorders: Interpersonal difficulties that had their onset, or were greatly exacerbated, after exposure to a traumatic event may be an indication of PTSD, rather than a personality disorder, in which such difficulties would be expected independently of any traumatic exposure.

Dissociative Disorders: Dissociative Amnesia, Dissociative Identity Disorder (DID) and depersonalization-derealization disorder may or may not be preceded by exposure to a traumatic event or may or may not have co-occurring PTSD symptoms. When full PTSD criteria are also met, however, the PTSD "with dissociative symptoms" subtype should be considered.

Conversion Disorder: New onset of somatic symptoms within the context of posttraumatic distress might be an indication of PTSD rather than conversion disorder.

Psychotic Disorders: Flashbacks in PTSD must be distinguished from illusions, hallucinations, and other perceptual disturbances that may occur in schizophrenia, brief psychotic disorder, and other psychotic disorders; depressive and bipolar disorders with psychotic features, delirium, substance / medication induced disorders and psychotic disorders due to another medical condition.

Traumatic Brain Injury (TBI): When a brain injury occurs in the context of a traumatic event (e.g.,traumatic accident, bomb blast, acceleration / deceleration trauma), symptoms of PTSD may appear. An event causing head trauma may also constitute a psychological traumatic event, and TBI related neurocognitive symptoms are not mutually exclusive and may occur concurrently. Symptoms previously termed post-concussive (e.g., headaches, dizziness, sensitivity to light or sound, irritability, concentration deficits) can occur in brain injured and non-brain injured populations, including individuals with PTSD. Because symptoms of PTSD and TBI related neurocognitive symptoms can overlap, a differential diagnosis between PTSD and neurocognitive disorder symptoms attributable to TBI may be possible based on the presence of symptoms that are distinctive to each presentation. Whereas re-experiencing and avoidance are characteristics of PTSD and not the effects of TBI, persistent disorientation and confusion are more specific to TBI than to PTSD.

Comorbidity

Individuals with PTSD are 80% more likely than those without PTSD to have symptoms that meet diagnostic criteria for at least one other mental disorder (e.g., depressive, bipolar, anxiety, or substance use disorders). Comorbid substance use disorder and conduct disorder are more common among males than females. Among U.S. veterans in Afghanistan and Iraq, co-occurrence of PTSD and TBI is 48%. There is considerable comorbidity between PTSD and major neurocognitive disorder and some overlapping symptoms between these disorders.

Debate

Criterion A is still of great debate within the mental health industry since the DSM III. The debate has consisted primarily around the criteria, and what is defined as traumatic enough to warrant a PTSD diagnosis. The American Psychiatric Association (APA) had thought they got it right with the DSM IV, cleverly writing specific words into the criterion, such as; "experienced" "witnessed" "confronted" "event" "events" "involved" "actual" "threatened death" "serious injury" "a threat" "physical integrity" "self" "others". The problem was, as society continually evolves, often meanings become broader and broader, as tested by society. This is simply referred as criterion creep, which occurs to individualistic views on defining a word or interpretation of meaning.

Symptom Signs & Duration

Another topical area is the criterion duration for symptoms. Hand in hand with ASD, it is theorized that ASD will only last between 3 days and one month. Putting a time-frame on symptoms and healing duration is unrealistic at best. Studies have shown that a majority of persons exposed to a traumatic event may meet PTSD criterion, however; completely heal without intervention after several months.

PTSD diagnostic duration is being tested by several authorities, including the US Military, as their findings are that a majority take longer than 12 months to display symptoms, without real understanding of delayed onset, yet funnily enough, so does this very forums own poll on the matter, which shows of 533 participants (at time of writing - ongoing poll) that 46.5% did not show symptoms until 12 months or later. Many stated it took years for symptoms to appear or take-over.

For older individuals, declining health, worsening cognitive functioning, and social isolation may exacerbate PTSD symptoms.

Misdiagnosis

One of the major problems with the PTSD diagnosis today, is that within some realms of the mental health field, people without the experience or clinical knowledge, tools of assessment or ability to interpret the assessment tools correctly, are handing out the PTSD label like its the coolest thing to have. Even worse, those with the knowledge, approximately 10% are still getting it wrong. [10] Without the full knowledge, a diagnosis can be a dangerous tool in the wrong hands, having innocent people wondering around with the belief they have something, that they really don't. A term is used often in conjunction with PTSD, abnormally traumatic. Without abnormally traumatic, being outside the expected experience within life, or deemed normal life trauma, is not justified for a PTSD diagnosis.

Treatment Options

There are four primary treatments for PTSD, being:
  • Cognitive Behavioral Therapy (CBT) (encompasses exposure therapy & stress-inoculation training)
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Invivo Exposure Therapy
  • Pharmacological Treatment
It is not uncommon that all four are used in-conjunction to treat PTSD, or tried at some point, especially against severe versions of PTSD. Regardless the type used, it must be determined over a duration of one month to accurately verify severity of trauma endured, as initial assessments have proved inaccurate.

The first line of defense should be psychotherapy, followed by pharmacological treatment of symptoms, if severe enough. Short, immediate courses of CBT after trauma have proven to lessen the development of PTSD 3 & 6 months later when severe symptoms present.

Medication in general should be used for at least one year, whilst trauma therapy is conducted. Severe levels of PTSD may require medication for life.

PTSD is responsive to SSRI's, but response rates are controversial at best. Combat trauma is known to be extremely resistant to SSRI's, however, Olanzapine has shown to significantly reduce PTSD symptoms in this specific SSRI resistant strain of PTSD. Saying that, the results for SSRI resistant PTSD is still marginal for improvement, though showed improvement when conventional SSRI's do not work effectively. Options is the key word. Trial and error.

Experience based advice from someone with PTSD. Talk with your pharmacist, better yet, talk with several pharmacists, when it comes to be prescribed medications, because they are the experts on medication, not your psychiatrist / prescribing physician. Whilst medications come with recommended dosage and prescribing information it is often found that when tapering onto medications outside of the recommended amounts, and even lessening the recommended dosage, better results are obtain. Every person is unique in how medication will react, some take longer, some need less, some need more, and you must be prepared to reject medication that cause symptoms you do not want to accept living with, as alternatives exist, and plenty of them.

Prevalence

The last collective statistical data for the US on PTSD was approximately 2003, released 2004. At that point, the rates of PTSD were approximately 8% of sufferers for life strains versus 8.7% life risk of obtaining PTSD. Statistics otherwise projected above 20% prevalence overall. Today, those figures are estimated above 30% and life no change, if not an actual improvement towards approximately 6% life strain. Whether the overall estimation is due to mis-diagnosis, I could not ascertain. To obtain that figure I had to piece together a lot of smaller pieces posted, ie. demographic groups, type of trauma, etc.

Some countries have a much higher prevalence of life PTSD due to the demographics and persecution endured within those countries, such as Algeria - 37% life PTSD, Cambodia - 28% life PTSD, Gaza - 18% and Ethiopia - 16% life strains of PTSD. Obviously the overall prevalence is significantly higher.

Rates of PTSD are highest among military personnel, rape and captivity, where approximately 33% are at risk for PTSD. Police, firefighters and emergency personnel are also at risk, though much lesser than the prior groups.
 
M

Mary1

#2
How does one tell the difference between PTSD and manipulative behavior?
when an argument erupts, and he knows he wont win— blame PTSD and isolate while trying to make me feel bad for having feelings.
 
Thread starter #3
A very good question Mary. Many a PTSD sufferer can, and do, use PTSD as an excuse in an argument. PTSD often has some role in a persons behaviour from an argument, depending on their severity suffered, yet you also have to consider that PTSD affects approximately 60% of all sufferers very mildly, and they will fully recover within six to twelve months. If your partner is in the other 40%, then it comes down to how much of the behavioural response is PTSD and how much is just male stubbornness.

The problem in the argument — is winning. Your words, not mine. There is no winner in an argument — which you should be discovering by now. You both lose, even when one of you think you’ve won.

Maybe that should be the focus for discussion between you both — instead of who’s right and who’s wrong. My wife and I often are right and wrong, and we learned to accept who is either based on the facts, removing the argument aspect. If we argue — we walk away and have time out from each other. Even if one is at one end of the house, the other the other end. We bicker more nowadays than actually argue — keeping everything honest and out of us… and we both agree to look at all the facts in a discussion for anyone to be right or wrong.

Arguing due to winning and losing — you both lose — like you’re writing here about whether or not it is PTSD or just bad behaviour.
 
#5
New to this site. Grateful for it. Glad USA War Vets might find a bit of help here. Pray you all find whole-ness.
Wondering as a sub-category, how many here have C-PTSD from chronic abuse from partner? from care-giving elderly parent {Alzheiemers}?
 
P

PTSDangerman

#6
It’s not just vets suffer from this please bear this in mind , I’m in a denial about this illness and wonder if iam alone , my story in short is about being in a m/c accident hit by another driver , I played I’m tough guy get on with it don’t let it dent your pride , but as time gone by I have struggled with the denial as outbursts and sheer rage have taken over, I can’t really identify when it started to the date but it must be 13 -14 months ago after 15 months of physical pain and a let up in pain from the new medication it finally raised its head I thought it was just depression and then the madness started ( too long to explain ) tortureto the perpetrator wouldn’t be good enough to him and his family as I now live in my own world of lucid mash in my head it would of been better run over , I just wish I had a broken leg and arm I would of healed quicker
 
Thread starter #7
I don’t think anyone is in denial about the veteran status. Yes, the media use veterans as their focus for PTSD, however, veterans are a minority compared to sexual assault and childhood trauma.

You’re not alone… there are plenty of MVA with PTSD in the community. When you think you’re going to die, its real. Just getting mobile on the road puts you in harms way for death.

You’re right… a broken bone is much easier than PTSD. As a combat veteran myself, and having dismissed soldiers who got PTSD prior to myself as wanting attention and such, being slack, PTSD is something most will never truly understand unless they experience it. Just how incapacitating it really can be and worse, without understanding or how to really fix the problem.

PTSD is a life threatening mental health disorder, no questions about it.
 
L

Lynn1

#8
I have a question, after surviving a horrific dog attack, I was immediately sent for therapy for 3 months after attack, after 2 sessions, which mainly consisted of constant questions about childhood etc I explained to the therapist that my physical pain was stopping me from concentrating on the emotional aspect of the attack. 6 months later after finding myself in a situation that caused a massive anxiety attack I decided maybe I needed help processing it all. I found a therapist and the first session was explaining the trauma and then again a little family history, it went well, the therapist was sympathetic etc so we had a second meeting in which he repeated the stories from session one and then proceeded in explaining how he helped rape victims by making them spit over the balcony and evacuating the taste of sperm from their mouths, he then proceeded in telling me that on first impressions he thought me extremely intelligent but after hearing about my fear of dogs I came across ridiculous. There was not a 3rd meeting. Therapist 3. Because of a language barrier and being constantly asked to repeat myself I asked if I were being understood, (of course) was the response. She was also a specialist in emdr therapy, great so I’ll give her a try 9 sessions later with a total of 10 minutes emdr and two occasions in which she had a very hard time staying awake I decided that I wasn’t advancing, just being made to open up old wounds without any direction afterwards, there wasn’t any feedback, just questions, then lack of interest and see you again next week. I made the decision to put on hold therapy and try something else.

Instead of spending so much time in my head, I invested in art materials and started to sketch, paint etc and really started feeling my old self, of course there were down days, but then I make myself do an art tutorial and back up. So after much contemplation I decided that either therapy or the therapist are not right for me. 6 months later I’m feeling ok, still have a fear of dogs, but that’s pretty normal in my situation. Then I have an evaluation by the insurance companies therapist, who decides that I have not been given adequate help as my diagnosis was PTSD and I needed to find a new therapist, even though I explained that the evaluation was 6 months prior, yes it did take that long from the interview with the specialist until official report was given….I explained that since then I had tried other methods than medication and was doing well. This was of no importance, so put in a position of no choice spend 2 months finding a suitable therapist. Yet again the first session went well, yet again repeat everything, why I’m there, trauma, trauma but this time was given a personality test to fill out and send back to him along with all records so our next meeting he would be better able to help me, this was looking promising, definitely more interested in helping, and yes a lot more professional, there was 10 days until our next meeting and I was eager to see what direction we would be taking, because though I’d found a release I knew I could probably still benefit from his knowledge and expertise for the future and to better understand my situation. So finally my question, today I arrive, he greats me as though we haven’t met, I sit and wait for some direction, he asks why I’m there today, I ask if he read my files, sent by email to the address he had given me the week before, sent along with the questionnaire.

He replies he hasn’t checked his mail since, and replies how unprofessional it is and then just sits there waiting for me to say something. After the hour I left. And spent the next half hour on the drive home screaming, I was so angry, I really don’t know what to expect, but is this kind of attitude normal. I’m so sick of the get you in the door mentality and then the second visit, now the insurance is paying I don’t even need to remember who you are, I left feeling frustrated, angry, but now the choice is not mine, and I’ve already been told on paper it’s not looking good that I change therapists. Right now I’m feeling very disappointed, I really don’t know what I should be expecting, I just can’t carry on seeing someone I’m supposed to trust and open up to if they in the beginning show such bad professionalism. I would like to point out that I’m a foreigner in the country in which I’m living, which should have no bearing on this situation, but? Also after repeatingly expressing my wish to deal with my situation without medication, 10 minutes later, starts to talk to me about MEDICATION, is it not possible to combat PTSD without being medicated? Sorry for such a long winded text, but 1 life changing trauma, 3 subsequent medical complications because of trauma, 2 years 6 months of not being able to work, insurance companies, medical experts all fields, 2 years of physio therapy and osteo therapy, and 4 psychiatrists later I’m done, not crazy just mentally and physically exhausted, am I getting the right help?
 
A

Allyplus4

#10
I just got out of in patient treatment a month ago, which involves loads of cbt, some emdr etc and im beginning to feel myself slip back into my thought patterns again. for a bit i thought id beaten goliath.
 
Thread starter #11
It takes work Allyplus. You don’t attend inpatient, leave, and all is well. You have to now take those skills you acquired and apply them in your daily life. It is ongoing work, not leave and fall back to your ways again. Therapy skills are for you to apply, not for you to learn and do nothing further with. Hard work, years of it actually, repetition, and they stick.
 
#12
So am I correct in reading that PTSD is only diagnosed for sexual abuse or life and death incidents? What about unexpected loss of a large amt of money in short time when thinking I had made a good decision? Lost entire family inheritance $2m – I was/am middle class and never had that kind of money. Blessed and saved by God/Jesus I know – that keeps me going.

Lost $1.8m in a weeks time and thought it was all my fault so did nothing at the time. Found out years later after Statute of Limitations (see Wikipedia Callandra) he was cited by SEC for scalping – talking up investments and then his friends would sell and price plummet. I had financial acquaintance and pastor on 3way phone call with me but couldnt push button until it was all lost. Next was scammed by a good talker who said he could trade options for me. He didnt have a clue and I got a margin call and lost rest of inheritance – to total all $2m within the year.

My current symptoms are very similar to those described above – re inability to make decisions – current psycologist says OCD but no actual tests. Most recently, I have been unable to make other major decisions even though I do extensive research – e.g. currently I have 2 open insurance claims on house due to water damage and can’t decide on contractors – living with torn out walls and gutted bathroom/bedroom for 15 months. Have pretty much lost/alienated all friends and relatives. Coudn’t keep a “simple” job because of anger, pace and panick anxiety (before all this I had successful non-combat 21 year career in military). My major decisionmaking ability is shot and minor decisions are sometimes difficult – and no one wants to help because frustrated with me. No family support. Does this sound like PTSD to anyone? Can’t sleep more than 4 hrs at time, wake with severe anxiety, have withdrawn because hurt by rejection of friends, no interest in play like I used to. Circling and over thinking, panick, loss of appetite, and no solutions or decisions. Tried SSRIs a number of years ago but felt like a zombie. Now just on xanax as needed but decisionmaking problem remains unsolved and seems like getting worse.
 
Top Bottom