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The ptsd cup explanation

Nearly a decade ago (2006) I wrote The PTSD Cup Explanation, a simple view of how PTSD causes symptoms in day-to-day life. This article is an update to that original piece.

Regardless of the type of trauma endured, the PTSD Cup does not change, deviate or apply differently to your circumstance. The PTSD Cup is a basic representation of your capacity for tolerating stressors. As your cup fills, symptoms get worse. When your cup overflows, you may break down crying, become psychotic or manic, attempt to kill yourself, and many other possible outcomes.

The differences unique to each individual lay within their environment (exposure to daily life), their ability to manage stressors, and finally, the actions that occur upon overflow.

One example of this uniqueness is seen in a high functioning PTSD sufferer. They have the same cup as any PTSD sufferer; however, they may differ in their ability to manage work stressors. Their work may make them feel positive, good about themselves. Another area of their life may suffer, say... relationships. They feel good about their work, but a partner or friendship may cause stress they can't reconcile.

ptsd-cup.png


The above image contains one cup, through three stages. There is a fourth stage to the PTSD cup, applicable only to combat veterans. I will discuss that briefly at the end.

Variability

Each block within a cup is variable. Simply put, each block will move up or down with some predictability, based on your daily activities, how you feel, what you're thinking, and so forth.

Cup One (Left Cup)

Many people think good things don't cause stress. Well, they do! The difference is the net effect. When you get out of bed, have a shower, brush your teeth, comb your hair, drink your morning coffee, and so forth, you feel good after performing these daily tasks. This is called "good stress," and creates positive emotion.

These menial, often disregarded, tasks help reduce your bad stress. Positive and joyous interactions and feelings continuously counter negative stressors.

Cup Two (Middle Cup)

Here we've introduced bad stress. Bad stress is just that -- negative interactions that create negative emotion.

This cup represents everyone without PTSD. You can see how much room there is in that cup. Lots! People without PTSD have the capacity to deal with daily stressors. They balance their day with good stressors, and rarely overflow their cup.

When you go to sleep, sleep reduces negative stressors from your cup so you start the next day fresh. When a person ruminates overnight, they may awake with bad stress in their cup. An example is a teenager giving a presentation. They awake tired, grumpy and partially stressed, thinking they aren't prepared, or their presentation lacks something. When they deliver their presentation without incident, and obtain positive feedback, this creates positive emotion and removes the negative stress. That night, they will sleep better and remove all their remaining bad stress.

Think broadly when applying this to yourself.

Cup Three (Right Cup)

Now we introduce PTSD. The problem is that we still have the same good and bad stressors, but without the same overall capacity as a non-PTSD sufferer.

Who thought good stress could make you overflow? With PTSD, it can do just that - not to mention what bad stressors can do.

Think about it like this -- the reason you don't want to get out of bed, have a shower, do anything at all, is that your cup is full. Your brain tells you to stay in bed, otherwise you overflow. Place your own situation here; the model does not change.

The Obvious Question

It's easy to talk about a problem, ignoring its solution -- but this solution isn't rocket science.

Trauma is the problem. Trauma is full of bad stressors. Work through trauma and you reduce bad stressors. Make life changes where you're negatively stressed. Reduce your traumatic effect, you reduce your PTSD symptoms.

Depending on your level of trauma, this may take months, a year, or many years.

The Fourth Cup (Military Training)

The cup I didn't show is specific to those who have deployed within an operational zone where military training kept them alive. Add an additional block to the cup, call it "training." Now you have good and bad stress, PTSD, and training.

The above cup has little capacity already, so how does training fit? Well, it's squeezed and compresses all blocks. Part of the military training block is a lid with button. This lid and button is effective within a military environment, the cup is full, compresses, an order is given, the soldier explodes against the enemy.

Notice how overflow has been removed from the below image? Combat veterans have a lid and button. Everything builds-up, compresses, then explodes -- instead of overflowing.

ptsd-cup-military.png


This is useful in active service, but not very effective in regular society. The military used to control the button, for the most part; post-service, PTSD is in control. The cup can only take so much pressure before the button fails. With a constantly full and compressed cup, all it takes is for the toilet roll to be around the wrong way -- the veteran explodes at someone (spouse or child), or something (wall or door), and only then will the pressure be released.

This is behavioral conditioning that helped the veteran remain alive. When differentiating between a combat zone and civilian life -- the brain knows the difference, but still functions on instinct, in the ways that have been proven effective in order to stay alive.

The most obvious question is, why do combat veterans have this extra block and not all military?

When military are trained, they're trained to have some PTSD symptoms, especially Army, Marines, or Special Forces-type training. Hyper-vigilance, startle response, alertness -- these are all symptoms of PTSD. When leaving the military and without combat, this training quickly subsides and the person reverts to civilian behavior.

Once a soldier enters a combat zone the brain accepts that this training saved their life, or their buddy's life. This makes training a priority for survival. The training becomes instinctual, regardless of whether they are in a combat zone, or not. This block is one of the most difficult to lessen, and typically only diminishes from a combination of time, and decreasing the traumatic effect.

Conclusion

The PTSD cup is a simple representation that defines your internal stress. We all react differently when our cup overflows. Some may cry, some may dissociate, some may become angry. A soldier may explode with horrific rage and violence. To control the effect is to minimize the cup's content, where possible.

I might wish we could remove the PTSD block -- that would be ideal. Unfortunately, there is no cure. So, work with what is within your reach. What immediate stressors can you reduce or remove with the least amount of change? What did you used to do that made you happy? Remember, good stress counters bad stress, so do things that make you happy to create capacity within your cup.

Remember that this is, more often than not, a long-term process. Managing your internal stressor cup takes time, education, and skills learned for future improvement.
 
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I was diagnosed with PTSD in the military due to MST. However, I was suffering with CPTSD long before then, that was never recognized or diagnosed. At the age of 5 years, I had a babysitter that would strangle me and make me touch him. At the age of 8 years, I stabbed him in the neck with a pair of scissors. I was also physically abused by my stepfather from the age of 5 years until the age of 16 years. I'll be honest, the majority of my issue was the lack of support and help I received. I would have bruises on my neck from my babysitter. We were playing rough is how he explained it, I was 5-8 years old, he was 16-19 years old. My stepfather would hit me, left bruises, split my lip, split my eyebrow, received cigarette burns and would have my skin twisted off with pliers. I repeatedly sought help at school, and no one would do a damn thing. I attended a private school with my sister, my stepfather paid over 18k a year in tuition. School didn't want to hurt their bottom line. Would tell police what was happening at home, he would deny it, and that was it, no further investigation. I continued to make complaints, found myself labelled a problem child, and seeing therapists who would scoff when i would tell them what was happening to me. And that's not even all of it....BUT I can't say anymore because I'm getting too pissed to continue...I'll be back
 
All that stuff that you described that happened to you is enraging. I'm so sorry you went through all that and I don't blame you for having to step away. Hope you are okay.
 
Hi @anthony,

though I agree with much of what you said, I'm a little confused on why you say ptsd is trauma based and then go on to claim that there is NO cure. Where does such a claim come from? That seems more like a 'biomedical model of mental health' kind of statement.

oops, I meant the biochemical model...
 
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Good article. Training certainly affects PTSD, the button analogy probably makes sense for combat vets who act at the command of another.
I wonder if there’s another analogy for law enforcement where our training sometimes comes from military, but is used in a civilian setting, and we often have to rely on our own instincts to figure out when to use our training.
In my experience, training that comes from real world experience is the most effective. It is chilling to go into a real situation that feels like the training. But, the alternative, to not have the training, would be worse. After that, it’s easy to see the triggers everywhere, there is less of a button for the cup and more like a steam vent, not freely overflowing, but not as controlled as though there was a button. The results are over reactions, aggression and constant fear.
 
The "cup" model has been very helpful to me. Thank you for sharing (and re-sharing) it.

Through somatic therapy, I've been addressing my tendency toward dissociation and dysregulation and I'm discovering within myself a subjective "stress level indicator". This way I'm able (when I remember to check in with myself) to determine what degree of emotional reserve I have on tap. I'm learning when to "call it a day" and when to take on an extra activity.
 
I love this explanation. Not only did it help me understand myself, it allowed me to finally explain to my mother, years ago, what was wrong. She thought once I was released from the hospital that I was cured. Kinda like being sick, getting medicines, getting cured and coming home. Ha! Best thing Anthony ever posted, in my opinion!
 
I was diagnosed with PTSD ... However, I was suffering with CPTSD long before then, that was never recognized or diagnosed.

Bingo!

The rub for me on several fronts entails this distinction of `active duty' related PTSD when it was cPTSD which made me `fit' for the duty the navy recruiter conned me into signing up for.
To wit, though I wanted to `be' a programmer and program computers the intellectualization I adopted as a coping strategy in my cPTSD youth was what prepared me to score better on the ASVAB than had I not intellectualized in an attempt to cope with the neglect, menacing, exploitation and soul sucking FEAR experienced in my dysfunctional family of origin; because my ASVAB scores were high enough to qualify me for advanced electronics and nuclear power -- the highest requirements for the Navy at that time -- the recruter conned me into an advanced electronics rating entailing a 6-year hitch rather than the programmer rating entailing only a 4 year hitch.
Then once IN the military, in boot camp, an interesting ad hoc survey revealed something I can't believe is unrelated: 80% of the guys in my boot camp company came from `broken' or single-parent homes.
Does `comes from broken homes' either mean or entail cPTSD? I don't think so.
But I do suspect that those coming from vaguely `broken' homes are more likely to have experienced the ongoing trauma promotive of cPTSD than those NOT coming from `broken homes'.

The military RECEIVES pre-traumatized recruits as per the predispositional vulnerability addressed by the diathesis-stress model then proceeds to expose them to stress.
SURPRISE!
What happens when someone from a broken home and perhaps although not traumatized enough to fail the entry level psyche eval experiences distress, anxiety, Stress, and the likes while on active duty?
Do the branches of the military stop the buck and accept that PTSD symptoms were `caused' by military service ... or can that causal bullet be dodged by claiming pre-existing conditions as a disqualifying factor for actual, virtuous `combat', MST, or `military-related' status?

It seems a double bind. If the pre-existing condition didn't sufficiently maim or limit the recruit's options then said recruit could have had better options to pick from than military enlistment as an indentured servant for whom consent can't be withdrawn over the duration of one's enlistment.

{aside: I had an E5 respond to my bitching at having been volunteered for a working party on that occasion by reminding me, "You don't have to LIKE it; you just have to DO it."
No kiss, no foreplay, no consent required. Only insubordination charges if one doesn't PERFORM as commanded.}

We see this catch in this group as well. The phraseology of `Military' group is: `The group is open for all who have PTSD from military service '.

The `from' term is a loaded legalistic weasel word, given the cumulative nature of trauma.
For those of us primed for `combat' PTSD or MST by cPTSD in our (mal)formative years, this distinction between `from' and `prior' a la `pre-existing conditions' is a slap in the face.
If we had not have been pre-traumatized would we have been as primed and likely to enlist in the military as per `repetition compulsion', subconscious motivations, or the paucity of opportunities available to those (mis)raised in such homes, neighborhoods, and such?

I characterize the US military as `Uncle Sam's Orphanage'. And since the all-volunteer status has been established in the wake of the Vietnam war the overwhelming majority of those `volunteering' are lower and lower-middle class than when `the draft' caught fresh fish from all the socio-economic strata ... or not.
Presidents Clinton, G.W.Bush, and Trump all managed to effectively dodge the Vietnam war.
Whereas those who didn't and wound up traumatically wounded served as guinea pigs for F. Shapiro to come up with EMDR as a therapy for those not able to dodge the traumatic bullet known as PTSD.

Where did YOUR `PTSD" come `from'? Go ahead an use attribution just like military doctors and VA professionals do.
Regardless of the attribution method, last tag, YOU'RE IT!
It experientially-manifests in YOUR neural net, no matter what attribution scheme is used to play pin the tail on the donkey as to what CAUSED IT.
And you'll have the added joy of watching discrimination games based on attributed causality play out in various sectors: even HERE ... oh, the irony.

My `trauma informed' PTSD-certified VA clinical psychologist brought up the option of meeting with a trauma group composed mostly of MST peeps. Do I want to be a participant in a group where I'm a minority member gender-wise, where I AM the gender of the perpetrator class ... so my very presence may trigger trauma in those I'd rather NOT ... while allowing some to scapegoat me through the magic of (over)generalization as One of Them?
Sorry, I'm not that brave. I'll own my avoidance on this would-be `opportunity' as the attachment-trauma of my own cPTSD preceded yet FURTHER damage incurred while on active duty.

For some of us, the PSTD our personal neural networks manifest was not either civilian-child `complex' OR an active-duty subspecies -- such as `combat' or MST -- it was BOTH.
And to add insult to injury we get to play patty cake with fools who discriminate which more virtuous-than-Thou attributable causes may be applied for fun and profit.

Just a few thoughts.

Cheers!
 
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Bingo!

The rub for me on several fronts entails this distinction of `active duty' related PTSD when it was cPTSD which made me `fit' for the duty the navy recruiter conned me into signing up for.
To wit, though I wanted to `be' a programmer and program computers the intellectualization I adopted as a coping strategy in my cPTSD youth was what prepared me to score better on the ASVAB than had I not intellectualized in an attempt to cope with the neglect, menacing, exploitation and soul sucking FEAR experienced in my dysfunctional family of origin; because my ASVAB scores were high enough to qualify me for advanced electronics and nuclear power -- the highest requirements for the Navy at that time -- the recruter conned me into an advanced electronics rating entailing a 6-year hitch rather than the programmer rating entailing only a 4 year hitch.
Then once IN the military, in boot camp, an interesting ad hoc survey revealed something I can't believe is unrelated: 80% of the guys in my boot camp company came from `broken' or single-parent homes.
Does `comes from broken homes' either mean or entail cPTSD? I don't think so.
But I do suspect that those coming from vaguely `broken' homes are more likely to have experienced the ongoing trauma promotive of cPTSD than those NOT coming from `broken homes'.

The military RECEIVES pre-traumatized recruits as per the predispositional vulnerability addressed by the diathesis-stress model then proceeds to expose them to stress.
SURPRISE!
What happens when someone from a broken home and perhaps although not traumatized enough to fail the entry level psyche eval experiences distress, anxiety, Stress, and the likes while on active duty?
Do the branches of the military stop the buck and accept that PTSD symptoms were `caused' by military service ... or can that causal bullet be dodged by claiming pre-existing conditions as a disqualifying factor for actual, virtuous `combat', MST, or `military-related' status?

It seems a double bind. If the pre-existing condition didn't sufficiently maim or limit the recruit's options then said recruit could have had better options to pick from than military enlistment as an indentured servant for whom consent can't be withdrawn over the duration of one's enlistment.

{aside: I had an E5 respond to my bitching at having been volunteered for a working party on that occasion by reminding me, "You don't have to LIKE it; you just have to DO it."
No kiss, no foreplay, no consent required. Only insubordination charges if one doesn't PERFORM as commanded.}

We see this catch in this group as well. The phraseology of `Military' group is: `The group is open for all who have PTSD from military service '.

The `from' term is a loaded legalistic weasel word, given the cumulative nature of trauma.
For those of us primed for `combat' PTSD or MST by cPTSD in our (mal)formative years, this distinction between `from' and `prior' a la `pre-existing conditions' is a slap in the face.
If we had not have been pre-traumatized would we have been as primed and likely to enlist in the military as per `repetition compulsion', subconscious motivations, or the paucity of opportunities available to those (mis)raised in such homes, neighborhoods, and such?

I characterize the US military as `Uncle Sam's Orphanage'. And since the all-volunteer status has been established in the wake of the Vietnam war the overwhelming majority of those `volunteering' are lower and lower-middle class than when `the draft' caught fresh fish from all the socio-economic strata ... or not.
Presidents Clinton, G.W.Bush, and Trump all managed to effectively dodge the Vietnam war.
Whereas those who didn't and wound up traumatically wounded served as guinea pigs for F. Shapiro to come up with EMDR as a therapy for those not able to dodge the traumatic bullet known as PTSD.

Where did YOUR `PTSD" come `from'? Go ahead an use attribution just like military doctors and VA professionals do.
Regardless of the attribution method, last tag, YOU'RE IT!
It experientially-manifests in YOUR neural net, no matter what attribution scheme is used to play pin the tail on the donkey as to what CAUSED IT.
And you'll have the added joy of watching discrimination games based on attributed causality play out in various sectors: even HERE ... oh, the irony.

My `trauma informed' PTSD-certified VA clinical psychologist brought up the option of meeting with a trauma group composed mostly of MST peeps. Do I want to be a participant in a group where I'm a minority member gender-wise, where I AM the gender of the perpetrator class ... so my very presence may trigger trauma in those I'd rather NOT ... while allowing some to scapegoat me through the magic of (over)generalization as One of Them?
Sorry, I'm not that brave. I'll own my avoidance on this would-be `opportunity' as the attachment-trauma of my own cPTSD preceded yet FURTHER damage incurred while on active duty.

For some of us, the PSTD our personal neural networks manifest was not either civilian-child `complex' OR an active-duty subspecies -- such as `combat' or MST -- it was BOTH.
And to add insult to injury we get to play patty cake with fools who discriminate which more virtuous-than-Thou attributable causes may be applied for fun and profit.

Just a few thoughts.

Cheers!

Soldiers and non soldiers like myself that served with DEA on the FAST team and did count them 20 four month tours in Afghanistan can still serve with PTSD. For some of us it’s the only place we felt normal. Personally I align more with military than law enforcement because we on FAST had to not only go thru DEA training but also navy SEAL training. Due to our then director being a former SEAL. We worked side by side with them doing the exact same thing only got paid a whole lot more.

You are going all over the map on your rant and I can’t really follow it. What are you trying to do get disability from the VA? If your PTSD was not service related then you shouldn’t. Yes by all means take full advantage of the system for therapy and medical care since you served. Or are you just ranting about stuff in general? I even read the post a second time and have no idea what you are getting at.
 
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