Understanding post traumatic stress disorder (ptsd)

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About PTSD​

PTSD is a non-curable, yet treatable and manageable disorder. When you have reached the level for a PTSD diagnosis, you have reached the peak of many individual disorders rolled into one. Don’t freak out about non-curable, it just means once your brain has endured this level of distress, you can heal and manage symptoms, though another event could heighten symptoms, or make them worse as time goes on. Some people fully recover and experience little or no ongoing duress due to lack of future traumatic experience and excellent self management skills. Approximately 6% of PTSD sufferers never fully recover and experience regular debilitating symptoms that limit their ability to participate in society.

Anxiety, sleeplessness, hyper-vigilance, dissociation, hallucinations, anger and paranoia are all associated with a PTSD diagnosis. In addition comorbid disorders (meaning added due to the primary disorder, though would not exist without the primary disorder, being PTSD) such as depression, substance abuse, mood, dissociative and personality based disorders are the most common additions to a PTSD diagnosis for insurance and prescription purposes.

Introduction To Diagnosis​

Diagnosis is not as cut and dry as some think, or make it out to be. There is no online diagnostic tool that can accurately assess PTSD, contrary to some website trying to make you believe. You can meet every symptom cluster of PTSD and not have PTSD. You can have endured a lifetime of trauma and not have PTSD. Trauma and PTSD are not synonymous with one another, meaning they do not automatically go hand in hand. There are many factors involved that a majority do not know or understand within a PTSD diagnosis.

A person can quickly become confused in the belief that a PTSD diagnosis is merely meeting the symptoms, like a tick and flick list. In reality, this couldn’t be further from the truth. A PTSD diagnosis requires that an abnormal traumatic life event is present, that a minimum symptom cluster is met, that the symptom severity meets a specific severity, the person meets certain physical attributes that will be displayed due to all the above, and the largest factor is everything combined ‘causes significant distress or impairment in social, occupational or other important areas of functioning.'

If you’re diagnosed with PTSD, once treated and managed, you no longer meet the diagnosis by eliminating one or more of the above aspects. Usually it is the lowering of symptom severity, even though the symptoms may still be present, the severity no longer causes significant distress or impairment in social, occupational or environmental daily functioning.

Brain Imaging​

PTSD can be diagnosed by neurological imaging. It was once more theory than conclusive, though as technology has increased, so has the capacity to use forms of imaging to see how the brain reacts to certain stimuli, positive or negative. Keep in mind, they type of imaging required to diagnose PTSD is not necessarily cost effective day to day diagnostic method.

Neuroscience has given us much new information, such as the pharmaceutical companies theory of PTSD being a chemical imbalance being untrue, as neuroimaging shows no chemical balance exists to begin with. The latest buzz word ‘neuro-plasticity’ is used for brain cell regrowth. Contrary to previous science, the brain can, and does, heal itself.

Sufferer Ignorance​

Often the sufferer will downgrade their own symptom severity, as one of the main problems with PTSD is trust. The sufferer does not have an instant rapport with an assessing officer; hence they may not disclose true feelings to the assessor. All perfectly normal from a PTSD sufferer.

Physician Experience​

This is quite a controversial area in its own right, as diagnosis is best guess based on experience and the use of known markers established and recorded over time, applied as commonalities. Psychiatrists and psychologists may believe they’re created equal, though patients will tell a vastly different story through experience of using several physicians due to indifference, knowledge, beliefs and experience between them in the area of trauma and PTSD specifically. There are studies demonstrating this fact, where those with and without PTSD were assessed by various physicians with diagnostic outcomes indifferent to their actual existing diagnosis.

Stress - Grief - Trauma​

Acute stress, grieving a loved one and experiencing trauma, can all produce symptoms that meet those within a PTSD diagnosis. This is perfectly normal and expected. Every individual feels differently after a traumatic event. This does not mean that any type of stress, frightening experience, death and even abnormally traumatic event, causes PTSD. It just doesn’t work that way, even though some may try to perpetuate such things for their own selfish financial gain.

There are people who claim they have PTSD from airplane turbulence, a bad marijuana trip, relationship breakdown or natural death of a loved one. None of these meet the criteria for a PTSD diagnosis, yet some less than experienced physician may give such a diagnosis for monetary gain (treatment). This does not help the patient or the system. The trauma and experience is valid, the diagnosis is not.

By diagnostic application you could diagnose a person with PTSD if they meet the criteria longer than a month, there is great debate on whether such a diagnosis is correct under such circumstance. The reason for this is that studies have demonstrated that 60% (approx) of persons exposed to an abnormally traumatic event will recover fully without intervention within 3 months of the event. A further 20% (approx) will recover fully after 6 months, also with zero psychological interference. This leaves a minority of people who won’t recover without some intervention. These are the people who realistically could have PTSD, being an actual disorder outside of ‘normal’ boundaries for recovery. Of this remaining percentage, approximately 6% will endure what is called ‘Lifetime PTSD,' which I happen to have myself, meaning I will endure symptoms ranging from annoying to severe my entire life, sporadically, based on self management and stress exposure, aka, day to day living.

Editing this all those years later, and I still get randomly taken out by symptoms for no apparent reason. Sometime I know what is causing it, but other times, I do not. The 6% are the ones who truly need to do the most self-work in my opinion, as nobody knows you better than yourself. It just takes self honesty.

Self Diagnosis​

The Internet has some real advantages to helping people understand medical issues. It also has many pitfalls with people turning themselves into pretend professionals. There is underlying knowledge and experience in diagnosis that you cannot obtain from the web. If you’ve studied psychological texts, diagnostic manuals, assessments and so forth, then yes, you will have a decent understanding of diagnostic application without a degree, though you should still seek independent assessment for accuracy. You won’t have the experience, but you will have a dam good understanding. If not, don’t convince yourself you have PTSD or any mental disorder based on reading a checklist or taking an online assessment.

Multiple Diagnoses​

There are catches to multiple diagnoses when it comes to PTSD. PTSD is often misdiagnosed with Bipolar disorder. In other words, if you didn’t have Bipolar before trauma, then chances are you don’t have it now either. You just have PTSD.

Earlier I mentioned comorbid disorders being additions to the primary diagnosis. These exist for several reasons, sometimes good, sometimes selfish of the treating physician. The majority of PTSD sufferers will suffer Atypical depression, being a mood based depression. This depression requires a diagnosis before an antidepressant can be prescribed, it also applies a name for other physicians to quickly understand the full spectrum of symptoms you present and manage. A majority of military with PTSD have substance abuse disorder added as military culture highlights drinking as a coping strategy.

The truth when reading a list of labels applied upon you, is that you have PTSD. Without PTSD, this list would not otherwise exist. All focus should remain on PTSD. Targeting PTSD you systematically target all comorbid disorders by proxy.

Contentious Labels​

Labels are everywhere within medicine. Some people like them, some don’t. Regardless of your personal beliefs, labels have a purpose to treating physicians as they can quickly say a lot about your situation without having to get immediately specific.The counter to this positive is that physicians create labels for themselves, or perpetuate false labelling as diagnoses to patients.

Trauma vs. Diagnoses​

Here is the largest misunderstanding to do with labels, trauma type versus actual diagnoses. The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) do not contain, nor will their next release contain any of the following as a diagnosis. Both manuals contain the globes legal classifications for diagnosis. If its not contained within either of these manuals, then its not legal or treatable through insurance, because it doesn’t actually exist.

So, lets look at the primary offenders for PTSD:
  • Combat PTSD, and
  • Secondary PTSD.

Combat PTSD​

A trauma classification that is used to quickly categorize a person. Its says the person is a veteran, being that they served in combat. It quickly denotes the likely outcome of diagnoses for a clinician, being PTSD + substance abuse disorder + mood disorder and symptoms: heightened anger, startle and hypervigilance.

Secondary PTSD​

Again, not a diagnosis but a trauma classification. Secondary PTSD is used as a label to identify spouses and supporters of a PTSD sufferer who themselves now display PTSD symptoms, or have PTSD due to the trauma endured being with someone with uncontrolled PTSD. A person with PTSD can often be emotionally and/or physically abusive to a partner, or children, thus resulting in their own PTSD forming. The diagnosis is PTSD. Purely a label to make that above statement, that someone with PTSD gave you PTSD.

Hope Exists​

A PTSD sufferer can live life to its fullest again. Sufferers may be overwhelmed with symptoms they don’t understand, though they must find ‘up’ for themselves again, as they’re the only ones who can do it. Every sufferer can live a healthy life with none or few daily symptoms once they heal trauma and learn to self manage daily stressors. A sufferer must face their past aspects that bring negative emotion to their present. It can be done, I am proof of that, along with thousands of people who have passed through this website and gotten themselves to a better place.

Supporter Responsibilities​

Whether you’re a spouse, family member or friend, supporting the healing process of a PTSD sufferer is going to be one of the toughest things you ever do. If you don’t have thick skin you will have after this process.

There are two current books, either of which I would consider excellent for a supporter. I have read them, but you will be better informed after reading just one:
  1. Loving Someone with PTSD: A Practical Guide to Understanding and Connecting with Your Partner after Trauma (The New Harbinger Loving Someone Series): Matsakis PhD, Aphrodite T.: 9781608827862: Amazon.com: Books
  2. When Someone You Love Suffers from Posttraumatic Stress: What to Expect and What You Can Do: 9781609180652: Medicine & Health Science Books @ Amazon.com
Regardless your role within the process a supporter must ensure they look after themselves first, the sufferer second. Why? The answer is simple. If you the supporter are not well enough to perform your role in support, then the only thing that will occur is more stress for the sufferer, and yourself, thus the sufferer gets worse, which often means more backlash directed at the supporter themselves. Often a good idea is for supporters to also have their own counseling. Think airplane oxygen! Put your own on first so you don’t pass out, then you can help others.

A supporter must become an assertive person, if not already. There are five types of behavioral character, passive, aggressive, assertive, passive aggressive and whats called an alternator. An alternator switches constantly between passive and aggressive, not to be confused with being passive aggressive. Assertive is the only character that effectively works in support, the same as which a sufferer themselves must achieve. If you’re passive, the sufferer will walk all over you. If you’re aggressive the sufferer will not respond to you, thus more stress and the revolving argumentative cycle. If your passive aggressive and insult the sufferer with a smile, back to the revolving argumentative cycle. Alternator just messes with your head as much as having PTSD to begin with. You could often say a person with PTSD becomes an alternator, being one minute they are lovely to be around, the next, angry and yelling.

Being assertive means you can give and take without stepping over boundaries either way. You will give support whilst the sufferer is willing to accept it. The moment the sufferer turns on you, you’re confident within yourself that their words are just words, not true feelings, and walk away to allow the situation to calm down without further aggravation.

Medical Problems With Uncontrolled PTSD​

Sufferers believe they can live without treatment. They rely upon alcohol or cigarettes and deny dependence upon them. They’re possibly a habitual user of drugs; though deny they have an addiction. Besides the obvious issues associated with PTSD, there are serious health consequences to not healing trauma.Trauma creates a requisite amount of stress to the body without PTSD. PTSD creates a phenomenal amount of stress to the body. Often people who have PTSD have aged faster than they had pre-trauma. The reason is stress. It's nothing to hear of a sufferer having heart attacks, cancer and other life threatening issues under the age of 50. These are not hereditary, but instead caused by the stress PTSD exerts upon the body.

Here are a few off the problems a PTSD sufferer should be expecting when ignorant of treating stress:
  • Acne
  • Allergies, hives, hay fever
  • Asthma
  • Backaches
  • Cancer
  • Crohn's disease
  • Depression
  • Dermatitis
  • Diabetes
  • Diarrhoea
  • Digestion slows
  • Dry mouth
  • Eczema
  • Fast beating, racing heart, often palpable
  • Fast racing breath
  • Frigidity
  • Glucose and fats pour into the blood
  • Headaches
  • Heart attack
  • Heart disease
  • Herpes simplex (cold sores)
  • High blood pressure
  • Impotence
  • Infertility
  • Insomnia
  • Irrational fears and anxiety
  • Irritable bowel syndrome
  • Loss of self confidence
  • Lowered libido
  • Migraines
  • Muscle tension
  • Obesity
  • Oesophageal spasm
  • Physical and mental fatigue "burn-out"
  • Premature ejaculation
  • Premenstrual tension
  • Psoriasis
  • Rushing thoughts
  • Spastic colon
  • Stroke
  • Suppressed immune function
  • Sweaty palms
  • Thickening of the arteries (atherosclerosis or plaque formation)
  • Thrombosis (formation of blood clots)
  • Ulcerative colitis
Uncontrolled PTSD is a killer. If suicide doesn’t get them first through depression, stress will definitely get them sooner rather than later. PTSD is not something that can be ignored due to PTSDs’ serious health consequences.

PTSD Reaction​

The following information is aimed to help you understand why sufferers do certain characteristic things, making decisions you cannot understand, and why a sufferer can go from nice to angry in a split second.

The Stress Cup​

Think of our internal coping mechanism for stress as a cup. Within that cup we can only fit so much stress (emotion) before it overflows. This is the basic principle that occurs within every person, PTSD or not. In a stress cup there are certain knowns. A civilian’s stress cup without PTSD contains two types of stress (keeping it simple), good (good emotion) and bad (bad emotion). I say civilian, because as you will later learn, a soldier’s stress cup contains more than a civilian’s due to military factors.

Notice the use of (emotion) in brackets? Stress is an overall name for lots of good and bad emotion. This is why you focus on emotion identification, understanding and resolution to heal PTSD.

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(Images left to right)

> Image #1 – Normal stress cup for all people

> Image #2 – Daily bad stress increase

> Image #3 – Emotional system overflow (crying, etc)

Good Stress Consists​

  • Getting out of bed
  • Feeding oneself
  • Having a shower
  • Motivation in the morning
  • Relaxation events
  • Relationships and sex
  • Hobbies
Anything that takes us to function, or is enjoyable, is often good stress. Our body requires good stress in order to maintain a healthy mind. Good stress makes up only a small portion of our daily stress intake as we’re constantly dealing with the stress because we need it or enjoy it, thus our mind processes it quickly. It even counters bad stress.

Bad Stress Consists​

  • Finances
  • Relationships
  • Employment
  • Family
  • Sickness
  • Driving in peak hour traffic
Events we often cannot control contribute to bad stress. The reason for this is that one of the body’s mental mechanisms is control. With lack of control, stress is created. Bad stress consists variable portions within our daily stress intake. I say variable because depending on what events take place daily, future events too, depends how much bad stress goes into one’s daily cup.

Variables​

Events can create both good and bad stress, or only good or bad. For example; relationships contain both good and bad stress. Children contain both good and bad stress, etc. Good stress is fairly constant within daily life for most people. Bad stress is the changing factor. As stress goes into our daily cup, we deal with each stressor uniquely, and as each are dealt with, our stress level decreases proportionally. As more stress goes in, our level increases once again.

Sleep is the body’s method to decrease stress intake. If sleep is deprived or foreshortened, our body cannot remove our daily stress as part of its normal routine. Our stress levels constantly work on this rise and fall cycle.

Stress Cup Overflow​

When our cup fills up with too much bad stress (Figure 1 - image #3), it overflows from the cup. This means we have more stress than we can cope with. When our stress overflows, this is the body’s natural pathway in which release is through tears, crying, a short-term anger burst, and so forth. Once we release the emotional overflow our stress levels decrease so we may continue resolving and absorbing more stress.

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(Images left to right)

> Image #1 – Normal stress cup for all people

> Image #2 – A PTSD sufferer

> Image #3 – PTSD sufferer with one new bad stressor increase

The PTSD Sufferer​

If we all have this good and bad stress (normal), then more often than not we function without overflow. The problem with PTSD is that to have PTSD one has suffered abnormal life trauma. This means that a sufferer now has this extra entity within their daily stress cup called PTSD (trauma / symptoms). (Figure 2)

As you can see for yourself a sufferer’s daily stress cup now has less room to expand with life’s normal daily bad stressors. To make it worse, this PTSD (trauma / symptoms) also expands and retracts with bad stress. So now a sufferer has double the trouble within their daily cup of stress. One of PTSD’s sources to feed is stress. One bad stress equates two PTSD portions within their cup. The reason for that is because PTSD consists an array of symptoms, often one stressor does not only affect one symptom and it has residual effects into multiple symptoms at once.

This is why a PTSD sufferer becomes unstable so many times a day, because their cup is constantly full. To make matters worse as bad stress is dealt with PTSD does not dissipate in conjunction with bad stress as there is constantly residual bad stress within the cup feeding PTSD, thus slowing the proportionate dissipation rate compared to bad stress alone.

To put this as easy as I can, if someone knocks into you, which annoys you, annoyance is a negative emotion (stressor). This gets added into your cup. Because you have PTSD, this one stressor (being annoyed) multiplies within the PTSD block as symptoms (hypervigilance, startle response, anxiety, etc). So in other words, add one negative emotion, you fill your cup with multiple negative stressors because one negative emotion allows PTSD to create symptoms, and even may send you into your past to gather up some more negative emotions due to a traumatic event that involved lots of being knocked around, ie. bullying, abuse, etc. You started with one little event, being accidentally knocked, which filled your cup with the event + symptoms + possible past memories (past emotion). See how fast your cup can fill from one small event?

The Explosion​

How many times have you seen a sufferer have an outburst because of some insignificant little thing? Lots! The reason is because their stress cup is constantly bordering full, with little to no room for movement with new stressors when introduced. This is when PTSD is completely running wild, or referred to as uncontrolled PTSD.

The Prolonged Calming Process​

As discussed previously, as bad stress is dealt with it is removed from the cup, however; as PTSD increases with bad stress it doesn’t decrease proportionately as bad stress is dealt with and removed. The reason for that is because PTSD is made up of many symptoms, the major one being anxiety.

Once anxiety is provoked it takes time in order to reduce in severity because the anxiety is a consequence of the bad stress and not something that can be directly dealt with and removed. It can only decrease with time, not so much an action itself. This is why you would see a sufferer take days to calm when their cup is full and they have exploded, because whilst the bad stressor has been removed the anxiety takes days in order to reduce thus allowing them to be exposed to more normal bad daily stress.

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(Images left to right)

> Image #1 – Normal PTSD stress cup

> Image #2 – New bad stressor introduced, thus with every one bad stressor introduced, PTSD symptoms expand two fold across the range of symptoms.

> Image #3 – Bad stressor dealt with, thus removed and bad stress returns to normal levels, though the PTSD symptoms are still provoked by the prior bad stressor, even though removed / dealt with; bad stress still feeds the PTSD, thus only time will now allow that symptom spike to decrease to its previous level.

Prolonged Calming Effect Through Sleep​

You wakeup in the morning feeling refreshed, lets use this as a starting point.

As your day continues you have good and bad stressors going into your cup. Depending on the amount of stress you have going into your cup, depends whether you explode during that particular day. So, you go to sleep at night.

During your sleep your body naturally releases stressors within your cup when you went to sleep. This means by morning you wakeup with an empty cup again ready to begin your next day. So what happens if you don’t sleep well? What happens if you sleep very little? The recommended amount of sleep per night is eight (8) hours, uninterrupted sleep.

This means it takes that amount of time for your body to dissipate the prior day’s stressors. Now add this anxiety issue into the equation. You go to sleep with high anxiety; this means this anxiety is a huge negative stressor sitting in your cup. During your sleep you have nightmares, dreams and terrors, all of which are creating more anxiety and stressors for you. Now a sufferer just woke up in the morning with more in their cup than when they went to sleep. Before starting the day they have overloaded.

Regardless of PTSD this model applies to all human beings. If you go to sleep and sleep only 4 hours a night your body isn’t given the time required in order to remove all the prior days’ stressors. So you begin your next day with a little of yesterdays stressors in your cup.

The next day you have a more stressful day, sleep less again, wake up the following day starting with two days of residual stressors left in your cup, plus an extra amount due to an unusually stressful day.

Your body copes like this until the weekend in which most people fall over Friday, party to relax and/or rest more during the weekend. What happens if you work on the weekends? More stressors! What happens if you still don’t sleep much or have nightmares? More stressors! Put the pieces together yourself, the cycle can get very untidy, very quickly.

For the sufferer who is not dealing with their prior trauma they awake daily with a full cup. This is why just getting out of bed is too much stress for them and spouses, doctors and therapists believe it comes from depression, where in fact it is more the body instinctively taking care of itself and the brain says, “stay in bed, stress cup is full already.” It only gets worse!

This is the primary depression for all PTSD sufferers, being mood based depression, caused directly due to anxiety and not actual biological or psychological depression. Welcome to the cause of PTSD’s depression.

Combat Training​

A soldier, some police, or anyone with combat training is categorized differently with their stress cup because of the training they have endured. This training creates a known factor within their stress cup. Let’s call it alertness.

Don’t confuse some basic combat skills training with complete combat training, they’re not the same thing.

Alertness is formed during the basic training process (hypervigilance and exaggerated startle response). A trained stress response is changed from the civilian normal freeze response to what’s called the fight & flight stress response.

This response is changed to make a combat trained person instinctive in action. This means that when they are faced with danger a civilian’s response would be to run the other way, but a combat trained person’s response has been changed to send them toward the danger, not away from it.

This is done during all forms of basic training so humans fight, so they kill the enemy instead of freezing or running away. Combat trained persons are trained intentionally to hate and be aggressive in response when their stress cup is full. The real problem with this training is when its confirmed within an operational environment, which confirms in the soldiers brain that this training has relevance in their life, period.

Police are not trained to kill first, yet are trained to be hypervigilant and aware. So Police will endure heightened symptoms in these areas, though not typically the heightened anger, which is the dangerous component. Tactical Police are trained further, so they may experience similar anger symptoms.

To put it simply, anyone with combat training is programmed with a standby button (denoted at the top of the cup by a blue circle). You know a standby button, the same as your TV and DVD player. The system is on and ready to fire-up at the push of a button, last memory intact from standby power, which is faster than if you had to turn a switch on then press a button, then find the last channel or position of your movie. See the point?

These buttons are placed at the top of a combat trained person’s cup so that when stress builds up it is harnessed, not released through the natural human overflow system.

The reason for this is because organizations do not want a combat trained person breaking down into tears when stressed, they want them to use that built-up stress and release it at the enemy with hatred, rage and anger in order to kill the enemy and not be killed.

The only problem to the near perfect technique is that it serves no purpose in society, only in military environments and on the battlefield. Hence why Police are trained differently, because they interact with the public, not an enemy.

Now the military are not silly by any means, so what do they do in order to keep a soldier under control within a barracks environment? They introduce alcohol, nicotine, forced sport, workaholism, difficult training and so forth. Alcohol is a depressant; nicotine a stimulant and sport lowers stress. Being a workaholic or constantly busy removes the thought of stress, as the idea is to cap stress with mind diversion. Whether a soldier, partner or family member, you would be aware that soldiers are forced to “boozer” parades, compulsory functions, rewarded with alcohol from winning a sporting event and so forth, all in order to help control the soldier within the barracks environment. Police and other trained personnel would have something similar.

If you compare older soldiers to the newer generation, older soldiers smoke and drink quite heavy because they took to the control methods enforced. Do older soldiers have fewer problems? Debatable to say the least! New generation soldiers drink less, don’t smoke, thus they are breaking down sooner because the control measures needed are no longer being encouraged or used. Simply, these control methods are ineffective in today’s society by current societal standards. Just turn on the TV, you will find a commercial to quit smoking, how bad alcohol is for you, the effects of drugs and the list goes on. It just isn’t as socially tolerable nowadays to be drunk or chain smoke.

From what you know thus far let’s now look at the soldier, or anyone who has endured combat training and see what their cup looks like. Using the first examples of what every persons stress cup looks like, without changing the stress amounts, see what happens when you add combat training to the cup. Less room available across all cups, one exploded, not just overflowing.

(Combat training is a known, like good stress, though does not change or fluctuate)

cup-4.png


(Images left to right)

> Image #1 – Normal stress cup of someone who has endured combat training. You can now identify the normal daily stressors, giving less room for new stressors.

> Image #2 – Add normal daily stressor increases, and the individual now has less room again to cope.

> Image #3 – Too much stress and not only has the cup overflowed, but don’t forget about that standby button that is now present. The stress overflow you see in the third cup is tolerated by that pause button, and has now built-up to not overflow, but the slightest little stressor will now push that button causing an explosion (anger, rage outburst). Combat training (alertness) can be deprogrammed to a certain point, but there will always be an amount of alertness that is now instinctive within the person.

cup-5.png


I don’t believe by this stage much explanation is required. You can see for yourself that any person who has endured combat training and has PTSD, it’s just a very ugly emotional cup of stress (a time bomb if you like).

Compare this to the original cups and you can see why a veteran is within so much internal turmoil, so much rage, hatred and anger. It’s got nothing to do with you the person standing there, it is merely a consequence that you happen to be within the firing line when the smallest thing is added to an already full cup of internal stressors.

For those who understand the concept “walking on eggshells” around your sufferer, this is why you feel that way, because you are merely awaiting that small stressor to push that stand-by button programmed from training, and boom, explosion. It could be a look, touch, you just try and talk to them about dinner or ask a question!

There are no limits when an internal stress cup is that packed down and waiting a reason to explode.

Breaking Down The Cup Further​

The following now breaks the cup into specific examples that I have come across, and most likely you as the supporter / sufferer are / have experienced.

cup-6.png

PTSD Cup Broken Down​

Now you can be as creative as possible with this cup and the parts that make it up within your daily, unique lifestyle.

You can see from the example that there is enough room for one more stressor. This means that the sufferer is constantly bordering a full cup of stress, constantly on edge.

Remember we’re talking about PTSD that is uncontrolled, no healing of trauma, no deprogramming of previous learnt skills, just more stress. I haven’t even included nightmares or the like to this one.

Let’s also not forget that the PTSD component increases twice for every stressor. If you added one more stressor to that basic cup, PTSD would expand in conjunction, thus the cup would be over-full, overflow or explode as such.

Now begin the thinking process supporters and partners.

If the PTSD and training components are knowns and not going to decrease because the sufferer doesn’t understand the problem nor comprehend the reason for such emotional instability, then that only leaves the good and bad stressors for them to remove from their daily cup in order to give themselves some breathing room as such.

What’s the largest stressor? Relationships / marriage, so they leave and remove that from their cup. As a consequence, they also remove sex from their good stressors. The sufferer likes sex though, so what do they do? They go into a relationship that doesn’t require commitment, doesn’t require them to take on so much stress, find someone who will do many things for them to reduce more stressors.

Basically, its not uncommon for a sufferer to skip from relationship to relationship using the honeymoon period to keep themselves balanced. The moment relationship commitments are felt, they leave that relationship looking for the next honeymoon period. The honeymoon period can be weeks, months or a year or two.

What else is synonymous with sufferers? They lose interest in hobbies, interests and activities? So they remove those stressors, good or bad, to make more room. They may remove them before giving up a relationship, attempting to make more room for the relationship stressors.

It all depends on the sufferer’s current thoughts, how each stressor is progressing within their life. If they know they need their spouse and children (love overwhelms thoughts), they will remove other stressors first, before concluding such a large decision that affects more than them.

Employment by itself can be a small stressor depending on job and environment, though when you combine driving to work, then home, peak hour traffic, dealing with people at work and so forth, it’s generally a much larger stressor than depicted, thus the sufferer removes it and is incapable of such daily stress with everything else already within their cup. If they work, then they may not have the capacity to be within a relationship as well.

What happens if we remove getting out of bed, prolonging it, showering, shaving, motivating ourselves? Some people like to think these actions are all about depression, when in actual fact they're not.

It has to do with trying to remove stressors the sufferer can control (anxiety), thus laying in bed, sleeping lots and so forth are all a form of stress reduction. The depression endured by a PTSD sufferer is a mood based depression caused by anxiety, not biological or psychological depression which requires anti-depressant medication.

This is why anti-depressants often make a PTSD sufferer more depressed, suicidal even, because the depression is caused by nothing other than heightened anxiety. Treat the anxiety with purely anxiety based medication, you remove the mood based depression, medically referred to as Atypical type.

What would happen if a sufferer instead try chipping away at their trauma? They make more room to handle good and bad stressors, thus allowing them to move back into a healthy lifestyle once again. Sure, other stressors can be removed quickly, though not all without a certain amount of further pain and suffering, such as leaving a relationship.

Are you seeing the hidden code to PTSD?

Trauma​

Now you have the idea of the internal stressor cup, the last thing to go in is the sufferer’s individual traumatic events. These must be listed and included as for each traumatic event is actually a bad stressor. Lots of trauma, lots of bad stressors! These bad stressors that remain un-dealt with are taken to bed each night and still ever present the following morning when they wake up.

Do not try and remove trauma first when things are all bad, try to remove quick and easy stressors. When the sufferer deals with their trauma, it’s not a quick process to be removed. In fact, dealing with their trauma will increase their trauma stressors more, so its not the best to begin with. As a supporter with a sufferer that is ready to heal, help them remove easy stressors then face trauma therapy. As they remove past trauma you can introduce typical daily stressors to them once again.

Trauma therapy will make a sufferer much worse initially, during the process, though the longevity result is the aim. As more trauma is removed over time, then the person will change and function better, constantly improving overall, with small hiccups during, slowly decreasing in intensity.

Secondary Trauma​

Something that supporters should be aware of is what’s called “secondary PTSD.” Secondary PTSD is when a supporter, typically one who lives with the sufferer full-time, begins obtaining symptoms of PTSD themselves, if not actual PTSD. This occurs because living with a sufferer of uncontrolled PTSD is nothing short of a complete emotionally abusive relationship. They most certainly can be physically abusive also. The majority are emotionally abusive, the verbal abuse that degrades the supporters self esteem to little or nothing.

Secondary PTSD is not PTSD itself, it is a label used to those supporters who begin showing signs and symptoms of PTSD, though in fact can become PTSD if not treated. How does this happen exactly? Well, if you think of those who where kids and grew up in emotionally, verbal and physically abusive homes, it is exactly the same except now you’re an adult living the very same abuse. If not treated through therapy you most certainly could obtain full PTSD over-time.

It is nothing to begin hearing spouses / supporters of a sufferer talking about having a drink before bed every night, or two even, or to hear their attitudes change and begin being verbally abusive themselves. Anxiety kicks in, depressive bouts and even suicidal thoughts and tendencies. They begin cheating, going out to parties and clubs, strange out of the ordinary behaviors. These are the signs and symptoms of secondary PTSD from living within an abusive relationship due to PTSD.

Therapy is essential for all supporters of someone with uncontrolled PTSD. Uncontrolled PTSD is defined simply by someone who fails to heal their trauma, fails to manage their PTSD, and fails to take responsibility for their actions, words and life as it stands.

The Fallout​

After reading this far I have no doubt as a supporter, sufferer even, you’re likely thinking about what you know and applying it. Be careful what you apply here. Some things you will know for sure, some you will not. If your partner has left you and your children, it is not about what is more or less important to them at this time, it is merely they have no idea which way is up, they do not understand what is going on within them, they do not understand this stress model.

All the sufferer knows is that they must remove themselves for some reason because it gives them internal relief and allows them a little breathing and coping room. They don’t understand why, they just know it does. Does this mean your relationship will survive if the person is given time? Well, no, that is an unknown quantity.

There are things you can do to help them understand. Sit down with them and work through this document, read it to them if need be, just giving the important facts and leaving out anything that will bore them or send them into an anger outburst.

Sit down and ensure they understand the internal stressor model. Help them understand, but ensure you understand first. Work through their personal internal stress model naming off as many possible aspects that are causing him/her stress. Try and categorize them into good and bad stressors, remembering that some aspects of life have both, not just one or the other.

Trauma is not PTSD, they are two different things so please don’t confuse that aspect of their internal stress model. Past trauma can be dealt with and completely removed from their stress cup; PTSD cannot.

Don’t forget to include any training they have had, if military / police. Include their trauma stressors if you know them. This means listing each one of their traumas into the cup model, as they carry them all in a negative way. This means each un-dealt trauma is a bad stressor within their daily cup. They go to sleep with them, they have nightmares from them, they wake up in the morning with them and even sometimes more trauma caused by PTSD creating memories for them. Yes, you read that correctly. PTSD creates new traumatic events that never even happened for the sufferer, so not only do they have to work out what is real, they often must work through what is not.

Conclusion​

Living with a sufferer of uncontrolled PTSD can be a nightmare on its own. This document hopefully aids the supporter in understanding a few facts regarding what is occurring within the sufferer.

This document is not exhaustive, far from it.

Hopefully you are now a little wiser to the understanding of the PTSD sufferer and why they do certain behavioral aspects. Believe me; these behavioral aspects don’t change between sufferers.

This is not a solution to your problems or relationship, though it is an understanding of what actually occurs within a PTSD sufferer. Again, I suffer PTSD and have now been actively studying and researching it for years for my own benefit and the benefit of others around the world. What you have here is the bare basic outline as simple as I could think. I like simple, hopefully you do also for the purpose and intent of this document.
 
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Nelson2015

Learning
I love this article!!

My fiancé left me after his cup overflowed. We have been living together and inseparable for years. He has always been so sweet. He has apparently been hiding his unhappiness for months. By the time his cup overflowed it was too late. He wanted to break up. His anger is crazy… He is a different person. He says he doesn’t love me and he doesn’t remember when that happened. I hoping he is just putting those emotions to the side for a moment. He says he is getting help. I am 100% a supporter. I hope to work things out eventually.

But on the daily I have to wonder… Why do I make him so angry? Why doesn’t he love me? He has pushed me away, but still talks almost daily… Did he leave me for safety reasons?
 

anthony

Founder
Nelson, it isn’t about you, and it isn’t what you necessarily do. Its about him and his PTSD. PTSD shortens a persons fuse, if you like, so it doesn’t matter whether you please or do not please him, it really comes down to the specific mood he is in at that given time. My point is to not take it personally and self-blame. It is most likely PTSD and him, not necessarily you.

I use those cautionary words because I don’t know the specifics of your relationship, obviously… though if you admit to yourself truthfully that things are otherwise good between you both, then it really is just PTSD and has nothing to do with you.

I have been married some years now, and more importantly my third marriage due to PTSD. There are still days that I want to be single and alone, wakeup and make my decisions based on how I feel without complication of worrying about what anyone else wants or needs from me (aka a partner). The easy option is to walk away and do just that, but that decision has positives and negatives for me and my PTSD. It’s taken me a lot of years to understand that and not just react with my first instinct, usually which is PTSD focused and whats best for PTSD, not necessarily whats best for me.

Flip flopping is normal, and that screams PTSD. The fact he has left but still maintains daily contact, screams PTSD. His brain is basically tearing him in two, between what PTSD wants and what he wants. PTSD quite often wins the argument, until you understand it as a sufferer and can control it. At a guess… right now he can’t, thus you both lose.
 

Lagatha

New Here
This article makes so much sense! Yet at the same time I am confused. The cups diagram breaks it down, and I realize I have many internalized stressors. I work, and that is a stressor in itself, yet often wake up very late on my days off/find trouble falling asleep. Woke up at nearly 3pm today! relationship-definitely a stressor, although nothing specific. And adding to the equation of making the decision to have children with my spouse. I don’t think I should, I don’t think I can handle it, sadly, even thinking about the stressor seems to bring my anxiety level up, more than the love I might have for a child.

I have been diagnosed with dysthymia, major depressive disorder, Premenstrual dysphoric disorder (PMDD), and generalized anxiety disorder. Even though I have had some therapy, I feel some of these on a daily basis, and definitely feel my cup is on the brink or overfilling, almost daily. I have not been diagnosed with PTSD, and certainly don’t want to diagnose myself, but it is very similar to everything this article is describing. Is it possible to have PTSD from a previous suicide attempt. This is also bothering me.

Now, what kind of work should I do/therapy/treatment, to help resolve/treat this? I hope that was enough information.
 

anthony

Founder
Hi Lagatha, as per my other comment regarding whether you meet PTSD or not.

Based on what you’re saying, I would tend to agree that trying for a baby is not ideal for you at this time if your stress cup is constantly full. A baby is a stressful event in itself.

What therapy is best? You should aim for the cause, being your suicide attempt. EMDR, PE, TF-CBT, along those lines. You need to dig into what is distressing you and resolve it about your suicide attempt.

You likely need to engage some good daily exercise to help relieve and control your depression and stress cup.

The stress cup itself — write yourself a list of what is stressful for you, then write a list of possible solutions. If you can’t find solutions, that is what the forum is for, to have others give you ideas, which if you ask a specific question, you can then get varied responses to pick from that may work for you.

Find what you think will work best for you, then work on just one stressor at a time, to reduce it or remove it. Once you have done that, move onto the next one.
 

Lagatha

New Here
Hi Anthony,
This illustrates that there is much more work to be done- although I am ready now.
Thank you for introducing some therapy that might work. I have done some CBT but that was ten years ago,
recently tried mindfulness (not sure it’s working or it’s enough, seems like it is something to augment therapy), PE- Prolonged Exposure Therapy? That sounds interesting as well.

Looks like I need to do some deeper introspection, all I can say as of now is that I am *generally* stressed out by my work, and *generally* stressed out with relationships (i.e. family, friends, spouse), but cannot identify specifically what about them. Would a therapist help work with me to identify specific stressors and work on them?

Also, one more question: when looking for a therapist, what kind of qualities would you suggest in a psychologist/psychiatrist?

I had a friend recommend a psychiatrist to me, I met with the psychiatrist but felt almost immediately uncomfortable. I felt judged, and I was promised to be ‘fixed’ very quickly, she tried to address all my issues in one meeting. It felt overwhelming, and I was berated for not ‘trusting’ her immediately (because I did not tell her my profession), stated that is needed for a ‘therapeutic alliance’. While I understand therapeutic alliance, I also feel like I personally take time to open up. .I was told by this psychologist that I am very “guarded”. While all this is true, and I understand therapy is not meant to be comfortable, I also don’t want to feel like I am bullied, or obligated to share whatever I am not comfortable to at the moment. Furthermore, it is tough to find psychiatrists/psychologists who are not fully booked. I need to do some work, and cannot also afford to prolong my suffering or be set back by previous trauma. At the same time, I don’t want to feel absolutely terrified during the process. Thoughts?
 

anthony

Founder
Yes, a therapist would help you work the solutions to the problems.

Psychiatrists are not therapists, they’re doctors and often just diagnose and prescribe meds… they’re often too clinical, where therapists are not clinical and more communicative oriented.

Seeking therapy and having your guard up, at the same time, is pretty much a contradiction. This is why I just ask people, “are you really open to therapy at this time?”

Are you?

It is a waste of your time and the therapists if you need 6 months to feel comfortable with them, when you are seeking their help to begin with. What happens is people feel disappointed that nothing has been accomplished, blame the therapist, when in fact they haven’t really worked hard and jumped into the process that they sought to help themselves.

Going to therapy means you need to check your guard at the door and just blurt it all out to them and see what comes out the other side. No secrets in therapy, that is the beauty of it… but you have to go into it with that mentality. Approach it like a no secrets aspect of your life that you otherwise haven’t had, or don’t have, and just let it all go to them.

In essence, they’re a stranger with confidentially restrictions, so they can’t say anything to anyone else. People confuse therapy and complicate it. They want to befriend the therapist and feel ultimately comfortable, when really they still just keep secrets and fool themselves into a belief they’re being open and honest, knowing they’re not.

Therapy is like coming online… you can say anything you want with a whole lot of privacy, except therapy offers you the more personal touch.

Don’t over think therapy. Use it as a tool without losing sight of what you’re doing — being you want to help yourself and need feedback and ideas. To get that, you need to just blurt out everything, honestly, and use them like a sounding board. You will get through therapy much faster that way. The work that MAPS does is exactly this, using MDMA to relax the client so they just blurt it all out, and therapy results have jumped to a whopping 80% success with much shorter time period.

We can actually do that ourselves, just by approaching therapy with the right attitude and instead of worrying what this paid therapist thinks of you, as though they’re your friend or such (which they are not), just let rip and unload your heads thoughts upon them to decipher and help you work through… to help you solve your own thoughts.

You will be in and out of therapy much faster, with near guaranteed successful results.
 
R

Reverie702

Thank you so much for writing this. I’ve learned more about PTSD than any of the books I’ve read, by reading your post. I loved the cup examples. Thank you for helping me!!! I’m new to this site so I’m excited to have read such an insightful and well written post right off the bat. My boyfriend has Combat PTSD with a TBI. He retired after 20 years and many tours. He has nightmares and a service dog. He sometimes says things that seem off and he shows his emotions differently than guys I’ve dated in the past. I think he’s dealing well with his symptoms but I want to learn as much as I can so I know how to react when he says or does things that are offensive or seem cold. His social cues seem off. He’s a very sweet, good man and I admire him in so many ways. I’m glad you mentioned the “honeymoon dating phase”. I want to talk to him about this to make sure it’s not something he’s doing with me but I assume that if he is, he might not even be aware. Anyways, I wanted to thank you for helping me understand.
 

anthony

Founder
I’m glad it has helped you. PTSD is not complicated, the effects of trauma are complicated. PTSD works in certain ways, and its affect range simply differs on which symptoms a person suffers. Most of the PTSD attributes though are similar when compared to same trauma type, i.e. combat vets endure similar symptom patterns, sexual abuse similar, childhood trauma similar, so forth.
 
R

Rob Urquhart

Hi, this article is absolutely spot-on. It's what we (my wife and I - I am a military vet) have coined as the Noel Complex. Noel being No 'L' in the fight or flight response: I only have a fight or fight response!
 

Jin

Learning
About PTSD
PTSD is a non-curable, yet very treatable and manageable disorder. When you have reached the level for a PTSD diagnosis, you have reached the peak of many individual disorders rolled into one. Don’t freak out about non-curable, it just means once your brain has endured this level of distress, you can heal and manage symptoms, though another event could heighten symptoms, or make them worse as time goes on. Some people fully recover and experience little ongoing duress due to lack of future traumatic experience and excellent self management skills. Approximately 6% of PTSD sufferers never fully recover.
Thank you ?
 
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That's the best description of ptsd effects I have ever come across by far!.. I will forever envisige a mental cup in my mind, and be very mindful of how it's filling and what I'm pouring in... I look forward to putting this into practice. Many many thanks!
 
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