PTSD Breakdown

What's up, Cadre fam? Evan here, your resident mental health and addiction therapist. Welcome to my live stream. Today we're going to be talking about a topic that whenever I bring it up, I get so many questions, and they're usually extremely good because it's kind of a complicated topic, and that is all about PTSD, post traumatic stress disorder. And there's a lot of common questions I get when I start to break it down for people. So we'll go over some of those and I'll give you my take. And really just kind of what the.

What the system is and what the symptoms are and how it's basically diagnosed when you go to therapist, psychiatrist, whoever your mental health professional may be. So, basically, I think everyone has a certain idea of what PTSD is. Kind of just like depression, like you, in a general sense, understand that it's when you go through something extremely traumatic and then have reactions to that that are severe, whether it's emotional, physiological, you know, just essentially, in a way, just being shook up for an extended period of time in an extreme way, kind of, you know, the view, that general view, it's not all that incorrect.

Like, if I just ask a random person, like, what is depression? They would probably be able to tell me with, you know, pretty good accuracy, just in a general sense, what depression is like, what it looks like, maybe not like the nitty gritty details, but I think it's pretty interesting when you start to break down PTSD into some of those nitty gritty details just so you could get a better understanding of it and how it's diagnosed. Now, there's some complicating factors in diagnosing PTSD, and some of it is, there's some things wrapped up in it that are maybe a little political or financial because, you know, PTSD is one of those diagnoses where people can get disability for.

Right. And so sometimes it can be hard to get that diagnosis or get that diagnosis approved, let's say, by the VA, you know, veteran administration. Right. The medical system, you know, or get, like, certain types of benefits or treatment for it, right. A lot of times, you know, we don't want to admit that we're sending folks into battle and they're coming back with this. Right. So there's a history of that. I think, you know, it's getting better. I'm not a too immersed in the military world. I've worked with a handful of veterans, for sure, but.

So getting that diagnosis. So, first off, what is PTSD? Well, it is one of the disorders on the trauma and stressor related disorder spectrum, basically any trauma, stress related disorder is linked to an event or series of events that create consequences, not necessarily consequences. That's definitely a word you could use, but it creates a reaction, an abnormal reaction. Now, one could say, well, it is kind of a normal reaction, right? If you go through something traumatic to be shaken up by it for a long period of time with many different symptoms.

But actually it is fairly. I hate to use this word abnormal, but let's just say, like, most of the time, when people go through a certain trauma, you're shaken up, right? But you heal over time, right? Just like getting an injury, right? You get an injury, but eventually you heal up over time, and hopefully you get to the point where you don't have any symptoms anymore. So. So psychological injury, something like PTSD, is very similar to a physical injury, right? Because there's all different types of physical injuries, just like there's all types of traumatic things you could go through, though it usually follows trauma.

You know, psychological trauma, you usually break it down into, like, you know, a few specific categories, but you know, you're affected differently, right? Like, with the physical injury, depending on the type or where it is, right. And some injuries do not necessarily heal on their own. They're, like, better than they were the day it happened. But it could be a year, two years, five years later, you still have symptoms from that injury, right. You may not be able to say you injured your leg, maybe, you know, it feels better than it did the day before.

But I can't run, I can't jog anymore without having a certain amount of pain. And so, just like that, humans could go through a variety of different unique experiences and have a different reaction. So most people do not have that prolonged reaction, because one of the key features of PTSD is that it lasts for a significant amount of time. Usually it just has over a month, but typically it would last longer than that of the trauma. Stress related disorders. PTSD is the core disorder. However, it is also, one would argue, the most severe, intense.

But the symptoms of PTSD are kind of the core of the trauma. Stress related disorder symptoms, just like a major depressive disorder would be the core of the different depressive disorders. And from there, how it manifests, how many symptoms, how intense, that's how we differentiate. So for PTSD, it's broken down into five categories. So you have to have symptoms like a certain amount in each category, but the first one, it's like criterion, right? So criterion a. And now I'm like, worried. I'm like, oh, crap, am I gonna get them all?

And I'll probably get them all, but it may not all be in the perfect order, but five criterion a, B, C, D, E. So I know for sure a is experiencing a traumatic event, right? And this is where it gets interesting, and this is where a lot of people ask questions, which is what qualifies as a traumatic event? Well, in the diagnostic manual, it states that it has to be something that is, you know, kind of related to violence, whether it's going through something violent, fear for your life, witnessing, you know.

Yeah, like I think I said, witnessing violence or something else like that. A sexual assault is another one. But those are kind of the main, you know, criteria for it to be a traumatic event. Now, we all know there's plenty of other traumatic events, but, you know, what's usually stated is that it has to be something of this nature to then qualify for PTSD, even though, I mean, there's other types of events, people will have a PTSD reaction that could be as severe. So, you know, could be a little bit of disagreement there.

But again, this is just where we're drawing the lines, right? So everybody's symptom presentation is going to be a little bit different, but this is just kind of where they're drawing the lines. So basically, experiencing a traumatic event now may as well just stay on this for a bit because, like, people would ask me, like, well, what about losing a loved one? Well, it. In this case, technically, it would depend how that happened, right? Because losing a loved one is unfortunately a normal part of life, even if it is often sudden.

Hey, James, so, like, let's say someone had, you know, you had a family member who had cancer or something like that, right? And they were young or you had a child, right? Typically, yeah, I mean, I think that would be a criteria, right, because you're like, witnessing, right? So if you witness this horrible thing, like your child going through it, and you have all the other symptoms we're going to talk about. Yeah, I think that would be safe to do. Diagnose someone with, or you witness someone die suddenly in a car accident, they're right next to you, right?

That would be considered an event, for lack of better term, worthy of that diagnosis. Now, again, that's just PTSD. Remember, there are other trauma and stressor related disorders. So as a therapist, there is some wiggle room there where maybe you don't meet the exact criteria for PTSD, but you still have had an event or series of events that I could give you an unspecified other specified, it's maybe not making sense, but there's like other specified trauma and stressor related disorder, which is basically like, hey, you meet some of the criteria, some you don't, but it's still significant.

Right. So there's wiggle room of how to diagnose. We just don't have a great name for it. We have something like acute stress disorder, which is if it's within 30 days of the trauma and then once it goes past 30 days, then it's post traumatic stress disorder. Post trauma. Right. You also have things, I'm bouncing around a little bit. You have things called adjustment disorders. And there's a little bit of joke around adjustment disorders because this is usually what therapists will diagnose people with when they don't want to diagnose them with anything, which is basically like you are going through some stressful things and you are having difficulty coping with it.

Right. So like an example of like an adjustment disorder would be like, let's say like a kid, parents got divorced and all of a sudden they're experiencing symptoms of depression and anxiety. Usually it's broken down depression and anxiety that comes from it. Yes. You could diagnose them with an adjustment disorder. There's kind of a shelf life on that. I don't remember if it's three, six months, something like that, where after that, if it's still happening, you just got a say, depression anxiety disorder.

Yeah. So that's something you could diagnose someone with as well. And other symptoms category. Again, these are not perfect. You know, we're just doing their best. So, you know, let's say you lose a loved one, another example. Right. So that's, you know, be considered an average type experience. Someone would have, Kerry, so the difference between post traumatic stress disorder and post traumatic syndrome, I actually don't know what that is. I've never heard of, like what, post post traumatic syndrome?

Can you tell me a little bit more and maybe look that up? I'm not actually sure. But let's say you lose a loved one. And this is interesting because we've changed this up a bit. This is a new diagnosis added something called prolonged grief disorder where let's say you lose a loved one, there is a average normalized period of grief. But if it's like a year later and you're still having the feeling like it happened yesterday. Right. They say, okay, well, you know, let's call that a symptom. Let's say like, so you could be diagnosed with prolonged grief disorder.

Another thing for all these different trauma stressor related disorders, at the end of the day, it's like we want to know what it is so we can match it with treatments that. So that we. I believe we call acute stress disorder what I was talking before, because anything before 30 days is acute stress disorder. I don't know if others refer to it as post traumatic stress syndrome, so I'm not sure where that comes from. But in DSM, it's typically acute stress disorder. So it'll be interesting. I want to look into that a little bit more.

So, yeah, so that's criterion a, right? Experiencing one of those severe traumas, now we start to get into the symptoms themselves. So one of them, maybe it's criterion B or C, that would be intrusive symptoms. So these are things that intrude into your life. And d***, I only got like five more minutes. So this will just be part one. We're going to do a part two where we go over the criteria. So I'm going to go a little bit quicker and not divert into my usual rants and I'm not doing so well. Intrusive symptoms.

So basically this is where you have like the flooding of thoughts, the memories, right. It's like you're feeling like it happened yesterday. You have images, flashes in your mind. Let's say. I like to use the example, the 35 w bridge collapse here. That was just a couple miles this way, where literally a bridge collapsed full of traffic, right. And there were some survivors and affected a lot of people. So let's say I have these images in my mind of the bridge collapsing and me and my car and the water, the Mississippi river's coming in, and this is continuing to happen.

And I'm having a physiological reaction because one of the ways we look at a post traumatic event or a traumatic event, a traumatic reaction is I am experiencing this event now. My body experiences it as if it is now and not something that happened in the past. It's almost like not even a memory. It's like happening now. Right. And so when we talk about treatment, probably in part two, we'll talk about how we try to convert it to more of a memory versus something you are re experiencing. So those are intrusive symptoms, thoughts, feelings that are coming now.

The other one is avoidance symptoms. Let's say we're talking about the metaphor of the leg injury. That would be like, okay, well, I avoid walking in certain places, running. I do things to not upset the injury. The bridge collapse, it's like I just don't drive over bridges. So it takes me 30 more minutes on average to get anywhere because I am avoiding all bridges. Right? So basically in this case, just like with anxiety, the actual probability of harm is less than the actual reaction to it, right?

It's probably not like fully logical to avoid bridges, but you had this one in a million experience, right? So your brain, your body is telling you this is not safe based on your experience. Just like you're a kid and you touch the hot stove and you burn your hand and you're like, oh, probably shouldn't do that again. Well, it's the same thing. Well, when I drive over bridges, they collapse, so you avoid them. Right. So that is avoidance of not only avoiding places, people, things, but also avoiding the internal cues, memories, right?

So. Oh, man. Another one would be emotional, how it affects your thoughts and your mood. So basically it's easy to say anxiety, symptoms of severe anxiety and depression, and also changes the way you think. Just like with depression, like having, like, feeling of guilt and shame. And then another criterion would be, you know, reactivity. So things like extreme fear, anger, emotional volatility, hyper vigilance, right? Kind of looking over your shoulder and then the other one, I don't remember exactly.

How do you label this? But basically unhealthy coping patterns, like doing kind of like risky things, like risky behaviors, substance use disorder, almost any kind of addiction, but doing things that are kind of unsafe and damaging. The rest of the criteria is just about how long it lasts. We talked about that greater than 30 days from the event, but that's how those are the criterion. And pretty much to get the technical PTSD diagnosis, you have to have symptoms, experience the particular type of trauma, and then have a certain amount.

It's like 2333 in each criteria for the different symptoms. So that's just like a general overview so you can look it up and see if you want to look a little bit more in detail. But I'm curious too, to look more into that post traumatic, because I have heard that before, Carrie. But I'm curious. Maybe that was something we used before. But anyway, folks, I gotta go, but I think it's definitely appropriate for part two on PTSD and we could talk more about treatment of it. So awesome, thanks for those who participated.

And we will see you, maybe not next week, but the following week. I will be out of town here, so see you. We'll see you all soon. Bye.