Help Me Understand PTSD
December 2, 2009 7:03 AM   Subscribe

I've just been diagnosed with PTSD. Please help me understand it.

After years of unsuccessful attempts at medication and therapy, I'm in an intensive treatment program for depression. The psychiatrist who I am working with thinks that I have PTSD as the result of growing up with mother who had an unmedicated psychotic disorder and was chronically unstable -- deeply caring, but also paranoid, irrational, and prone to rages and outbursts based on even the smallest provocation.

Like most people, I associate PTSD with soldiers who've been traumatized by battle experiences. but what I experience fits the bill: flashbacks, nightmares, stimuli that trigger unfathomable and unmanageable emotions, and a terrible time managing anxiety and depression, which I remember feeling since I was 10 years old.

I'm not interested in claiming a diagnosis as a validation of just how bad my childhood was. Instead, I hope the diagnosis will shed some light on what I'm struggling with, and offer another angle on what's going on and how I could move forward.

So I'm trying to get a better (i.e. beyond Wikipedia) understanding of what PTSD is and how it works, especially how trauma is experienced and processed by the brain, its long-term consequences, and its relationship to the development and persistence of depression.

Your experiences, thoughts, and resources would be much appreciated.
posted by anonymous to Health & Fitness (9 answers total) 17 users marked this as a favorite
 
I always recommend this book to people who are curious about PTSD because it was enormously helpful for me, but with the caveat that

(1) It can be a tough and graphic read.

(2) If you're struggling with the question "How can I claim to have PTSD? I'm not a soldier/incest survivor/former political prisoner," it can be a doubly tough read, since it focuses on many of these extreme cases. But it can also be very validating to see how well it manages to describe your own symptoms.

Keeping that in mind, Judith Hermann's Trauma and Recovery is very lucidly written and changed the way the clinical community thought about PTSD by introducing the idea of the complex PTSD that can result from cases like yours, where the trauma went on over a period of time.

It includes a really interesting history of attempts to treat trauma victims, case studies that, like I said, can be enormously validating, and an overarching theory about how our brains experience and adjust to trauma, and also how they can start to process trauma so that we can start to heal. It's one of the books where I wish I had a library full of them so I could just hand them to everyone who needed it.
posted by besonders at 8:10 AM on December 2, 2009 [1 favorite]


Most importantly: PTSD is a response by normal people to abnormal situations. You are not crazy. You are not broken. Something bad happened to you and your PTSD is the result of a normal brain dealing with that trauma.

Trauma based CBT and EMDR (Eye Movement Desensitization and Reprocessing) are useful therapy models for recovery. I thought EMDR was bunk until I knew someone who was successfully treated this way. It is really an interesting therapy model and she found it quite useful.

How the brain experiences and processes trauma?

First off, let me say that I'm not a clinician. I'm a mental health professional with enough knowledge (and personal experience) to attempt a well meaning and layman's response to your question. I hope it helps.

Well, as a kid, you had little control over your circumstances. Our responses to stress include either flight, fight, or freeze. You experienced enough of this at an early age that your "emotional thermostat" got set higher than other peoples. What does that mean? It takes less stimulus to raise you above your threshold. To complicate matters, you're stuck with memories, both cognitive and physical, of trauma. When something sets you off, your "thermostat" sets off a fight, flight, or freeze response and then that physical response triggers memories, flashbacks, and nightmares. It's a catch-22, really - a vicious cycle of triggering, remembering, and re experiencing the trauma. The unmanageable emotional responses make sense if you consider that as children we are unequipped to deal with the difficult and complicated emotions. Emotional triggers and stimuli return you to your childhood experiences and you experience emotions as you did as a child.

The goal of recovery is too fold: 1) to understand and process your experiences. Many people believe that traumatic experiences are filed away in difficult to reach places of our brain and therefore cognitive reintegration of these experiences is necessary for recovery. 2) to develop coping and mindfulness skills to help you cope with painful emotions and experiences in the present.

I'm wondering: How are your adult relationship skills? Do you have intense and painful interpersonal relationships? Do you burn other people out emotionally? Do you push away others but at the same time fear abandonment? Experiences such as yours can cause all of the above and committing to treatment can help you learn ways of managing.

Feel free to memail me if you'd like. You can't change the past, but you can recover from the damage the past caused. Hang in there.
posted by dchrssyr at 8:56 AM on December 2, 2009 [8 favorites]


Another resource....
posted by HuronBob at 9:05 AM on December 2, 2009


I developed a lot of my understanding of PTSD by reading Spero Manson's Ethnocultural Aspects of Post Traumatic Stress Disorder. IANAD, but read it at the recommendation of one. Because he is examining it in a cross-cultural context, Manson really gets at what PTSD is and how it gets misdiagnosed due to cultural perceptions. He asks the question "How does one recognize psychic numbing? In the presence of threatened cultural disintegration, and high levels of cultural demoralization how does one accurately asses loss of interest, feelings of detachment or estrangement, or a sense of a foreshortened future?" For me, reading this question made me wonder about why these very things seemed as normal as air to me.
I congratulate you on your decision to pursue treatment. I know it isn't easy, but hope that you stick with it.
posted by Sara Anne at 9:05 AM on December 2, 2009 [1 favorite]


The Judith Hermann book referred to above is the gold standard. You might also get a great benefit out of looking at plain vanilla Anxiety Disorder, not otherwise specified literature. PTSD is a specific anxiety disorder. And although treatment protocols for PTSD seem to be poorly defined (I have read a couple peer-reviewed blurbs that claim the most successful treatment is Eye Movement therapy, and nobody has any idea what the mechanism is; pure speculation (and I forget where I got this): a huge fraction of the brain is devoted to optical processing, so when you force feed a bunch of sensations through those ubiquitous optical neural pathways you disconnect a few disfunctional connections here and there which is what provides the relief), treatment protocols for anixiety are near unanimous. Minimize the caffeine and alcohol intakes. Healthy diet and exercise and plenty of sleep. Medications may help. Meditation may help.

(Not a doctor here but an extremely anxious patient.)
posted by bukvich at 10:04 AM on December 2, 2009 [1 favorite]


Yoga has been shown to help survivors of trauma. Here are a couple of articles on the subject. You may even be able to find a class specifically for trauma survivors.
posted by ekroh at 11:15 AM on December 2, 2009 [1 favorite]


I suffered from PTSD due to a sexual assault. I personally found that CBT designed specifically for PTSD was immensely helpful to me. I'm not sure where you are located, but I went to the department of psychiatry at the University of Pennsylvania for my treatment, and they were excellent. If you live near a large university, I would suggest starting there (not to say that you can't find a good doctor if you don't - just sharing my experience).

The other two things that helped me were being put on lamictal for about 6 months, and smoking marijuana. If you google either of the drugs + PTSD you will get a lot of information.

I wish you the best in your recovery. I think the best thing you can do is educate yourself about the condition so that you can understand why you feel the way you do and work with a professional who can point out hiccups in your thinking that you won't realize. You can absolutely recover from PTSD and the sooner you start working on it the sooner you will be free from your demons. Be strong.
posted by sickinthehead at 11:15 AM on December 2, 2009


Seconding ekroh's suggestion: yoga helped me a lot.
posted by sickinthehead at 11:16 AM on December 2, 2009


According to RAND (resources here -- targeted to veterans, but still could be valuable to you), in addition to CBT and Eye Movement Desensitization and Reprocessing, another therapy that's been found to work in evidence-based studies is prolonged exposure: A therapist helps you go over your memories or flashbacks, repeatedly, to help gain control over them and the emotions that come with them.

IANA therapist, but I work at a military-specific publication and we cover this a lot.

There is no quick fix; beware of anyone who promises one. As other posters have said, there is nothing wrong with you. You had a normal reaction to an abnormal situation. Like any injury, it will take time to heal. Best of luck and much strength to you.
posted by Ladybug Parade at 11:39 AM on December 2, 2009


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