Sunday, June 1, 2014

Posttraumatic Stress Disorder - By Elizabeth S. Giammarco, PhD, LCPC, NCC

What do the words railway spine, battle fatigue, shell shock, soldier’s heart, homesickness, nostalgia, being broken, and irritable heart have in common. They all refer to what we know today as Posttraumatic Stress Disorder or PTSD. Although the disorder did not receive its current label until the 1970s nor make its way to Diagnostic and Statistical Manual (DSM) III, a way to diagnose mental health disorders such as depression, schizophrenia, drug issues, autistic spectrum disorders, etcetera until 1980, the idea of traumatic events having a long-lasting effects on individuals and groups have been around since early civilization. According to an article by Bentley (1991/2005), Herodotus, who was an historian in Early Greek Civilization, cited an incident whereby an Athenian soldier lost his sight immediately upon seeing a fellow warrior killed. Even though the sightless soldier was not injured in any way, the shock of the experience rendered him blind. The soldier in fact suffered vicariously in much the same way as some who witnessed the Rhode Island Station House fire of 2003, the Cocoanut Grove fire in Massachusetts of 1942, or the events of 9/11. PTSD then can be a result of witnessing something terrifying or having been actually part of it as is often the case with returning soldiers who have been injured. 

 However, PTSD is not just a condition of war or combative initiatives, it is an equal opportunity disorder. It can affect a person who sees something unnerving in much the same way that it does to an individual who actually goes through the event. In fact, two people can be part of the same crisis only to have one who suffers from long-lasting problems; whereas, the other not being troubled by it at all.
 Posttraumatic stress disorder is complex. So much so that it is now classified under Trauma- and Stressor-Related Disorders in the DSM – 5 rather than under anxiety disorders as it had been previously. The prevailing factor that needs to be part of the conditions for diagnosing PTSD is that a significant stressor or crisis has occurred. However, the criteria for diagnosing PTSD are tricky and should only be done by a qualified professional. 

 As one who sees clients and students, I am always amazed at how many have given themselves the label of having PTSD by looking up their symptoms on a search engine. While the idea of self-diagnosing may seem to be prudent for those who may be suffering -- it is not. It takes an assessment of not only psychological signs but also physical ones in order to give an accurate diagnosis. Not all individuals exhibit the same sort of symptoms. In fact, children who have PTSD as well as the elderly can present symptoms of distress other than those seen with adults. Then too, physical conditions such those that might be seen with neurological, thyroid and cardiac issues need to be sorted through as well. 

 Not only does the diagnosis of PTSD need to be accurate but also the treatment for it has to be according to the individual needs. In some cases, comorbidity or co-occurrences of other mental and physical disorders have to be taken into consideration prior to devising an adequate plan for therapy. Some treatments have to do with medications and others with thought-stopping therapy such as cognitive behavioral therapy (CBT). Yet for others, a combination of remedies are needed. 

 Not all people who suffer from PTSD want to revisit the initial stressor; whereas, others do not have a problem with going through it again mentally. Therefore, it is essential that there is a “good fit” when it comes to the professional that one chooses. Although finding help and going through therapy may be uncomfortable at first, the sessions need to be according to what the client wants and needs as this is crucial for a beneficial outcome. Newer drugs such as Ketamine that can relieve some of the more profound symptoms of the disorder from re-occurring are being looked at by researchers in the field. 

 PTSD is a disorder that is recognized as one that needs and requires attention so much so that June 27th has been designated as PTSD awareness day. Although the criteria for diagnosing PTSD is complex, an individual need not suffer in silence or at all. PTSD is very much treatable. If one feels that he/she is experiencing on-going problems that seem to be coming from a major stressor event, there is help available. The United States Department of Veteran Affairs has the following website that gives quite a bit of information: And in Maine, one can call 211 in order to find places that will help.

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