“When you get to the end of your rope, tie a knot and hang on.”
– Franklin D. Roosevelt
Sometimes I try to convince myself that I am not suffering from PTSD because I have never officially been labeled. In fact, every therapist, counselor, and psychiatrist I’ve seen has told me that I was experiencing “a completely normal response to a traumatic event” and insisted the anxiety and difficulty sleeping would improve with time. No one ever uttered the term PTSD. They looked at me as functioning normally and assumed I was ok despite the fact that I told them otherwise. The truth is, there is a huge grey area between being functional and well. People can function without sleep, when they are sick, or even when they are suffering, and it doesn’t mean they are at their baseline. It wasn’t until I spent time around other individuals suffering with PSTD that anyone pointed out the name for my symptoms.
Then the more I read about other people’s struggles with PTSD, the more I realized I could identify. I felt guilty because it seemed like my “trauma” was so trivial compared to others. There are people who have seen loved ones murdered, been to war, and been in terrible, horrific accidents; and all I went through was 5 years of ridicule. Doesn’t quite seem to measure up.
Here are the DSM IV criteria used to diagnose PTSD. I have highlighted the ones that apply to me:
Diagnostic criteria for PTSD include a history of exposure to a traumatic event meeting two criteria and symptoms from each of three symptom clusters: intrusive recollections, avoidant/numbing symptoms, and hyper-arousal symptoms. A fifth criterion concerns duration of symptoms and a sixth assesses functioning.
Criterion A: stressor
The person has been exposed to a traumatic event in which both of the following have been present:
- The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
- The person’s response involved intense fear,helplessness, or horror. Note: in children, it may be expressed instead by disorganized or agitated behavior.
Criterion B: intrusive recollection
The traumatic event is persistently re-experienced in at least one of the following ways:
- Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: in young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
- Recurrent distressing dreams of the event. Note: in children, there may be frightening dreams without recognizable content
- Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes,including those that occur upon awakening or when intoxicated). Note: in children, trauma-specific reenactment may occur.
- Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
- Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
Criterion C: avoidant/numbing
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
- Efforts to avoid thoughts, feelings, or conversations associated with the trauma
- Efforts to avoid activities, places, or people that arouse recollections of the trauma
- Inability to recall an important aspect of the trauma
- Markedly diminished interest or participation in significant activities
- Feeling of detachment or estrangement from others
- Restricted range of affect (e.g., unable to have loving feelings)
- Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Criterion D: hyper-arousal
Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:
- Difficulty falling or staying asleep
- Irritability or outbursts of anger
- Difficulty concentrating
- Exaggerated startle response
Criterion E: duration
Duration of the disturbance (symptoms in B, C, and D) is more than one month.
Criterion F: functional significance
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is three months or more
With or Without delay onset: Onset of symptoms at least six months after the stressor
While many of these symptoms have improved or are improving, everyone that is in bold I have had (and many still have) during the past 2 years. It is plain as day, and yet denial is a powerful thing. I can attest, though, that knowing the name and reason for the way I react to stress (or perceived stress) has made it tremendously easier to deal with. In a sense, the therapists were right, my symptoms did improve a lot with time (something I am incredibly grateful for!); but I continue struggle with nightmares and hyper-vigilance. I am sharing this post because I know that there are other victims of violence and abuse who discount the trauma they experienced and are not getting help when they need it. Everyone is entitled to a happy, productive life- acknowledging the problem is part of the path of getting there.
Resources (just a few of the many) for PTSD: