Friday, March 26, 2010

Are You Still Suffering from Memories of an Unpleasant Experience? (PTSD from Mild Trauma)

Interesting article from Robert London, MD at Psychology Today (his blog is Two-Minute Shrink). Dr. London points to the prevalence of PTSD in people who have not suffered severe trauma. This is important.

PTSD-like symptoms can stem from a milder traumatic event.

By now, most people are familiar with post traumatic stress syndrome, or PTSD. PTSD is defined clearly in the DSM-IV, the psychiatric manual that aims to define psychiatric disorders, as the development of "characteristic symptoms following exposure to an extreme traumatic stressor" (italics mine). Examples can be found in patients who have experienced military combat, violent personal assault, kidnapping, torture, incarceration, and/or man-made or natural disasters. The list of extreme traumatic stressors can be quite long. But what many people---even psychiatrists and psychotherapists---don't know is that you can suffer PTSD-like symptoms from a less-intense unpleasant experience. The trigger for PTSD does not have to be extreme.

I have seen a fair number of cases where people had symptoms that masqueraded as anxiety and depressive disorders, but when we explored the historical events in a person's life, these symptoms could be traced to milder traumatic or unpleasant experiences than are not normally associated with PTSD. And yet, their symptoms were exactly those of PTSD. In my experience, a milder traumatic event does not necessarily lead to a milder set of symptoms.

If you think you might be suffering from a past distressing experience, see if any of the following symptoms rings true for you: having recurrent nightmares, flashbacks, upsetting thoughts, or memories; feeling distressed when you're reminded of it; having physical symptoms, such as a racing heart or sweating when it comes to mind; irritability, jumpiness, angry outbursts, or difficulty sleeping; or feeling distant, negative, or uninterested in activities you used to enjoy. I've found that these are some of the classic PTSD symptoms you can get from an unpleasant experience, even if that experience would not be defined as "intensely traumatic."

Let me offer two examples illustrating problems of PTSD---two people who experienced life events that were emotionally disturbing but not the kind of extreme trauma suggested by the DSM-IV. Each had suffered a major loss and disruption of lifestyle. The first was a woman affected profoundly by a job loss that resulted in a major reduction in income. The second was a man who suffered after-effects from a divorce. Neither of these two events is usually considered a potential source of PTSD. Besides anxiety and depression, though, both people experienced flashbacks and nightmares, which forced them to relive the spectrum of traumatic experiences long after the events, as well as other symptoms usually present in PTSD.

In the clinical setting, one of the most modern successful treatments for PTSD is using virtual reality in which, using a head-mounted device, the person watches an interactive program created to replay traumatic events in an ascending hierarchy-from least to most disturbing-to expose and desensitize the person from the problem.

However, if you're still suffering the aftereffects from a distressing or unpleasant experience, you don't need fancy equipment to improve your symptoms. There are very clear treatment strategies involving relaxation, hypnosis, guided imagery, behavior modification. and cognitive behavior therapy that are useful in resolving the symptoms arising from unpleasant recurrent experiences, and there are therapists who specialize in such treatments.

For you, the first step is to recognize your own PTSD-like symptoms, and identify the unpleasant experience from whence they originated. I've found that once people understand the connection between their symptoms, the original event, and present-day situations that re-trigger those symptoms, we can very quickly and efficiently minimize or eliminate the condition. Best of all, many people with these symptoms can also begin to use self-care techniques I've developed-simple, practical strategies to counter PTSD-like symptoms stemming from unpleasant experiences in their past.


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