PTSD Symptoms: 7 Signs That May Signal PTSD

If you go from brittle to fragile following a horrendous trauma, the fear of being re-traumatized and going from fragile to shattered, fragmented and irretrievably lost can drive a person who needs to be in control to take desperate actions, including killing themselves.

Central to a diagnosis of PTSD is that there has been a severe psychological trauma whose effects are more lasting than what is referred to as an acute stress response. In my capacity as someone who tries to listen deeply and get where people are coming from their inside out (vs. plugging them into a diagnosis via checklists that I apply from their outside in), here is the process that occurs in previously tough and strong people who I have later diagnosed as having PTSD:

1. Feeling Bulletproof: Prior to the trauma, they often felt invulnerable as if nothing could harm them (the way a very wealthy person who can buy anything -- and sometimes anyone -- can feel all the way to a freshly trained soldier before they enter battle).

2. Horrendous Trauma: There is usually something horrific about the trauma. Horror has a way of destabilizing the acting, feeling and thinking parts of their brains so they can no longer work together. This may explain the use of the expressions: "Wigged out," "Coming unglued," "At wit's end."

3. Raw Vulnerability: As bulletproof as they once thought they were is as vulnerable as they have turned out to be. There is a belief that they don't know how they survived the first trauma and an unconscious belief that they wouldn't survive being re-traumatized. One of the reasons for anniversary reactions.

4. Brittleness: Not being able to find peace outside or inside their life or inside their psyche, leads to a brittleness where anything can set them off. This leads to the heightened startle respond common to people with PTSD.

5. Terror: Inside there is a deeply held belief that any re-traumatization will cause them to shatter and fragment and there is an feeling of impending inevitability that it will happen which creates a state of terror, difficulty sleeping, heavy self-medication (which also dulls ones rational thinking).

6. PTSD Symptoms: Most of the symptoms of PTSD from withdrawing to alcohol and substance abuse to not sleeping (since the experience of and fear of nightmares adds to the terror) are attempts to avoid re-traumatization.

7. Fragility: Feeling on the brink of going from brittle to shattering, fragmenting, losing their mind and never getting it back can cause a person who needs to be in control to take desperate measures. That is because to such a person, losing complete control is a fate worse than death.

Now of course this all begs the question, how do you treat this? Here's the rub. Unless someone goes back to the original trauma and reprocesses and fully processes all their emotional and psychological reactions and their aftermath, they will be in a state of psychological limbo and purgatory. If they re-experience their feelings they think they'll shatter/fragment; if they don't re-experience and feel them through ("Having Horror Heard Helps Heal Hurt") they will never strengthen their core vulnerability and they will develop increasing phobias and avoidance because it feels as if more and more things can re-traumatize and break them.

The simple answer is learning to safely re-experience their unfelt feelings and re-experiencing them until they build emotional strength and resilience from the inside out so that they can "take the hits" from life from the outside in and bounce back. As you can imagine, the answer may be simple, but it is not easy because of the fear that re-experiencing a trauma will re-traumatize and break them. Getting traumatized people to reach out for help and then accept and commit to it will be the subject of a future blog.

 

 

 

Follow Mark Goulston, M.D. on Twitter: www.twitter.com/markgoulston

Comments

[Victoria-nola]

10:09 PM on 01/02/2011

The late Dr Tod Mikuriya, a psychiatrist who was a cannabis researcher for the NIH during the Nixon years, wrote an article about the power of medical cannabis to help with PTSD:
http://mikuriya.com/cw_ptsd.html

He was an amazing healer and his insights into PTSD gave me more healing in a 30 minute consultation than all the therapy I'd tried for so many years. He knew what it was like, and validated that for me.

[GraniteSkyline]

03:16 PM on 01/02/2011

That's for the valuable information! This affects so many people, and yet it is so misunderstood. Hopefully more people will be able to encourage their friends and loved ones with PTSD to seek help.

[FZliveson]

03:54 PM on 01/02/2011

My best friend of my entire life, Benjamin Winfield James, committed suicide 26 years after returning home with his purple heart from Vietnam. He and his wonderful widow are the subject of a chapter in the most remarkable book on PTSD I have ever seen;

"Flashback" by Penny Coleman

Anyone who cares about saying "Thank you!" to the people who did the heavy lifting, when ordered, should read this book. Anyone who cares about the long lasting suffereing many of our veterans do need to read Flashback.

Here is the link to the part about my friend, Ben, whom I still miss, every day:

http://www.flashbackhome.com/story4.html

Thank you.
FZLO

[Sunnie7]

02:17 PM on 01/02/2011

I experienced PTSD after gong through Hurricane Katrina. I used EMDR with a therapist. It was very successful in alleviating my constant anxiety. I hope our returning soldiers get all the help they need. It's the least we can do for them...

http://www.emdr.com/index.htm

[Vajara]

10:02 AM on 01/02/2011

War Post Traumatic Stress, Anxiety and Depression is not the same as other trauma experiences, no matter what the DSM describes as a "disorder." It is not a disorder or illness, but is a serious injury that affects every body, mind, emotion, spirit and social system. Those who have been to war know this to be true; however, psychiatry and psychology fail to understand that the treatment required must reach deeply into every cell, organ and nerve system while incorporating integrative and holistic health practices with the injured warriors and their families.

The US Army has created the Ft. Bliss Restoration & Resilience Center to empower and return our injured warriors to the Force. Do visit the website and see the extensive and intensive treatement provided the injured warriors and their famlies. This is the model that should be offered all warriors identified with PTSd. It is obvious to those of us who work in integrative and holistic health settings that conventional mental or behavioral health methods don't work well and the pills only offer short term relief and numerous side effects. For the most part, they cover up and delay the treatment of this catastrophic and life threatening injury. After all, our injured warriors from Vietnam, Korea and other wars are still suffering and needing comprehensive, extensive and intensive interventions that engage and interact with the whole being and their family.

http://jerryvest.pages.qpg.com

[JoeyDee2]

01:00 PM on 12/30/2010

I assume PTSD is mostly associated with warfare. But I suppose it can be broadened. I've had a pretty sheltered life so I guess my threshold is ver low. I was shattered when a loved one turned on me, literally disappeared in the night.

My survival strategy emerged not as something conscious, more like a reflex or instinct. I know I won't expose myself to that hurt again. The professionals would probably not consider that a healthy response. To me it just isn't worth the pain again. As I write this I know it does sound unhealthy and even cowardly. I'm nearing 60, feel 10 years older, and I'm really tired.

Depressed? Technically. I consider it post-depression. Anti-depressants? Nah. They have better success when the condition results from within. I don't believe they work with situational depression. To change reality, you need different drugs.

[loki]

03:58 PM on 12/30/2010

PTSD is not mostly associated with warfare. It is very common with any type of traumatic accident or incident. Millions have it that have never been near a war area. It is however due to so many in our military becoming inflicted with PTSD that it is more recently being brought to the publics attention and talked about in a meaningful, and hopefully , helpful way.

[Jennifer Hernandez]

03:54 AM on 01/02/2011

ehm, it does not matter whether it is situational depression or endogenous depression, meds help!

[yogini4]

04:17 PM on 12/29/2010

PTSD is really a very physical phenomena as well as an intra-psychic one. If you are feeling unglued, try smudging, a strong dead sea salt bath and mind calming exercises to ratchet down the amped up nervous system.

[Aelfgifu]

07:13 PM on 12/29/2010

Thank you for your attempt to help. However, it's clear you've never experienced such extreme trauma if you think taking a bath is going to help.

[dugmaze]

02:28 AM on 01/02/2011

"it's clear you've never experience­d such extreme trauma "

I'm assuming you've already tried the bath and mind calming exercises after your PTSD?

[GraniteSkyline]

03:14 PM on 01/02/2011

She mentioned calming exercises, she is trying to be helpful and constructive--which is more than you are doing.