What is PTSD? Post-Traumatic Stress Disorder is a diagnosis in the DSM-5 that is not biological. You are not born with this, nor is it genetic. It happens to someone post-trauma as the diagnosis states. Many people believe they have this and sometimes this is correct. The U.S. Department of Veteran Affairs National Center for PTSD states that 7-8% of the population will have PTSD in their lives. Sixty percent of men and fifty percent of women will experience at least one trauma in their lives, they continue to state. To further clarify in regard to veterans: since Vietnam, between 11-15% of veterans have been diagnosed with PTSD (also stated on the website of the U.S. Department of Veteran Affairs National Center for PTSD).

Just because you do not have PTSD, this does not mean you were not abused. Therefore, emotional abuse is relative to abuse but this would not cause PTSD (more than likely not though it could be an indirect cause). The diagnosis must stem from witnessing or directly experiencing a traumatic event such as a natural disaster, serious accident, a terrorist act, war or combat, rape or other violent personal assault. This is also a diagnosis that can be given to police officers, social workers, psychotherapists, emergency workers, or anyone who deals with trauma on a day to day basis. One last point for clarification is that the symptoms must be there six months post-trauma. Most of my survivors of narcissistic abuse have not had PTSD. Generally, I see Anxiety or Depression but as they did not fit the criteria above they did not have PTSD. Don’t worry about the diagnosis, worry about healing from the trauma you experienced from your parent or partner.  The symptoms will more than likely decrease the further you get from the perpetrator and the more invested you are in healing with your psychotherapist. Your therapist should rule this out though, if you believe you have it. Since I specialize in this, I look for it in clients who mention abuse and I ask all my clients if they have been abused, right away when I hear them mentioning certain details or symptoms.

For every soldier who serves in a war zone abroad, there are 10 children who are endangered in their own house. Bessel A. van der Kolk, M.D. –  The Body Keeps the Score. Dr. van der Kolk has been working with trauma survivors for many decades. I met him once at the U.S. Body Psychotherapy conference at Johns Hopkins University in the early 2000’s where he spoke on his knowledge. I have followed his articles and have been reading this book, The Body Keeps the Score, most recently. The book discusses his work with trauma survivors of all types whether military or civilian populations.

Complex-PTSD is for those who have repeated or prolonged exposure to situations mentioned above, in which the person has limited or no chance of escape. As an example this might be attributed to a person who is kidnapped or is being tortured by their caregivers (or in war). In my opinion, both PTSD and c-PTSD are overused or assumed when someone has been in a traumatic situation. In social services, I had a supervisor once tell me that all of our clients had PTSD. This was not true of course given the statistics noted above. Thank goodness I did not listen and trusted my instincts.

Traumatic Brain Injury – is often seen with veterans and looks somewhat like PTSD but requires a medical specialist who can keep an eye on the brain as well as a psychotherapist who has knowledge of this diagnosis and can help the client through this process.  This comes from having a concussion and so with a veteran who has been in a bomb blast one time or even several times, this is possibly a diagnosis. It can also come from other things for non-veterans such as a car accident, being thrown from a horse, or a skiing accident for example. This is also seen in sports players. Now studies are being done to look at even more complex TBI which is called (CTE) or Chronic Traumatic Encephalopathy.

There is also Dissociative Identity Disorder which can occur with people who have been in a traumatic situation, usually at a very young age and their personalities have split or dissociated from one another. It is .01-1% of the population, according to the DSM-5.

With regard to the symptoms of Post-Traumatic Stress Disorder, you will primarily have flashbacks to the trauma, nightmares (of various intensities), dissociation, avoidance of stimuli related to the trauma, and other symptoms that will be clarified by your therapist and/or when completing a test with a psychological professional known as the PCL-5. We conduct the PCL-5 weekly during the Cognitive Processing Therapy process which lasts 12 weeks once it is determined that a person clearly has PTSD. Please note there are other treatment options for PTSD (i.e., Prolonged Exposure and EMDR). The Veteran’s Administration has a handout that I give to my clients about these treatment options and there is a test you can take online to see which modality might be best for you needs. Trust your instincts though with the online test – it is an online test. A client of mine scored for prolonged exposure therapy or CPT but when she read about prolonged exposure she was pretty clear that she did not want to do this.

I want to speak about dissociation here as this is a very interesting one that most people do not understand when being asked. It is like driving a car in “auto-pilot.” I will sometimes ask if they ever seem to “space out” and then ask them what this is like and how long it may last and how often this happens. As mentioned above, dissociation can split at a young age into different personalities. However, what happens with post-trauma is that the person will not split but will go off in a fugue for a period of time as a thought goes into their head about the trauma. Imagine sitting in a room and people are talking and suddenly you are not paying attention to them but to something that is going on in your head. To another person viewing this dissociation, it looks like a person has been tagged in the child’s game of “Freeze Tag,” or they are “there but not there.” A person can be brought back into consciousness with a light touch or by saying their name.  It is best to ask the person what they would like best as veterans have mentioned to me that being touched could cause an inappropriate outburst from them. The same might happen to a non-veteran as well depending on the trauma they experienced. Permission requested is almost always the best way of getting good results.

Dissociation can be self-supported by the victim through grounding techniques. I generally will teach the following to a client. First, begin to be aware of when you find yourself dissociating. Create a log or journal of these experiences and try to see if you can find a pattern (e.g.: every Friday at your son’s little league game you dissociate, though it may not be this simple). It could be linked to a stimulus from the trauma. One of my first clients of sexual abuse linked a clipboard that I held, to her perpetrator. It could be an object, a smell, a place, a touch, or a sound (the senses being reminded of trauma). It could be a person, such as being near the perpetrator again later in life or at family gatherings which will continue to happen.

Second, when you have noticed that you have returned from the dissociation bring yourself back into your body by taking in your surroundings. I explain this to people by talking about my room and have them say to themselves “I am sitting on the couch, there is a filing cabinet in front of me, there is a side table with a lamp, etc. etc…” Wherever you are at, you would look around your environment and repeat the things you see to yourself. This is helping you to be conscious again and bringing you back into your body. I also ask people to mentally say to themselves “Oh, I just dissociated again,” before they begin to bring themselves back into their body. Naming a symptom gives power to it as you are “owning” it. Post-Traumatic Stress Disorder is a part of who you are until you work on decreasing and eliminating the symptoms.

Thirdly, you can do a body scan if you happen to be at home or in a place where you can sit down and focus on your body more directly – and have the time to do this. Start from the tips of your toes all the way up to your head. Starting with the toes, you clench and then release. Then go up to your legs and clench and release, all the way up to your head where you have continued to follow this pattern. By the time you have gotten to your head, your body is deeply relaxed and soothed. At the same time, make a mental note of any areas of your body in which you might feel tension as you are going from toes to head. Make a note of this in your journal too after you are done. Insight Timer – a meditation app you can download, has Body Scans where you can listen to someone telling you what to do as well.

If you don’t have an ability to do the body scan in that moment, be prepared by taking a few moments of deep breaths. Maybe you carry a crystal in your pocket that you hold onto and meditate on for a few moments. Even in a room full of people, you can always take a few deep breaths and no one will be the wiser. You can also go outside and get some fresh air; nature is very grounding. If you have a trusted friend they could be a support person for you too but it is doubtful that they will always be standing next to you.

In conclusion, if you believe you might have PTSD, consult a psychotherapist. If you are looking at TBI, look for a TBI clinic in your community. They will conduct a brain scan to see if you have this and then let you know what comes next. For example, Ohio State University, in Columbus, Ohio has a TBI clinic.