When he gets to the hospital, he is told that his injuries aren’t serious. There is some bruising on his left shoulder (on which he landed) and he has sustained two cracked ribs on his right side. Other than that he seems fine and they let him go home after keeping him overnight for observation. But Mark isn’t fine. He can’t stop thinking about the bus coming toward him, his coat sleeve caught in the bench arm rest, and the feeling of helplessness and terror that engulfed him. The nightmares and poor sleep are temporary, he thinks. In no time life will return to normal.
For almost a year now, Mark has been living with recurring thoughts of that bus and what could have happened. He has even started to hear the screaming of the people from inside the bus before it hit the tree. His wife, family and friends worry about him because he has become despondent. He finds no joy in life and he is failing at work. Mark seems to have an addiction to the visions and the pain that he cannot rid himself of. He finally agrees with those closest to him that he needs to seek the help of a counselor.
What is PTSD?
Mark sits in a chair across from Guillermo and tells him his story: all the dreams he has; the fear he suffers through during the day; his inability at times to lose a rising feeling of panic. Guillermo suggests to him that he may be experiencing Post Traumatic Stress Disorder (PTSD). Mark seems confused.
“Isn’t PTSD something soldiers or Marines get when they have been in a battle situation? It has something to do with close calls with an IED from what I’ve heard.”
His counselor informs him that while what he has heard is true, the phrase “close calls” is more representative of what PTSD is than isolated situations like IED explosions. Guillermo grabs his tablet computer and says, “Here let me read how the free dictionary website defines PTSD, so you can get a better understanding of what I’m talking about Mark.” He reads:
“Post-traumatic stress disorder (PTSD) is a debilitating psychological condition triggered by a major traumatic event such as rape, war, a terrorist act, a natural disaster, or a catastrophic accident. It is sometimes marked by upsetting memories or thoughts of the ordeal, “blunting” of emotions, increased arousal, and sometimes severe personality changes.”
“As you can see,” Guillermo says, “PTSD is a condition that is much more prevalent than people at first believed. Of course, you may have heard of it in reference to battle, where it definitely occurs, but it is very relatable to situations like yours with the bus crash.”
What are some of the Associated Signs and Symptoms?
Mark believed what the counselor was telling him, but he still couldn’t believe that he was experiencing something that, in his mind, only happened to people who had known the trauma of a combat situation. Like many other people, he believed that every day trauma (as if any trauma could be “every day”) wouldn’t cause a person to go through PTSD. Even if his symptoms seemed to match the definition Guillermo had read, he remained skeptical.
“I understand what you’re saying, but I still don’t know. What are the signs and symptoms of PTSD?”
He tells him, “We use a book, called the Diagnostic and Statistical Manual (or DSM), to discover whether and individual has symptoms consistent with a particular diagnosis. For PTSD the DSM lists 8 levels of criteria. They are, in part:”
- Criteria 1: That you experienced the event, witnessed the event, learned of a close loved one that directly experienced the event, or you had repeated exposure to adverse details of a traumatic event.
- Criteria 2: You consistently re-experience the event in thoughts, dreams, hallucinations and other ways.
- Criteria 3: You avoid thinking or feeling about the event and you avoid places or people associated with the event.
- Criteria 4: You have thinking or mood problems such as – a persistent negative emotional state, you can’t remember exactly what happened during the bus crash, you are consistently down on yourself, you distance yourself from other people (there are more, he says, but these are a few of the changes in thoughts or mood).
- Criteria 5: You are aroused unnecessarily or reactive in a way you would not have been before.
- Criteria 6: These symptoms persist for more than a month.
- Criteria 7: You experience “clinically significant distress or impairment in functioning.”
- Criteria 8: This distress is not the result of substance abuse.
After reading the list of criteria to him, Guillermo says to Mark, I look at all of the criteria when I am thinking about your case and determine whether you can be diagnosed with PTSD. It is a process that mental health professionals take very seriously, Mark. One question, Do you have substance abuse issues?”
Mark answers, “No.”
“Then why don’t we talk about your experience of the trauma in relation to what we now know about the causes of PTSD.”
What is My Risk for Having PTSD?
Like Mark, many people are discovering that PTSD is not confined to a specific situation, but can be caused by any traumatic event. It is also not limited to people of a certain age. Although children may exhibit the signs of PTSD differently than an adult (for example it is possible to notice the symptoms of PTSD in a child by the way they interact with objects and other children during play), children can have PTSD. It is a condition then that isn’t restricted by type of trauma, age or any other physical factor.
However, some people may be more at risk for PTSD than others because of what they experience on a daily basis, how they react naturally to trauma, already have an injury (either physical or psychological) that depresses their natural defenses against stress, and many other factors. Also, some people are more immune because they have supportive family structures in place, understand that fear is an emotion that can be controlled, appreciate their own ability to avoid trauma and their own reactions when a trauma occurs, and others. While anyone can experience a trauma that will force them to experience PTSD, some are more able than others to avoid the symptoms.
When Is It Not PTSD?
The problem with a diagnosis such as PTSD which becomes a part of the popular lexicon (when the term is not isolated to mental health professionals) is that the concept can become distorted. While it is true that some may use the possibility of a PTSD diagnosis to elicit sympathy and other intrinsic and extrinsic rewards, many are simply confused about the diagnosis and see themselves as having PTSD when they actually do not. It is critical that the diagnosis be made by a qualified professional.
An individual may think they have PTSD because:
- They watched an event multiple times on TV that has given him or her nightmares;
- are under the influence of a substance and are hallucinating horrible images or sounds;
- experience stress due to adjustment that does not meet the full PTSD criteria.
These are just some of the many instances in which a PTSD diagnosis is not warranted. Again, it is critical to see a mental health professional and let him or her discuss your trauma with you. A misdiagnosis can lead to greater complications.
PTSD, as Mark discovered, is not limited to a certain segment of the population or a specific type of event. It reaches across all socioeconomic strata and all age groups. However, the diagnosis should be made by a trained mental health professional not by well-meaning family, friends or your amateur psychology sleuth neighbor Fred. It is imperative that the diagnosis is right so that you can receive the correct treatment. If you or a loved one need help, please call us at (888) 557-8091 or call a mental health professional near you.