PTSD: Causes, Impacts, and Therapy
Most of my clients have PTSD. As a result they keep remembering, flash back to (relive) and/or dream about their terrifying traumatic experiences. They are emotionally guarded, socially isolated, and constantly on the lookout for anyone or anything that reminds them of their trauma. They sculpt their lives to avoid coming into contact with such reminders, because exposure to them puts people with PTSD into fight, flight or freeze. Involuntary intrusions of trauma memories and the lifelong effort to block them make living with PTSD a hell on earth. It is not surprising that people with PTSD have suicidal thoughts (as an escape valve), and that they drink or drug to numb themselves. Living with so much stress can make them irritable, snappish, and angry, which is hard on them and on their loved ones.
The DSM-5 (the diagnostic manual for psychiatrists) narrowly defines PTSD as something that can only occur to people who are personally exposed to or who witness death, serious injury or sexual violence. It is most common among combat veterans and first responders who see the aftermath of murders, fires, drownings, fatal car wrecks, etc. Ordinary civilians can develop PTSD from a rape, a mugging, a kidnapping, a serious car crash, a natural disaster, a school shooting or the unexpected death of a loved one.
What is very important to know is that traumatic experiences that fall short of the narrow definition of the DSM-5 can cause some or most of the exact same distressing symptoms as PTSD. Although the DSM-5 does not recognize child PTSD (aka complex PTSD) the ICD-11 (the International Classification of Disease) does. Pervasive emotional neglect as well as cruel remarks and harsh, devaluing parental criticism and yelling, can cause complex PTSD within the definition of the ICD-11.
Treatment for PTSD are of two kinds, evidence-based and non-evidence-based. Evidence-based treatments have been empirically validated as safe and effective by a large number of gold-standard research studies that are double-blinded, placebo controlled, and carried out by highly respected institutions such as university medical centers known for highest quality research. The VA and the DOD recognize two current forms of treatment as evidence-based. These are cognitive processing therapy (CPT) and prolonged exposure therapy. Studies show that 80 plus to 90 plus percent of people who complete a full course of these treatments no longer show symptoms of PTSD. I have been trained in CPT. On average people who never enter treatment tend to remain symptomatic for at least 64 months, and in some cases much longer. In 2012 I met a veteran who was 17 years old when he was at Pearl Harbor and had to scoop bodies out of the water and stack them onboard his ship. He had been having flashbacks and nightmares for 71 years! Non evidence-based treatments can also be helpful. These include supportive counseling, group therapy, breathwork, meditation, yoga, art therapy, and movement therapy. When all treatments fail to reduce symptoms some people with PTSD will try a Stellate Ganglion Block. This involves two injections of an anesthetic into nerve bundles at the base of the neck near the head of the first rib. The purpose is to reduce the activity of the sympathetic nervous system and flight/flight. SGBs are still being researched. Medical clinics using SGBs find they work for some people and not others.