My therapist prescribed me to drink more alcohol. I had described symptoms of posttraumatic stress disorder (PTSD), yet once again, the diagnosis was completely missed. Even worse, this uniformed therapist suggested that I drink wine “medicinally,” beginning in the morning, to help cope with what he said was high anxiety. What makes this horrible advice even more dangerous is the fact that upward of fifty percent of those with PTSD also battle substance use disorder.
PTSD is often missed, and trauma is frequently dismissed. It is no wonder that so many of us who struggle don’t know it. Many of us already think “what happened to me wasn’t that bad,” so PTSD is nowhere on our radar. Using specific language like the words “trauma” and “PTSD” isn’t about labeling but rather about serving as a compass for help. This PTSD Awareness Month, let’s work to get the truth out about posttraumatic stress disorder, thus, getting more help to more people:
1. Trauma can be viewed as anything less than nurturing that alters your view of yourself and how you relate to the world. Mike Gurr, Executive Director of The Meadows Ranch, tells patients, “If it’s important to you, it’s important.”
2. Traumas not deemed PTSD-worthy, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), can lead to PTSD symptoms just as severe as traumas that do qualify.
3. Among those who experience trauma, up to 20 percent will go on to develop PTSD.
4. Those who develop PTSD are not weak. In fact, PTSD has a lot to do with genetics and biology. As one example, based on hormone levels, researchers can predict—prior to deployment—which soldiers will develop PTSD in the war zone.
5. Sexual assault, more than combat or any other type of trauma, is most likely to result in PTSD.
6. Women are twice as likely as men to develop PTSD.
7. Some individuals who don’t meet the rather strict diagnostic criteria for PTSD in DSM-5 experience just as much impairment as those with full-blown PTSD. Researchers call this partial PTSD; it deserves help.
8. One reaction during a trauma—lesser known than fight or flight—is freeze. Think deer in the headlights. Without seeking professional help, people who freeze during trauma might ask themselves for the rest of their lives, “Why didn’t I do anything?”
9. People who develop PTSD did do something during their trauma. They survived. Fighting, fleeing, and freezing are all biologically appropriate responses to a trauma.
10. The average lapse in time between the onset of PTSD symptoms and a diagnosis is twelve years!
11. PTSD is often misdiagnosed as bipolar disorder, borderline personality disorder, depression, schizophrenia, and anxiety.
12. Known as delayed expression PTSD (or delayed onset), symptoms can surface years after the trauma happened.
13. Although not included in DSM-5, clinicians and researchers widely agree that “complex PTSD” is a separate and unique form of the illness, one derived from exposure to multiple traumas, particularly in childhood.
14. People with PTSD are not crazy. PTSD is actually a normal reaction to an abnormal experience—a trauma.
15. PTSD can be passed on through DNA from parent to child, known as intergenerational trauma. Children of Holocaust survivors might struggle with PTSD symptoms even though they have never experienced a trauma directly themselves.
16. One of the greatest protectors against developing PTSD is social support.
17. People with PTSD are not dangerous. Many don’t even experience anger as a symptom.
18. PTSD looks different in everyone. Analyzing the various ways that the hallmark symptoms can manifest, there are 636,120 possible presentations of PTSD!
19. PTSD is no longer categorized as an anxiety disorder. Some with PTSD experience the disorder more as shame or grief-based and less as anxiety or fear.
20. Alongside PTSD often comes problems like eating disorders, substance use, depression, and insomnia.
21. Trauma can be stored in the body as chronic pain.
22. People with PTSD can’t just “get over it” any more than someone can just get over a broken leg. PTSD is a brain injury, one that needs treatment.
23. When people with PTSD are triggered, they have essentially lost access to their prefrontal cortex, the rational, decision-making part of the brain. This isn’t their fault, yet they can learn to take steps in accountability by seeking support.
24. Longtime “gold standard” evidence-based treatments for adults with PTSD include Eye Movement Desensitization and Reprocessing (EMDR), Prolonged Exposure, and Cognitive Processing Therapy, all of which involve exposure to the trauma memory.
25. Avoiding trauma-related thoughts, feelings, situations, and things can be a central maintaining factor of PTSD. (e.g., If someone avoids driving after a car accident, the likelihood of developing PTSD increases.)
26. To heal, living an exposure-based life can be key. We need to approach thoughts, feelings, situations, and things that scare us. (e.g., In the previous example, with support, get out on the highway and drive.)
27. A newer, promising exposure-based treatment called Writing Exposure Therapy can be completed in as little as five sessions.
28. Somatic Experiencing® (SE), a body-oriented trauma treatment with a growing body of evidence, does not require a person to directly revisit trauma memories.
29. PTSD is not a life sentence. While the trauma can’t go away (it’s history), with treatment, PTSD symptoms can and do.
30. Posttraumatic growth describes the positive transformation that can grow out of adversity, out of trauma and PTSD.
I stopped seeing the therapist who encouraged me to drink wine for breakfast. Ultimately, I connected with excellent treatment providers, and I recovered from PTSD, albeit slowly. With help, research shows and personal experience proves, we can take our lives back from the treacherous illness. No one chooses to have PTSD, but people can and do choose to get better.
A Senior Fellow with The Meadows and advocate for its specialty eating disorders program, The Meadows Ranch, Jenni Schaefer is a bestselling author and sought-after speaker. For more information: www.JenniSchaefer.com
References:American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (Arlington, VA: American Psychiatric Publishing, 2013).
D.M. Sloan, B.P. Marx, and D.L. Lee, “A Brief Exposure-based Treatment vs. Cognitive Processing Therapy for Posttraumatic Stress Disorder: A Randomized Noninferiority Clinical Trial,” JAMA Psychiatry, 75(3) (2018): 233-239.E.C. Berenz and S.F. Coffey, “Treatment of Co-occurring Posttraumatic Stress Disorder and Substance Use Disorders,” Current Psychiatry Reports 14(5) (2012): 469–477.J. A. Gordon, “Update from the NIMH” (presentation given at the Anxiety and Depression Conference, Washington, DC, April 5-8, 2018).
M.J. Friedman, T.M., Keane, P.A. Resick, Handbook of PTSD, Second Edition: Science and Practice (New York, NY: Guilford Press, 2015).
National Center for PTSD (2016, October 3). How Common is PTSD? Retrieved from https://www.ptsd.va.gov
P. S. Wang, P. Berglund, M. Olfson, H.A. Pincus, K.B. Wells, and R.C. Kessler, “Failure and Delay in Initial Treatment Contact After First Onset of Mental Disorders,” National Comorbidity Survey Replication, 62 (2005).
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R. Yehuda, N.P. Daskalakis, L.M. Bierer, H.N. Bader, T. Klengel, F. Holsboer, E.B. Binder, “Holocaust Exposure Induced Intergenerational Effects on FKBP5 Methylation,” Biological Psychiatry, 80(5). (2016): 372-80.
S. E. Back, A. E. Waldrop, & K. T. Brady, “Treatment Challenges Associated with Comorbid Substance Use and Posttraumatic Stress Disorder: Clinicians’ Perspectives,” American Journal of Addiction, 18. (2009): 15-20.