Medical PTSD and its Manifestations…

You might be wondering how medical PTSD manifests in my life.  Let me give you some examples.

Oh my god.  My pinkie is shaking ever so slightly when I hold my hand out in front of me.  I’m getting tremors from my medications!

Was that a skipped heart beat?  Am I having a heart attack?  What is wrong with my heart?!  Am I breathing more shallowly, too?  Oh my god – I’m dying.

I feel weird.  And spacey.  Something isn’t right.  Maybe I will fall over or faint.  Who will help me?  How long will it take to get medical help?  What if they aren’t skilled and can’t find what’s wrong?  Who will help me?  Will I be alone?

These are some of the things that I have thought since the PTSD has begun to suffer.  The problem for me is that my thoughts are a run-away train of catastrophe and emergency.  Unfortunately for my body, it doesn’t know that the thoughts I’m having are only thoughts and not reality.  So my body reacts as if what I’m thinking is really happening to me.  I will have significant anxiety or even panic attacks as a result.  I feel afraid to leave my house, which is one of the only safe places for me.  I’m afraid of something medical or physiological happening to me at a store, at work, in the car, at my partner’s parent’s house – you name it.  The fears aren’t founded and the logical side of my brain (when it is actually on-line) understands this.  Unfortunately, the anxiety can get so big that it is hard for the logic to be helpful.

I’ve been trying some different techniques to slow down the run-away train once I noticed it’s left the station.  I am trying to use grounding techniques, such as saying my name, age, what I am doing in the moment, and describing things around me in detail.  I also chant, “that was then, but I am safe now” or something to that effect.  It has been helpful in reducing the intensity of the fear.

The PTSD manifests in other ways, too.  I have trouble sleeping through the night without medication.  I can have dreams that I don’t remember (but I know I’ve dreamt) that wake me up from a dead sleep.  I scan my body to see if anything seems out of the ordinary, even a little.  I am super hypervigilant to changes in my body.  I recently went in to see the eye doctor who told me I am very sensitive to vision changes.  That’s just the tip of the ice burg.

I’ve noticed that this PTSD really started to get bad when I recently came down with an acute medical condition for which I am currently being treated.  I wonder if this experience has somehow tapped into old memories and brought them to the surface.

Related articles

• For Veterans Suffering from PTSD, ‘Fear Circuitry’ in the Brain Never Rests (thedailyneuron.com)

Recovery is a full time job.

Period.

If you’re serious about recovery then you’ve got to be working at it all the time until it no longer feels like work or your symptoms are under control.  For PTSD, there are many options, including eye movement desensitization and reprocessing (EMDR), somatic psychotherapies, cognitive behavior therapy (usually based on exposure principles), or mindfulness-based psychotherapies.  For a review of these therapies and more, I’d recommend reading Healing from Trauma by Jasmin Lee Cori.  She explains the options quite well.

I have elected to work with an individual therapist on sensorimotor processing therapy, take psychiatric medications, and attend an intensive outpatient program for 3 hours a night, 3 days after work.  The group primarily focuses on dialectical behavior therapy skills, which are useful for all sorts of problems, not just borderline personality disorder – which they were originally designed to treat.

My goal, here, is not to talk about these types of therapies (I may do that in another post), but to talk about the shear amount of commitment needed for a true and lasting recovery.  I am finding myself quite tired after being in therapies for 10-11 hours a week on top of my full time job.  And yet, I know without the treatment, I will not be healing and progressing and so I take a deep breath on the car ride home and will my car to turn right instead of left when I get off my exit, knowing right leads to recovery and left, my home.  Home will have to wait for me just a little longer tonight.

“It’s like living in hell…”

I explain to my therapist after describing the events of last night and this morning.

People with PTSD tend to have triggers – or events – that for some reason (perhaps they are close enough to the original event or are destabilizing in some way) create intense anxiety and panic.  Because my trauma is mostly medical in nature, I am particularly sensitive to changes in my body.  Unfortunately for me but fortunately for the human race, our bodies are doing funny things all the time, changing as they digest food or respond to infection, or react to temperature change.  Most people don’t notice these things.  I do.  I’m like a sniper waiting for a physical change to pop up and then *BANG* I pull the trigger on my body’s alarm system.  Now, of course this isn’t at all a conscious effort.  It happens so quickly.  Let me give you an example…

Last night I was at my partner’s parents house for family dinner.  Everything was going fine.  The kids were playing, we were talking and eating, and then….uh oh…what is this?  Is my chest feeling tight and constricted?  I noticed that I couldn’t take as deep of a breath and my lungs felt a little tight.  BUT I’m at my partner’s parents’ house.  I can’t totally freak out here, plus I’m involved in playing and eating and talking.  So the anxiety starts building.  I notice it but try to ignore it (that’s really my first mistake, but more on that in another post).  By the time we leave I am certain I will be having a panic attack this evening.  We get in the car and I tell my partner what’s happening.  I immediately start my grounding exercise – one in which I tell myself out loud who I am and what IS ACTUALLY happening and remind myself, “that was then, this is now and I am safe.”  I begin to calm down miraculously on the ride home.  We walk in the door and *BAM* I begin to have that familiar wave of panic – the intense adrenaline rush that makes my whole body tremble, my mind race, and my heart pound.  I’m thinking WTF?! I was just fine.  My partner asks me what we need to do to help me (she’s really good at this…she’s trying to get me to name my own needs and to identify what will help).  I have no clue because my frontal lobe is now offline (I’ll explain this one in a moment).  Since I can’t think clearly she suggests I take a hot bath and try to relax my body.  Getting in the bath was a good idea.  I was able to soothe myself and to tell myself logical things, such as, “My chest feels just a little bit tight.  And I have a tiny bit of phlegm in there (fair warning – if you don’t like to hear about bodily fluids this is NOT the blog for you…there will be more).  It’s not big deal.  I need some Mucinex and a humidifier for a couple of days.  No biggie.”  Luckily, I really believed what I was saying and slowly calmed down.

I want to back up a minute and talk about the different brain centers that are involved in PTSD and panic.  When we see an image or sense a stimuli that is threatening (in this case, restricted breathing), this happens:

Notice that the lower centers of the brain are involved.  The thalamus and the amygdala are responding.  The frontal lobe, or the area of the brain that is responsible for decision making, planning, and emotional regulation gets sort of shut down.  It goes offline.  So the reasonable, rational mind isn’t available.  This is what happens during a panic attack or during a flashback.  Here’s where the frontal lobe is:

Too bad that sucker doesn’t have an emergency “turn on” switch.

Needless to say my panic attack resolved, but my sleep was not good and my anxiety this morning was really high.  I have had mild symptoms in my chest (this description frontal lobe approved) relieved with Mucinex and drinking lots of water.  I anticipate that the next couple of days will be a bit of a struggle as the two opposing forces (the frontal lobe and the fear centers) square off like a scene from some western flick.

I hope the good guy’s got the faster gun…

My Recovery Starts Here…

I was recently diagnosed with Post Traumatic Stress Disorder (PTSD).  Many people are aware of PTSD that comes from being in combat or from being mugged or sexually assaulted.  All of those incidents can be an event that prompts PTSD.  Fewer people probably have what I am calling medical PTSD – PTSD derived primarily from medical interventions that were traumatizing in some way.  First, I think it is important that I lay out for you the criteria for the disorder.

CRITERION FOR PTSD 

From the Diagnostic and Statistical Manual – 5 (the book all shrinks use to decide on diagnostics):

Criterion A: stressor

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (one required)

1. Direct exposure.
2. Witnessing, in person.
3. Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
4. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Criterion B: intrusion symptoms

The traumatic event is persistently re-experienced in the following way(s): (one required)

1. Recurrent, involuntary, and intrusive memories. Note: Children older than six may express this symptom in repetitive play.
2. Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s).
3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play.
4. Intense or prolonged distress after exposure to traumatic reminders.
5. Marked physiologic reactivity after exposure to trauma-related stimuli.

Criterion C: avoidance

Persistent effortful avoidance of distressing trauma-related stimuli after the event:(one required)

1. Trauma-related thoughts or feelings.
2. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Criterion D: negative alterations in cognitions and mood

Negative alterations in cognitions and mood that began or worsened after the traumatic event: (two required)

1. Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol, or drugs).
2. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., “I am bad,” “The world is completely dangerous”).
3. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
5. Markedly diminished interest in (pre-traumatic) significant activities.
6. Feeling alienated from others (e.g., detachment or estrangement).
7. Constricted affect: persistent inability to experience positive emotions.

Criterion E: alterations in arousal and reactivity

Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (two required)

1. Irritable or aggressive behavior
2. Self-destructive or reckless behavior
3. Hypervigilance
4. Exaggerated startle response
5. Problems in concentration
6. Sleep disturbance

Criterion F: duration

Persistence of symptoms (in Criteria B, C, D, and E) for more than one month.

Criterion G: functional significance

Significant symptom-related distress or functional impairment (e.g., social, occupational).

Criterion H: exclusion

Disturbance is not due to medication, substance use, or other illness.

Specify if: With dissociative symptoms.

In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

1. Depersonalization: experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).
2. Derealization: experience of unreality, distance, or distortion (e.g., “things are not real”).

Specify if: With delayed expression.

Full diagnosis is not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

MY STORY…Well, sort of…

So…I meet criteria for PTSD because some horrible things happened to me in a couple of incidents when I was a child undergoing medical procedures.  My life was threatened in one of those incidents.  Details are not important here because 1) they can be triggering for other readers and 2) it does not appear to help me to retell my story.

Many people struggle with PTSD symptoms.  This blog is about my journey – one that began very recently with the official diagnosis.  I had the symptoms for many, many years but only recently was it diagnosed for what it is.

What I hope to get from writing this blog is a sense of meaning.  Hopefully, I can reach others who are suffering as I am and let them know they are not alone.  Secondly, I’d like to document my recovery with all its ups and downs, successes and failures.  Lastly, I hope this is my own Phoenix Process, as the author Elizabeth Lesser puts it:

The transformational journey is a voyage with a hundred different names…I call it the Phoenix Process – in honor of the mythic bird with golden plumage whose story has been told throughout the ages.  The Egyptians called the bird the Phoenix and believed that every five hundred years he renewed his quest for his true self.  Knowing that a new way could only be found with the death his worn-out habits, defenses, and beliefs, the Phoenix built a pyre of cinnamon and myrrh, sat in the flames, and burned to death.  Then he rose from the ashes as a new being – a fusion of who he had been before and who he had become.  A new bird, yet ever more himself; changed, and at the same time the eternal Phoenix…you and I are the Phoenix.  We too can reproduce ourselves from the shattered pieces of a difficult time…This is the Phoenix Process.

~Broken Open~

I am hoping that in my own Phoenix Process I can reclaim my body, my mind, and my spirit.  Or rather let go of those things that need to die and be reborn into a body, mind, and spirit more like myself.

Related articles

• The Neuroscience of Post-Traumatic Stress Disorder (psychologytoday.com)
• Higher Brain Failure In PTSD Patients (lunaticoutpost.com)