- Post Traumatic Stress Disorder; Not just a soldier’s problem
- Post-Traumatic Stress Disorder (PTSD)
- PTSD can leave you feeling stuck with a constant sense of danger and painful memories. But with new coping skills, you can feel safe again and move on from trauma.
- What is PTSD?
- PTSD vs. a normal response to traumatic events
- Signs and symptoms of PTSD
- PTSD risk factors
- PTSD causes and types of trauma
- PTSD self-help tip 1: Challenge your sense of helplessness
- Tip 2: Get moving
- Tip 3: Reach out to others for support
- Tip 4: Support PTSD treatment with a healthy lifestyle
- Getting professional help for PTSD
- PTSD treatment and therapy
- False PTSD: A Diagnostic Challenge
- Active Duty Patriot
- 6 Myths About PTSD We Need to Stop Believing
- Post-Traumatic Stress Disorder (PTSD) Not Always A Serious Mental Illness: Sally Satel in Wall St. Journal
- Malingering PTSD: Could Certain Soldiers Be ‘Faking it’?
Post Traumatic Stress Disorder; Not just a soldier’s problem
Former foster children are nearly twice as likely to suffer from Post Traumatic Stress Disorder (PTSD) as United States war veterans returning from tours in Iraq,
according to a study conducted by The Harvard Crimson, et. al.
One in four alumni of foster care experience PTSD and more than half experience at least one mental health issue such as depression, social phobia or panic syndrome.
As opposed to the horrors of war, which can be “expected,” the horrors of pre-care and foster care are not to be expected for children living in a healthy, normal
society. Children are not “expected” to experience abuse at the hands of their parents, other family members and then again at the hands of those in “care” that are
clearly expected to keep at-risk or abused children safe.
Survivors of traumatic events, later diagnosed with PTSD, often experience problems in their intimate and future family relationships…and even can extend to their
These problems could include, but are not limited to:
• Distancing or isolating self
• Lack of trust
• Severe abandonment anxiety
• Anger issues, lashing out
• Blaming others
• Nightmares (even “day” mares)
• Abnormal anxiety
• Fear as a natural state of living
• Inability to show appreciation for others or even self
• Physically hurting self and/or others
• Sabotaging behaviors
Foster children often go into the system because of what “unnaturally” occurred in their home environment. I personally know people that went into care because of
parental abuse which included incest, rape, violence with weapons, and other crimes. Living with PTSD often recreates the traumatic event that caused it and forces
the victim to re-live the occurrence.
So, in essence, a person relives an event–perpetrated by a parent or other family member–of incest, a rape, a gun pointed at their head, a knife pulled on them, torture,
betrayal, a shove from a moving car, a beating, etc. Again, keep in mind; these are NON-EXPECTED events for children in a normal, healthy society. Therefore, the
event intensifies the trauma of the psyche of the victim.
Episodes of these recurring traumas interfere in healthy relationships are often caused by “triggers.” Triggers cause the firing of the psychological recurrence of the
trauma/s that caused PTSD. Triggers include sights, sounds, smells, words and items. Many former foster children tell me that their triggers include cops, nuns,
clergy, hands, belts…even certain foods.
Are former foster children diagnosed with PTSD doomed to live tortured lives? Are they now, no longer the victim of their past, but now a permanent victim of their
diagnosis? Without acknowledging and without intensive work on their part…and love and understanding of others…probably.
Once PTSD/Always PTSD
A person can never be cured of PTSD, but the traumatic episodes can lessen in occurrence and in severity over time with attention and strategy.
Obviously, the first step of living well, even with PTSD, is acknowledging its existence an identifying what caused it. More often than not, intensive therapy will help
former fosters with this. In addition, therapy can help create strategies with will help lessen occurrences.
Specifically, my triggers include the words, “home,” “family,” “father,” “mother,” etc. I also have food triggers. In addition, my abandonment issues are ever present.
Furthermore, my “attack” triggers never abandoned me!
Step 1. Acknowledge
Step 2. Identify
Step 3. Get help
Step 4. Create strategies
I’m stopping here to describe my personal strategies that help lessen occurrences of my PTSD episodes. They may seem sophomoric, but they work. That is frankly
my only motivation. So if simple works, I’m good.
I just don’t use words that trigger my episodes, as in my reality, these words do no resonate with me. These trigger words used to debilitate me. Now, when I hear
someone speaking of these concepts, I am quietly grateful they are blessed with these concepts. Every once in a while, I find myself feeling sorry for myself, but that
happens less and less. I have acknowledged my food triggers and understand fully the reason they are my triggers. So I avoid them. Yes, as sophomoric as this may
seem, I avoid these foods. If you are my friend, I will have already told you that I have abandonment issues, so when we go somewhere, we will have put in place a
strategy to make sure nothing triggers me.
Another strategy that I employ is that I always sit with my back to a wall in public places. No one will ever sneak up on me again. These are simple strategies I use for
“simple” triggers. Obviously, triggers that set off even bigger issues need bigger strategies, as all experiences are unique.
Now, the final step…Helping others to be good partners.
Step 5. Help Others Help
Post-Traumatic Stress Disorder (PTSD)
PTSD can leave you feeling stuck with a constant sense of danger and painful memories. But with new coping skills, you can feel safe again and move on from trauma.
After a traumatic experience, it’s normal to feel frightened, sad, anxious, and disconnected. But if the upset doesn’t fade and you feel stuck with a constant sense of danger and painful memories, you may be suffering from post-traumatic stress disorder (PTSD). It can seem like you’ll never get over what happened or feel normal again. But with treatment and support, you can learn to manage your symptoms, reduce painful memories, and move past the trauma.
What is PTSD?
Post-traumatic stress disorder (PTSD) can develop following any event that makes you fear for your safety. Most people associate PTSD with rape or battle-scarred soldiers—and military combat is the most common cause in men. But any event, or series of events, that overwhelms you with feelings of hopelessness and helplessness and leaves you emotionally shattered, can trigger PTSD. This may happen especially if the event feels unpredictable and uncontrollable.
PTSD can affect people who personally experience the traumatic event, those who witness the event, or those who pick up the pieces afterwards, such as emergency workers and law enforcement officers. PTSD can also result from surgery performed on children too young to fully understand what’s happening to them.
PTSD vs. a normal response to traumatic events
Following a traumatic event, almost everyone experiences at least some of the symptoms of PTSD. When your sense of safety and trust are shattered, it’s normal to feel unbalanced, disconnected, or numb. It’s very common to have bad dreams, feel fearful, and find it difficult to stop thinking about what happened. These are normal reactions to abnormal events.
For most people, however, these symptoms are short-lived. They may last for several days or even weeks, but they gradually lift. But if you have post-traumatic stress disorder, the symptoms don’t decrease. You don’t feel a little better each day. In fact, you may start to feel worse.
A normal response to trauma becomes PTSD when you get stuck
After a traumatic experience, the mind and the body are in shock. But as you make sense of what happened and process your emotions, you start to come out of it. With PTSD, however, you remain in psychological shock. Your memory of what happened and your feelings about it are disconnected. In order to move on, it’s important to face and feel your memories and emotions.
Signs and symptoms of PTSD
PTSD develops differently from person to person because everyone’s nervous system and tolerance for stress is a little different. While you’re most likely to develop symptoms of PTSD in the hours or days following a traumatic event, it can sometimes take weeks, months, or even years before they appear. Sometimes symptoms appear seemingly out of the blue. At other times, they are triggered by something that reminds you of the original traumatic event, such as a noise, an image, certain words, or a smell.
While everyone experiences PTSD differently, there are four main types of symptoms.
- Re-experiencing the traumatic event through intrusive memories, flashbacks, nightmares, or intense mental or physical reactions when reminded of the trauma.
- Avoidance and numbing, such as avoiding anything that reminds you of the trauma, being unable to remember aspects of the ordeal, a loss of interest in activities and life in general, feeling emotionally numb and detached from others and a sense of a limited future.
- Hyperarousal, including sleep problems, irritability, hypervigilance (on constant “red alert”), feeling jumpy or easily startled, angry outbursts, and aggressive, self-destructive, or reckless behavior.
- Negative thought and mood changes like feeling alienated and alone, difficulty concentrating or remembering, depression and hopelessness, feeling mistrust and betrayal, and feeling guilt, shame, or self-blame.
PTSD symptoms in children
In children – especially very young children – the symptoms of PTSD can differ from those of adults and may include:
- Fear of being separated from their parent
- Losing previously-acquired skills (such as toilet training)
- Sleep problems and nightmares
- Somber, compulsive play in which themes or aspects of the trauma are repeated
- New phobias and anxieties that seem unrelated to the trauma (such as fear of monsters)
- Acting out the trauma through play, stories, or drawings
- Aches and pains with no apparent cause
- Irritability and aggression
Do you have PTSD?
If you answer yes to three or more of the questions below, you may have PTSD and it’s worthwhile to visit a qualified mental health professional.
- Have you witnessed or experienced a traumatic, life- threatening event?
- Did this experience make you feel intensely afraid, horrified, or helpless?
- Do you have trouble getting the event out of your mind?
- Do you startle more easily and feel more irritable or angry than you did before the event?
- Do you go out of your way to avoid activities, people, or thoughts that remind you of the event?
- Do you have more trouble falling asleep or concentrating than you did before the event?
- Have your symptoms lasted for more than a month?
- Is your distress making it hard for you to work or function normally?
PTSD risk factors
While it’s impossible to predict who will develop PTSD in response to trauma, there are certain risk factors that increase your vulnerability. Many risk factors revolve around the nature of the traumatic event itself. Traumatic events are more likely to cause PTSD when they involve a severe threat to your life or personal safety: the more extreme and prolonged the threat, the greater the risk of developing PTSD in response. Intentional, human-inflicted harm—such as rape, assault, and torture— also tends to be more traumatic than “acts of God,” or more impersonal accidents and disasters. The extent to which the traumatic event was unexpected, uncontrollable, and inescapable also plays a role.
Other risk factors for PTSD include:
- Previous traumatic experiences, especially in early life
- Family history of PTSD or depression
- History of physical or sexual abuse
- History of substance abuse
- History of depression, anxiety, or another mental illness
PTSD causes and types of trauma
Trauma or PTSD symptoms can result from many different types of distressing experiences, including military combat, childhood neglect or abuse, an accident, natural disaster, personal tragedy, or violence. But whatever your personal experiences or symptoms, the following can offer strategies to help you heal and move on:
PTSD in military veterans
For all too many veterans, returning from military service means coping with symptoms of PTSD. You may have a hard time readjusting to life out of the military. Or you may constantly feel on edge, emotionally numb and disconnected, or close to panicking or exploding. But it’s important to know that you’re not alone and there are plenty of ways you can deal with nightmares and flashbacks, cope with feelings of depression, anxiety or guilt, and regain your sense of control.
Emotional and psychological trauma
If you’ve experienced an extremely stressful event—or series of events—that’s left you feeling helpless and emotionally out of control, you may have been traumatized. Psychological trauma often has its roots in childhood, but any event that shatters your sense of safety can leave you feeling traumatized, whether it’s an accident, injury, the sudden death of a loved one, bullying, domestic abuse, or a deeply humiliating experience. Whether the trauma happened years ago or yesterday, you can get over the pain, feel safe again, and move on with your life.
Rape or sexual trauma
The trauma of being raped or sexually assaulted can be shattering, leaving you feeling scared, ashamed, and alone, or plagued by nightmares, flashbacks, and other unpleasant memories. But no matter how bad you feel right now, it’s important to remember that you weren’t to blame for what happened, and you can regain your sense of safety, trust, and self-worth.
PTSD self-help tip 1: Challenge your sense of helplessness
Recovery from PTSD is a gradual, ongoing process. Healing doesn’t happen overnight, nor do the memories of the trauma ever disappear completely. This can make life seem difficult at times. But there are many steps you can take to cope with the residual symptoms and reduce your anxiety and fear.
Overcoming your sense of helplessness is key to overcoming PTSD. Trauma leaves you feeling powerless and vulnerable. It’s important to remind yourself that you have strengths and coping skills that can get you through tough times.
One of the best ways to reclaim your sense of power is by helping others: volunteer your time, give blood, reach out to a friend in need, or donate to your favorite charity. Taking positive action directly challenges the sense of helplessness that is a common symptom of PTSD.
Positive ways of coping with PTSD:
- Learn about trauma and PTSD
- Join a PTSD support group
- Practice relaxation techniques
- Pursue outdoor activities
- Confide in a person you trust
- Spend time with positive people
- Avoid alcohol and drugs
- Enjoy the peace of nature
Tip 2: Get moving
When you’re suffering from PTSD, exercise can do more than release endorphins and improve your mood and outlook. By really focusing on your body and how it feels as you move, exercise can actually help your nervous system become “unstuck” and begin to move out of the immobilization stress response. Try:
Rhythmic exercise that engages both your arms and legs, such as walking, running, swimming, or dancing. Instead of focusing on your thoughts, focus on how your body feels. Notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of the wind on your skin.
Rock climbing, boxing, weight training, or martial arts. These activities can make it easier to focus on your body movements—after all, if you don’t, you could get hurt.
Spending time in nature. Pursuing outdoor activities like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing helps veterans cope with PTSD symptoms and transition back into civilian life. Anyone with PTSD can benefit from the relaxation, seclusion, and peace that come with being out in nature. Seek out local organizations that offer outdoor recreation or teambuilding opportunities.
Tip 3: Reach out to others for support
PTSD can make you feel disconnected from others. You may be tempted to withdraw from social activities and your loved ones. But it’s important to stay connected to life and the people who care about you. You don’t have to talk about the trauma if you don’t want to, but the caring support and companionship of others is vital to your recovery. Reach out to someone you can connect with for an uninterrupted period of time, someone who will listen when you want to talk without judging, criticizing, or continually getting distracted. That person may be your significant other, a family member, a friend, or a professional therapist. Or you could try:
Volunteering your time or reaching out to a friend in need. This is not only a great way to connect to others, but can also help you reclaim your sense of control.
Joining a PTSD support group. This can help you feel less isolated and alone and also provide invaluable information on how to cope with symptoms and work towards recovery.
If connecting with others is difficult
No matter how close you are to someone, or how helpful they try to be, the symptoms of PTSD that leave your nervous system feeling “stuck” can also make it difficult to connect to others. If you still don’t feel any better after talking to others, there are ways to help the process along.
Exercise or move. Before meeting with a friend, either exercise or move around. Jump up and down, swing your arms and legs, or just flail around. Your head will feel clearer and you’ll find it easier to connect.
Vocal toning. As strange as it sounds, vocal toning is also a great way to open up your nervous system to social engagement—as well as lower stress hormones. Try sneaking off to a quiet place before chatting with friends. Sit up straight and with your lips together and teeth slightly apart, simply make “mmmm” sounds. Change the pitch and volume until you experience a pleasant vibration in your face. Practice for a few minutes and notice if the vibration spreads to your heart and stomach.
Tip 4: Support PTSD treatment with a healthy lifestyle
The symptoms of PTSD can be hard on your body so it’s important to take care of yourself and develop some healthy lifestyle habits.
Take time to relax. Relaxation techniques such as meditation, deep breathing, massage, or yoga can activate the body’s relaxation response and ease symptoms of PTSD.
Avoid alcohol and drugs. When you’re struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs. But substance use worsens many symptoms of PTSD, interferes with treatment, and can add to problems in your relationships.
Eat a healthy diet. Start your day right with breakfast, and keep your energy up and your mind clear with balanced, nutritious meals throughout the day. Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed food, fried food, refined starches, and sugars, which can exacerbate mood swings and cause fluctuations in your energy.
Get enough sleep. Sleep deprivation can trigger anger, irritability, and moodiness. Aim for somewhere between 7 to 9 hours of sleep each night. Develop a relaxing bedtime ritual (listen to calming music, watch a funny show, or read something light) and make your bedroom as quiet, dark, and soothing as possible.
Getting professional help for PTSD
If you suspect that you or a loved one has post-traumatic stress disorder, it’s important to seek help right away. The sooner PTSD is treated, the easier it is to overcome. If you’re reluctant to seek help, keep in mind that PTSD is not a sign of weakness, and the only way to overcome it is to confront what happened to you and learn to accept it as a part of your past. This process is much easier with the guidance and support of an experienced therapist or doctor.
It’s only natural to want to avoid painful memories and feelings. But if you try to numb yourself and push your memories away, PTSD will only get worse. You can’t escape your emotions completely—they emerge under stress or whenever you let down your guard—and trying to do so is exhausting. The avoidance will ultimately harm your relationships, your ability to function, and the quality of your life.
Why you should seek help for PTSD
Early treatment is better. Symptoms of PTSD may get worse. Dealing with them now might help stop them from getting worse in the future. Finding out more about what treatments work, where to look for help, and what kind of questions to ask can make it easier to get help and lead to better outcomes.
PTSD symptoms can change family life. PTSD symptoms can get in the way of your family life. You may find that you pull away from loved ones, are not able to get along with people, or that you are angry or even violent. Getting help for your PTSD can help improve your family life.
PTSD can be related to other health problems. PTSD symptoms can make physical health problems worse. For example, studies have shown a relationship between PTSD and heart trouble. Getting help for your PTSD could also improve your physical health.
Source: National Center for PTSD
PTSD treatment and therapy
Treatment for PTSD can relieve symptoms by helping you deal with the trauma you’ve experienced. A doctor or therapist will encourage you to recall and process the emotions you felt during the original event in order to reduce the powerful hold the memory has on your life.
During treatment you’ll also explore your thoughts and feelings about the trauma, work through feelings of guilt and mistrust, learn how to cope with intrusive memories, and address the problems PTSD has caused in your life and relationships.
The types of treatment available for PTSD include:
Trauma-focused cognitive-behavioral therapy involves gradually “exposing” yourself to feelings and situations that remind you of the trauma, and replacing distorted and irrational thoughts about the experience with a more balanced picture.
Family therapy can help your loved ones understand what you’re going through and help you work through relationship problems together as a family.
Medication is sometimes prescribed to people with PTSD to relieve secondary symptoms of depression or anxiety, although they do not treat the causes of PTSD.
EMDR (Eye Movement Desensitization and Reprocessing) incorporates elements of cognitive-behavioral therapy with eye movements or other forms of rhythmic, left-right stimulation, such as hand taps or sounds. These techniques work by “unfreezing” the brain’s information processing system, which is interrupted in times of extreme stress.
Finding a therapist for PTSD
When looking for a therapist, seek out mental health professionals who specialize in the treatment of trauma and PTSD. You can ask your doctor or other trauma survivors for a referral, call a local mental health clinic, psychiatric hospital, or counseling center.
Beyond credentials and experience, it’s important to find a PTSD therapist who makes you feel comfortable and safe. Trust your gut; if a therapist doesn’t feel right, look for someone else. For therapy to work, you need to feel comfortable and understood.
False PTSD: A Diagnostic Challenge
Distinguishing false post-traumatic stress disorder (PTSD) from the real thing can be very tricky, but it’s necessary in order both to help patients and to make sure treatment resources are allocated correctly, according to Mikel Matto, MD, assistant clinical professor of psychiatry at the University of California San Francisco.
“There is a very finite number of psychiatrists who are well-qualified to treat PTSD, and if they’re spending time on PTSD cases, they’re not able to treat the people who need help the most, ” Matto said in a phone interview.
At last month’s American Academy of Psychiatry and the Law annual meeting in Portland, Ore., Matto laid out a framework for assessing potential PTSD cases. Matto is a captain in the California Army National Guard and chief mental health officer for the Joint Force Headquarters.
The framework delineates five possible types of PTSD diagnoses:
- Misattributed PTSD: Symptoms that are consistent with PTSD but are actually more attributable to a co-morbidity such as anxiety. Misattributed PTSD is fairly common, since 92% of patients with a primary PTSD diagnosis have at least one other psychiatric diagnosis, according to Matto.
- Malingered PTSD: Symptoms are being deliberately falsified by the patient in order to achieve some sort of external gain, such as pension or disability payments, or dismissal from a lawsuit.
- Factitious PTSD: Symptoms are being deliberately falsified by the patient for intrinsic gain, such as respect from peers or using the “victim” role to justify a poor level of functioning, like failed relationships or legal problems.
- Elevated PTSD: Symptoms are consistent with PTSD but seem exaggerated.
- Genuine PTSD: Symptoms are real and are consistent with a diagnosis of PTSD.
To spot misattributed PTSD, “The first thing you look to see is whether or not someone who is misidentified as having PTSD when there’s a set of symptoms that are better explained by another diagnosis,” he said.
For example, “Misattribution is very common in victims of trauma. You have a clinician bias — ‘Oh, they were in a war’ — that leads to an early PTSD diagnosis, when in fact the most common response to trauma is depression or anxiety. If it does misattributed, you can address the underlying pathology instead of progressing down the PTSD treatment path, which is inappropriate and won’t get optimal results.”
Once misattributed PTSD is ruled out, the clinician should look at the symptoms and say, ‘Are they being volitionally produced or not?'” Matto continued. If they are being intentionally produced, “Physicians in the past have attributed it to malingering PTSD,” but clinicians should dig deeper and see whether it’s being produced for primary or secondary gain.
Only if it’s produced for secondary gain — external rewards such as getting out of legal responsibility in a criminal case — is it actual malingering, according to Matto. For example, a patient might decide, “I was assaulted by an employee at WalMart; I’ll sue WalMart and claim that I have PTSD as a result of the assault.”
This is a common strategy in civil cases as well, he said. “The most accurate data seem to be that in 20%-30% of personal civil injury lawsuits, PTSD is falsely claimed.” In the case of the Veterans Affairs health system, PTSD was the third most common disability claim by 2012.
How to Treat Malingering
As for malingering, “I get called in for challenging or diagnostically unclear cases, so probably see more of it than most,” said Matto. Although it can be hard to address, “If someone’s malingering it’s because they want something. I have folks malingering for the sake of getting a pension, so I will say, ‘You do not have PTSD but I can tell you’re suffering; if it’s because of financial need, let’s see what resources I have to help with that.'”
If the patient is producing the symptoms for primary gain — an intrinsic reason like getting to play the role of a sick person — that’s known as factitious PTSD. “This is very common in primary care physician offices — people want the sort of sympathy that comes from being sick; they want to be pampered. They will inject insulin — or even inject feces to make themselves septic.”
“The main difference between factitious PTSD and malingered PTSD is that malingered PTSD is not a mental illness, while factitious PTSD is a psychopathology. Factitious disorder is recognized in the DSM, whereas malingering is not.” The treatment for factitious PTSD is longitudinal psychotherapy, since one of the main motivations is unmet social need, he added.
There is real danger in not recognizing malingered PTSD, Matto noted. “If malingered PTSD isn’t caught, then you get the stereotype of it being violent, since people are using it to get out of responsibility for committing crimes. “
“Also, not catching it calls into question legitimacy of the research database,” he said. “That’s because if you take a look at people’s response rates to therapy or pharmaceutical interventions for PTSD, never claim to get better. That makes the efficacy rates for different treatment modalities look worse than they are and people might be more reluctant to enter treatment.”
Then there are the cases of elevated PTSD, in which patients have PTSD but appear to be volitionally producing symptoms. “Sometimes when you do psychological testing, the symptoms can appear amplified; that’s something we need to be very cautious about,” he said.
“Studies have found that a certain number of veterans seem to be overreporting their claims, but when you look a little deeper, they’re not doing so for the sake of malingering; they’re doing it as a cry for help … One study showed that of the evaluated claims, 23% appeared to be intentionally exaggerating their symptoms but 77% were actually a sign of distress. This requires careful calibration of neuropsychiatric testing to make sure we’re not missing folks.”
The Devil is in the Details
Matto suggests people depart from the traditional way of thinking about PTSD. “The traditional way has been to look for signs and symptoms of malingered PTSD; I’m saying go the other way around — look for genuine PTSD and if there’s a deviation, see whether it’s false PTSD or not.”
This involves carefully going through the patient’s medical records and look very closely at progress notes, rather than at case summaries, he said. “You really want to look at progress notes because you can get a day-by-day accounting of symptoms and create logs yourself to see how people are doing over time, and compare it with testing that may occur on particular days, or with symptom logs you give the patient.”
He also recommended looking at military records, in particular the DD-214 discharge form from the military. “It’s a one-pager; it’s not hard to fake,” Matto said. “I recommend people request it directly from the National Personnel Records Center.”
Also, when you’re talking to patients about their about military service, try to get as much detail as possible, he said. “One stereotype physicians have about individuals with PTSD is that they don’t want to talk about their military experience. They may not want to talk about traumatic experiences, but they should be able to talk about other details. if they were in the Navy, you can ask, ‘What sort of boat were you on and where did you stop?'” Or you can ask about their uniform; if the response is “I wore my greens,” the physician can ask what was on their utility belt. “We should ask for a lot of details.”
In addition, “I always recommend they take a look for inconsistencies in their story between what they’re describing and what they’re demonstrating,” said Matto. For example,”I’ll patients with their back to a door and while I’m talking to them” because a common sign of PTSD is being uncomfortable with having one’s back to a door.
If the patient genuinely has PTSD, “they’ll see where the chair is and ask to move it,” whereas a patient with false PTSD may seem fine until you start asking about their symptoms, and then they may remember about that being a symptom and will ask to move the chair.
Or they may say that their memory is terrible and they can’t remember what happened the day of their trauma, but if you ask what day they filed a lawsuit they’ll know the exact day and year. “Look for those inconsistencies,” but also give them a chance to explain them because there may be a good reason for it, he said.
Last Updated November 15, 2016 Comment
Active Duty Patriot
I’ve thought a lot about this, and have wanted to say something about this for a long time, but I was never really angry enough to break past the filmy barrier that’s been preventing us from saying things about this for a long time. Do I care for my brothers who have PTSD? Absolutely. Do I understand that PTSD is debilitating? Absolutely. I have it myself and it’s a really hard thing to live with. Can it even be disabling? Yes. If you’ve seen some of the people I have, you’d absolutely understand that.
But it is NOT A FUCKING EXCUSE.
I will admit here that I struggle with my anger every day. Every single day. I am number one for walking out on the job right now, because my leadership understands that walking out and cooling down is much more productive than yelling or hitting something. But once you know that you have PTSD, I think you have a responsibility as well to try to temper it. You try as hard as you possibly can to avoid situations that you know are going to tempt you. For example: I used to love going out by myself to strange bars and drinking with new friends. I don’t do it anymore, after the time when I got myself involved in someone else’s fight and spent the next hour limping, bleeding, and talking my way out of trouble with the MPs. Do I wish I had the control to be able to do it? Yes, you’re damn right I do. But I acknowledge that it’s a risk factor, and so I don’t go out drinking unless I’m accompanied by someone I trust to get me out of Dodge if trouble looks like it’s rising.
I’m sick and tired of people who claim that their PTSD is the excuse for them indulging in all sorts of bad behavior. It’s an explanation, but it’s not an excuse. If you had the opportunity to mitigate or avoid the situation but decided to stick it out anyway because you knew you could get away with it by claiming PTSD? You are not a victim, you are an asshole.
I’ll put myself on blast here, and explain that my PTSD is ‘noncombat’, in that it does not directly relate to official combat with an official enemy. Instead it is domestic violence and sexual assault related, in that the combat involved me unarmed, facing an armed enemy who also happened to be my husband at the time. I still, to this day, am affected by it. Every day, I am quick to lose my temper, and god help me if you abuse women in my presence. I once got into a fistfight with a man a head and a half taller and two feet wider than myself over it. When someone deserves it, I am happy, genuinely happy, to wade into the fray even if I am going to take some serious damage. But when someone doesn’t deserve it, I hold back.
I’ve had to deal with a lot of other people with PTSD in the line of work I involve myself in. Dealing with veterans, you see a lot of it. But what I also see, and I wish I didn’t, is a pattern of using it as an excuse. Using combat PTSD as an excuse for why someone beats their wife, or raped a woman. Why they attempted to attack someone half their size for no apparent reason. Why it’s okay to rip kids off bikes if you think they’re doing something like you saw once in Iraq.
It’s not fucking okay.
It is not fucking okay.
It is NOT FUCKING OKAY.
If you feel like you need to beat your wife? Maybe it’s time to go in to counseling. Tell your wife what’s going on. Start leaving the house when you start getting angry.
If you feel like you’re incapable of getting physical without forcing your way to sex at the end because dammit, you somehow deserve to get what you want? You need to be away from women for a while. Seriously.
And here’s another important one: if you want to get people to tiptoe lightly around your mental health issues, you need to tiptoe lightly around theirs. If you want people not to make loud noises around you, you need to listen to a woman’s request that you give her a room with a lock on it. If you want people to try not to provoke your temper? You need to try not to provoke other people’s, and be adult enough to walk away when you are.
I respect those whose sufferings in combat have caused them great pain that they are not able to fully recover from. But their mental health issues are not one bit more holy or sacrosanct than anyone else’s. We all need to be respected, we all need to be treated as human and as brothers. /Especially/ as soldiers and veterans, and especially within veterans groups.
Images here are from the very excellent Men Can Stop Rape campaign, that my SARC showed me to.
Originally published by The Havok Journal in June of 2015 and updated after a recent article in The Guardian.
I know I’m going to catch hell from my brothers and sisters in the veteran community on this one, but it needs to be said: I’m becoming skeptical of some PTSD claims, and you should be too.
Post Traumatic Stress Disorder is to this generation of veterans what “back pain” was to mine; both are real conditions with real victims, but the symptoms are so common and so easily faked that anyone can claim they have the condition, and no one can prove that they don’t.
PTSD has become a “get out of jail free” card, or at least a “feel sorry for me and excuse my behavior card,” a very powerful one with no expiration date. This has become increasingly — and distressingly — true in the veteran community.
Don’t believe me? Read any news story about a veteran who gets in trouble with the law, either military or civilian, and I guarantee that in at least ¾ cases (and nearly 100% of felony cases) either the individual charged or one of the lawyers involved will explicitly or implicitly claim “the PSTD made me do it.” These days, in the veteran community no offense is too big, or too small, to use PTSD as an excuse. Examples:
Plagiarized your War College thesis? PTSD! Like to get drunk and pick fights with civilian women? PTSD! Murdered a police officer? PTSD! Drug smuggling, kidnapping, spousal abuse, sexual assault? PTSD! Made some really, really bad life choices? PTSD! Want to get paid, get attention, or get sympathy? PTSD, PTSD, PTSD!!!
Additionally, PTSD has become sort of a “third rail” within the veteran community, to the point that few people are willing to write objectively about it. Even fewer major publications are willing to run articles the slightest bit critical of anyone who has, or who claims to have PTSD. Well, that’s not how we roll here. Sometimes the truth hurts, but that doesn’t make it any less true. So if you don’t appreciate Real Talk, then do us both a favor and stop reading Havok Journal.
How easy is it to get a PTSD diagnosis? The short answer is, “too easy.” Here’s a personal anecdote: I was once referred to a civilian, off-post doctor to seek relief for my sleep apnea. The discussion was going well until he found out I’m a veteran, at which time he wanted to put me on all kinds of drugs for PTSD. I had to talk him out of it by categorically refusing to go on PTSD meds in the first place. As confirmed by 2nd and 3rd opinions as well as my objective self-evaluation, I don’t have PTSD; I have sleep apnea.
Whether my sleep apnea is pre-existing, age-related, or service-related, I don’t know. But I do know that if I went with the PTSD diagnosis, I would have joined a long line of people who were misdiagnosed with the condition. I would have been on a cocktail of behavior-modifying, mood-altering, and thought-inhibiting drugs. I felt that I also would have been at risk to lose access to my firearms or perhaps even my security clearance (although I later found out PTSD is not necessarily a disqualifier for a clearance). And most importantly, I never would have gotten help with my real, underlying health condition.
I respect doctors and almost always heed medical advice or believe professional diagnoses. If a doctor looks at an X-ray and tells me my leg is broken, I believe him. If a doctor does an MRI and says she thinks I have cancer, I take it seriously. But telling me I have PTSD simply because I’m a veteran is the kind of voodoo, kneejerk misdiagnosis that clogs the medical system and does a disservice to the veteran community.
“If you went to war and didn’t come back with PTSD, did you even deploy at all?”
Further complicating the situation is that many symptoms of PTSD are similar to those of other conditions. In my case, my sleep apnea was characterized by nightmares, sleep deprivation, headaches, dry mouth, mood swings, and anxiety. All of these things, it turned out, were my body’s reaction to not sleeping. So if I would not have questioned the initial diagnosis, I would have been on a treatment regimen of questionable effectiveness AND my underlying condition, sleep apnea, would have remained untreated, leaving me drugged up AND still unable to sleep. But hey, at least I could tell people I have PTSD!
The evidence of over-diagnosis of PTSD in the veteran community is not just anecdotal, nor is it unique to the US military. In a January 2016 article posted by The Guardian, a leading newspaper in Great Britain, the former head of the UK’s veterans’ mental health program opined that 42% of PTSD claims were for issues unrelated to military service, and that at least 10% of claims were either grossly exaggerated or were based on total fabrications. If true, those are some pretty damning figures.
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6 Myths About PTSD We Need to Stop Believing
Post-traumatic stress disorder (PTSD) is one of the most common issues I encounter in my therapy practice. Whether it’s an adult who narrowly survived a serious car accident or a child who endured abuse, the consequences of PTSD can be long-lasting. Although public awareness of PTSD has significantly increased over the past few years, there’s still a lot of confusion about the symptoms and treatments. Unfortunately, as with many other mental health issues, there’s still a stigma attached to PTSD that prevents some people from seeking help.
These are six of the major myths about PTSD we need to stop believing:
1. Only combat veterans get PTSD.
It’s estimated that 7.7 million American adults have PTSD. Many of them are not military personnel. Almost anyone who has been exposed to a traumatic incident can develop PTSD. Natural disasters, accidents, the loss of a loved one, and near-death experiences are just a few of the events that can lead to PTSD.
2. Everyone who is exposed to a traumatic event gets PTSD.
People respond to traumatic experiences differently, and not everyone who endures a horrific event will become traumatized. Some people experience short-term distress following a traumatic event, but the symptoms only last for a short period of time. Other people actually experience posttraumatic growth. Following a tragic event, these individuals find new meaning and purpose in life. Often they report that their lives were made better by the traumatic event they experienced.
3. People who get PTSD are weak.
PTSD has nothing to do with mental strength. There are risk factors that place some people at a higher risk, but many of those factors are not within an individual’s control. Someone who felt helpless during a traumatic event—like an individual who was taken hostage—is at a higher risk than someone who was able to save themselves from a fire. People who lack social support following a traumatic event are at a higher risk for PTSD as well. And those who have a history of depression may also be more likely to develop PTSD.
4. PTSD isn’t a big deal.
People with PTSD aren’t overly dramatic and they’re not simply seeking attention. Their symptoms can be debilitating. People with PTSD often experience higher rates of divorce and unemployment. They’re also at a higher risk of depression and suicide. And many people with PTSD self-medicate with drugs and alcohol, putting them at risk of developing serious substance abuse problems.
5. There aren’t any treatments available for PTSD.
There isn’t a single medication that cures PTSD, but medication can reduce the symptoms. Antidepressants, anti-anxiety medication, and sleep aids are sometimes prescribed. Psychotherapy can be very effective for PTSD by providing the education and skills required to manage the symptoms. Exposure therapy may also be used to help people confront their trauma in a safe environment. And virtual-reality exposure therapy has shown promising results with combat veterans.
6. PTSD is a personal issue.
Like other mental health issues, PTSD can take a serious toll on an individual’s ability to perform his job. Reduced productivity, increased absences, and difficulty staying engaged are just a few of the problems employees may experience. In-service trainings and open conversations about mental health issues like PTSD can help employees recognize the importance of this issue. Improved communication can also reduce the stigma, and encourage people with PTSD to seek treatment.
Watch my TEDx talk The Secret to Becoming Mentally Strong.
This article first appeared on Inc.
Post-Traumatic Stress Disorder (PTSD) Not Always A Serious Mental Illness: Sally Satel in Wall St. Journal
The Battle Over Battle Fatigue
Soldiers can now claim trauma from events they didn’t actually experience. Is the diagnosis losing meaning?
By Sally Satel
Military history is rich with tales of warriors who return from battle with the horrors of war still raging in their heads. One of the earliest known observations was made by the Greek historian Herodotus, who described an Athenian warrior struck blind “without blow of sword or dart” when a soldier standing next to him was killed. The classic term—”shell shock”—dates to World War I; “battle fatigue,” “combat exhaustion” and “war stress” were used in Word War II.
Modern psychiatry calls these invisible wounds post-traumatic stress disorder. And along with this diagnosis, which became widely known in the wake of the Vietnam War, has come a new sensitivity to the causes and consequences of being afflicted with it.
Veterans with unrelenting PTSD can receive disability benefits from the Department of Veterans Affairs. As retired Army Gen. Eric K. Shinseki, secretary of Veterans Affairs, said last week, the mental injuries of war “can be as debilitating as any physical battlefield trauma.” The occasion for his remark was a new VA rule allowing veterans to receive disability benefits for PTSD if, as non-combatants, they had good reason to fear hostile activity, such as firefights or explosions. In other words, veterans can now file a benefits claim for being traumatized by events they did not actually experience.
The very notion that one can sustain an enduring mental disorder based on anxious anticipation of a traumatic event that never materializes is a radical departure from the clinical—and common-sense—understanding that disabling stress disorders are caused by traumatic events that actually do happen to people. This is not the first time that controversy has swirled around the diagnosis of PTSD.
In brief, the symptoms of PTSD fall into three categories: re-experiencing (e.g., relentless nightmares; unbidden waking images; flashbacks); hyper-arousal (e.g., enhanced startle, anxiety, sleeplessness); and phobias (e.g., fear of driving after having been in a crash). Symptoms must last at least one month and impair the normal functioning to some degree. Overwhelming calamity, not only combat exposure, can lead to PTSD, including natural disasters, rape, accidents and assault.
Not everyone who confronts horrific circumstances develops PTSD. Among the survivors of the Oklahoma City bombing, 34% developed PTSD, according to a study by psychiatric epidemiologist Carol North. After a car accident or natural disaster, fewer than 10% of victims are affected, while among rape victims, well over half are affected. The reassuring news is that, as with grief and other emotional reactions to painful events, most sufferers get better with time, though periodic nightmares and easy startling may linger for additional months or even years.
Large-scale data on veterans are harder to come by. According to the major study of Vietnam veterans, the 1988 National Vietnam Veterans’ Readjustment Study, 50% of those whose stress reactions were diagnosed as PTSD recovered fully over time. A re-analysis of the data, published in Science in 2006, found that 18.7% of Vietnam veterans suffered PTSD at some point after returning from war, but half had recovered by the time the study was conducted in the mid-1980s.
A 2010 article in the Journal of Traumatic Stress summarized over two dozen studies and found that among servicemen and women previously deployed to Iraq and Afghanistan, between 5% and 20% have been diagnosed with PTSD.
The story of PTSD starts with the Vietnam War. In the late 1960s, a band of self-described antiwar psychiatrists—led by Chaim Shatan and Robert Jay Lifton, who was well known for his work on the psychological damage wrought by Hiroshima—formulated a new diagnostic concept to describe the psychological wounds that the veterans sustained in the war. They called it “Post-Vietnam Syndrome,” a disorder marked by “growing apathy, cynicism, alienation, depression, mistrust, and expectation of betrayal as well as an inability to concentrate, insomnia, nightmares, restlessness, uprootedness, and impatience with almost any job or course of study.” Not uncommonly, Messrs. Shatan and Lifton said, the symptoms did not emerge until months or years after the veterans returned home.
This vision inspired portrayals of the Vietnam veteran as the kind of “walking time bomb” as immortalized in films such as “Taxi Driver” and “Rambo.” In the summer of 1972, the New York Times ran a front-page story on Post-Vietnam Syndrome. It reported that 50% of all Vietnam veterans—not just combat veterans—needed professional help to readjust, and contained phrases such as “psychiatric casualty,” “emotionally disturbed” and “men with damaged brains.” By contrast, veterans of World War II were heralded as heroes. They fought in a popular war, a vital distinction in understanding how veterans and the public give meaning to their wartime hardships and sacrifice.
Psychological casualties are as old as war itself, but historians and sociologists note that the high-profile involvement of civilian psychiatrists in the wake of the Vietnam War set those returning soldiers apart. “The suggestion or outright assertion was that Vietnam veterans have been unique in American history for their psychiatric problems,” writes the historian Eric T. Dean Jr. in “Shook over Hell: Post-Traumatic Stress, Vietnam, and the Civil War.” As the image of the psychologically injured veteran took root in the national conscience, the psychiatric profession debated the wisdom of giving him his own diagnosis.
During the Civil War, some soldiers were said to suffer “irritable heart” or “Da Costa’s Syndrome”—a condition marked by shortness of breath, chest discomfort and pounding palpitations that doctors could not attribute to a medical cause. In World War I, the condition became known as “shell shock” and was characterized as a mental problem. The inability to cope was believed to reflect personal weakness—an underlying genetic or psychological vulnerability; combat itself, no matter how intense, was deemed little more than a precipitating factor. Otherwise well-adjusted individuals were believed to be at small risk of suffering more than a transient stress reaction once they were removed from the front.
In 1917, the British neuroanatomist Grafton Elliot Smith and the psychologist Tom Pear challenged this view, attributing the cause more to the experiences and less on those who suffered them. “Psychoneurosis may be produced in almost anyone if only his environment be made ‘difficult’ enough for him,” they wrote in their book “Shell Shock and Its Lessons.” This triggered a feisty debate within British military psychiatry, and eventually the two sides came to agree that both the soldier’s predisposition to stress and his exposure to hostilities contributed to breakdown. By World War II, then, military psychiatrists believed that even the bravest and fittest soldier could endure only so much. “Every man has his breaking point,” as the saying went.
In 1980, the American Psychiatric Association adopted post-traumatic stress disorder (rather than the narrower Post-Vietnam Syndrome) as an official diagnosis in the third edition of its Diagnostic and Statistical Manual. A patient could be diagnosed with PTSD if he experienced a trauma or “stressor” that, as DSM described it, would “evoke significant symptoms of distress in almost everyone.” Rape, combat, torture and fires were those deemed to fall, as the DSM III required, “generally outside the range of usual human experience.” Thus, while the stress was unusual, the development of PTSD in its wake was not.
No longer were prolonged traumatic reactions viewed as a reflection of constitutional vulnerability. They became instead a natural process of adaptation to extreme stress. The influence of individual differences shaping response to crisis gave way to the profound impact of the trauma, with its leveling effect on all human response.
If the pendulum swung too far, obliterating the role of an individual’s own characteristics in the development of the condition, it served a political purpose. As British psychiatrist Derek Summerfield put it, the newly minted diagnosis of PTSD “was meant to shift the focus of attention from the details of a soldier’s background and psyche to the fundamentally traumatic nature of war.”
Messrs. Shatan and Lifton clearly saw PTSD as a normal response. “The placement of post-traumatic stress disorder in allows us to see the policies of diagnosis and disease in an especially clear light,” writes combat veteran and sociologist Wilbur Scott in his detailed 1993 account “The Politics of Readjustment: Vietnam Veterans Since the War.” PTSD is in DSM, Mr. Scott writes, “because a core of psychiatrists and Vietnam veterans worked conscientiously and deliberately for years to put it there…at issue was the question of what constitutes a normal reaction or experience of soldiers to combat.” Thus, by the time PTSD was incorporated into the official psychiatric lexicon, it bore a hybrid legacy—part political artifact of the antiwar movement, part legitimate diagnosis.
While the major symptoms of PTSD are fairly straightforward—re-experiencing, anxiety and avoidance—what counted as a traumatic experience turned out to be a moving target in subsequent editions of the DSM.
In 1987, the DSM III was revised to expand the definition of a traumatic experience. The concept of stressor now included a secondhand experience. In the fourth edition in 1994, the range of “traumatic” events was expanded to include hearing about the unexpected death of a loved one or receiving a fatal diagnosis such as terminal cancer. No longer did one need to experience a life-threatening situation directly or be a close witness to a ghastly accident or atrocity. Experiencing “intense fear, helplessness, or horror” after watching the Sept. 11 terrorist attacks on television, for example, could qualify an individual for PTSD.
There is pitched debate among trauma experts as to whether a stressor should be defined as whatever traumatizes a person. True, a person might feel “traumatized” by, say, a minor car accident—but to say that a fender-bender counts as trauma alongside such horrors as concentration camps, rape or the Bataan Death March is to dilute the concept. “A great deal rides on how we define the concept of traumatic stressor, says Harvard psychologist Richard J. McNally, author of “Remembering Trauma.” In the civilian realm, Mr. McNally says, “the more we broaden the category of traumatic stressors, the less credibly we can assign causal significance to a given stressor itself and the more weight we must place on personal vulnerability.”
For some non-combat servicemen and women, anticipatory fear of being in harm’s way can turn into a crippling stress reaction. But how often symptoms fail to dissipate after separation from the military and subsequently morph into a lasting disability is unknown.
Americans are deeply moved by the men and women who fight our wars. We have an incalculable moral debt, as Abraham Lincoln said, “to care for him who shall have borne the battle.” Yet rather than broaden the definition of PTSD, it would do our veterans better to ensure they first receive quality treatment and rehabilitation before applying for disability status. Otherwise, how can we assess their prospects for meaningful recovery no matter their diagnosis?
The new regulations announced by Mr. Shinseki take the definition of PTSD further than any of his predecessors surely imagined.
Sally Satel is a psychiatrist and resident scholar at the American Enterprise Institute.
© JULY 17, 2010 Wall St. Journal
Malingering PTSD: Could Certain Soldiers Be ‘Faking it’?
Since when did a doctor become an investigator, responsible for fact-checking a soldier’s story? That hardly seems an appropriate responsibility for a doctor in the VA system. It also seems silly that when evidence shows the soldier to be lying, nothing can be done. A dishonorable soldier who has no trouble lying would seem to be one you wouldn’t want to be honoring with unearned income.
The system is clearly broken. But this article does little to help us understand this problem in context. Out of the 1.6 million troops who served, we’re talking about a known 8,846 problem individuals — or 0.55 percent. Is this an epidemic? Who knows, again, the article gives little clue as to whether these are numbers are cause for serious concern or not.
Malingering is hard to detect, even by well-trained professionals. Malingering is always going to be an issue when you tie a monetary reward to a specific diagnosis. If you disconnect the direct monetary incentive from the diagnosis, I suspect you’ll find far less malingering going on. And there needs to be an intermediary step of fact-checking in there, as well as serious repercussions for lying about one’s symptoms.
Read the full article: In tide of new PTSD cases, fear of growing fraud
Malingering PTSD: Could Certain Soldiers Be ‘Faking it’?