Symptoms of PTSD: Understanding the Diagnosis

If you, or a loved one, have been diagnosed with Posttraumatic Stress Disorder (PTSD) or are wondering if your symptoms might align with the diagnosis, it is worth talking to a professional to get an accurate diagnosis and correct treatment. The information that follows will provide a starting point to learn more about the diagnosis and bring questions to talk with your provider, or therapist, about.

It is important to note that having a diagnosis of PTSD doesn’t necessarily mean you will always hold the diagnosis- it is often possible for people to significantly reduce, if not eliminate, the symptoms with the right treatment and support. It is also helpful to know that the symptoms outlined below are a normal response to an abnormal situation. Many individuals develop PTSD to various degrees after traumatic events and need support in processing the traumatic event in a healthy way. Sometimes, if enough support is present both directly before and after an event, development of PTSD can be avoided. Though this often is not possible or available to a survivor in the moment due to various social, cultural, and relational barriers.

Symptoms develop as a way to cope with an overwhelming event(s), often as a survival tactic- as the nervous system isn’t able to fully integrate or process the charge of the situation on its own. I like to tell my clients that their symptoms are, or were, a survival response that we can thank for getting them through the moment (or even keeping them alive) in the best way they can. Sometimes, these symptom strategies outlive their usefulness and start to prevent us from living a life we can thrive in. This is where trauma therapy comes in, as an external support and resource to help the person (and their nervous system) process the intensity that they went through in a healthy way- ultimately allowing them to find a greater sense of resolution, meaning-making, control, and safety after the event(s). 

To better understand the diagnosis symptom cluster, I have included an outline of the DSM 5 (Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition) definition of PTSD.

Understanding the Diagnosis of PTSD:

Posttraumatic Stress Disorder is defined as a cluster of symptoms that last for 1 month or longer after experiencing a traumatic (or multiple) traumatic event. Experiencing a traumatic event can occur either through direct experiencing, witnessing an event occur, or experiencing  extreme/repeated exposure to aversive details of the traumatic event. 

The symptoms include:

Presence of one (or more) of the following intrusion symptoms:

  • recurrent involuntary distressing memories of the event

  • recurrent distressing dreams of the event

  • dissociative reactions (flashbacks) where you feel or act as though the traumatic event were occuring in the present

  • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

Persistent Avoidance of stimuli associated with the traumatic event(s), by presence of one or both of the following:

  • Avoidance of distressing memories, thoughts, or feelings about or closely related to the event(s)

  • Avoidance of external reminders (people, places, conversations, activities, objects, situation(s) that bring up distressing memories, thoughts, or feelings (or are closely related with) the traumatic event(s)

Negative Alterations in cognitions and mood associated with the traumatic event(s), as seen in at least two of the following symptoms:

  • Inability to remember an important aspect of the traumatic event(s)

  • Persistent exaggerated negative beliefs or expectations about oneself, others, or the world (such as “I’m bad,” “No one can be trusted,” “The world is completely dangerous,” or “My whole nervous system is completely ruined”)

  • Persistent distorted cognitions about the cause or consequences of the traumatic even(s) that lead the individual to blame themselves or others

  • Markedly diminished interest in participation in significant activities

  • Feelings of detachment or estrangement from others

  • Persistent inability to experience positive emotions 

Marked alterations in arousal (nervous system) and reactivity associated with the traumatic event(s), including two or more of the following:

  • Irritable behavior and angry outbursts (with little or no provocation) 

  • Reckless or self-destructive behavior

  • Hypervigilance

  • Exaggerated startle response

  • Problems with concentration

  • Sleep Disturbance

In addition, the following must also be true:

  • The symptom cluster causes clinically significant distress or impairment in social, occupational, or other important areas of your functioning.

  • The disturbance is not attributable to the physiological effects of a substance (medication or alcohol) or another medical condition.

  • You may (not everyone with PTSD has this) also have depersonalization (persistent or recurrent feelings of detachment from, or like you are an outside observer to, your mental processes or body….as if in a dream) or derealization (persistent or recurrent experiences of unreality of surroundings...the world around you is experienced as unreal, dreamlike, distant, or distorted).  

The symptoms described above cluster into unique patterns for each person with the diagnosis, it is important to understand your own diagnosis and get support in finding the best treatments for your specific needs. Also, please remember that a diagnosis is simply a common way to clinically describe similar clusters of symptoms; it doesn’t define you. Each person with a PTSD diagnosis also has other important aspect of themselves that need attention and cultivation during the process of trauma healing. Sometimes, there can even be surprising and unexpected strengths that become apparent once someone has experienced a traumatic event(s). Trauma can both devastate us and help us come closer to what is most important in our lives. Many survivors go on to make important contributions and changes in our society that would not have been possible prior to the experience.


About the Author

AiyaS_1005.jpg

Aiya Staller is a Licensed Professional Counselor, Licensed Addiction Counselor, and Board Certified Art Therapist who sees private clients in Boulder, CO, while also working with various mental health organizations. She specializes in trauma treatment/resolution, body-based psychotherapy, art therapy, anxiety, and LGBTQ+ concerns. She is an artist, interested in inspiring others to connect more deeply with their authenticity and resilience. Please visit her website, at aiyastaller.com for more information or to explore the option of therapy.

Finding Your Center: 10 Skills to Help Your Nervous System Relax after a Trauma Trigger or Stressful Event

Symptoms of a Trauma Trigger or Stressor:

  • Narrowing Vision (or tunnel vision)

  • Hypervigilance or “On Guard” and Reactive/Jumpy

  • Saying what you don’t mean or reacting more strongly than the situation warrants

  • Racing heart, rapid breathing, “freeze” in body

  • Flashbacks or intrusive thoughts/images

  • Avoiding and leaving situations/hiding

  • Urges to use unhealthy coping mechanisms (binge eating, alcohol, cutting, over-exercising, over-working to ‘perfection’, etc)

  • Feeling of “panic” and needing to escape

  • Negative thought cycles or snowballing worries

If you have an unprocessed trauma history or PTSD diagnosis, it is often hard to feel safe or calm.

Our nervous systems are wired for survival and, when a traumatic event occurs, it sometimes goes into overdrive- or doesn’t stop after the event.  This can leave you in a constant state of “fight, flight, or freeze” where the body doesn’t know that the event is over now. Because the nervous system is on high alert, trauma survivors sometimes react more quickly or intensely than the current situation calls for. It isn’t your fault by any means, but you often need specialized support in order to feel more calm and in control again.

This blog will highlight a few resources and tools that many of the clients I work with find useful. This isn’t a replacement for therapy, though can be a good starting point. There are many types of trauma treatment available to survivors of trauma these days that can help resolve the triggers and help them find relief. For more information about a few of these, see my trauma resolution treatment pageIf you are a survivor of trauma and resonate with the symptoms noted and wish to engage in trauma focused treatment, consider outreaching a trauma therapist to discuss the therapy options available to you. You can also contact me here for support as well. You don’t need to do this alone- it’s normal to need help. Having support in this healing journey is often necessary for survivors. In this blog, I’m outlining some of the skills that I teach in therapy and that my clients have reported useful to them in their process. It can be a useful place to start. Everyone is different, so notice which ones resonate with you and which ones don’t. 

10 Skills to Help Find Your Center:

STOP Skill:

Stop, Take a Step Back, Observe, Proceed Mindfully. Before using any other skills, you want to be sure you are actually safe and have some capacity to make decisions. This is a DBT (Dialectical Behavior Therapy) skill that is used to pause before proceeding with any other skill. You use the skills when you know you are not in current danger, but you feel a strong reaction/your body is responding as though it is in danger. For many people, when they feel triggered (or have an emotional response that is greater than a “6” on a 1-10 scale where 1 is no distress and 10 is the most distressing experience ever) they need a break to get calm before they can make the next best decision.

Diaphragmatic Breathing:

This one is a simple but effective CBT (Cognitive Behavioral Therapy) exercise to reset our nervous systems. Practice it daily or multiple times a day to support retraining your nervous system. To use this skill, find a relaxed breath- don’t try to force it. I imagine having a balloon right below my ribs/by my diaphragm (which is your low belly).  After an inhale, exhale out of the balloon for 5 counts, then inhale for 4 counts. Keep this pattern of inhaling for 4 counts, exhaling for 5 counts, in the lower belly for 10 or so cycles.  You can change the number of counts you need/rhythm that works for you.  The important thing is to have your lower belly activated with rhythmic relaxed breathing and a slightly longer exhale.  This is because the longer exhale from the lower belly activates the parasympathetic nervous system- which is the calming side of our nervous system.  If we breath in our upper chest and “hyperventilate” then we make ourselves more anxious.  

“I Am Aware”:  

This skill is used in EMDR (Eye Movement Desensitization and Reprocessing) therapy and various mindfulness practices. It is useful to bring you into the present moment and out of the trigger memory, which allows our prefrontal cortex to re-activate. Once our prefrontal cortex is re-activated, we are then able to make more balanced decisions. To practice: look around you and name 3 things you are aware of.  For example: I am currently aware of the succulent sitting on the window sill, the round shaped mirrors on the wall, and the sounds of the keyboard as I type this. Keep naming things that you are aware of until you start to feel a little more settled. Be gentle with yourself. 

Math: 

When your head is spinning and thoughts are racing after a trigger, sometimes it is helpful to give our brains a task to slow it down. Try counting backwards from 100 by 3’s for as far as you can.   Alternatively, count the number of items of a certain category in the room/space (such as “count the number of picture frames”, “count the number of trees,” etc). 

Calm Place: 

Our nervous system responds to visual cues and visualization similarly to real events. This is why competitive athletes or public speakers often use visualization before performances. This skill is used in EMDR Therapy, Art Therapy, and in Mindfulness Practices. To take it a step deeper than visualization only, you can create a picture of this space, or take a picture, to remind yourself of this resource whenever you need it. To use: Take a moment to imagine either a real place, or a place you would like to have/create for yourself in your mind’s eye. This place should be safe, calm, and dedicated just for you. Examples clients have told me include: a cabin in the woods with nature around them, by a river/water, in their apartment with their dog, under the stars at night, in bed with their cat, in their office, or next to a tree in their backyard. This place will be unique to you. Imagine being there and notice what you sense around you (see, touch, smell, hear,). Notice how your body feels when you do this and give it time to ‘anchor’ in your nervous system.

Protector Figures:

 To use this skill effectively, we are shooting for a sense of feeling protected, supported, and potentially more powerful. To use it, take a moment to imagine what kind of figure you would like or wish you could have as a protector. This might be an imagined entity (dragon, bear, superhero, force of nature, etc) or a real entity (animal, person you know who is safe, etc). Bring in as many as you need, imagine placing them in the space around you and notice how your body feels as you visualize them with you.  

Talk to a Friend (but not to vent/ruminate): 

Getting support or talking to friends is natural for some people. It can also be a healthy way to not feel so alone and have a helpful second set of eyes on a situation. Identify people in your life who respect and love you. Also, be sure they are someone who knows how to listen and help you calm down versus the friend or family member who will escalate the situation (by getting more angry or anxious with you, or jumping to conclusions/reacting). Hint: sometimes getting together with a friend to distract with a healthy activity can be the best bet. Letting them know you are having a hard time and need to shift mindsets can help to both acknowledge the trigger but not ruminate in it.

Distract with a Pleasurable Event:

This one is a DBT skill that is useful for learning how to self-sooth. When you aren’t triggered, identify a list of things you enjoy doing. Bonus if they engage the 5 senses (taste, smell, sound, sight, touch). Examples include: a cup of warm tea, getting outside in the sun, looking at the skyline, gardening, playing or listening to music, wearing a soft sweater, working on a project you enjoy (woodworking, art, cleaning the house, sports, fishing, planning a vacation, trying a new recipe, etc), enjoying a meal or treat, using essential oils, taking a bath, talking to a friend, or spending time with a pet. Make your own list and ask others for ideas if you get stuck. Then, if you are ever triggered, use some of these events to distract and calm down. Or, if not triggered, use them just for enjoyment/to re-enforce pleasurable feelings that are healthy.  

Distance- Zoom Out from the Situation:

This skill is useful if you are having trouble with intrusive images/memories or replaying a situation in your head repeatedly. In your mind’s eye, turn the intrusive image/flashback or memory into a movie screen- as if you are watching the movie rather than in it. Then, zoom out from the movie screen until you are at a distance that feels less intrusive/more calm. Notice what it is like to have control over how close the image is to you- or even when it stops and starts. 

Move-Shake it Off: 

After we are triggered, there is a significant amount of energy running through our bodies.  It can be helpful to find a way to “discharge” this extra energy. Peter Levine studied animals in the wild and noticed that after an escape from a predator or dangerous situation they “shake it off” to discharge the adrenaline. As humans, we have learned to control our impulses and hold things in/not allow ourselves to discharge.  Let yourself cry, shake, and/or move, without any story or trying to figure it out. To do this, go somewhere you feel safe and comfortable to start. Then, shake your hands and feet, slowly building to adding your arms, legs, and shoulders/body. You can even jump up and down, or move in a circle. Anything to get the energy moving and out of your body. Hint: You can also use dancing, something faster paced/rhythmic to discharge.

Skills are a useful resource in our recovery journey, though we often need relational support as well.

The skills above are used to support your nervous system in developing new neural pathways that are wired for calm. It can take some time to rewire the brain/body, so be patient and kind to yourself as you practice. Also note that not all skills will be right for you, listen to your own body and learn how it responds to the different resources provided.

I like to remind my clients that skills can help, but we also heal in reparative relationships- particularly if the trauma we experienced was relational in any way. Some people find healing relationships in friendships or partnerships. Others, find they need specialized support from someone who understands the path of trauma resolution and healing. If this is the case for you, consider reaching out to a trained trauma therapist.


About the Author

AiyaS_1005.jpg

Aiya Staller is a Licensed Professional Counselor, Licensed Addiction Counselor, and Board Certified Art Therapist who sees private clients in Boulder, CO, while also working with various mental health organizations. She specializes in trauma treatment/resolution, body-based psychotherapy, art therapy, anxiety, and LGBTQ+ concerns. She is an artist, interested in inspiring others to connect more deeply with their authenticity and resilience.

 

Tips on getting the most out of counseling...

Licensed therapists go to school for many years to learn how to best support people in counseling, but clients don't always know what to expect or how to best use their therapists.  I've included some helpful suggestions and questions to ask to maximize benefits of therapy.

  • Be open and honest about your thoughts, feelings, behaviors, and desires

  • It's normal to feel anxious about first meeting a therapist, give yourself a few sessions to settle in and feel more comfortable

  • Look up your therapist's credentials- what education or training do they have? In Colorado, people can be a registered psychotherapist with minimal education or life experience, check out what kind of training or experience your therapist has working with folks like you

  • Practice skills and/or concepts between sessions and talk about how this was for you

  • Have some goals & ideas of where you would like to go, but be open to detouring

  • Focus on Process Goals (your own actions, behaviors, and feelings- things you can control that will get you closer to where you want to be)

  • Prioritize Therapy: the benefits are directly related to how much work you put into it

  • Be gentle with yourself (allow yourself to make mistakes/ask for help)

  • Minimize venting: try to focus on yourself and "I" statements

  • Bring up any concerns you may have related to differences (race, sexual orientation, ethnicity, gender identity, religion, spirituality, national origin, disability, age, socio-economic status, etc.)

  • If you think your therapist missed something or said something you do not like, ask about it!

  • Notice how you feel with your therapists, it's okay to feel challenged or uncomfortable- though you should also feel respected and supported

  • Re-assess the relationship every few months and check in with your therapist if things aren't working or you are thinking of ending

  • If you are angry or appreciative of your therapist, practice telling them!

  • Schedule at a time where you are not rushed (allow 10-15 minutes to yourself before & after sessions to write/integrate)

  • Bring a journal and write notes during session

  • Talk to supportive people about your therapy (have boundaries, but share with people who want to see you succeed & grow; avoid talking to people who minimize your therapy work or are enabling of old patterns you want to change)

  • Ask Questions!

Sometimes we get stuck alone in our head....

Let your therapist know what is going on inside!