Wednesday, 12 November 2014

Full blown or sub-threshold Post Traumatic Stress Disorder?

PTSD stands for Post Traumatic Stress Disorder.

One of my former colleagues, Joy Griffiths, was on ITV Good Morning today. She shared the sofa with a couple of therapists who had helped a woman with severe symptoms of PTSD, which they were able to eliminate very quickly. I wanted Joy to be able to say so much more than she could in the allowed time.

I am not going to reinvent the wheel when Chapter 11 in the book says all I want to say. I will 'cut and paste' the beginning here. Two points first.

1. I would like to mention PTSD Resolution. Free help for former armed service personnel, reservists and their families.  If you know anyone from these categories who needs help, please get in touch with this wonderful charitable organisation. 

2. The therapists mentioned that the woman who they helped, wanted help and was ready to do what was necessary. This is a most important point. You cannot make people accept help. They will be more receptive when they are ready. Sometimes, they have to go a long way down, before they are ready the climb back up. Sometimes there is too much to give up getting better eg: attention and money. It may sound strange, but it's true. There's more about Secondary Gain in Chapter 17.

From 'Are you Chasing Rainbows?'
Chapter 11 "I'm frightened."


It is my belief that this chapter informs all the other chapters. Fear is what is at the root of ‘chasing rainbows’ behaviour.
I believe that some adults experience a sense of fear of ‘not being good enough’ in certain areas of their life. The root of the fear lies in childhood, when they were first able to feel that they were not good enough in some way. It may result from something actual or something perceived; there was a level of trauma associated with the experience or experiences, and the brain still has the ability to switch on the fear alarm.
“I’m frightened” is a perfectly normal and healthy reaction to a situation where we feel under threat. We experience a feeling of fear: it could come suddenly or creep up more slowly. Our bodies may show psychological changes, including breathing increasingly rapidly, a heart rate increase and a feeling of nausea. Our bodies are responding normally and telling us to take action using one of the most primitive resources we have: the flight, flight or freeze response.

Post-traumatic stress disorder
Many people have heard of post-traumatic stress disorder (PTSD) – it is mostly spoken of and written about in relation to the armed forces, but it can affect anyone, and few will know the diagnostic criteria. PTSD is the development of characteristic and persistent symptoms, along with difficulty functioning, after exposure to a life or integrity-threatening experience, or an event that either involves a threat to life, integrity or serious injury. In some cases the symptoms of PTSD disappear with time, as the brain processes or files the memories in another part of the brain, whereas in other cases they persist for many years. Why this happens has a great deal to do with the person getting other needs met healthily.
The following is an accepted description of PTSD. The symptoms can arise suddenly, gradually or come and go over time. Sometimes symptoms appear seemingly out of the blue; at other times, they are triggered by something that reminds the person of the original traumatic event, such as a noise, image, certain words or a smell. While everyone experiences PTSD differently, there are three main types of symptoms. These are required for the diagnosis of PTSD, and may be divided into clusters of symptoms: they should be present for at least one month.
1. Re-experiencing the traumatic event:
  • Intrusive, upsetting memories of the event.
  • Flashbacks – acting or feeling like the event is
    happening again.
  • Nightmares – either of the event, or of other frightening
  • Feelings of intense distress when reminded of the
  • Intense physical reactions to reminders of the event
    – for example, a pounding heart, rapid breathing, nausea, muscle tension, sweating.
2. Avoidance and emotional numbing:
  • Avoiding activities, places, thoughts or feelings that remind the person of the trauma.
  • Inability to remember important aspects of the trauma.
  • Loss of interest in activities and life in general.
  • Feeling detached from others and emotionally numb.
  • Sense of a limited future – for example, not expecting
    to live a normal life span, get married, have a career. 3. Increased arousal:
  • Difficulty falling or staying asleep.
  • Irritability or outbursts of anger.
  • Difficulty concentrating.
  • Hypervigilance – feeling on constant ’red alert’.
  • Feeling jumpy and easily startled.
    Other common symptoms of PTSD are:
  • anger and irritability
  • guilt, shame or self-blame
  • substance abuse
  • depression and hopelessness
  • suicidal thoughts and feelings
  • feeling alienated and alone
  • feelings of mistrust and betrayal
  • headaches, stomach problems, chest pain
    PTSD is a major psychological illness. It causes a great deal of distress to the person experiencing it and their family – especially if it has not been diagnosed, which often happens with personnel from the armed forces and the emergency services.
    The list of symptoms and behaviour make interesting reading. While full-blown PTSD is dramatic and obvious, what about a milder form of the symptoms, something that could be called ‘low-level PTSD’, ‘sub-threshold PTSD’ or ‘frozen trauma’? It appeared to me that over the years of helping and supporting people, I was observing people who showed various degrees of reactions to trauma. It could be 100% PTSD developed from exposure to a very frightening or threatening event, or similar symptoms arising from a lower level of exposure to something that the person found frightening. It may have been real or perceived. Following this train of thought, I wondered if some of the behaviour that I was observing was in fact that of a traumatised child. If obvious symptoms of PTSD can go unrecognised in adults, then how much more difficult would it be to recognise a frightened mini-me taking over an adult’s brain?
Extreme fear is the common emotion
If PTSD can go unrecognised and undiagnosed, then what about one of the symptoms – panic attacks? They can be misdiagnosed as a symptom of physical ill-health rather than emotional imbalance. A GP, Suzanne, came to see me with recognisable symptoms of PTSD, but she was undergoing investigations for a heart problem. This is not uncommon. I mentioned to Suzanne that I was aware of many people with misdiagnosed and unrecognised panic attacks, and why weren’t doctors able to diagnose them? She told me that if patients were told their symptoms were panic attacks, then there might be a possibility of missing a heart problem.
If you have ever experienced PTSD or known someone that does, the diagnostic criteria listed above may be familiar to you. However, look at the criteria again and think about a behaviour that you may have. Maybe a phobia? Maybe an overreaction to something or somebody? Perhaps an avoidance behaviour of some sort? You are unlikely to be experiencing full-blown PTSD, but what about a ‘low-level trauma’, a ‘sub-threshold trauma’ or ‘frozen trauma’? 


Thursday, 6 November 2014

Small changes can make big differences.

This is the October Wellbeing Column from the York Press.

The clocks are going back an hour, the leaves are falling and we are wearing warmer clothing. A time of change.

There is a well known song written by Pete Seegar from the 1950/60s called, ‘Turn, Turn, Turn’.  What is not so well known is that it’s almost word for word from the Bible. Ecclesiastes 3 v 1-8.

To every thing there is a season, and a time to every purpose under the heaven:
A time to be born, and a time to die; a time to plant, a time to reap that which is planted;
A time to kill, and a time to heal; a time to break down, and a time to build up;
A time to weep, and a time to laugh; a time to mourn, and a time to dance;
A time to cast away stones, and a time to gather stones together;
A time to embrace, and a time to refrain from embracing;
A time to get, and a time to lose; a time to keep, and a time to cast away;
A time to rend, and a time to sew; a time to keep silence, and a time to speak;
A time to love, and a time to hate; a time of war, and a time of peace.

The words help us to understand that change is a given and all around us. We can all become frustrated when shops change their layouts, but most of us are able to get used to it fairly quickly. The brain adapts. It’s the same in our own homes, cars and workplaces. Change happens and we adapt. 

If we don’t change, we won’t grow. Emotionally, if we remain responding to life as a child in an adult’s body, we will be unhappy and make others unhappy too.

I was giving a talk on change and used our shoe size as an illustration. I suggested that it would be odd, if as an adult, we had one foot wearing an shoe in an adult size, but the other foot was still wearing a child’s shoe. A man in the audience had a ‘light bulb’ moment. “Oh, my goodness, I’ve been emotionally limping through my life.”  Someone else pointed out that there’s expression, ‘Act your age, not your shoe size!’

Change can be exciting, but often we’re held back by fear of change and the fear of the unknown. We’re comfortable in what we know, our routine and our surroundings, even if truthfully there is discomfort, even danger, in remaining as we are, where we are.

Some changes are huge, but there is a good deal of truth in, ‘small changes can make big differences.’ Can you start today?

Turn, turn, turn.