By Mike Pond, special to the sun
August 19, 2013
Not so long ago when we talked about Post Traumatic Stress Disorder (PTSD), we meant someone suffered extreme trauma, like war vets.
Now the diagnosis seems pervasive in our culture, affecting everyone from actress Amanda Bynes to former female RCMP officers. And before anyone rolls their eyes derisively, according to the updated criteria for the illness in the new DSM 5, the bible of psychiatry, it’s very likely the diagnosis is correct.
I treat a lot of First Nations people for addictions, depression, anxiety and aggression. But the deeper we get into the therapy, the more they reveal the extent of the horror they experienced in residential schools, the more obvious it is to me my clients actually suffer from PTSD, and all the other problems are symptoms of it.
PTSD was finally added to the DSM in 1980 by the American Psychiatric Association in response to the many Vietnam War vets who just couldn’t hold it together. PTSD is a unique disorder because it’s identified not only by its symptoms but also must have a precursor: the traumatic event.
What is PTSD? A person must have witnessed or experienced a traumatic event that caused adverse psychological responses that continue long after the event, things like war, a tsunami or a mass shooting. But we have come to realize everyone has a different trauma threshold. What is “debilitating” for one person, may not register as deeply on another. How we deal with trauma depends on how we’re wired, both cognitively and emotionally. For instance, it’s now known that one in four people who have a stroke suffer from PTSD. The stroke is the traumatic event.
The DSM-5 now explicitly adds sexual assault as a traumatic event, which is mind-boggling to me that it wasn’t specified before. It also added a “preschool” sub-type, which means it can be diagnosed in very young children. To make an accurate diagnosis of PTSD, patients must meet five criteria:
• Exposed directly or indirectly to: death, threatened death, actual or threatened severe injury, or actual or threatened sexual violence.• The traumatic event is re-experienced in at least one of the following ways: Intrusive memories. Nightmares. Flashbacks. Intense or prolonged distress after exposure to traumatic reminders.
• Avoidance of distressing trauma-related stimuli after the event.
• Distorted negative thoughts or feelings. Blames self or others. Inability to recall key features of the traumatic event. Is overwhelmed by fear, horror, anger, guilt or shame. Feels alienated from others and has trouble expressing positive emotions.
• Heightened arousal response. Reacting all out of proportion to events being irritable or aggressive, reckless and self-destructive, poor concentration and sleep. Actual physical reactions similar to panic attacks.
Last week, I was a visiting therapist at a remote First Nations band. The community was in mourning because a prominent band member had died. She’d testified at her Indian Residential School hearing, went back to drinking and drugs and sadly took her own life. This is PTSD at work.
Almost on third of those diagnosed with PTSD attempt suicide. It’s time we took this disorder much more seriously.
Michael Pond is a Vancouver psychotherapist and a recovered alcoholic. See michaelpond.ca.
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