Reading for one of my trauma classes. I’m not summarizing the whole thing, just bits I found especially interesting.

Chapter One: Clinical Features of PTSD. Nothing new here.

Chapter Two: Cognitive and Behavioral Features of PTSD.

Amnesia. People rarely have global amnesia for traumatic events (not even knowing it happened or having no memories of any of it), unless they also had a head injury or other physical damage (ETA: or are children, or there were a whole series of similar events, of which only some are remembered. What doesn't happen often: a sober adult has something horrible happen to them, and later does not even recall that it ever happened.) But partial amnesia is extremely common. A typical example is “weapon focus,” in which a person might recall every detail of the gun but nothing about the attacker’s face.

Taylor suggests that this is caused by “attentional narrowing,” which is a common result of extreme arousal. The apparent amnesia is caused by hyperfocus on certain details and total ignoring of others, so the ignored details were never encoded into memory at all. (As opposed to being forgotten or being present but inaccessible.)

My note: be upfront with people about this – they may never be able to recall everything, and that’s okay. Total recall is not necessary to healing.

Guilt. Trauma survivors tend to have a number of incorrect beliefs about the trauma which cause them a lot of pain and suffering. Helping them identify and argue with these beliefs can be very helpful. Great breakdown of common false beliefs on p. 34-35. I’ll just list a few.

- Hindsight bias. “I should have (magically) known the drink was roofied.”

- Justification distortion. “What I did/did not do during the trauma was unjustified.”

- Responsibility distortion. “It was entirely my fault.”

- Wrongdoing distortion. “What I did during the trauma went against my morals and ethics.”

These come about for the following reasons (I only excerpt a few); unraveling them and making them explicit may be very helpful.

- Judging your actions not based on the reality of the situation, but against an ideal or fantasy that didn’t actually exist. “I should have disarmed and kicked the asses of the men who were holding me at gunpoint.”

- Blaming yourself for not acting on ideas you didn’t get until after the fact. “I should have memorized the license plate.”

- Overlooking actual benefits of actual actions. (ie, you got out alive, possibly because of what you actually did.)

- Focusing only on imaginary good outcomes of actions you didn’t take. “If I’d tried to disarm him, I definitely would have succeeded.”

- Not taking into account that when all options are bad, selecting the least bad is a highly moral choice.

- Not taking time and emotional factors into consideration – what you’d do if you had an hour to contemplate it in the peace of your own living room is different from what you do when you have seconds and a gun to your head.

Beliefs about Symptoms

- People with PTSD often think their symptoms mean they’re “going crazy.”

- They tend to interpret emotions or physiological responses as objective truth. “My heart is pounding and I’m frightened, therefore the situation is dangerous.”

- Physical/emotional arousal has become so entwined with negative feelings that they may avoid all arousal, including that caused by exercise or positive feelings. (Anxiety sensitivity.) Interoceptive exposure (inducing arousal in a safe, controlled manner) is good for this.

Clinician's Guide to PTSD: A Cognitive-Behavioral Approach

My paper for one of my trauma classes is copied below, on the question of including CPTSD (complex PTSD) in the DSM-V . It's 4 pages long, and as per the assignment, summarizes the arguments in a set of papers I read, then describes my own proposal. Quote marks used here as LJ doesn't support block quotes. Also, apologies for the alphabet soup.

( Read more... )

I'm writing a paper on PTSD and combat-related berserk states as depicted in pre-1650 sources and comparing it to the current understanding of both. Ideally, I will be able to reference substance/alcohol use and abuse in relation to this.

Can you recommend me some sources to check out? I am definitely going to be using Shakespeare's Henry V, Part I. I have already thought of Macbeth (possible PTSD), and The Iliad and The Mahabharata (berserk states). Nonfiction is also fine.

NOTE: No Civil War memoirs! I'm trying to find sources from before PTSD was really conceptualized as such, and it had been conceptualized as "soldier's heart" by then.

This is about triggers in the technical sense, of the "cues" mentioned by the DSM-IV in its criteria for PTSD: "intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event."

I have a much more detailed explanation of triggers here. (Warning: uh, triggery in that it contains descriptions of PTSD and abuse.)

In LJ/DW culture, people often use "trigger" in a much more colloquial sense, to mean "a thing which is upsetting/disturbing/unpleasant." But in the technical, trauma-related sense, this is what a trigger is:

Triggers are not merely upsetting in general. They are things which bring back memories or feelings associated with trauma.

Triggers are highly, highly idiosyncratic. (There are exceptions to this, which I'll get into in a moment.) They don't have to directly relate to the general nature of the trauma. In fact, they are at least as likely to relate to some random thing associated with the trauma, not with the nature of the trauma itself.

For instance, a person who was raped in a car would be at least as likely to be triggered by hearing the song which happened to be playing on the radio during the rape, or by the feel of a vinyl car seat, as she would be by fictional depictions of rape, discussions of rape, or the word "rape." (Some people, of course, do end up triggered by all fictional depictions of rape, etc. I'm just saying, not all people, not always.)

I suspect that the reason for this is that "rape" is a very general thing. But a specific trauma is specific. A fictional rape may bear very little resemblance to one's real rape, and so not touch off any specific memories. But the song, the vinyl seats, the smell of the man's cologne, and so forth, are real things which get burned into the very cells of one's brain, and the fibers of one's nervous system. They may bring up reactions which happen before you even know why you're reacting.

ETA: Forgot about the exceptions to the "idiosyncratic" thing. There's two big categories of those:

1. Most people whose traumatic reactions reach the level of diagnosable PTSD will be physically triggered by sudden loud noises and unexpected touch. It has to do with how our nervous systems are wired. Those things are inherently startling, and if your startle reflex is cranked up past a certain point, inherently startling things will provoke the same level of physiological/emotional reaction people normally have when, say, someone suddenly leaps out of a dark alley and sticks a gun in their face.

2. When similar sorts of traumatic things happened at the same time, in the same space, to large groups of people, you can take a pretty good guess at what triggers will affect many or most of them simply by looking at notable features of the trauma or the area in which it took place. For instance, some insensitive landscape designer stuck a bamboo grove on the grounds of the Veteran's Administration. Unsurprisingly, you can tell who the Vietnam vets are by which ones are taking a very wide path around the bamboo. In the unlikely event that burning papers start fluttering down from the sky, the people who have very strong reactions are probably the ones who were present in New York during 9/11.

End ETA.

People often warn me about fictional depictions of child abuse. I am not triggered by that, or by fictional anything. I was tied up and abused. I'm not bothered by rope bondage in fiction. (Feel free to rec me rope bondage in fiction!) But I did have something trigger me yesterday, and I'm writing it up because it was such a great example of how triggers actually work - and can be dealt with.

( Cut for length; also, kind of navel-gazey. )