Monthly Archives: September 2014

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ptsd

Introduction to Flashbacks, Nightmares, etc.

An Introduction to Flashbacks, Nightmares, and Intrusive Memories

The next few weeks I’ll focus on another symptom group, Intrusive Symptoms, also called Re-experiencing. These are the prototype symptoms of PTSD and include nightmares, flashbacks, and intrusive memories.
The difference between a flashback and an intrusive memory is simple. In a flashback you’re actually reliving the memory, which means you’ve lost awareness of your current situation. This type of symptom is called DISSOCIATION and is more frequently seen in younger people.
With intrusive memories, you know where and when you are, but the memories keep intruding in your mind.
You may also experience severe emotional or physical distress without the actual memory attached. This often leads to misdiagnosis, as it looks more like an anxiety attack or episode of acute pain.
That said, all of these are examples of traumatic memories that have resurfaced and are seriously interfering with your life, both awake and asleep.

What are Traumatic Memories?

Traumatic memories are not the same as normal memories. In normal life, your brain lays down a sequential memory track, kind of like a video but with all the senses. But in a truly terrifying situation, the brain regresses to more primitive functioning and grabs sequential snapshots, usually combined with very strong emotions, which it then isolates from your normal memory. I think of a traumatic memory as an emotional abscess, which your brain then walls off in order to protect you.
Traumatic memories are very potent. They contain a lot of negative emotions like terror, rage, shame, and despair, which makes flashbacks and nightmares emotionally overwhelming and disturbing.
Trauma memories don’t deteriorate with time. Our normal memories diminish or even get lost through the years, but if you activate a traumatic memory 50 years later, it recurs with all the same emotional intensity it held when it just happened.
Why do our brains do this? I can only assume this serves some life-preserving function. If you survive the first event, you can draw on this experience and repeat it whenever a similarly dangerous situation occurs. After all, you survived the first time.

Why do you revisit a Traumatic Memory?

Reminders of the trauma, or Triggers, can evoke the release of traumatic memories. Triggers are everywhere. They can be anything your mind sees as similar to the situation where you were traumatized. They cause your brain to retrieve the trauma memory in a “flash”Fireworks:triggers
Common triggers include:
Environment: heat, cold, rain, storm, etc.
Senses: smell, hearing, seeing, feeling, pain
Thoughts: about self, about the past, about a similar situation
Emotions: fear, anger, distress, disgust, guilt, shame
Media: news or movies about a similar situation
People associated with the trauma.

Your trigger may be as simple as a smell, a sound, a name, or the temperature outside. It may be a scene in a TV show, or a subject of conversation over dinner. In fact, we all do this with good memories, hear a song or smell a food that reminds us of a pleasant occurrence in our past.
With traumatic memories, it’s good to learn and keep a list of your own triggers. That can help you to anticipate problems and understand what’s happening when re-experiencing occurs. If you live around someone with PTSD, it’s good to know his or her triggers. That way you won’t unintentionally hurt them. Two-way communication about triggers can be helpful to both parties.

Treating Intrusive Memories:

There are no medications that safely control the re-experiencing of traumatic memories. The treatment approaches that work best all have the same goal:
1) Detoxify the memory
2) Integrate it into the normal memory flow.
To accomplish this feat, you have to work in layers, kind of like peeling off an onion.

Detoxifying means reducing the intensity of affect and pain associated with the memory. It’s a little like letting the pus out of an abscess and significantly reduces the discomfort. There are many approaches to this “letting go” process, and I’ll give more detail in the next blog.
With less affect in the way, you’re better able to examine the memory in detail, including your feelings, physical sensations, and beliefs about its cause, intent, and long-term consequences of the trauma.
This process—detoxifying and reexamining the memory—has to be repeated over and over. (Remember the onion) Each time you work on it, you will make more progress until it can be safely integrated.

Next blog I’ll discuss specific treatment approaches for intrusive symptoms.

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Do You Have PTSD?

Every successful treatment begins with a correct diagnosis. The VA diagnoses PTSD according to DSM V, the psychiatrist’s diagnostic manual. You have to meet ten criteria to be diagnosed by the VA and included in one of their treatment programs. Private therapists and psychiatrists will often treat clients who do not meet all ten, but most folks I’ve treated met those and more!

First, you must have suffered a Traumatic Event. DSM V defines this as: Exposure to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in one of the following ways:
1) Direct exposure.
2) Witnessing, in person.
3) Indirectly, by learning that a close relative or close friend was exposed to trauma. If the event involved actual or threatened death, it must have been violent or accidental.
4) Repeated or extreme indirect exposure to aversive details of the events), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). This does not include indirect non-professional exposure through electronic media, television, movies, or pictures.

Second, you must have Intrusive Symptoms such as one of the following:
1) Recurrent, involuntary, and intrusive memories.
2) Traumatic nightmares.
3) Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness.
4) Intense or prolonged (emotional) distress after exposure to traumatic reminders.
5) Marked physiologic reactivity (physical distress) after exposure to trauma-related stimuli.

Third, you must have one symptom of Avoidance defined as:
Persistent, effortful avoidance of distressing trauma-related stimuli after the event, such as:
1) Trauma-related thoughts or feelings.
2) Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations).

Fourth and Fifth, you must have an increase in Negative Moods and Cognitions (thoughts) after the trauma:  You need two of the following:
1) Inability to recall key features of the traumatic event (usually a dissociative amnesia; not due to head injury, alcohol, or drugs).
2) Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., “I am bad,” “The world is completely dangerous”).
3) Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences.
4) Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt, or shame).
5) Markedly diminished interest in (pre-traumatic) significant activities.
6) Feeling alienated from others (e.g., detachment or estrangement).
7) Constricted affect: persistent inability to experience positive emotions.

Sixth and Seventh, you must have a marked increase in Arousal and Reactivity following the trauma. Two of the following are required:
1) Irritable or aggressive behavior
2) Self-destructive or reckless behavior
3) Hyper vigilance
4) Exaggerated startle response
5) Problems in concentration
6) Sleep disturbance

Eighth: You’ve had this disturbance for at least a month.

Ninth: Your symptoms are severe enough to interfere with daily functioning.

Tenth: Your symptoms are NOT due to another illness, injury, or substance abuse.

Bottom Line:

Proper diagnosis is important. PTSD is often misdiagnosed as an anxiety disorder, panic disorder, depressive disorder, personality disorder, sleep disorder, or substance abuse disorder. But treatments for those diagnoses will prove inadequate if you actually have PTSD.

So what treatments work? During the next few months, I’ll go over each of the symptom groups in detail including the physiology behind the symptoms. Then I’ll discuss both established and experimental treatment options, other problems associated with PTSD, and some related diagnoses.

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PTSD UPDATE

Welcome to PTSD UPDATE, a new blog dedicated to providing information about PTSD.

WHAT IS Post Traumatic Stress Disorder?

1) Stress is a normal reaction to a terrifying situation.
2) PTSD is a prolonged reaction to severe, prolonged, or repetitive stress.
3) Stress activates the sympathetic nervous system, which leads to the release of stress chemicals.
3) Prolonged exposure to stress chemicals can actually injure the brain.
4) But these wounds can heal.
5) PTSD can be both treated and prevented.

PTSD is a diagnosis I have struggled with most of my life. So learning how to treat it was a personal quest. In my books, Saving Superman and Attack from Within, I’ve tried to share secrets that I’ve learned and show that PTSD is not something you need to feel ashamed of or fear.
Stress is a normal reaction to a terrifying situation, but prolonged or repeated stress can lead to PTSD. It is a silent and invisible wound caused by excessive stress chemicals.
Our body reacts to trauma by activating the sympathetic nervous system, our fight or flight response. That system reacts by releasing adrenaline and glucocorticoids. These chemicals help us survive in dangerous situations, but prolonged exposure to them can actually cause damage to both your body and your brain.
The areas of the brain that process memory (hippocampus), speech (Broca’s area), and control emotions (Amygdala and prefrontal cortex) are most frequently involved. In PTSD the hippocampus actually shrinks, making it more difficult to lay down normal memory. The speech area also loses cells. On the other end, the Amygdala, which ignites emotions like rage and terror, grows in size while the prefrontal cortex, which calms the amygdala, shows impaired chemistry.
But like all wounds, the brain can heal, especially if it’s treated early on. I was taught years ago that nerve cells could not regenerate, but science has shown that our brains produce new cells, especially in the hippocampus, the memory center of our brain. So we can heal from PTSD. We now have medications that block the sympathetic nervous system, reduce the toxic chemicals, and can actually prevent PTSD. Other medications, most antidepressants, activate the prefrontal cortex so it can calm the amygdala and reduce your rage and panic.
Bottom line: PTSD is both treatable and preventable, but like all wounds it heals best if it’s treated early on. The longer you wait, the more permanent the scars.

My next post will address: How do you know if you have PTSD???

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