# How do you know it's PTSD?
**URL:** https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347
**Category:** In My Humble Opinion
**Created:** [March 30, 2009, 8:35pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347 "2009-03-30T20:35:08Z")
**Posts on this page:** 20
**Page:** 1
### Author:  [@Kalhoun](https://boards.straightdope.com/u/Kalhoun)
#### Post date: [March 30, 2009, 8:35pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/1 "2009-03-30T20:35:08Z")
What are the identifying markers of this disorder? How do you know it’s PTSD and not something else? Can a person recover without treatment?
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### Author:  [@The\_Devil\_s\_Grandmother](https://boards.straightdope.com/u/The_Devil_s_Grandmother)
#### Post date: [March 30, 2009, 9:02pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/2 "2009-03-30T21:02:05Z")
The Mayo Clinic has [a list of symptoms](http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246/DSECTION=symptoms) and seems (to me) to imply that while \*some \*people who have healthy coping methods might get better on their own, [most people need help](http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246). They also have some [advice on when to seek help](http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246/DSECTION=when-to-seek-medical-advice).
I have no experience with it personally, but I do not know anyone who was diagnosed with PTSD and then got better on their own.
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### Author:  [@Reply](https://boards.straightdope.com/u/Reply)
#### Post date: [March 30, 2009, 9:13pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/3 "2009-03-30T21:13:50Z")
IANAP and someone more knowledgeable will come along soon. In the meantime, this might be interesting:
> [@](#):
>
> From: [BehaveNet: Posttraumatic Stress Disorder Diagnostic Criteria according to the Diagnostic and Statistical Manual of Mental Disorders](http://www.behavenet.com/capsules/disorders/ptsd.htm)
> **Diagnostic criteria for 309.81 Posttraumatic Stress Disorder**
> [list=A][li] The person has been exposed to a traumatic event in which both of the following were present: [/li] [ol]
> [li] the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others [/li] [li] the person’s response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior [/li][/ol]
> [li] The traumatic event is persistently reexperienced in one (or more) of the following ways: [/li][ol]
> [li] recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. [/li] [li] recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content. [/li] [li] acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur. [/li] [li] intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event [/li] [li] physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event [/li][/ol]
> [li] Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following: [/li][ol]
> [li] efforts to avoid thoughts, feelings, or conversations associated with the trauma [/li] [li] efforts to avoid activities, places, or people that arouse recollections of the trauma [/li] [li] inability to recall an important aspect of the trauma [/li] [li] markedly diminished interest or participation in significant activities [/li] [li] feeling of detachment or estrangement from others [/li] [li] restricted range of affect (e.g., unable to have loving feelings) [/li] [li] sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span) [/li][/ol]
> [li] Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following: [/li][ol]
> [li] difficulty falling or staying asleep [/li] [li] irritability or outbursts of anger [/li] [li] difficulty concentrating [/li] [li] hypervigilance[/li] [li] exaggerated startle response [/li][/ol]
> [li] Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month. [/li]
> [li] The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.[/li][/list]
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### Author:  [@Kalhoun](https://boards.straightdope.com/u/Kalhoun)
#### Post date: [March 30, 2009, 9:32pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/4 "2009-03-30T21:32:34Z")
Thanks for those links, **Devil’s Gram** and **Reply**. I know someone who exhibits some of these traits, but who tends to minimize (or at least not vocalize) the impact of the trauma. Playing down the impact doesn’t show up on the list, but it sure seems like a protective mechanism, akin to avoidance.
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### Author:  [@Reply](https://boards.straightdope.com/u/Reply)
#### Post date: [March 30, 2009, 9:35pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/5 "2009-03-30T21:35:01Z")
> [@Kalhoun](#):
>
> Thanks for those links, **Devil’s Gram** and **Reply**. I know someone who exhibits some of these traits, but who tends to minimize (or at least not vocalize) the impact of the trauma. Playing down the impact doesn’t show up on the list, but it sure seems like a protective mechanism, akin to avoidance.
You’d probably want to get a qualified professional to make a diagnosis.
ETA: Oh, and look at C1: efforts to avoid thoughts, feelings, or conversations associated with the trauma. But still, IANAP and if you aren’t either, it’s not smart to randomly guess. A lot of the disorders have similar, vague symptoms.
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### Author:  [@Kalhoun](https://boards.straightdope.com/u/Kalhoun)
#### Post date: [March 30, 2009, 9:39pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/6 "2009-03-30T21:39:46Z")
> [@Reply](#):
>
> You’d probably want to get a qualified professional to make a diagnosis.
>
> ETA: Oh, and look at C1: efforts to avoid thoughts, feelings, or conversations associated with the trauma. But still, IANAP and if you aren’t either, it’s not smart to randomly guess. A lot of the disorders have similar, vague symptoms.
I don’t think this person would want to be diagnosed. Getting by is good enough for them. And infinitely less bothersome than the alternative.
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### Author:  [@The\_Devil\_s\_Grandmother](https://boards.straightdope.com/u/The_Devil_s_Grandmother)
#### Post date: [March 30, 2009, 9:42pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/7 "2009-03-30T21:42:52Z")
Yeah, I know people like that. I hope you can push/lead your friend towards help.
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### Author:  [@Malleus\_Incus\_Stapes](https://boards.straightdope.com/u/Malleus_Incus_Stapes)
#### Post date: [March 30, 2009, 10:11pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/8 "2009-03-30T22:11:29Z")
That’s interesting. My doctor thought I might have PSTD, but looking at the list of symptoms, I’m not sure. I did have a traumatic experience, and I did start experiencing mental issues a few months later, but I haven’t been having flashbacks or anything.
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### Author:  [@The\_Devil\_s\_Grandmother](https://boards.straightdope.com/u/The_Devil_s_Grandmother)
#### Post date: [March 30, 2009, 10:37pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/9 "2009-03-30T22:37:25Z")
Will your insurance let you talk to your doctor some more, **Malleus, Incus, Stapes!**? I’d be curious why s/he thought you might have PSTD. There might be more indicators than they posted on the website.
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### Author:  [@Spice\_Weasel](https://boards.straightdope.com/u/Spice_Weasel)
#### Post date: [March 30, 2009, 11:17pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/10 "2009-03-30T23:17:30Z")
I have lived with a pervasive case of PTSD for nearly a decade. The short answer is that PTSD has high comorbidity with other psych disorders and it’s probably best for a lisenced professional to sort out what’s what. I look forward to participating in this thread more extensively once I’m home.
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### Author:  [@PatriotGrrrl](https://boards.straightdope.com/u/PatriotGrrrl)
#### Post date: [March 30, 2009, 11:21pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/11 "2009-03-30T23:21:16Z")
I think it’s important to point out that the symptoms do not necessarily show up right after the traumatic event, nor are they necessarily continuous. A person can seem to have gotten over whatever it was, and feel ok for years, then suddenly get worse. That happened to a close friend of mine.
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### Author:  [@Spice\_Weasel](https://boards.straightdope.com/u/Spice_Weasel)
#### Post date: [March 31, 2009, 2:31am UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/12 "2009-03-31T02:31:38Z")
IANAD (though some day I should be a certified expert on this shit!) but this is what I’ve gleaned from years of trying to figure myself out via the leading research.
Every trauma survivor deals with the experience in a different way. Most survivors of traumatic events experience at least some symptoms of PTSD in the immediate aftermath of the event, but they go away rather quickly. Only about 14% of trauma survivors actually develop PTSD as described in the DSM-IV. Whether or not the victim develops this disorder is dependent on a number of factors: number of times the traumatic event occurred, severity of traumatic event, whether trauma involved captivity, whether trauma was interpersonal vs. impersonal (i.e. rape vs. earthquake.) Those are all predictive factors, but at best they give a statistical guideline. Some people go to hell and back and suffer little if any ill effects, others may experience one traumatic event and fall to pieces.
PTSD happens because, for whatever reason, the traumatic event wasn’t processed in the same way as narrative memory. It’s not a coherent story in your head, it’s a collection of sensation, visual cues, expressions, phrases, emotions, etc. It’s like someone took an event in your life and bludgeoned it with a sledgehammer until it was scattered into a million pieces. People with PTSD may spend an exorbitant amount of time piecing those experiences into a cohesive narrative. It’s what the eminent Judith Herman calls ‘‘speaking the unspeakable’’ and it appears to have a physical impact on the trauma survivor’s neurology. The idea of the personal narrative is a fundamental part of treatment. Theoretically you can do that on your own.
While oscillation between avoidance and obsession are a common symptom of PTSD, minimizing the impact of a traumatic experience may not it itself be indicative of PTSD… it might be indicative of someone who never developed PTSD and would really like people to shut up already about how he/she is supposed to feel. Not everybody has their life torn apart by trauma. I really think it should be a personal decision. For me, it’s been off and on… I’ve stopped and started treatment at various times depending on what I felt I needed at the time.
Having said that, PTSD has high comorbidity with depression, anxiety, substance abuse, and a number of other psychosocial problems. It’s also worthy of note that PTSD is considered an anxiety disorder itself. As to sorting out what’s attributable to the traumatic event and what’s not, that’s very tricky. It’s especially difficult given no information about the trauma or about the current symptoms you think might be indicating trauma.
I am a survivor of multiple kinds of repeat trauma throughout childhood, which is about as statistically sound as you can get for predicting PTSD. Every doctor I’ve worked with has diagnosed me with PTSD, however I’ve also had multiple comorbid diagnoses at various times depending on whatever my acute symptoms were. The psychologist/psychiatrist I worked with the longest both diagnosed me with Complex-PTSD, Major Depressive Disorder and Anxiety Disorder NOS and since they worked with me for four years I consider those to be the most reliable diagnoses.
The PTSD itself comes and goes. Also because of the number of different traumatic experiences I’ve had it’s hard to say where all of the symptoms come from. Lots of kids are emotionally abused and have low self-esteem as a result. Does the emotional abuse count toward the PTSD? I think the fact that it was often in conjunction with violence makes the answer yes. The other day I was in the kitchen and I dropped a glass. The sucker literally _exploded_ as soon as it hit the floor. I was immediately and instantly affected, not only physically but emotionally as well. I managed to make it over to the couch before my knees gave out, and I sat there practically hyperventilating while my husband cleaned it up. Not only was I trembling from head to toe, I was inundated with thoughts of self-hatred. Breaking glass is probably one of the most familiar sounds of my childhood. THAT was definitely PTSD.
But when I make a snarky post on the Dope and then feel guilty about it to the point that I feel like a horrible person and get extremely depressed, what is that? Is that PTSD or just low self-esteem? Who the hell knows? When I can’t sleep for hours because I can’t stop thinking about grad school and how afraid I am of failure, is that because of the many years I was told what a colossal failure I was destined to be, or is it because I’m about to start grad school and that’s fuckin’ scary for anyone? Or what about the fact that horror movies trigger severe flashbacks and make me nauseated? Is it ONLY PTSD or am I also just an exceptionally empathetic person who can’t stand to see others suffer? Who knows?
So I think the best indicator as to whether it’s PTSD or some other psych issue is to _treat the other psych issue_ and see what you have left. I have treated my anxiety and depression very successfully but I still have PTSD.
Effective treatments for PTSD do exist, but too few mental health practitioners actually use evidence-based methods. Two very promising treatments are EMDR and exposure therapy. There are also narrative and cognitive therapies that show some results. It is almost impossible to find anyone trained to do any of those with trauma survivors. Instead you get talk therapists, who may do all right if you have a very strong collaboration, but aren’t really using any methods proven to work. This is one very strong reason I am considering writing my Master’s thesis or Ph.D. dissertation on evidence-based treatments for PTSD… perhaps particularly on proliferation of training, since that seems to be where we are most lacking.
I’ve had too many therapists say to me, ‘‘Oh, you won’t have PTSD forever.’’
Well, I’ve had it for 10 years. It’s kind of hard for me to believe that. At this point I’ve just sort of accepted it and learned to enjoy life as much as possible, as you would with any other chronic illness.
I guess that’s just as much a vent as it is an answer to your questions. As I said before, the severity of my symptoms come and go, usually depending on how many other stressors there are in my life. Major transition periods are the worst, as are October and November of pretty much every year. I think I am just frustrated, after all the work I have done, with how little things seem to have changed when I am at my worst. One symptom, fixation/obsession, is something I still have a huge problem with, or else I wouldn’t have spent 3 hours writing this post. I do this a lot on the Dope. I have this compelling need to figure it out, as if it’s a puzzle that can be undone with enough thinking. I’m still constantly suffering on some level.
Getting your friend into treatment is no guarantee they will get better, but if you can get them to address the comorbid conditions, I truly believe it will result in a better quality of life, as my quality of life is so much better now that I have learned to cope with the anxiety and depression. If things never get better for me, I’ll still be able to live a healthy and satisfying life. I have found a way to be happy living with PTSD.
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### Author:  [@Reply](https://boards.straightdope.com/u/Reply)
#### Post date: [March 31, 2009, 2:54am UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/13 "2009-03-31T02:54:54Z")
Thanks for sharing that, **olives**. I always look forward to reading what you have to say.
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### Author:  [@Pyper](https://boards.straightdope.com/u/Pyper)
#### Post date: [March 31, 2009, 3:08am UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/14 "2009-03-31T03:08:47Z")
That’s good information, **olives**. I experienced a traumatic event a few years ago, after which I was very fearful and startle-prone. Innocuous sounds associated with the event would cause a spike of fear to go through me. It faded over time, and I am fine now. I think I had some post-traumatic stress, but not the disorder.
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### Author:  [@Kalhoun](https://boards.straightdope.com/u/Kalhoun)
#### Post date: [March 31, 2009, 12:28pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/15 "2009-03-31T12:28:48Z")
Thanks, **Olives**. Based on what you wrote, I tend to think that it’s probably not PTSD, as there are no “triggers” that I’m aware of…it’s more like a constant anger lying just under the surface. There have been periods of substance abuse, violence, and an overblown sense of self at times, but without the triggers, I tend to think it is more of a depression/anxiety thing than PTSD.
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### Author:  [@Malleus\_Incus\_Stapes](https://boards.straightdope.com/u/Malleus_Incus_Stapes)
#### Post date: [March 31, 2009, 2:02pm UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/16 "2009-03-31T14:02:38Z")
> [@The\_Devil\_s\_Grandmother](#):
>
> Will your insurance let you talk to your doctor some more, **Malleus, Incus, Stapes!**? I’d be curious why s/he thought you might have PSTD. There might be more indicators than they posted on the website.
Like I said, I got bitten by a lion, and then a few months later started having diabilitating mental issues. So he figured there was probably some connection.
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### Author:  [@Pyper](https://boards.straightdope.com/u/Pyper)
#### Post date: [April 1, 2009, 3:10am UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/17 "2009-04-01T03:10:29Z")
> [@Malleus\_Incus\_Stapes](#):
>
> Like I said, **I got bitten by a lion,** and then a few months later started having diabilitating mental issues. So he figured there was probably some connection.
You…wait, what?
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### Author:  [@drachillix](https://boards.straightdope.com/u/drachillix)
#### Post date: [April 1, 2009, 3:54am UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/18 "2009-04-01T03:54:35Z")
> [@Malleus\_Incus\_Stapes](#):
>
> Like I said, I got bitten by a lion, and then a few months later started having diabilitating mental issues. So he figured there was probably some connection.
All I can say is :eek:
Glad you’re still here.
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### Author:  [@Spice\_Weasel](https://boards.straightdope.com/u/Spice_Weasel)
#### Post date: [April 1, 2009, 10:03am UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/19 "2009-04-01T10:03:51Z")
> [@Malleus\_Incus\_Stapes](#):
>
> Like I said, I got bitten by a lion, and then a few months later started having diabilitating mental issues. So he figured there was probably some connection.
This may be a really random and weird place to say this, but I have really enjoyed reading your posts throughout the board, and hope you stick around.
Seriously, a _lion_?
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### Author:  [@Kalhoun](https://boards.straightdope.com/u/Kalhoun)
#### Post date: [April 1, 2009, 10:33am UTC](https://boards.straightdope.com/t/how-do-you-know-its-ptsd/491347/20 "2009-04-01T10:33:11Z")
> [@Malleus\_Incus\_Stapes](#):
>
> Like I said, I got bitten by a lion, and then a few months later started having diabilitating mental issues. So he figured there was probably some connection.
I would have thought the same thing. Glad you’re ok! Were you seriously injured?