I am an alumnus of Stoneman Douglas High School and am highly trained in the field of trauma and PTSD. As we approach the 1 year anniversary of this inconceivable event, I want to share as much information as I can to help a community that I am deeply connected to prepare emotionally over the next several weeks. I’ve compiled the most frequently asked topics from parents and teenagers I’ve worked with to create this four part Trauma Series. I hope this information is helpful as we enter this next phase of recovery. If you are looking for Part 1 of the series you can find it here.
What is PTSD?
PTSD used to be classified under the group called Anxiety Disorders however in the latest revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) PTSD was moved into a category called trauma and stress related disorders. The main reason for this move is that PTSD often presents with symptoms that are non-anxiety related (dissociation, anger and self-harm). Surprising isn’t it? Perhaps it’ll be helpful to discuss what PTSD is not so we can gain a better picture of what PTSD is.
- Having anxiety in public places is not PTSD
- Having to look for exits in theaters or restaurants is not PTSD
- Having nightmares about a traumatic experience is not PTSD
- Never wanting to go back to a place of a traumatic experience is not PTSD
- Experiencing high levels of stress is not PTSD
These examples on their own accord do not indicate a presence of PTSD. As we discussed in Part 1 of the series, these symptoms are quite normal to experience for a period of time after a traumatic event. In fact, most people who experience a traumatic event won’t develop PTSD or any other mental health disorder.
Approx. 70% of the population will experience a traumatic event and only 20% of those people will develop PTSD.
In order to meet criteria for PTSD there are 8 categories that must have at least one symptom present in each category. The four main symptom groups include:
- Intrusion Symptoms: The traumatic event is persistently re-experienced in one or more of the following ways:
- Recurrent, involuntary, and intrusive memories
- Traumatic nightmares or upsetting dreams with content related to the event
- Dissociative reactions, such as flashbacks, in which it feels like the experience is happening again
- Intense or prolonged distress after exposure to traumatic reminders,
- Marked physiological reactivity, such as increased heart rate, after exposure to traumatic reminders
- Avoidance: Persistent effortful avoidance of distressing trauma-related reminders after the event as evidenced by one or both of the following:
- Avoidance of trauma-related thoughts or feelings,
- Avoidance of trauma-related external reminders, such as people, places, conversations, activities, objects, or situations.
- Negative Alterations in Mood: Negative alterations in cognition and mood that began or worsened after the traumatic event as evidenced by two or more of the following:
- Inability to recall key features of the traumatic event
- Persistent, and often distorted negative beliefs and expectations about oneself or the world, such as “I am bad,” or “The world is completely dangerous.”
- Persistent distorted blame of self or others for causing the traumatic event or for the resulting consequences.
- Persistent negative emotions, including fear, horror, anger, guilt, or shame.
- Markedly diminished interest in activities that used to be enjoyable.
- Feeling alienated, detached or estranged from others.
- Persistent inability to experience positive emotions, such as happiness, love, and joy.
- Alterations in Arousal and Reactivity: Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event, including two or more of the following:
- Irritable or aggressive behavior
- Self-destructive or reckless behavior
- Feeling constantly “on guard” or like danger is lurking around every corner (hypervigilance)
- Exaggerated startle response
- Problems in concentration
- Sleep disturbance
Criterions F, G and H explain that these symptoms must be experienced for more than one month, must be interfering significantly with school/work/family/friends and cannot be explained by some other illness such as substance abuse or from medication.
Is it PTSD or Acute Stress Disorder?
The symptomology between PTSD and Acute Stress Disorder is basically the same. The distinction between the two comes down to when symptoms present themselves and how long they last. Acute Stress Disorder occurs very quickly after experiencing a traumatic event and can be diagnosed with only a few days of experiencing symptoms. PTSD requires a longer duration of experiencing symptoms (over a month) and can develop months after a traumatic experience. It’s important to note that not all cases of Acute Stress Disorder will develop into PTSD and not all PTSD cases will have a previous diagnosis of Acute Stress Disorder. However, early intervention at the sign of symptoms can prevent either one of these disorders from manifesting into a chronic problem.
When depression, anxiety and self-harm behaviors develop in addition to “classic” PTSD symptoms, this is considered Complex Trauma. Although many individuals who suffer with PTSD experience these symptoms, they are not included in the diagnostic criteria for PTSD which has been a source of controversy between mental health professionals.
Now that we’ve got a solid foundation for PTSD and what to expect after trauma exposure, keep an eye out for Part 3 of the trauma series where we will be discussing strategies to cope with life post trauma.
Some people recover from traumatic experiences on their own; others need help learning how. If it has been over a month and your symptoms have not improved or are getting worse, a mental health professional can help you get an evaluation and learn ways to cope. Vitality Counseling & Wellness offers telehealth sessions throughout North Carolina and Florida — book a free 15-minute consultation.
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline).