Types of Posttraumatic Stress Disorder (PTSD.)

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

PTSD.
Photo courtesy of Pixabay.com

Not all trauma and stressor-related disorders are the same.

Most people are familiar with Posttraumatic Stress Disorder (PTSD) the granddaddy of all the trauma and stressor-related disorders.  In addition to PTSD, there are a number of other trauma and stressor-related disorders.  There are two types of attachment disorders, Acute Stress Disorder, a number of varieties of adjustment disorders, and even a category for other specified or unspecified Trauma- and Stressor-Related Disorders that don’t fit these categories of disorders.  For more on these other disorders take a look at these related posts on counselorssoapbox.com

In Posttraumatic Stress Disorder, there are recognized and unrecognized subtypes.

Recognized PTSD subtypes or specifiers.

Two subtypes of PTSD dissociative symptoms are recognized.

Depersonalization.

Depersonalization, that is the experience of feeling like you’re outside of yourself looking in.  You may feel like you’re in a dream or are an outside observer watching yourself.  It may feel as if time is moving more slowly or as if you are not real.

Derealization.

Derealization is the experience of feeling like the world is unreal.  You may feel like you’re in a dream or that things are very distorted and different.

Delayed PTSD.

When someone experiences delayed PTSD we use the specifier “with delayed expression.” Delayed expression occurs when it takes more than six months after the event for the symptoms to become obvious.

PTSD subtypes used with children under six.

There are slightly different criteria used in diagnosing PTSD in children under the age of six.  As a result, we also have two additional subtypes for use with children.  All of the subtypes used with adults can also be applied to children.

PTSD with persistent avoidance of stimuli.

Children with this subtype go to great lengths to avoid anything that would remind them of the original traumatic event.

PTSD’s with negative alterations in cognitions.

Children with this subtype develop all kinds of negative thoughts about themselves and the world.  That may have high levels of fear, shame, and guilt, confusion, and sadness.  They may withdraw from other people and lose their interest in playing.

PTSD unrecognized subtypes.

Complex Trauma.

While not officially recognized in the DSM-5 a good deal has been written about a condition referred to as “complex trauma.”  Both research and practical experience suggest there is some validity to this idea.

This condition occurs when someone is repeatedly traumatized in a very similar way.  Think about somebody who breaks their leg and goes to the hospital.  They have it treated and the leg mends.  If they were to break the same leg again, in the same place, it is less likely to heal a second time.

These types of repeated traumatization are often the result of abuse or domestic violence.  Complex trauma also frequently coexists with substance use disorders or behavioral addictions.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Is it Anxiety, Stress or PTSD?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Stress person

Stress.
Photo courtesy of Pixabay.com

Just how stressed out are you?

Everyone experiences a little stress in their day-to-day life.  Having anxiety in your life is considered just a part of modern life.  But sometimes that stress and anxiety overwhelm people.  The things that get called trauma come in all shapes and sizes.  Many times these traumas resolve in a short period of time.  Traumas that don’t resolve, that hang on for long periods of time and interrupt your daily life, can turn into a serious mental illness such as an anxiety disorder a stress-related disorder or even Posttraumatic Stress Disorder.

If you’re struggling with difficulties, anxieties, stress or even some traumatic events it is helpful to know just what kind of problem you’re dealing with.  Some things will sort themselves out on their own.  Other times anxiety, stress, and trauma need professional help.  Here are some of the problems that you might be experiencing and some thoughts about how to tell the different problems apart.

Stress.

Stress is that reaction the body has to challenges from the environment.  Stress can be small and repeated or large and dramatic.  Even good things can be stressful.  That first day on a new job can be full of stress even when you really want that job.  Many people get sick the first week on a new job.  Weddings or the birth of a baby can be stressful also, even when these have been something you have looked forward to.

Most of the time people have stress and it goes away.  But over time people can accumulate a great deal of stress, and this can result in physical, emotional and mental illnesses.  One very important life skill is learning how to manage and reduce stress.  Take a look at the other posts on counselorssoapbox.com about stress and stress management.

Animals get stressed and so do people.

Humans are not the only creatures to get stressed.  Animals in the wild can have a very stressful life.  Sapolsky wrote a very interesting book called Why Zebras Don’t Get Ulcers.”  The main difference between humans and animals seems to be how they adjust to stress after it has come and gone.  Animals who were stressed returned to a low-stress state very quickly.  Humans get stressed and years later they are still experiencing that stress.  For humans, this accumulation of stress over time can result in chronic illnesses.

Anxiety.

Anxiety is a normal human response.  But when it gets out of control it can become a disease.  If you’re in a dangerous situation, anxiety and even fear can help you stay safe.  If the volume on your anxiety is turned up too high, it can cause you to overreact to many everyday situations.  Sometimes people have what they call anxiety attacks.  For a brief period of time, they feel excessive anxiety but eventually, these anxieties attacks subside.

When this high anxiety continues too long and begins to interfere with your daily life, your job, or your relationships, it is excessive and may be diagnosed as an anxiety disorder.  There are a number of different recognized Anxiety disorders depending on the particular features of your anxiety.

Post-Traumatic Stress Disorder or PTSD.

Post-traumatic Stress Disorder or PTSD is a diagnosable mental illness.  Sometimes in life people experience overwhelming traumatic experiences.  They may witness a violent death, a tornado, hurricane, or other natural disasters.  In these events, the person may fear that they or someone close to them is going to die.

This condition was originally identified in the veterans returning from war zones.  It has since been identified in civilian populations who have been exposed to traumatic events and feared for their lives.

As a result of this trauma, people begin to develop difficulties functioning.  Some people will struggle with these problems for a short period of time, a month or so.  Other people will very quickly return to normal function.  In some cases, as a result of these traumatic experiences, people will continue to have symptoms for years afterward.  These continuing symptoms may be PTSD.

Complex trauma.

Repeated traumatization becomes more difficult to heal from.  There has been a good deal of research and writing about a condition that is sometimes called complex trauma.  While it’s not an official diagnosis, is helpful for many people to think about it this way.  Someone may be able to experience a trauma and recover from it.  If that same person experiences the same trauma repeatedly, each time it becomes more difficult to recover.

If you are struggling with anxiety, stress or PTSD consider getting professional help.

Staying connected with David Joel Miller

Six David Joel Miller Books are available now!

Dark Family Secrets: Some family secrets can be deadly.

What if your family secrets put you in danger?

Letters from the Dead The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead?

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive?

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter.

Support Groups for people with PTSD or Complex Trauma.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Group.
Photo courtesy of Pixabay.com

Anyone know of support groups for people with PTSD?

This question came in from a reader. They were specifically asking about local support groups here in Fresno. I did not come up with much and so I thought I would offer a few suggestions and then ask those of you out there if anyone else knows of any other resources.

Unfortunately, most of my suggestions may not help the person who asked the question, the resources are limited.

1. Try on-line groups.

I am familiar with some groups or communities on the internet. More and more the specialized groups are becoming self-help or peer-run groups on the internet.

One, in particular, is Trauma and Dissociation which is a Google+ community. You have to have a google+ account to access this but opening an account is easy and free.

You can also try the WordPress Blog: http://traumaanddissociation.wordpress.com/

2. Larger insurance providers may have something to offer if you have private insurance. Kaiser for one has offered some groups. Can anyone add to that list?

3. Your insurance provider may be able to refer you to a private therapist and some few of them specialize in PTSD an even smaller number may offer group formats.

4. If you are in substance abuse recovery some A.A. and N. A. groups, while not specifically devoted to people with PTSD can be supportive places for people in substance use recovery who have PTSD or another mental health issues also. Check out the group and make sure you feel comfortable with them before divulging the details of things other than the official topic.

5. VA has some groups and more likely to come in the future as so many veterans are returning from multiple deployments with PTSD and the related MST (Military Sexual Trauma.)

6. Those people who are receiving services through their local Community Mental Health Department should check with them for available groups. In Fresno County, if you have no insurance there are county-run programs for those on Medi-Cal and those with no or very low-income.

It remains to be seen if these groups will be expanded. Personally, I think specialty groups for people with specific issues can be especially powerful. I anticipate that as more people become eligible for services in the government-run systems we will increase the number of groups run by both peers and professionals.

Any other suggestions?

Complex Trauma, Stress and PTSD

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

What is Complex Trauma and how is it connected to other emotional problems?

Most therapists recognize the existence of a “thing” that might be called Complex Trauma. We are pretty sure it exists. We see clients with it all the time.  Only it looks different in different people. Sometimes it looks like a stress disorder, sometimes it looks more like Post Traumatic Stress Disorder (PTSD) other times it looks a lot like depression or anxiety.

We, professionals, are just not sure what to call this thing and worse yet we are not all sure how to treat it.

This confusion is aggravated by the problem that there is was no diagnosis for this thing, this complex trauma monster, in the DSM-4. Worse yet, even with the increased attention to stress caused disorders in the new DSM-5 Complex trauma did not make the new book either.

The result is that we have a disorder that we all see in our clients but it looks different in different light and we give it different names depending on who has this issue.

This problem, this idea that multiple, complex trauma is different from single trauma and that the results of multiple traumas are not a case of two plus two equaling four is not new. With complex trauma two plus two maybe six or even seven.

We know this from reading books and articles on zoology. Humans are not the only creatures who suffer more from repeated traumatization. Other creatures can recover from a single large trauma but when subjected to repeated traumas they lose the ability to adjust.

Let me attempt to explain this problem by using a far-fetched analogy.

Complex Trauma is kind of like a hurricane or monsoon.

Most of us know what a hurricane is, sort of. The wind blows really hard. It damages things and knocks things down. A tree may blow over and smash your roof or the wind may break some windows and blow over some things breaking them. But that is not all.

With the wind comes a lot of rain. The rain fills up creeks and small rivers and then they overflow. Your house may get flooded.

That tree may miss your house when it falls and hit a power pole. That pole may start a fire and your house could burn down. If you live near the coast the tide from the ocean may become a tide surge and sweep your home away.

All of these things are the consequences of the hurricane, but the effect on you and the way your insurance company sees things may be very different depending on whether your house is damaged by a falling tree, flooded, swept away by the tide or burns due to a falling power line.

Complex trauma is a lot like that. Different people are affected differently. Some get depressed, some get anxious, some people dissociate and others think of harming themselves or others. All of these possibilities and more are the result of the stress or trauma but each person experiences them slightly differently and they all may get different diagnoses.

A different diagnosis may result in different treatment which means some people are way more responsive to a particular treatment.

We used to think that there were a discrete number of mental illnesses, two, neurosis or psychoses. Then a hundred or so and in the DSM-4 about 400. Now we are thinking that if we keep splitting up these problems of living we are going to end up with one diagnosis per person. So we are trying to think more in terms of a continuum. Some people are only a tiny bit depressed occasionally and others are major depressed all the time.

This variation in features is also impacting the way professionals see and respond to stress-related problems.

Over the next few weeks as time and space permits, I want to talk more about complex trauma, how it develops and why it is sort of like PTSD, anxiety and other named disorders and why it is enough different from those other disorders that clinicians are developing specialized treatments for this issue.

People can and do recover from complex trauma so stay tuned and we will talk about the steps to recovery from this misunderstood disorder.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

6 ways to recover from Complex Trauma or Complex PTSD

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Words about PTSD

PTSD.
Photo courtesy of Pixabay.com

You can recover from Complex Trauma or Complex PTSD.

Complex Trauma or Complex PTSD is the result of repeated injuries, each of which creates additional trauma. Complex Trauma frequently arises in children who are abused or neglected over long periods of time or survivors of sexual assaults who are re-assaulted.

Being injured once is bad enough but repeated traumatization can result in problems far in excess of those caused by a single trauma. People who were traumatized in childhood and then retraumatize in later life are likely to develop severe and debilitating symptoms. Some researchers have suggested the name of Complex Trauma or Complex PTSD for this condition.

It appears that many people can experience severe trauma, recover and not develop PTSD. Some of the symptoms of PTSD are normal reactions to experiencing a trauma – in the short run. If the reaction is excessive, interferes with a job, friendships or relationships then it first becomes Acute Stress Disorder when the symptoms continue for long periods of time and seriously interfere with functioning the name and diagnosis is changed to Posttraumatic Stress Disorder (PTSD).

Complex Trauma adds trauma upon trauma and results in long-term suffering.

Some treatments make the symptoms of Complex Trauma worse and some things are effective in treatment. Here are the basic rules for recovering from Complex Trauma. I based this on the research of Conner & Higgins and their description of the work of Chu, with my own usually twists.

1. CAUTION – do not start digging until you know what is buried out there, avoid black holes.

The first reaction of someone trying to recover from complex trauma and the approach of many counselors is to go searching for the buried details. People ask “Why can’t I remember things?” Counselors are tempted to try to recover those lost memories. This can result in more trauma and pain and runs the risk of digging up stuff that wasn’t really buried in your yard but the yards of neighbors or even fictional characters.

Some serious damage has been done by forcing people to remember things way before they were ready and by hunting for things that you are not sure happened. Ask a kid often enough about sexual abuse and they will begin to “remember” things that “may have happened” or they “think” happened. These contaminated memories have resulted in a lot of extra pain.

There are a number of other steps that need to be completed before you go digging into the past for answers. The brain tries to protect us by hiding details from us that might keep us from functioning well enough to survive. Trust the process.

2. Have a supportive therapist or counselor as well as a support system in place.

You can’t make this journey of healing alone and the more capable the companions you have on the journey the better. Professionals are important because there may be things you need to tell them that you won’t feel safe telling others. Peers are also helpful for similar reasons.

Group counseling can be especially effective when and if you are ready to talk in front of others.

3. Ensure your personal safety

If you are in a dangerous situation healing is not likely until you deal with the current emergency. Make a safety plan and execute it. You need to feel safe and have reliable food clothing and shelter before you think about other aspects of recovery. But don’t put off recovery waiting for the day you will miraculously feel safe. Get started on the safety part first. Just taking steps to move to a safe place can be empowering.

Challenges to your safety don’t only come from outside. You may be a big part of the danger. Avoid, control or work on urges and cravings. Confront any urges to commit suicide and seek help immediately if you have thoughts of suicide. Recognize and deal with non-suicidal self-injury, substance abuse, eating disorders and the urge to try out risky behaviors. Don’t put yourself at risk to be victimized anymore.

4. Get your daily routines and rituals in place.

Most people who experience a crisis lose that ability to get up, eat, care for themselves and then move about their day. The sooner you re-establish your daily routine the better.

When children are involved the recommendation is the sooner you can resume family rituals the better. Get back to your spiritual home. Remember to have some sort of ritual in your life; birthdays, Christmas or any other familiar activity makes everyone feel better.

Returning to a job or other activity can be a great way to begin your recovery. If you can’t work at a paid job consider volunteering. Having a reason to get up and out of the house can jump-start your recovery.

A regular and consistent amount of sleep is important. So is some form of exercise. Be as consistent as possible with mealtimes and bedtimes. Include time for relaxation and positive activities.

5. Learn as much as you can about stress, acute stress and the more difficult forms PTSD and Chronic Stress. Learn to manage your primary symptoms.

Knowledge is power. When you know you are not “crazy” or “losing your mind” but that the things you are experiencing are common responses to what you have been through, then it is easier to look for the things others have found useful in recovering from their chronic stress.

Accept what you feel. Try to learn to feel what you are feeling rather than run from the uncomfortable feelings. The feelings will come and go. Learn that you don’t have to run from feelings, but you do need to move away from real danger.

6. Begin work on your long-term issues, the chronic stress symptoms, the problems you had before the stressor and lastly the actual event.

Often people who develop PTSD or a chronic stress disorder discover they had other issues before the stress that put them at risk for the PTSD.

Begin to talk about you. What does the experience mean to you? Who are you aside from the trauma? What does the trauma say about the person or thing that hurt you? What if any sense can you make of this?

The discussion of what actually happened should occur when you are ready to tackle this information.

7. Have patience with yourself and the persistence to work through your problems.

Recovery does not happen all at once. There may be sudden leaps forward or slips back but a continued effort will get you to recovery.

Use tools like positive affirmations. You are a worthwhile person no matter what has happened to you. Give yourself credit for the things you accomplish.

You can recover from Complex Trauma or Complex PTSD.

Staying connected with David Joel Miller

Three David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

SasquatchWandering through a hole in time, they encounter Sasquatch. Can they survive? The guests had come to Meditation Mountain to find themselves. Trapped in the Menhirs during a sudden desert storm, two guests move through a porthole in time and encounter long extinct monsters. They want to get back to their own time, but the Sasquatch intends to kill them.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Books are now available on Amazon, Kobo, iBooks, Barnes & Noble, and many other online stores.

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.