Asking yourself whether you have PTSD or post-traumatic stress disorder is a difficult question to answer. It’s an emotionally loaded question, and so it’s difficult to answer. It’s even difficult to get to the point of asking the question. Veterans have reported not being able to explain what was wrong with them and feeling ashamed of their weakness. They lacked the vocabulary and the knowledge of mental injury.
Learning Changes Us
We are constantly changing and learning in response to the environment around us. This change is healthy. It shows that we are adaptable and flexible. It’s how we can tell that we are alive.
Some life events leave a larger mark on us than others. Consider for example a six-month trip backpacking around the world. The trip would be memorable, full of ups and downs, and stories that can be shared for a lifetime.
If a recreational backpacking trip can change us, then it is no surprise that a six-month deployment in a war zone can cause even bigger changes. The experiences, both positive and negative, would be so much more intense. There is also the additional stress and exposure to trauma. We wrote previously about exposure to trauma as a precursor to PTSD. This exposure is necessary, but not sufficient, meaning that not everyone who witnesses trauma goes on to develop OSI or PTSD.
If a traumatic event didn’t have an impact on someone, at least in the short term, it would be cause for concern.
From Natural to Disordered
Since it’s natural to learn and to be affected by events, we may never go back to being the “old self.” The six-month backpacking trip can result in a permanent change in a person, in their outlook, thinking, and personality. Yet we don’t call this PTSD. Someone can also be in a fender bender, which causes them to be more cautious at intersections. We also don’t call this PTSD.
PTSD arises when people don’t recover from the traumatic events. After experiencing trauma, people can be extra sensitive. They may repeatedly replay events in their mind, have trouble sleeping, or be more emotionally reactive than usual. But after a while this heightened mental state calms down and no longer interferes with day-to-day life. When someone does not return to a routine, non-reactive state, even after the passage of time, the diagnosis of PTSD needs to be considered. The amount of time allowed varies, but a common threshold is one month. After a while, unhealthy coping behaviours emerge, such as avoidance and addiction.
We are all different and PTSD can affect and show different symptoms in each individual diagnosed.
Jamie MacWhirter, founder of PTSD Buddies, hid in his basement for several days after his return from Afghanistan, not wanting any contact with people.
Romeo Dallaire wrote about his experience when he first acknowledged his PTSD symptoms in his book Waiting for First Light.
“This extreme horror had finally made itself known to me, burrowing up from whatever part of my brain in which I’d hidden it. It invaded me, and I could not get away from it. It was there, inside me, every time I closed my eyes. I didn’t have to find a way to replicate the horror: I carried these indelible images inside me.” – Romeo Dallaire
When meeting a peer for a first time, Fred Doucette had a mental checklist,
“I am listening for clues like, ‘I can’t sleep, I’ve been drinking a lot, I’m angry, I can’t stand anyone, I’m lonely, I cry at the least thing, I feel anxious, sometimes I can’t breathe…”
Criteria for Diagnosis
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) is the definitive guide on diagnosing mental disorders. Psychologists and psychiatrists use the criteria in them to determine if someone has a particular disorder. Reading it cover to cover is not recommended. One, it’s pretty dry. Two, there is the risk of diagnosing oneself with many disorders. In fact, this is called psychology student’s disease. Every one is vain or egotistical to some degree, but it usually doesn’t rise to the level of narcissistic personality disorder. It’s important to keep in mind that the symptoms need to severe enough that they get in the way of routine expectations, such as participating in work, school, or home life.
The DSM-V defines post-traumatic stress disorder (PTSD) as “the development of characteristic symptoms following exposure to one or more traumatic events.”
There are many criteria an individual must fit before they can be diagnosed with a disorder such as PTSD. For example, Romeo Dallaire was exposed to actual deaths; he witnessed in person the events as they occurred to others. Many military personnel who participate in combat will fit into this category for PTSD. Many others Jamie MacWhirter was on alert for possible attack for months on end. Jen, a drone operator, ordered and witnessed many kills on enemy combatants.
The criteria listed in the DSM-V are as follows:
- Exposure to actual or threatened death, serious injury, or sexual violence
- Presence of one (or more) intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred
- Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred
- Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred
- Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s)
- Duration of disturbance in (2, 3, 4, 5) is longer than one month
- The disturbance caused clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition
This classification helps identify where the trauma began and the exact symptoms. As mentioned, trauma can impact and show differently per the individual seeking support. Trauma can also be defined differently for everyone. Hannah Holroyd writes that the stressful life events, particularly those for soldiers such as being deployed on combat missions or even attempting to reintegrate into civilian life are unique in comparison to the rest of society. She further states that the atrocities of war combined “with other factors such as fatigue, depression, martial breakdown, financial issues, substance abuse behaviours, devaluation by peers, and pressures to confirm to group standards” can increase the risk of PTSD symptoms.
PTSD is caused by some type of trauma, but soldiers do not have to be in a combat situation to feel the symptoms. The rigorous training that soldiers must endure in order to become that of a soldier, can be traumatic. The stories soldiers hear from those who have been deployed, can be traumatic. Some situations mentioned in previous articles such as fellow soldiers death, innocent citizens in other countries dying, combat situations, being away from ones family for extended periods of time, etc. can lead to symptoms of PTSD. Each scenario mentioned can impact a soldier differently and each soldier will experience symptoms to a different severity.
Getting Diagnosed
The only way to be diagnosed with PTSD is to see a trained psychiatrist, psychologist, or other qualified counsellor. Don’t take our word for it. For military or first responder PTSD or OSI, be sure to find someone with prior experience.
There are a number of online screening tools. I like the one from Healthy Place, because you get the results right away.
How about you? What made you finally ask, “Do I have PTSD?”