BRAIN FREEZE – UNDERSTANDING PTSD (Chapter 8, pages 142-152)
Excerpted from Mark I. Nickerson and Joshua S. Goldstein's book "The Wounds Within: A Veteran, a PTSD therapist, and a Nation Unprepared (2015).
The DSM-5 lists four clusters of
PTSD symptoms. They are: 1) alterations in hyperarousal and
reactivity; 2) intrusion; 3) avoidance; and 4) negative alterations in cognitions and
moods:
1. Hyperarousal
and Reactivity
a.
Hypervigilence
b.
Sleep
disturbance – Wired tired, nightmares, night terrors, and night sweats
c.
Anger
, irritability, impatience, low frustration tolerance, hostile or cynical
attitude, chip on shoulder, dislike/distrust of those exerting authority
d.
Anger
brings on major physiological changes—release of stress hormones, increase in
heart rate and blood pressure, heightened sensory perceptions, tightened
muscles in preparing for action
2. Intrusions
a.
Unwanted
thoughts, images, sensory experiences, impulses, memories, feelings
b.
Traumatic
event is persistently re-experienced in the present (not as a memory)
c.
When
speaking, switches between past and present tense (from about to within)
d.
During
sleep, memories may include small fragments or a mix-up of elements
e.
Triggers
can be external or internal; common triggers for veterans include:
i. Direct references to war (news,
movies, conversations, questions)
ii. Bad news (report of a death)
iii. Loud noises (car doors,
helicopters, heavy equipment, fireworks)
iv. Smell associated with blood or
fuel
v. Driving in hot and dusty
conditions, driving over potholes, seeing bags on the side of the road
vi. Busy highways, overpasses, riding
in the back seat
vii. Crowded places such as
restaurants and shopping malls
viii.
Hearing
languages or seeing people whose nationalities are similar to the war zone
where the veteran served
ix. People who look similar or
familiar to enemy-victims
x. Feeling enjoyment (or seeing
others enjoy) can activate unresolved guilt
3. Avoidance
a.
Persistent
effort to avoid things (people, places, conversations, activities, objects,
situations) that stimulate trauma memories
b.
Avoidance
of therapy, frequently due to denial that a problem exists
c.
Can
lead to strong urges to isolate (often enforced by intense feelings of guilt or
shame), leading to relationship problems and social phobias
d.
Psychological
numbing: disassociation from reality (what is going on around them) used to
keep a mental distance from traumatic memories
e.
Substance
abuse, primarily alcohol and marijuana, to dull the pain; “alcohol is
everywhere in military culture…whatever someone says they drink, triple it”
4. Negative
cognitions and mood
a.
Coldness
and detachment; a leave-me-alone attitude; intense sadness and depression; an
inability to have fun
b.
Formerly
pleasurable activities, places, and people lose their meaning
c.
Thoughts
of suicide, which also include:
i. Amnesia about the trauma
ii. Persistent negative beliefs about
oneself or the world
iii. Blaming oneself for a traumatic
event
iv. Inability to feel positive
emotions
v. Low self-esteem
vi. Feelings of alienation
vii. Bitterness toward civilians for
not understanding or respecting what the soldier had done for his country; bitterness
toward commanders for putting people at risk
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