PTSD definition questioned, Another hurdle for Survivors

In a March 21 article on NewScientist.com, we found the following opener:

Doubt cast on definition of PTSD
13:06 21 March 2007
NewScientist.com news service
Roxanne Khamsi

Many patients suffering from severe depression "test positive" for post-traumatic stress disorder, regardless of whether or not they have actually experienced trauma, a new study reveals.

Based on this finding, researchers say that psychiatrists need to identify more specific criteria for PTSD. Doing so, they suggest, will "save the diagnosis" from becoming too general and therefore misleading.

Our first thought was,"Gee does Ms. Khamsi have any idea how hard it is to get a therapist to consider starting with a preliminary diagnosis of PTSD and not depression when the precipitating event is not in the immediate past?" Probably not.

There is a lack of solid evidence that post-traumatic stress is biologically different from depression not triggered by a specific event. "I really don't think we know" what distinguishes them biologically. Dr. Alexander Bodkin of Harvard's McLean Hospital

Bravo Sierra! According to this article, the study comprised of "101 patients with severe depression" 78% tested affirmative for PTSD but 36% also tested affirmative for PTSD without evidence of trauma. It is the opinion of this writer that self-reporting of trauma is a tricky business at best. Consider the shame factor alone in cases of sexual assault of all definitions; there is a mountain of clinical evidence supporting the theory that sexual assault is the most under reported contributing factor in mental health caseloads. Therapists routinely report that clients will not disclose this type of trauma without a carefully crafted basis of therapist/client trust.

Barbara Olasov Rothbaum, director of the trauma and anxiety recovery programme at Emory University School of Medicine in Atlanta, Georgia holds a more reasonable position. She believes "it is crucial to distinguish PTSD as unique because 'the treatment is very different' for this disorder than for other forms of depression."

Indeed it is. Clients treated with some anti-depressants have reported an increase in symptoms of anxiety, the very symptom which is a daily undercurrent in PTSD. PTSD survivors are more prone to a condition called "hypervigilance", hyper meaning heightened and vigilance in this instance would be analogus to a part of the client's brain standing watch, continuously. Anti-depressants aggrivate this symptom.

It is difficult enough for PTSD survivors to overcome their very real barriers to treatment, convince a therapist to address PTSD first and leave discussion of depression for when there is a sufficient trust bond. This usually takes place when clients who are fed up with being told they are just depressed or bi-polar or borderline personality disorder(ed) finally recognize what their own symptoms are telling them.

We believe that the sampling of 101 clients who are severely depressed is not a useful scientific sampling. The observations of Dr. Bodkin & his colleagues are just so much crappiccino. Depression may very well be a secondary symptom, generated by the fatique hypervigilance and anxiety produce over the long term of a client's experiences. But "depression" in all it's various incarnations should never be the catch-all first diagnosis in self reporting clients.

PTSD is a very real, treatable condition which stems from the experience of trauma. It has a beginning, a well documented set of symptoms and is according to the newest research and treatment trials, curable. For PTSD survivors, that's great news!

Tags: PTSD, post traumatic stress disorder, depression, bodkin, rothbaum

The Life Skills Approach: Frustration of your Handicap

The Life Skills Approach: Frustration of your Handicap

I was poking around a new service called Blogcode.com looking for an interesting read when I came across the above article. In the comments section one reader asked what happens to old habits when you are in what athletes call "the zone"? Yeah, that's what I want to know.

The Frustration of your Handicap doesn’t come from what is wrong with you; the real hassles come from the way you interpret what is going on. You may not have the power to change your disability, but you have the power to control your interpretation.

The zone for those of you who are athletically challenged like me is that place where you hit your perfect stride. Nothing can stop you from your best performance. There seems to be a mental switch that fires when you are in the zone which blocks your natural fear (not your apprehension) of a new or challenging situation. You are fully aware that the situation is stretching you beyond what you are confident you can do but you are able to overcome your fear and perform at a level above what your confidence level tells you you can.

I want some answers. I just experienced this in a condensed French class. I took this class, not having spoken, read or written French for hrm...thirty plus years, figuring if I got a C, good deal. To my amazement, I was banging out an A- consistently. Then I shot myself in the foot.

I allowed fear and lack of confidence to sh*t-can a week's worth of work, dropping me to a low C. The catalyst was a situation with two other students where we had to present oral dialogue every week. I was totally uncomfortable with the content of the dialogue and had a panic attack the second time we had to present. Instead of getting up there and risking getting half credit, not only did I not do the dialogue, I did not turn in my homework or take that week's test.

The good news is that I switched dialogue partners and worked extra hard to claw my way back to a respectable grade. Last time I checked I had brought the grade back up to a B, prior to the final exam.

So it would seem that throughout the class I was performing in 'the zone', then I let the outward circumstances dictate how I would perform. My reaction was in part, my lack of confidence in my ability to carry off an embarrassing dialogue. So I did actually shoot myself in the foot regardless of what the other participants did.

I found the other content in the above mentioned website worth exploring. I'll pop back in with other comments as I explore this site.