While reading another person’s post on how PTSD affects her behaviors it dawned on me that I could see similar behaviors within myself. This of course caused me to stop, think, and try to come to some understanding of how PTSD is effecting my daily life; apparently, it is having more effect on my daily life than I was aware. Whilst I have tried to focus on small bite size portions of my problems, I am coming to see it’s impossible to separate one noodle from the others since they have baked together for so long. Whilst this revelation is important, it’s also terrifying at the same time. I can get me head around the idea of taking small bites of my issues, but the realization all of my issues intertwine and I need to address them as one is harder to deal with.
Before getting into how my PTSD affects my behavior I’m going to list the DSM-IV criteria for PTSD (please note, there are some slight changed between DSM-IV and DSM-V)
Criterion A: stressor
The person has been exposed to a traumatic event in which both of the following have been present:
- The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.
- The person’s response involved intense fear, helplessness, or horror.
Criterion B: intrusive recollection
The traumatic event is persistently re-experienced in at least one of the following ways:
- Recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
- Recurrent distressing dreams of the event.
- Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated).
- Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
- Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
Criterion C: avoidant/numbing
Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
- Efforts to avoid thoughts, feelings, or conversations associated with the trauma
- Efforts to avoid activities, places, or people that arouse recollections of the trauma
- Inability to recall an important aspect of the trauma
- Markedly diminished interest or participation in significant activities
- Feeling of detachment or estrangement from others
- Restricted range of affect (e.g., unable to have loving feelings)
- Sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
Criterion D: hyper-arousal
Persistent symptoms of increasing arousal (not present before the trauma), indicated by at least two of the following:
- Difficulty falling or staying asleep
- Irritability or outbursts of anger
- Difficulty concentrating
- Exaggerated startle response
Criterion E: duration
Duration of the disturbance (symptoms in B, C, and D) is more than one month.
Criterion F: functional significance
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Acute: if duration of symptoms is less than three months
Chronic: if duration of symptoms is three months or more
With or Without delay onset: Onset of symptoms at least six months after the stressor
As normal, I have highlighted those symptoms I have had diagnosed with in italics.
I am going to use an example from Thursday’s IOP session as I am now seeing some of my behaviors with a different understanding.
When I go to IOP, I always sit in exactly the same spot. A spot I picked out my first day of IOP because I felt comfortable in that spot and I have never sat anywhere else in the room; not that the group therapists haven’t tried at different times to get me to move from my spot. My spot is away from the main table, with the wall to my back, and gives me a clear view of not only everyone at the table, but also the door as well. The instant someone starts turning the doorknob, my attention is instantly drawn to the door to see who is opening it and placing them into the friend or foe category. When out in public, I go out of my way to get a table or booth in a corner of the restaurant so I have my back to the wall and a clear view of the rest of the restaurant. Because I am constantly scanning my environment for real or perceived threats, it makes it difficult to concentrate on whatever is at hand. These are all examples of my PTSD at work; behaviors I never recognized for what they are until now, namely hyper-arousal.
Another example of my hyper-vigilance is at home I constantly check the doors and windows to make sure they are locked. Taking this further, I have barricades at all the doors so when I am home there is no way anyone can get into the house. I also lock the door to whatever room I happen to be in; if I am in my bedroom the bedroom door is locked, if in the bathroom the bathroom door is locked, and the like. I am always attempting to place as many barricades between threats and myself. However this behavior serves two purposes at home, namely it keeps everything that may trigger me out, but just as importantly it keeps me locked inside the house when I sleepwalk. As one who sleepwalks a couple of times a week, one of my biggest fears is my getting out of the house while sleepwalking; another is falling down the stairs.
I suffer insomnia (hyper-arousal) because I know nightmares and night terrors await me on the other side of sleep (intrusive recollection). I have had more than my fair share of flashbacks and those are the worst part of my PTSD (I have always recognized my flashbacks as part of my PTSD since they are always of events that caused my PTSD). External things beyond my control have always triggered my flashbacks whether sounds, smells, or actions by others (intrusive recollection). My ex once went to push the hair back from my eyes, but it triggered a flashback and I lost it at something a simple and stupid as someone who loved me being thoughtful enough to push the hair from my eyes. Another time a sound sent me into a flashback; I curled into a ball, pushed myself as tightly as I could into a corner, begging not to be beat, and nothing those there could do calmed me. When I’m in flashback mode, touching me, talking to me, or pretty much anything only makes matters worse, which is hard on those who love you because they feel hopeless in their inability to do anything for you.
Sigh, just more pieces to the puzzle of my life. Seems I need to start paying more attention to my behaviors and trying to dissect them to determine just where they are coming from. With everything feeding in to one another it becomes overwhelming, which makes me just want to give up and slowly sink into oblivion.
Peace, love, and contentment,