Trauma Part One

Diagnosis

I was diagnosed with PTSD today. Post Traumatic Stress Disorder. I went to see a licensed psychologist after searching on Google and speaking to my former therapist because I knew I was dealing with something other than just anxiety and depression. I’ve dealt with anxiety and depression since age 13. I called a behavioral healthcare clinic and asked specifically to be evaluated because the treatments and interventions for PTSD are different and I felt I needed something more than psychotherapy.

I’ve been evaluated by mental healthcare professionals in the past, having been diagnosed with Generalized Anxiety Disorder, Major Depression, Clinical Depression, and Eating Disorder-Not Otherwise Specified (NOS). I expected to take a lot of long tests where I would be required to fill in many bubbles, rating the severity and frequency of my symptoms. He had me quickly do the Beck Depression Inventory and the Hamilton Anxiety Scale, reaffirming the severe anxiety and depression I’ve been dealing with, but he mostly asked me questions and took notes.

I read to him from a previously published article because it’s difficult to succinctly recount exactly where things went wrong. That article can be found below.

Post Traumatic Stress Disorder

In order to get a diagnosis of PTSD, the patient must meet certain requirements as outlined in the DSM-5 - the most recent version of the Diagnostic and Statistical Manual of Mental Disorders. These requirements are:

• Direct or indirect exposure to trauma, such as threatened death, threatened or actual bodily harm, or sexual violence.
• Persistently re-living the trauma through flashbacks, intrusive memories, nightmares, emotional distress, or physical reactivity.
• Avoidance of trauma-related thoughts or reminders.
• Negative thoughts that began or worsened after trauma, such as an inability to recall features of the trauma, low mood, feeling isolated, loss of interest, or exaggerated blame of self or others.
• Trauma-related reactivity such as irritability or aggression, risky or destructive behavior, hypervigilance, heightened startle reaction, difficulty concentrating, or difficulty sleeping.

Complex PTSD

“... knowing that we are seen and heard by the important people in our lives can make us feel calm and safe, and... being ignored or dismissed can precipitate rage reactions or mental collapse.”“Over the years our research team has repeatedly found that chronic emotional abuse and neglect can be just as devastating as physical abuse and sexual molestation. Not being seen, not being known, and having nowhere to turn to feel safe is devastating...” ~Dr. Bessel Van Der Kolk, The Body Keeps the Score

Dr. Van Der Kolk is a psychiatrist who has been studying trauma since the 1970s. A friend had loaned me the book several months ago, but I didn’t start reading it until after I left the bad situation I was in. I have a lot of regrets, but one is that I didn’t start reading that book when I received it. I definitely have PTSD, but I believe what I struggle with, and what I’ve been struggling with on a daily basis for many years, is Complex PTSD.

Complex PTSD isn’t characterized by experiencing a singular trauma of limited duration, but by continuous trauma over months or even years. This can include what prisoners of war, victims of human trafficking, and victims of domestic or child abuse or neglect. C-PTSD has the additional symptoms of impaired emotional regulation, consciousness, self-perception and relationships, a distorted perception of the perpetrator, and a loss of faith or sense of hopelessness and despair.

Despite the body of evidence to suggest that C-PTSD is distinct from PTSD and that many clinicians and doctors, such as Dr. Van Der Kolk, advocated for a separate diagnosis, it was not included in the DSM-5. This is unfortunate as it could lead to misdiagnoses and improper treatments.

Psychological Abuse

I am a survivor of psychological and emotional abuse. I lived with someone for three years who looked me in the eye and told me he loved me and would then shame, guilt, and belittle me. I walked on eggshells because he took his irritability and anger out on me. I weathered emotional outbursts and unpredictable behavior. I was isolated, spited, punished, and devalued. I was struggling with severe illness during that time, leaving me feeling trapped, alone, and hopeless. My trauma is more complex than the trauma for which I was diagnosed, which was based on the incident with the gun.

I told my evaluating psychologist I thought my abuser might be a narcissist: arrogant, self-righteous, manipulative, controlling, and lacking empathy.

“You know that saying about the duck,” he said.

I can’t be certain of my assessment. I can only be certain of his pathological lack of empathy for me, as evidenced by the way he treated me and because he said he couldn’t feel empathy.

The next step for me is to find a counselor who has experience with treating C-PTSD and psychological abuse, or if they don’t have direct experience, they need to be willing to learn.

Questions I’ll be using to choose my counselor:

• What is your approach to therapy?
• How much experience do you have treating PTSD and C-PTSD?
• Do you involve family and other loved ones in therapy?
• How much experience do you have treating survivors of psychological abuse?

I called several counselors today in my area. My next story will be my continued journey once I’ve chosen a counselor.