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PTSD

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Sources/Resourcs Pheonix Australia, Open Arms, Help Guide, National Centre for PTSD

Source: https://www.phoenixaustralia.org/wp-content/uploads/2022/07/Chapter-2-Trauma-and-trauma-reactions.pdf

B. Nine (or more) symptoms from any of the following five categories (with onset or exacerbation after the traumatic event).

  1. Recurrent, involuntary, and intrusive distressing recollections of the event(s) (children may
    express this symptom in repetitive play).
  2. Recurrent traumatic nightmares (children may have disturbing dreams without content).
  3. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to
    complete loss of consciousness (children may re-enact the event in play).
  4. Intense or prolonged distress or physiological reactivity after exposure to traumatic reminder.
  1. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
  1. Effortful avoidance of distressing trauma-related thoughts or feelings.
  2. Effortful avoidance of trauma-related external reminders (e.g., people, places, conversations,activities, objects, or situations).
  1. Sleep disturbance.
  2. Irritable or aggressive behaviour.
  3. Hypervigilance.
  4. Problems with concentration.
  5. Exaggerated startle response.
  1. An altered sense of the reality of one’s surroundings or oneself (e.g., seeing oneself from another’s perspective, being in a daze, time slowing).
  2. Inability to remember an important aspect of the traumatic event(s) (typically not due to, e.g. head injury, alcohol, or drugs).

Symptoms of trauma can overlap with Autism1, and also post concussion syndrome and other types of brain trauma. 2


Many people experience fear and anxiety during and after a traumatic event. Anxiety symptoms usually overlap with generalised anxiety disorder.

Understand Generalised Anxiety Disorder



Symptoms of anxiety and stress overlap, certain thoughts and behaviours can reinforce anxiety and stress.

If you become more aware of changes in your thoughts and behaviour when faced with challenging situations, you can then test whether it is reasonable in the circumstances. You can use the smart approach model and other tools to change your behaviours (cognitive other) to help you cope better with and improve your situation. Support from a mental health professional can be beneficial. Sometimes medication can be help with anxiety, but some can have be addictive e.g. Benzodiazepine.

SMART Diagram

Using the SMART model

The steps in using the SMART model are:

  1. Determine how you are reacting to a situation. Is the reaction mostly affecting your emotions, your thoughts, your physical reactions, or your behaviours?
  2. Test your perceptions and your reactions by asking two questions:
    • Is this reaction reasonable, given the situation I am in right now?
    • Is this reaction helping me deal with the situation I am in right now?
  3.  Adjust your reaction to achieve a more optimal performance as required.

Adjustment strategies

Engaging in relaxation activities can be of great benefit, particularly if you feel physically agitated or tense.

Physical reactions

Use simple relaxation techniques, including:

  • controlled breathing
  • progressive muscle relaxation
  • meditative relaxation strategy
  • exercise

Thoughts

  • combat any negative self-talk
  • ask yourself “Where is the evidence for that thought or belief?”
  • accept the reality of the situation
  • reinterpret the situation emphasising its positive aspects
  • use humour
  • use thought stopping strategies to prevent negative thoughts lingering in your mind and spiralling
  • think of someone you trust, respect and perceive to always cope well with stress and ask yourself, “What would he/she think in this situation?”

Emotions

  • identify your negative thoughts
  • question why you are being negative?
  • practise thought changing strategies
  • exercise

Behaviours

  • use the thought changing strategies
  • practice relaxation
  • get good sleep
  • talk to your mates
  • seek support when required

Enoyable and rewarding behaviours https://www.openarms.gov.au/get-support/self-help-tools/show-all-tools/behaviours/enjoyable-and-rewarding-activities

A major and commonly overlooked part of living with EDS is medical trauma, stemming from contact with medical professionals who may not always understand, believe, or even listen. It’s something I sadly see a lot of in sessions and can even become a barrier in our work together (which we always overcome in time!). But what is medical trauma? How does it happen? And most importantly, how do we overcome it?

In this blog, we’ll explore the reality of medical trauma in the EDS community, looking at the real-life experiences of those impacted and what needs to change. 

Learn more at The Fibroguy Article by Trauma. Counsellor Serena Foster3

Pain can co-occur with PTSD in some people and can contribute to a worsening of some symptoms including anxiety. Pain can impact your thinking.

4Neuralibrary: Moderate to high quality evidence finds a small association between increased PTSD symptoms and increased chronic widespread pain. Lower quality evidence found a bidirectional associations between pain and PTSD symptoms within six months post-trauma. There were unidirectional patterns found after six months, either from pain to PTSD symptoms or from PTSD symptoms to pain. Moderate to low quality evidence finds medium-sized increases in fibromyalgia and chronic widespread pain in people previously exposed to any trauma, regardless of a PTSD diagnosis.

Irritable bowel syndrome is a common gastrointestinal disorder. It is characterised by chronic abdominal pain and a change in the frequency or form of stool. Its pathophysiology remains poorly understood but is thought to involve dysregulation of the hypothalamic–pituitary–adrenal axis,5 neuroendocrine alterations, and emotional hypersensitivity. Mechanisms that might underlie any association between post-traumatic stress syndrome and irritable bowel syndrome include hyperarousal,6 an exaggerated response to stress, and hypervigilance to bodily sensations.

Chronic fatigue syndrome is a widely accepted medical condition characterised by extreme fatigue. The fatigue lasts for at least six months, worsens with physical or mental activity, and does not improve with rest. The fatigue cannot be explained by an underlying medical condition. The causes of chronic fatigue syndrome are still being investigated, but may include viral infection and/or exposure to psychological stress.

What is the evidence for chronic fatigue syndrome in people with PTSD?

Moderate to low quality evidence finds a medium-sized effect of increased rates of chronic fatigue syndrome in people with previous exposure to trauma.

7Persistent inability to experience positive emotions (e.g., inability to experience happiness,
satisfaction, or loving feelings) can happen as a result of trauma, along with others symptoms including difficult emotions which may include high irritability.

Depression

There are effective treatments available to help people overcome their depression. One of the most effective treatments is cognitive behavioural therapy (CBT). This approach recognises that the way we think and act affects the way we feel. During this therapy you will learn:


 A structured approach to problem solving to help you manage the day to day stressors.
 How to challenge your negative thinking, which will have a positive impact on the way you feel.
 Strategies to help you get back to your routine and enjoying your usual activities.


The therapy may involve 8-12 weekly sessions with a mental health professional, but may require longer depending on your needs.

Your doctor may also have suggested medication which can be of assistance in overcoming depression, especially in the case of severe depression.

Below is a list of internet and other written resources that may help you, together with the treatment recommended by your doctor.


 Open Arms (https://www.openarms.gov.au/) has information on mental health and wellbeing, wellbeing programs, smartphone apps and information booklets.


 There are also internet based self-help programs available e.g., MoodGYM (https://moodgym.com.au/).


 Useful books include Mind over Mood: A Cognitive Therapy Treatment Manual (2nd Ed; Padesky and Greenberger 2016) and Feeling Good: The New Mood Therapy (Burns 2008).

Anger

Everyone gets angry, and anger can sometimes be useful to motivate people and help them to deal with situations in which they need to be assertive. However, if anger is expressed in ways that are harmful to the person or others, or persists over a long period of time, then it can become a problem.
Anger tends to be experienced in the following ways:
 It can be acute or ‘explosive’ in nature when a person flies into a rage. With this type of anger there tends to be strong physical
reactions such as muscle tension, heart palpitations and sweating.
 Longer-term anger or resentment. This type of anger tends to be the result of thinking negative thoughts over and over again –
for example, replaying frustrating events over and over again or constantly having revenge fantasies.
While anger is often a response to perceived injustice or frustration, it can be driven by a range of feelings like sadness, hurt or
feeling unsafe or threatened. For example, a parent may become angry with their child for crossing the road without looking,
when, in fact, the driving emotion is fear for their safety.
When is anger a problem?
Anger can have its benefits when it is not accompanied by violence or intimidation. It can give people the courage to confront
someone they do not usually have the courage to confront. Anger can also motivate people to be assertive, spurring them into
action to help solve a problem or have their needs met. However, if anger gets out of hand and leads to actions such as hitting or
threatening someone, or ending up with an assault charge, it becomes self-defeating. Intense or long-lasting anger is draining, and
can affect relationships at home and at work. In the end, people’s needs are more likely to be met and their relationships kept
healthy if they can manage their anger and communicate their needs assertively rather than aggressively.
Anger may be a problem if:

  • your anger is causing problems with your personal or work relationships, your health or the law
  • you feel angry a lot of the time
  • your anger involves verbal, emotional or physical abuse of those around you
  • you think the only way to get what you want is to be angry
  • your anger is out of proportion to the trigger that set it off
  • it takes a long time for your anger to subside after the situation triggering your anger has passed
  • you feel anxious, remorseful or depressed about your anger
  • you use alcohol or substances to manage your anger
Depression

At times, people may experience symptoms such as sadness, loss of interest or low motivation. Sometimes these symptoms
become intense and are present most days for a long period of time.

When symptoms such as these start interfering with everyday life and last more than two weeks, we refer to them as ‘clinical
depression’ or ‘major depression’.

Major depression is very different from simply feeling ‘blue’ from time to time and includes the following changes:

Changes in mood

 Moods common to depression include sadness, anxiety, guilt, worthlessness, hopelessness and anger.
 If depression is mild, individuals may not feel bad all day but still describe a dismal outlook and a sense of gloom. Their mood
may lift with a positive experience such as seeing a good friend, but fall again with even a minor disappointment.
 In severe depression, a low mood will persist throughout the day, failing to lift even when pleasant things happen.

Physical changes

 Trouble falling, or staying, asleep and waking up too early is common. Some people, on the other hand, find themselves
sleeping more.
 Weight can change, with appetite decreasing or increasing significantly.
 Sexual interest may decline.
 Energy levels fall, as does motivation to carry out everyday activities, including things that were enjoyable in the past.

Changes in thinking


Individuals with depression sometimes find that they have difficulty thinking clearly, or concentrating on tasks or activities.
Depressed people tend to see themselves as being useless, inadequate and failures. They dwell on how bad they feel and on howhopeless everything is. Sometimes, these thoughts are so negative that they can contemplate taking their own life.

Changes in relationships
People who experience depression may become unhappy and dissatisfied with their family relationships, close friends, etc. They
may feel shy and anxious around others and have trouble socialising. They may feel lonely and unloved, but at the same time, feel
unable to reach out to others.
What causes depression?
Depression is not usually caused by one thing. We know that an individual may be vulnerable to depression if there is a history of
depression in the family, and we also know that particular thinking patterns (e.g., overstressing the negative) are also associated
with depression. It is important to note that having a vulnerability to depression does not mean that someone will experience
depression. There are many situations that can trigger depression including, loss of a loved one, loss of working ability, relationship
difficulties, or a traumatic event.

Getting Help


There are effective treatments available to help people overcome their depression. One of the most effective treatments is
cognitive behavioural therapy (CBT). This approach recognises that the way we think and act affects the way we feel. During this therapy you will learn:


 A structured approach to problem solving to help you manage the day to day stressors.
 How to challenge your negative thinking, which will have a positive impact on the way you feel.
 Strategies to help you get back to your routine and enjoying your usual activities.

The therapy may involve 8-12 weekly sessions with a mental health professional, but may require longer depending on your needs.

Your doctor may also have suggested medication which can be of assistance in overcoming depression, especially in the case of
severe depression.

Sleep helps our mind and body regenerate, restore and repair. If you are not sleeping well you might feel drowsy or irritable, and have trouble concentrating or physically functioning.

Disturbed sleep is a common complaint in people with trauma. The majority of individuals will experience periods of sleep disturbance at some stage of their lives. Sleep disturbance can be caused by many different factors.

For example, it can be caused by an illness and stress, or by poor sleep habits (e.g., too much alcohol or caffeine before sleep, too much physical or mental stimulation before going to bed).

Sleep problems can also develop as a consequence of disrupted sleep patterns It should be noted that sleep disturbance can also be related to mental health problems. For example, depression can result in too much or too little sleep, and replaying anxious thoughts can keep people awake.

Also, frequent nightmares, sometimes associated
with posttraumatic stress disorder, will disrupt sleep patterns.

Prolonged periods of sleep disturbance can have negative impacts on your physical and mental wellbeing, and interfere with your
daily work and social functioning. For example, people can experience attention and memory problems and increased irritability.

There are specific factors that affect sleep quality and this tool can help you work on them to make sure you’re getting the best possible sleep.

Neura Library8People with mental disorders may show increased rates of co-occurring conditions such as sleep apnea. The most common form of sleep apnea is obstructive sleep apnea (OSA). OSA is seen in around 5-10% of the general population and occurs when the muscles of the upper airway relax in such a way that they block the airway during sleep. As a result, OSA is associated with daytime sleepiness, cognitive dysfunction, and the development of hypertension, cardiovascular disease, and abnormalities in glucose metabolism. OSA also has adverse effects on quality of life and can lead to anxiety and depression symptoms.

What is the evidence for sleep apnea?

Moderate quality evidence finds around half of people with PTSD have obstructive sleep apnea. Rates are highest in veterans, in older people, and in people diagnosed using the apnea-hypopnea index with a cut-off of five rather than ten events per hour of sleep.

A common treatment for obstructive sleep apnea is continuous positive airway pressure. Moderate quality evidence found large improvements in PTSD symptoms and reduced nightmares after treatment.

Sleep Tools

https://www.openarms.gov.au/get-support/self-help-tools/show-all-tools/behaviours/healthy-sleeping

  1. https://www.wpspublish.com/blog/is-it-autism-trauma-or-both-understanding-the-overlap ↩︎
  2. https://library.neura.edu.au/ptsd-library/co-occurring-conditions-ptsd-library/physical-disorders-co-occurring-conditions-ptsd-library/traumatic-brain-injury-3/index.html ↩︎
  3. ↩︎
  4. https://library.neura.edu.au/ptsd-library/co-occurring-conditions-ptsd-library/physical-disorders-co-occurring-conditions-ptsd-library/chronic-pain-and-fibromyalgia/index.html?utm_source=google&utm_medium=cpc&utm_campaign=21926626713&utm_content=&utm_term=&gad_source=1 ↩︎
  5. https://library.neura.edu.au/ptsd-library/physical-features-ptsd-library/functional-changes-ptsd-library/hypothalamic-pituitary-adrenal-axis-3/index.html ↩︎
  6. https://library.neura.edu.au/ptsd-library/signs-and-symptoms-ptsd-library/general-signs-and-symptoms-signs-and-symptoms-ptsd-library/hyperarousal/index.html ↩︎
  7. https://www.phoenixaustralia.org/wp-content/uploads/2022/07/Chapter-2-Trauma-and-trauma-reactions.pdf ↩︎
  8. https://library.neura.edu.au/ptsd-library/co-occurring-conditions-ptsd-library/physical-disorders-co-occurring-conditions-ptsd-library/sleep-apnea-3/index.html ↩︎