Mental Health Monday–PTSD

Since it’s a federal US holiday, I’m reprising a previous Mental Health Monday post. I think it’s apropos because today is Memorial Day–a day of remembering those men and women who died while serving in the military. New research is being conducted identifying how pervasive PTSD (Post-Traumatic Stress Disorder) is in soldiers. Below, I’ve highlighted details of the illness and some examples of what it looks like.

Please note, this post is solely for the purposes of writing, and is NOT intended for medical advice or treatment.

PTSD (Post-Traumatic Stress Disorder) is classified as an anxiety disorder (see NOTE below, commenting on DSM 5). Technically, the person must have a constellation of symptoms for at least 30 days to qualify for the diagnosis. Some people recover, some go on to have a chronic course, lasting months to years. Symptoms can recur several years later as well, with a period of remission between.

An event must be perceived as life threatening or potentially life threateningto qualify as traumatic. Immediately, that lends a LOT of subjectivity. What’s life threatening to me may be different for  you. That being said, I’m sure we can all pretty much agree on the biggies–combat, rape, assault, natural disasters, terrorism, abuse (sexual, neglect, physical, emotional, verbal, whether as an adult or child).

The traumatic event can either be one “biggie,” or it can be the accumulation of “smaller” events over a prolonged period of time (such as child abuse or domestic violence).

Classic symptoms include:

Hypervigilence: The person doesn’t trust others. They may feel uncomfortable in exposed places (malls, crowded places, being around strangers). They will frequently make sure their back is to a wall (so it’s not exposed). They’ll keep an eye on the exits and make sure they can get to one fast if needed. They’ll also show a “startle” response, where they jump at a loud, sudden sound. Some people jump when the phone rings, for example.

Avoidance: This is pretty much self explanatory. The person will avoid triggers and things associated with the trauma. This can include movies, locations, people, even certain subjects of discussion for fear it will lead to symptoms. This, by the way, makes PTSD difficult to treat in some instances, because the very thing bringing a person to treatment, is the thing they want to avoid discussing.

What’s important to know is the brain remembers details about a traumatic event that the sufferer may not consciously recall. Furthermore, an otherwise innocuous stimuli may be paired with the event and become “dangerous.” If, for example, a person’s attacker wore a blue jacket, then the person may experience an anxiety response when confronted with a blue article of clothing. The jacket itself is benign, but the brain “remembers” it as a threat via association.

Another example would be a soldier in Iraq who has returned home and every time he goes under an overpass, he searches for IEDs (Improvised Explosive Devices) tucked under the framework.

Which leads me to my next point. For a soldier in Iraq, being hypervigilent is conducive to survival. It makes her good at her job. BUT, when she returned to civilian life, her sensitive attunement to stimuli in the environment does not return to baseline. That is NOT conducive to living in a non-war zone.

That’s what PTSD is. A state of “hyper arousal” that is above baseline. It’s like drinking 16 cups of coffee and maintaining that level of tension and awareness ALL THE TIME.

Other cardinal symptoms of PTSD include: Flashbacks and nightmares: If someone is presented with a “trigger” (like a blue jacket), they may experience a flashback. Flashbacks can be mild (where the person is able to recognize it as a flashback and they can control it) or they can be severe, where the person actually feels like they’re reliving the event in real time.

Final tidbit: The person who suffers from PTSD is at higher risk of misusing drugs and overusing alcohol. Substance abuse and dependence as a co-morbid diagnosis is therefore common and an important aspect to address.

NOTE: ***Once the DSM 5 comes out, PTSD will be in its own category. I look forward to seeing how this new classification system works and how it encapsulates a very serious and life-altering illness.***

Mental Health Monday–Phobias: Are They Catching?

Natasha Hanova asks:

What is the difference between haphephobia and chiratophobia? Is it believable that a child with such a parent might exhibit symptoms too?

GREAT QUESTION!

I had to do some research to find the answer…

HAPHEPHOBIA, simply put, is the fear of being touched. This can happen particularly in the cases of sexual assault whereby the victim becomes phobic of being touched by a member of the opposite sex (or the sex of whomever assaulted them, I’d guess).

A bit of lit trivia: Christian Grey from Fifty Shades of Grey apparently suffers from this phobia…though I didn’t really get that vibe from reading the book. He had trouble with casual touch, but when it came to, well, BDSM, he had a grand old time. *ahem*

Moving on…

Other names for Haphephobia include:

• aphephobia
• haphophobia
• hapnophobia
• haptephobia
• haptophobia
• thixophobia
• chiratophobia

(Thank you, Wikipedia, for that info!

Phobias are considered the most common Anxiety Disorder. Most suffers are women (90% of phobia sufferers are women, in fact). Phobias often start from some sort of childhood incident that incited fear, dread, fear of death, or panic. Once someone equates fear with an object or situation (and the incident is extreme enough for that person), then they develop symptoms of anxiety and panic whenever presented with said object or situation. No one likes how anxiety/panic feels, so then the object or situation is avoided. MOST kids outgrow these fears (like the fear of the dark), HOWEVER, some people retain these phobias into adulthood.

There are several theories of how phobias work. It appears to include a combination of genetic inheritance (people with anxiety are likely to pass it off to their offspring genetically AND behaviorally), learned behaviors (I’m repeating myself, in a way, but it comes down to the Nature vs. Nuture debate), and individual experiences with scary things.

So, to answer Natasha’s second question, I’d say:

Yes, children can develop similar symptoms to their parents if their parents exhibit a phobia. They would likely be genetically prone to developing an anxiety disorder and symptoms can emerge based on how their parents interact with them.

For instance, a parent who is phobic of touching probably wouldn’t engage in much hugging, kissing, or general affection, etc with their kid and so the child would learn that it’s not okay to touch or that touching isn’t part of how people interact.

The good news is that phobias ARE treatable with therapy and/or medication.

Ok. Enough of my rambling. I hope that was helpful, Natasha!

Remember, these posts are for writing purposes only and are NOT intended to be medical/psychiatric advice or treatment.

Please don’t hesitate to ask a question–I’d be happy to host your Mental Health Monday question any time! Just leave a question in the comments, email me, tweet me, or find me on Facebook–links are on the sidebar.

EDIT: PICTURES REMOVED TO AVOID COPYRIGHT INFRINGEMENT. CLICK ON LINK BELOW TO SEE IMAGE F YOU’RE INTERESTED.

(photo credit)

Mental Health Monday–Amnesia and Anxiety Disorders

A writerly pal and blogging buddy, Lynn Rush, has some fantastic questions for today! I met Lynn several months ago on the interwebz and have become an avid fan. Not only is her blog, Catch the Rush, fun and engaging with movie trivia quotes, writer’s journeys, and guest spots with her characters, but Lynn herself is upbeat and always encouraging. And she’s written a TON of novels!!!!

Thanks, Lynn, for posing such interesting questions!

1) What is the treatment for amnesia (trauma induced)?

I’m glad you pointed out trauma induced amnesia, because there are several instances where amnesia can occur (perhaps I’ll tackle that in a later post…). Gosh, I wish I could say there was some magical medication available to cure amnesia, regardless of its cause. Alas, we don’t have such a thing.

 Trauma induced amnesia leads me to believe there was some assault (injury) to the brain. A common example would be a car accident where someone hits their head and is knocked out. They could have injury ranging from mild to severe concussion to a fractured skull, coma, or brain bleed.

There are also two main types of amnesia: Retrograde (where the person doesn’t remember memories from before the incident) and Anterograde (where the person can’t make “new” memories after the incident).

Most treatment includes:

• sedatives such as low dose anti-psychotics (if the person is distraught or agitated and needs the aid of a medication to calm them)
• cognitive rehabilitation (in other words working with the person to regain skills)
• TLC (I add this becuase amnesia is a frightening experience and most benefit greatly from support of friends and family)

2) What medications would you prescribe for someone with OCD (Obsessive-Compulsive Disorder)?

OCD is an Anxiety Disorder where the individual suffers from intrusive, recurrent, often unpleasant thoughts (obsessions) and engages in repetitive behaviors (compulsions) to ward off, defend themselves against, and fight those thoughts. It is a disorder when it interferes with the person’s functioning and when it causes significant distress. Severe forms of OCD literally take the quality of life away from someone becuase they are engaging in their thoughts and behaviors for HOURS a day.

I’m gonna amend this by saying we all have had that experience of, “Oh, crap, I left the stove on,” or “Did I lock the door when I left for work?” It’s okay to go back and check, as long as it doesn’t happen for hours a day.

Treatment includes a combination of Cognitive Behavioral Therapy (where the person works with a therapist to identify the thoughts, the emotions behind them, and strategies to break into the compulsion cycle) and medications. The most commonly prescribed medications for the treatment of OCD include anti-depressants such as Prozac, Lexapro, Celexa, Zoloft, Luvox, etc. (I haven’t named all of them here, but suffice it to say they all have some effect in ameliorating symptoms and it comes down to what works best for that individual.) Studies have shown Luvox to be particularly good at curbing symptoms, however, it can react with other medications when metabolized in the liver, so it is used less frequently. Another oldie, but goodie, are the TCA (tricyclic anti-depressants) class. However, they tend to be dangerous in overdose and, since the advent of Prozac and other “SSRI’s” (Selective Serotonin Reuptake Inhibitors–AKA they regulate a chemical in the brain called Serotonin), they have been prescribed less and less.

3) What treatment would you try with agoraphobia? Both meds and behavioral therapy?

Like OCD, agoraphobia is considered an Anxiety Disorder.

Agoraphobia itself means: an abnormal fear of open or crowded/public spaces.

Agoraphobia is commonly associated with Panic Disorder (which occurs when an individual experiences frequent panic attacks, characterized by overwhelming anxiety, sense of doom, lightheadedness, fear of loss of control, tingling of extremities, racing heart, shortness of breath, sweating, upset stomach, etc, that lasts from 5-20 minutes). The fear becomes overwhelming when the person believes there is no way out or they will be completely unable to get help if something bad happens. The general cycle is that someone has a panic attack, then anticiapates it occurring in that location again, so they avoid going there, then another panic attack happens somewhere else and they avoid going there, until finally, they are literally housebound.

Treatment for Agoraphobia, like OCD, is two-fold. While avoidance of anxiety-provoking situations is helpful in the short-term (we all use this strategy, by the way), it tends to have negative consequences in the long-term (ex. becoming housebound because you can no longer go anywhere). So, CBT and something called Exposure Response Therapy is helpful because it helps the person confront their fear with the guidance of a therapist.

Therapy is often supplemented with medications. Anti-depressants again are most effective in these cases because they help regulate Serotonin and help the individual to cope better with their anxiety.

Alrighty, gang, we covered a lot of material here today–I hope y’all made it to the end, LOL! Any questions or clarifying I can do?

And don’t forget to check out Lydia’s post on Medical Monday!