PTSD confusion

[chocolateorangeinhaler]

Hi all

This post is not meant to cause offense to anyone suffering with any mental health issues but I would really like to understand peoples thoughts on PTSD.

I've noticed it's a term that people use now all the time increasingly in the workplace. on fit notes from GPs words such as 'could' and 'might be' are used without any hint of a formal diagnosis leading to the person involved telling all and sundry from that point on that they have PTSD.

I asked a physiatrist about this to be told that the criteria for a diagnosis is actually very tough and usually the ptsd is a result of sustained, imminent and real threat to life and inability to live normally after the threat has gone. Think soldier in active conflict, abused wife, husband or children.

So why has it been generally accepted that people have PTSD after a normal life event e.g. death of a relative. The physiatrist I chatted to said this is more a psychological difficulty and definitely not ptsd.

People with PTSD go through hell everyday and I'm sure would do anything not to have it. So I'm perplexed as to why people who really don't have it want to think they do.

Lots of people self diagnose maybe part of it or actually maybe there are jsut more people than we realise who have been through trauma

Something you can get over easily might be traumatic for someone else

1. mental wellbeing to mental ill health is a spectrum not a yes/no cut off. So someone might be quite distressed about traumatic experiences without meeting psychiatry standard criteria for PTS Disorder.

2. the likelihood of experiencing a post traumatic stress response (flashbacks, intrusive memories nightmares) dont depend on how severe other people perceive the trauma. They depend on what has happened to you in the past and also how you experienced the event. So, you are much more likely to experience post-trauma symptoms and distress if a) you have a history of maltreatment or traumatic experiences and b) if the event felt like it was under someone else's control or no control. This is one reason why birth trauma is relatively common - feeling like you have no control in a traumatic situation.

3. theres lots of debate about whether psychiatry defined cut offs for disorder are meaningful or valid. Who is to say that someone who has nightmares 3 times a week for 3 months is significantly more affected by it than someone who has nightmares 2 times a week for 3 months? One would meet criteria and one wouldnt. Thinking in y/n terms about diagnostic criteria is sometimes unhelpful because of that.

4. we all tend to talk this way sometimes for example "I'm a little ocd". Its not great, as it can be frustrating and stigmatising to people who have really high levels of difficulties with these symptoms. But I suspect people with PTSD symptoms may say this because a) other people understand what they mean by PTSD and b) it helps them express how strongly they were affected by an event.

I hope that helps @chocolateorangeinhaler - there are other reasons but typing hands are tired!

Sorry, another reason specifically for your examples 5) unfortunately workplaces often have poor respect for mental ill health and it's onlywhen it hits criteria for mental illness that they will offer support or time off. This puts GPS under pressure to allude to diagnosis. For example, perhaps your poor work colleague wouldnt get more paid time off for a grief reaction (cause our compassionate leave policy is 2 weeks) but would if the GP writes PTSD

That's a really good question. I suffer with PTSD and only my close friends know about my diagnosis. All of those close friends believe that I have it due to a grief reaction when my parents died suddenly. Same for my employer.

Only my sister, my GP/psychiatrist/therapist and my DH know that the grief just made my PTSD symptoms impossible to live with and pushed me to go to the doctor about it.

My close friends are lovely and just reacted to my diagnosis with understanding, and said 'oh yes, I was the same after my mum died' (with the best intentions, and I love them for it).

When I talk about what happened to me sometimes I dissociate, sometimes I seem totally fine and but then end up dealing with suicidal impulses a few days later, sometimes I get flashbacks or can't sleep for 72 hours at a stretch etc. etc.

I won't tell you why I have PTSD. Like I say, I wouldn't tell my closest friends and if I wrote about it here now I wouldn't be able to work or function for the rest of the day. But I need something that I can say to a friend over coffee, and my parents' death is a reasonable and socially acceptable thing to say, so I say that.

Can I gently suggest to anyone reading this, that if someone tells you they have PTSD, maybe the best follow up question isn't "What did you get that from?" but "Is there anything I can do that would help you right now?" You can just go ahead and assume that if someone has PTSD then something happened that they weren't able to process, and leave it at that, unless they actually want to talk to you about it.

Maybe with all the 'destigmatise mental health' movement these days, there's an idea that being really open about everything is good. But for my own case, when it comes to talking about trauma it is best done in very controlled and safe circumstances, not necessarily in the HR office of a company or in Starbucks with a friend.

Just to reiterate - it's a really good question, I'm glad that you asked it OP, because I think it would be good for more people to understand this.

Thanks for the replies to my question. I'm in no way trying to say ptsd is an easy thing to live with and I understand one persons tolerance is different to another's hence one person may not cope as well.
I'm very much of the school of if there is a genuine problem then employers must do as much as possible to promote an environment where the individual feels safe and also feels safe to talk when starting to feel anxious. Helping people overcome their issues is really important to me.

@chocolateorangeinhaler

I think I understand what you mean.

But I have to just add clarification that if my employer said that they wanted me to talk to them when 'starting to feel anxious' I would leave that job, because my employer has absolutely no mental health qualifications and wouldn't be able to help me if I dissociated or started to have flashbacks. They could potentially make things much worse for me by wanting me to talk about it. They have no idea why I have PTSD (they think they know, but they don't), and they have no right to know. My employer won't be helping me to overcome 'my issues'. I have boundaries.

All I ask is that they don't discriminate against me. If I were too unwell to work then I would expect to be able to take sick leave, that's all. Luckily I don't need many workplace accommodations - just time for appointments and the ability to take a day's holiday at short notice.

As far as whether it's 'genuine' or not - you will just have to take their doctor's word for it. I'm sure @TheDaydreamBelievers is right that sometimes GPs might put PTSD just so that an employer allows the employee to have some time off. Quite right, if that's what it takes to allow people to recover their mental health.

Sometimes that "normal life event e.g. death of a relative" is horrendously traumatic. Not just the death itself, but the preceding days/weeks/months and aftermath.

DS1 has PTSD as a result of DD1's death. He certainly has PTSD not just a "psychological difficulty". He was diagnosed by a specialist tier 4 CAMHS team. and over 6 years on still struggles daily. He narrowly escaped an admission, attended a CAMHS day unit for a while, takes an antidepressant and antipsychotic and still has significant therapeutic input now.

for you and your DS1 @1jumpforward2back

@runningoverthefields have you tried emdr therapy? Apologies if you already have.

@runningoverthefields have you tried emdr therapy, apologies if you have.

it's an interesting one - I was diagnosed with PTSD after the birth of my daughter. But while that was the event that triggered the diagnosis, it wasn't what caused it, that was a previous, sustained trauma. So I suppose I might say it was PTSD post-birth to someone who asked. Not that they would because I never admit it to anyone in real life.

It's an absolute fucking nightmare, PTSD, but I wouldn't assume to know anyone's circumstances.

Please read the DSM definition of PTSD, it's far wider in scope than you suggest.

www.brainline.org/article/dsm-5-criteria-ptsd

Relating it solely to active combat or sustained abuse is not helpful and pretty ignorant. We all have different responses to traumatic situations, and PTSD relates to your reaction to an incident (or an accumulation of incidents), not to what the incident was.

@Hendersonsisnotrelish - no need to apologise . EMDR is not offered by the NHS in my area but I talked to the psychiatrist about it last time I was assessed in case it was worth saving up money for. He said that he wouldn't recommend it for me right now. I still might consider it in the future.

@changingstages Same, same, same. So true - the event that triggers the diagnosis might not be the underlying trauma that causes PTSD. And people assume they know what the trauma is - and they really don't. So best not to make assumptions.

@Orf1abc - yes, that's a really helpful thing to point out. I didn't seek help for ages because I 'wasn't a soldier', even though I met the 'severe' criteria when I was finally assessed.
I would also add that people who have suffered a trauma will often minimise it ("It wasn't that bad, I should just pull myself together") so it's a particularly pernicious idea that someone's trauma has to be 'bad enough' for their PTSD to be "genuine"

Thanks everyone for the input it's very informative.

So currently if I know someone has an issue of any kind when I say I encourage them to talk to me I don't mean tell me all the details. I ask them what I can do to help them, what do they need from me etc. I never ask or expect to be told what's wrong and I tell people that when talking with them I also am very open in saying if they are not comfortable talking to me then we can find someone else who they would feel more comfortable with. My main aim is not to make anything worse for people and to try and build up a feeling of trust.

An abused wife, husband or children are more likely to have CPTSD, which is even more poorly recognised and more difficult to get treatment for.

(Not that it's a competition, it's all heartbreaking)

OP you aren't going to build trust when you are judging them, doubting they have PTSD and dismissing their MH problems as "more a psychological difficulty". Whether it's diagnosed PTSD, potentially PTSD or another condition it doesn't change the fact they are off work and need support on their return. Would you respond in the same way to a physical illness?

Thanks Runningoverthefields.

I wish DS1 could access EMDR, I have heard brilliant things about it, but he's too immature and would be unable to engage with it at the moment.