Is it Anxiety or PTSD?

Is it Anxiety or PTSD?

by | Anxiety, Trauma

Lots of people can relate to being anxious, and wonder if they have anxiety or PTSD.

Sometimes the feelings are mild: slightly elevated heart rate or blood pressure, some discomfort in social settings, or too many thoughts to get back to sleep easily. Other times, experiences of anxiety are really debilitating: panic attacks that make the heart race and leave a person feeling like they are having a heart attack, or physical symptoms resulting from obsessive worry about all the “what ifs” involved with an upcoming event.

There are many types of anxiety. Social anxiety, generalized anxiety, acute stress disorder, and phobias all fall under the “anxiety disorder” umbrella, among others. But, up until 2013, so did Posttraumatic Stress Disorder (PTSD). And, with quite a lot of overlap in symptoms whether it’s anxiety or PTSD, it can be hard to distinguish the variety of anxiety disorders from PTSD, which the newest edition of the Diagnostic and Statistical Manual of Mental Disorders now calls a “trauma and stressor-related disorder.”

So, what is trauma?

It would be so much simpler if we could just identify which stressful experiences are “traumas,” and which aren’t. The trouble is that trauma isn’t in the event itself. It’s in each person’s experience of the event—even an event that happened to someone else, but was witnessed—and how his or her brain and nervous system perceive and process the threat.

You might not necessarily tie a traumatic event to your anxious thoughts and feelings, or even realize you experienced “trauma.” You might think you just feel bad. You might want help for your persistent nervousness or tools to manage the unexplained panic that comes “out of nowhere.” You may be frustrated by how out of control you feel when you’re stressed.

There is some complex neurobiology at work in a brain that perceives an event as traumatic. But, when most people think about anxiety and trauma, they think about their experiences. Let’s look at those.

How Do Anxiety and PTSD Compare?

There are clear symptomatic similarities. Anxiety and PTSD affect sleep and energy. They both impact disposition and mood. They both fuel a need to be alert and exhaustingly on guard. Both conditions generate fear and worry surrounding non-imminent threats.

For the most part, typical anxiety is often generated without an actual precipitating situation.  Thoughts present in anxiety disorders do not necessarily relate to past events, and no real circumstance needs to drive the upset. The worry and fear are real, but the cause is often based on unsupported assumptions.

On the other hand, PTSD’s symptoms are driven by a significantly different force than other anxiety types. Suffering occurs because frightful circumstances are not imagined. Something frightful actually happened, and in fact, a person with PTSD experiences the symptoms as if the event was happening again and again.

While anxiety symptoms and PTSD symptoms can overlap, PTSD is always related to traumatic and stressful past events.

You might ask, “Isn’t social anxiety sometimes linked to stressful past social situations, for example?” Sometimes, but it’s much more usual that anxieties are not specifically related to a certain past event. For example, the stressful thoughts suffered by someone with Obsessive-Compulsive Disorder are not usually provoked by past experiences.

But, PTSD is always related to specific past events. It might be a one-time event in adulthood, like a horrific car accident. It could be a series of events over a period of time like many combat veterans experience. Or, it might be the ongoing developmental or complex traumatic stress experienced in childhood or later developmental years. Whatever the event(s), traumatic stress disorders have their roots in past events, and they can produce many symptoms in a sufferer’s current life.

PTSD is much more than fear and worry related to the frightening circumstance.

Enduring something so frightening or terrible that our very existence is threatened—or perceived to have been threatened— has the power to change not only perceptions, but the nervous system itself.

In fact, trauma survivors are distinctly and uniquely affected as the nervous system adapts to what it perceives as a more dangerous world in the aftermath of trauma. It is an inability to release oneself from the emotional, mental, and bodily sensations that accompanied that experience. It’s like the traumatic event or events are still happening. The brain and nervous system find ways to compensate for the perception of danger, and distinct symptoms result.

Let’s compare common symptoms of anxiety unrelated to trauma and common PTSD symptoms.

Anxiety Symptoms

  • Fatigue and restlessness
  • Hypervigilance
  • Irritability
  • Excessive, persistent worry
  • Intrusive, fearful thoughts
  • Difficulty with sleeping, digestion, and tension
  • Reduced concentration
  • Racing heart, sense of doom

Although many of these are also associated with PTSD, Traumatic Stress Symptoms Fall into Four Categories, and Include:

  • Re-experiencing symptoms, such as nightmares and dissociative flashbacks, or intense distress related to triggers some parts of the event, and/or having bodily sensations specifically associated with the traumatic event.
  • Avoidance symptoms, such as avoiding any people, places, actions, words or objects related to the event, and feeling detached, “spaced out,” or emotionally numb.
  • Negative thoughts and mood, including difficulty remembering important parts of the event(s), ongoing negative moods and trouble having positive experiences.
  • Arousal symptoms such as irritability, angry outbursts, recklessness, self-destructive actions, watchfulness or edginess, feeling easily startled, poor concentration, sleep problems.

While some anxiety symptoms and PTSD symptoms clearly overlap, the difference is that with anxiety, the intrusive thoughts, persistent worry, and other difficulties are generally not tied to a specific or past event, whereas in PTSD, they are.

PTSD impairs your ability to recover from overwhelming events, or to establish healthy thought patterns and relationships. It deserves to be set apart from standard anxiety disorders for good reason. To recover is possible, but the care of a well-trained therapist using safe, effective, research-based methods can be crucial.

How about you? Are you anxious and unsure why?

Do you need help distinguishing the way you feel now from what you endured in the past? Or, are you unsure if your current symptoms are related to anxiety or PTSD? Getting answers to these questions and gently working it out with a compassionate, skilled trauma therapist can make all the difference.

Traumatic Grief: Trauma, Grief, or Both?

Traumatic Grief: Trauma, Grief, or Both?

by | Trauma, Random

Traumatic grief.

Traumatic Grief. Reading the two words together signals that something terrible happened. They highlight shock and suffering. Something happened to you suddenly, or was stripped away from you tragically. Perhaps someone even betrayed you unexpectedly.

Traumatic grief reveals distressing emotional injury and awful loss.

Now trauma lives in your mind and body along with your sorrow. Your thoughts and emotions can’t help but return to those events. Even sensations within your body hold reminders of what happened. And when you’re not re-experiencing it, your mind and body go numb.

Memories intrude and reoccur. Your body upsets, resets, and reacts. Now, loss is happening again and again inside you. Nightmares haunt your sleep.  Each time it’s real to you, and just as raw. Each time you hurt and are held back from the healing you hope for. Somehow, you just can’t get to the hope and help that painful but healthy grief eventually affords.

Why is it so hard?

Because unlike the road traveled by conventional grievers, your unprocessed trauma always takes priority, stifling a healthy journey through loss and acceptance back to your way forward in life.

So, how do you know when to seek help? How long do you grieve before you really know to reach out to a counselor rather than just family or friends? Are there signs you should look for? Are there questions to ask yourself?

Do you recognize these traumatic grief symptoms?

Grief and mourning are normal processes and responses to loss. As such, many find that the support of family, friends, or a non-profit grief group is enough. Even so, seeking extra support through counseling for a safe, confidential environment that’s all yours can aid many grievers.

But, you know it’s time to seek help when you experience these symptoms for more than a couple of months:

  • Frequent attempts to avoid any reminder or mention of the event or person,
  • A sense that the future is pointless,
  • Feeling numb or emotionally detached,
  • A persistent sense of being shocked or stunned,
  • Difficulty acknowledging and accepting the reality of the person’s death,
  • A sense that life is devoid of meaning or purpose,
  • Inability to even imagine a return to a full, rewarding life,
  • Feeling like part of yourself died, too,
  • Disrupted or disturbed sense of security, trust or control,
  • Identifying with damaging or harmful behaviors connected to the deceased person,
  • Anger, irritability, hostility, or bitterness,
  • Self-care seems useless,
  • Significant impairment of social, occupational, or other crucial functioning,
  • Nightmares or a sense of being disconnected from time.

(Of course, if you experience thoughts about self-harm or suicide, call 911, a 1-800 crises line, a counselor, family member, friend, pastor, or doctor.)

Do these symptoms seem familiar? Do you get the feeling they are not improving? Are you exhausted because your emotional pain is too difficult to tolerate and you can’t control the thoughts and images in your mind?

The neurobiology of trauma can seriously impair the ability to grieve in a healthful process. This is because trauma is the intrusion of traumatic events into the here and now, through thoughts and physical reactions, as though the events were happening again and again. To help you address your symptoms, you may need a trauma-informed grief counselor or trauma therapist who can help you consider and employ effective strategies for addressing the trauma first. Then they can help you proceed with grief processing afterward.

There is very little you can do to grieve effectively and completely until the traumatic impact to your nervous system is recognized, calmed, and corrected.

Is your brain struggling to recover?

We experience loss in a biological, physical, neurological, and emotional way. Hormones and chemicals are released, normal internal responses are disturbed, and key internal systems go on alert. A traumatic loss—traumatic grief—is intense. And the nervous system directs it all.

Your psychological responses to trauma tax the regions of your brain managing attention and memory. The areas that focus on emotion and relationships are overstimulated. The zones that are dedicated to planning and language are strained. Also, hormones reserved for emergencies pump through you too often. Your “threat assessment” center is in overdrive.

Thus, you likely cannot process your loss because it’s as if your thoughts and emotions are continually stuck on repeat. You are re-experiencing the traumatic events connected to the loss but not the return to calm and progress that eventually follows the grieving process.

“Grief,” for you, becomes a cycle of disproportionate, unrelenting, negative emotions, physical sensations, and thought intrusions. Your mind and body do the best they can. But, it’s rough trying to go on that way without knowledgeable help.

Is your support system supportive enough?

Sometimes, trauma survivors, or those experiencing loss in a dramatic manner, recover on their own. Especially if they have enough trusted friends or family who actively support them and come alongside them to grieve. Sometimes the trauma symptoms that accompany a traumatic loss will abate in a month or two.

But often, the need to discuss the circumstances and heartbreak of your loss repeatedly can prove too much for friends or family. Furthermore, to shore up more support, many find relief in grief support groups or online forums. However, there is much to be said for individual traumatic grief counseling to tease apart what constitutes the symptoms of healthy grief versus symptoms of posttraumatic stress.

If you sense you are not progressing through grief well, an objective perspective is often helpful amid the roiling emotions of your loss. In addition, a professional traumatic grief counselor can help determine whether your thoughts, emotions, and perceptions are grief with its normal stresses and sense of bewilderment, or whether lingering symptoms might indicate traumatic stress.

You’re hurting right now, maybe badly. And learning to live with your loss won’t be easy, and it will take as long as it takes in a process that’s individual to you and the relationship you have with whomever or whatever you lost. But, you can find help and relief if posttraumatic stress is compounding your suffering.

7 Ways PTSD Affects Your Relationship and How to Restore Your Connection

7 Ways PTSD Affects Your Relationship and How to Restore Your Connection

by | Relationships, Trauma

PTSD is hard on relationships. And it won’t just go away if you realize how much you love each other. Or ease its assault of isolation, flashbacks, nightmares, sense of failure, or waves of sadness and sudden anger on its own.

PTSD breaks connections. The trusting, intimate, loving kindness you used to have can fray until you fear you both can’t hang on any longer. And, on top of the disconnection, irritability, and other causes of relationship troubles due to PTSD, the survivor may be wracked with guilt and shame.

The statistics bear it out. PTSD can be an effective relationship destroyer. But it doesn’t have to be. Not if you recognize how it affects your relationship, and then get the information and support you need to fight for your restored connection.

You can both do this. First, you have to know what you’re dealing with.

7 Ways PTSD Comes Between You and your Partner

1. General numbness and disinterest become the norm; when you’re not feeling like a caged tiger, you feel like a zombie

Posttraumatic stress disorder often numbs the trauma survivor. PTSD can drain interest in doing anything social or participating in hobbies or activities, as the person with PTSD feels generally distant and disconnected. A tendency toward isolation wedges itself between you two.

If this describes your partner, you may feel frustrated and alienated, disappointed and discouraged much of the time as you try to engage. And you might become angry or distant yourself when the numbness keeps your loved one from responding or reaching out.

2. Lack of physical intimacy and sexual disinterest

PTSD does a number on trust. Reliving the trauma can keep feelings of betrayal, pain, abuse, or horror present in the survivor’s mind and body. So much so that physical intimacy may be scary, uncomfortable, or even distasteful. This can be true even if the trauma wasn’t sexual trauma.

If your partner seems disinterested, you might feel even more separate and abandoned, not to mention feeling rejected and lonely. For the survivor, disinterest in sex can be baffling, or it can increase feelings of shame or guilt.

3. Irritation, demands, and control

It’s not uncommon for trauma survivors to remain permanently on edge. They don’t trust the world around them any longer. This can show up in ways specific to the trauma, or in a more generalized sense. This leaves them feeling on guard and anxiously intense.  They may be unable to relax, and they could respond to loved ones with irritability, demands, or even explosive rage.

As the partner, day after day this can’t help but wear on you. After a while, you may end up feeling pressured, resentful, controlled, or even terrified. Communication may be very difficult or contentious. And for the survivor, intense feelings of guilt and shame can accompany this change in their own behavior.

4. Troubled sleep

One of the most common issues for PTSD sufferers is disrupted sleep, nightmares, or insomnia. Lack of sleep has been shown to exacerbate the symptoms of posttraumatic stress.

Just sleeping with your partner may be difficult or impossible, further impeding intimacy and closeness. You can both get exhausted, decreasing ability to cope with stress. And, the PTSD sufferer can be left feeling dazed and disconnected after nightmares, both craving sleep and resisting it.

5. Tough talk

Trauma survivors sometimes wrestle with anger, rage, and impulse control. To manage roiling emotions, they may stuff their feelings and behave badly to avoid closeness. In an effort to self-protect, they may also become critical, act as though they are dissatisfied with their partners, or become downright verbally abusive.

If you’re in this position as the spouse of someone with PTSD, and you feel kept at arm’s length by negativity, you may lash out or retreat as well. Some partnerships might devolve into verbal abuse or worse. Given the instability posttraumatic stress symptoms can introduce, physical altercations may occur as well, in which case it’s extra critical that treatment and support happen safely for both parties.

6. Over-dependence

Some posttraumatic stress sufferers feel shut down by trauma. They don’t trust themselves to operate in the world or read people correctly. They struggle to trust others, but they’ve also lost confidence in themselves. While many survivors disconnect and reject support, some lean heavily on loved ones and may unintentionally end up draining the emotional and material resources of a partner who is trying to be supportive.

If you are partnered with a trauma survivor, you may also feel guilty and overburdened by the symptoms of your partner’s posttraumatic stress disorder. Your feelings may vary, from an intense desire to support and assist your partner, through a normal range of longing for change and wondering how you will cope.

7. Poor coping methods

Too many couples find themselves battling the symptoms of posttraumatic stress disorder and the fallout of coping methods that do more harm than good. Alcohol abuse and substance addiction are two of the most common issues. These destroyers of formerly intimate and loving relationships have been shown to spike the severity of PTSD and offer no lasting relief. Other compulsive, addictive, or thrill-seeking behaviors can also occur as forms of self-medication.

As a survivor’s spouse, to endure the co-occurring conditions of PTSD and addiction could be too much to bear or draw you into your own dark place. It’s important to find ways to cope that are healthy and beneficial.

Untreated PTSD poses unique difficulties for relationships. But there is hope and help that provides solutions and restoration.

How You Can Restore Connection with your Partner with PTSD

Seek help!

First and foremost, the best thing you can do to restore connection is to seek professional help. Find a counselor with the expertise to help dismantle PTSD’s hold on your lives. It is very common for survivors with PTSD to resist seeking help for many and varied reasons. However, taking the journey together can provide you both hope.

Individual trauma therapy for the trauma survivor will require patience and support from the partner. Couples counseling for the sake of learning the most effective communication tools and restoring your bond is invaluable as well. Many marriages can become stronger than ever through trauma therapy and marriage counseling.

Acknowledge and accept the impact of the symptoms

PTSD can convince your partner that they are never prepared enough or really in control. The ultra-alert, hypervigilant state of mind is upsetting and draining for you both. To endure it and continue building relationship requires patience and respect on both sides. Educate yourselves about the disorder for increased understanding.

It’s important to recognize that posttraumatic stress disorder is a brain- and body-based condition. The symptoms aren’t character flaws, and a person can’t “snap out of it.” A therapist experienced in both trauma recovery and couples counseling can help you understand how to tease apart the couples work you can do, and the trauma recovery that is necessary.

Be as present and available as possible

As mentioned before, PTSD sufferers often push people away. As a partner, you may wonder how far to pursue your loved one or whether to simply let go. But it needn’t be an all or nothing situation.

Don’t force connection. Be available. Remind them they aren’t alone. Honor your commitments. Check in with each other often. Listen. And, make sure you are getting your own support.

By the same token, look for ways to honor your partner’s need not to talk. Demonstrating respect and understanding for each other’s experience can provide a sense of safety. Working with a good couples counselor can help you each balance getting individual and couple needs met.

Remember that words matter

PTSD sufferers live in a particularly delicate place. Managing the mental and environmental triggers, traumatic re-experiencing, anxiety, and low mood can get to be too much. A partner who is compassionate and careful not to take many of their responses personally makes a big difference.

That isn’t to say that abusive language or emotionally flooded conflict should be tolerated. Be honest and communicate that his or her words are hurtful. But recognize, too, that PTSD is intense and deeply internal, not something your partner is trying to do to you. Offer each other grace and forgiveness often, while you are pursuing treatment. Concentrate on listening more and “fixing” or controlling each other less.

Provide each other threads of normalcy

Again, PTSD is intense and disruptive. Your life together may seem less overwhelming if you can focus on providing each other a safe, regular activity as reliable friends. Communicate daily that you belong together. Share regular cups of coffee, shopping trips, walks to the park every day, or whatever activities reduce triggering. Bond as you build predictable routines.

Recovery from PTSD is the ultimate goal.

Healing is what you both want—for the partner with PTSD, for the stressed person who loves him or her, and for your relationship. But, it can be hard for both of you to believe it’s possible. However, while traumatic experiences do change us, it is possible for the survivor to heal from the PTSD symptoms that are so hard on relationships and recover the sense of purpose and self-respect that keep a person grounded in meaning. Neither of you need to suffer forever, or lose the love between you.

[A note about safety: If you or your partner are feeling unsafe with each other or at risk of self-harm, please seek immediate assistance by calling 911, visiting the emergency room, or calling any of the suicide or crisis hotlines such as (800) 273-8255, or domestic violence hotlines such as (800) 799-7233.]

Finding Relief for Trauma (Hint: There Are Logical Reasons for Your Symptoms)

Finding Relief for Trauma (Hint: There Are Logical Reasons for Your Symptoms)

by | Trauma

What if you were experiencing excruciating trauma symptoms (like a break) to your leg, and it didn’t hold you up when you put weight on it? And what if your painful symptoms kept you from getting around in your daily life: sleeping through the night, getting dressed for work, or having a conversation with someone you cared about?

Then imagine you went to a doctor. She asked you about events leading up to the symptoms, took x-rays, and performed other evaluations. She announced that your leg was broken. You’d had no idea. You might have known that you’d had a fall that seemed to produce the injury, but you really hadn’t thought it could have been bad enough to create all that pain. It would be a relief to know you weren’t crazy.

There are Logical Reasons for Your Trauma Symptoms

As a trauma counselor, I often get to see my clients experience this type of relief. I’m not a medical doctor, and the relief isn’t related to broken bones. The symptoms people share are often things like:

– Insomnia,
– Chronic irritability,
– Being more startled by things than others are,
– A sense of narrowed vision or distant hearing during stress,
– Recurring nightmares,
– “Spacing out” in certain situations, and many other symptoms or experiences.

These symptoms can make a person feel like something’s wrong with them, but they don’t know what. Their doctor has ruled out physical illness (that’s an important step!).

Understanding How Your Brain Creates Trauma Symptoms is a Powerful First Step to Healing

Many clients tell me I must be a mind reader. I’m definitely not! But, many men and women have described the same types of symptoms. So, I’ve learned to ask about things that many people are too embarrassed to volunteer. They might feel that their experiences must be so weird that they’re afraid to find out what they might mean. Or, clients are so used to living with these experiences that they no longer think of them as important to tell me. They’re surprised when I ask about sensations, experiences, or symptoms that they’ve had in some cases for many years. They didn’t think anyone would get it. Many clients have asked me, “How did you know that?”

When a client says, “How did you know?” I almost always ask, “Is it okay if I take a few minutes and give you a little spiel?” Then, I give them some information about our incredible brains and nervous systems, including the vagus nerve (the longest cranial nerve). We discuss how events and circumstances impact both the childhood and adult brain to shape our responses to everyday life. Often, the person says, “No one ever explained it to me like that before,” or, “Nothing that bad has ever happened to me, so I just thought something was wrong with me.” The response is usually relief.

Knowing There’s a Logical Reason Can Make it Easier to Get Started with Healing

Now, in the case of that broken leg, knowing about the injury isn’t enough. You need to know what kind of break it is. You and your doctor need to choose the right treatment for your specific and unique circumstances. But, when you know the logical reason behind your pain, it frees you to get the treatment you need to heal, and it helps you realize you’re not actually crazy to be experiencing all those symptoms. That goes a long way toward doing something about them and getting your life back.

In future posts, we’ll talk more about specific parts of this process. Or, talk to me now to see if I’m a good fit to help you with this work.