The world becomes smaller for many people with post-traumatic stress disorder.

“I don’t want to go anywhere where I am going to see, hear, taste, smell something that is going to remind me,” said Carlisle therapist Lori Moskel, describing the condition.

For 10 years, this licensed clinical social worker has made it part of her practice to help people stuck in a mindset where trauma controls their life.

Avoidance behavior is among the outward signs of inward turmoil people experience when trying to process all the emotions that accompany a particular event or circumstance.

If left undiagnosed and untreated, PTSD could lead to depression and even thoughts of suicide. There are people who self-medicate using alcohol and drugs, Moskel said. “Their relationships with family members become broken.”

Other people either underperform or overperform at their jobs, believing the world unsafe and insecure. This could manifest itself as tension with the person acting overly bossy because they feel a lack of control in everyday life, according to Moskel.

But not everyone with a trauma history ends up with a PTSD diagnosis, said Valerie Domenici, a licensed clinical psychologist in Carlisle. How emotions are processed is highly individual.

“Some people are going to need to seek out help where others are going to walk right out and not think about it again,” Domenici said.

Clinical updates 

In her paper “Symptoms & Diagnosis of PTSD”, Sara Staggs said clinicians use the Diagnostic and Statistical Manual of Mental Disorders as a guide in understanding the clusters of symptoms so that they know how to treat different clients.

Issued in 2013, the fifth edition of the DSM moved PTSD from the category of an anxiety disorder to a new category of “Trauma and Stress-related Disorders."

“This could help de-stigmatize PTSD since it is no longer an anxiety related mental illness, but a disorder connected to an external event,” wrote Staggs, a therapist in Washington, D.C., specializing in trauma and PTSD.

The DSM defined a traumatic event as one in which a survivor is exposed to actual or threatened death, serious injury or sexual violence. The exposure can be direct or witnessed.

Trauma can also occur indirectly if the person hears about a death by accident or violence from a relative or close friend. Certain professionals such as first-responders can also suffer PTSD from either repeated or extreme indirect exposure to a traumatic event.

“Many professionals who work in trauma differentiate between ‘big-T traumas’ and ‘little-T traumas,” Staggs wrote. “Little T-traumas can include complicated grief, divorce, nonprofessional media exposure to trauma, or childhood emotional abuse; and clinicians recognize that these can result in post-traumatic stress, even if they don’t qualify for the PTSD diagnosis.

“There is no longer a requirement that someone had to have an intense emotional response at the time of the event,” Staggs wrote. “This requirement excluded many veterans and sexual assault survivors in the past.”

Categories of symptoms 

Symptoms tied to PTSD fall into four main criteria — intrusion or re-experiencing, avoidant, negative alterations in mood or cognition and increased arousal.

Intrusion is when the mind replays the event or circumstance leading the body to respond physically. This includes having intrusive thoughts or memories, nightmares or flashbacks related to the events or having a negative response to a reminder of the event such as an anniversary.

Avoidant symptoms are ways in which the person may try to avoid any memory of the event by avoiding thoughts or feelings connected to the event or people and situations connected to it.

“Their world becomes smaller,” Moskel said. “They just don’t function the way they would normally function. They don’t want to live their lives and enjoy the activities they once did.”

Negative alterations symptoms are new criteria included in the DSM's fifth edition and describe a decline in mood or thought patterns. People with these symptoms have problems remembering the event or they become stuck in the emotions tied to the trauma (horror, shame or sadness), according to Staggs.

These people can also have negative thoughts or beliefs about their own self-worth or about the world at-large. There can also be a distorted sense of blame for the event on themselves or others, severe disinterest in pre-trauma activities and feelings of detachment or isolation from other people.

Arousal symptoms relate to the way the brain remains wary and watchful of threats. This can manifest itself as a loss of concentration, irritability, increased temper, difficulty sleeping, hypervigilance and being hyped up or easily startled.

“They are always living in this fight or flight or freeze [mode],” said Moskel, describing the innate response to threats in human behavior. “They are living in a high-stress zone.”

Email Joseph Cress at jcress@cumberlink.com.

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