Post-traumatic stress disorder, PTSD you certainly heard of
in the news a lot. A lot of people who go into combat related situations
experience it. A lot of people experience it in natural disaster situations, tornadoes
(we've had those locally),
hurricanes, earthquakes, tsunami's
so those are some some pretty devastating experiences to people.
Other examples might be personal traumas.
One being assaulted, attacked, raped,
robbed, beaten. Those are possible. A car crash.
Anything where death was a possibility for you
or where you witnessed death or the eminent possibility of the
death of somebody or of somebody close to you would be
a trauma. That doesn't mean that you're going to go on to have a disorder
because
all of us are likely to experience some type of trauma in our lives.
But not everybody goes on to have this kind of a response to it. This kind of response to it
include symptoms such as
avoiding similar situations. Well, that's what we saw on phobic disorder, right?
So if you
had been attacked on a corner you might not feel comfortable going to that corner.
You may not feel comfortable with people who look like the attacker. You may not
feel comfortable
in situations that resemble the situation in which you experienced your
trauma,
right. And, problems with memory and concentration.
Preoccupations, worries interfere with one's ability to think well and
so difficulties arise. Flashbacks which are vivid
re-livings of experiences. Some of them can be so
severe as to be dissociative, as if they are in the experience itself.
But most of the time it just is a really vivid
re-membering of a situation that one very much does not want to remember, does
not want to think about,
would like to avoid thinking of. Hyper vigilance
looking out all the time for something to go wrong.
Looking for danger. Vigilance is good, right. Be vigilant.
Hyper vigilance is not being able to turn that off,
even when you are actually safe. I met a person once who was back, I believe
the tour duty was in Iraq, it may have been Afghanistan, it was just at our
clinic because he was getting some testing done
for job screening. He wasn't there for therapy. He was just there.
And we struck up a conversation and he was like, "man, you know there's this weird thing.
I live in Elizabethton and I'm driving around
and I cant stop looking around me at all times. He is like,
I'm just sitting there and I am tense and it drives my wife crazy. What is that?"
And I say well, tell me about your tour of duty and what did he do? He drove in convoys
where IED's were an immanent possibility at all times. He had known people who were
affected by explosions and he had been in situations
where explosions occur but not to him directly and what he had learned in his military
training and they told him to be
on guard at all times because you might die at any moment and you need to be
prepared to avoid that situation.
And when you go home you don't just turn that off, right?
It became a survival tactic. Now it wasn't a big deal.
He was functioning well. He wasn't complaining of anything else.
His biggest problem was that it bothered his wife. She wanted him to relax
and calm down. It's Elizabethton. Nobody's going , and he's like I know there's no bombs
here. And again frontal lobe actively, he knows that there's not a
a true imminent threat there but he felt
he couldn't let his guard down in a driving situation. And that's not PTSD.
But to go on to higher and higher levels of suffering
related to trauma either delayed or
or acute, meaning it happened right after, you then start to look at diagnoses like this
and there's different kinds
of treatment. The best treatment for non complex traumas, meaning
traumas that only happened once or twice, right,
is exposure therapy. Systematic desensitization
and just getting people comfortable with having thoughts about the trauma
because they're trying to avoid those thoughts. Now we'll see with OCD, the
more you try not to think about something, the
more likely you are to think about it, right. And so getting people, it's not that you
make it better
or you make it less painful to think about, in a soulful
sense, but you make it where they can stand to think about it and they
don't have to
avoid that thinking and they're able to get over it. But it's different for
different circumstances. Somebody who lives in a war-torn country
has grown up with death as a constant possibility
or a really dangerous, dangerous neighborhood, or somebody's on a tour of duty
because that's not just a trauma.
That's not a specific situation that's living for years
in the midst of hyper vigilance and trauma. So it's a much more complicated
situation and why it's much more difficult to treat
combat-related PTSD. And,
we don't know why some people get it and some people don't get it. We have some
theories but
no conclusions. You don't to know this part right here, I just want to point out
that these things are shifting.
It used to be an anxiety disorder. You can imagine why. All of the things I have just been
describing are anxiety responses to stimuli,
right. But they've moved it to a thing they are now calling trauma
as stressor related disorders because there's a very specific
set of circumstances that lead to these conditions. So they moved it
for clarity and because research suggests there's more utility
than considering it separately. You've heard of OCD.
Having a few proclivities and eccentricities is not OCD.
OCD is obsessive-compulsive disorder.
And you have to differentiate that from obsessive-compulsive personality
disorder which is another thing altogether.
So obsessive-compulsive disorder OCD
is persistent, intrusive, anxiety provoking thoughts.
That's what an obsession is. You ever had
a one of those things they call earworm, a song in your head you really hate?
And you can't seem to get it out your head. It just keeps on going and you are
like, Oh, I wish I could stop thinking about that.
Well, in other words it's intrusive. You don't want it, and it's
persistant and it's hanging around but eventually it goes away for most people.
With the obsessions that go with OCD, they don't go away, they don't fade away, you don't
stop thinking about it. They stay
persistent. They keep coming and there are obtrusive. People don't want to
think them. Now a lot of people worry about
thoughts that they have. And we talk about thoughts
not being actions not being deeds and things that people think about are not
necessarily meaning they're bad people.
In fact, there's nothing you couldn't think about,
right.There's no dream that was awful that you couldn't have,
no concept under the Sun, no new thoughts under the Sun.
Thinking things is not a bad thing. But if you have thoughts that keep coming over
and over in you're
uncomfortable with them and you think there may be something wrong with you
for having them to begin with
or that they're just so accountable you don't think them, that becomes
problematic,
right. And you try not to think about it.
You all DON"T think of a pink elephant right now.
Don't think of a pink elephant!
Try not to think about something and what happens is paradoxically
it gets more power. The more you try not to think about it the more you're
thinking about it.
The more aversive it becomes and some way you can get rid of that
is to do something. Engage in a behavior. The distraction
from it. Sometimes these behaviors are related to the obsessions.
For example: If I had I an obsession that I might get
a disease from being contaminated by germs
Well, this is a normal though for any body, right?, Or it should be.
We should all wash our hands every time you go the restroom wash
your hands or use some handy dandy
stuff, right? You use some stuff,
some antibacterial stuff. Why? It's just good sanitation,
right. It's good hygiene so that you kill germs so that you are less likely to get sick
That's normal. But what if you can't stop thinking about it? What if as soon as you
wash your hands you are wondering if you got it all
or if the next thing you touch might recontaminate you and the next thing
you touch might recontaminate you and you can't let go of that. Well, one thing you might do is
engage in frequent
hand-washing which then first serves to alleviate the obsession right
I was anxious about the thought, that's why it was an anxiety disorders,
anxious about that thought well I wash my hands and it
should have fixed it. But the thought comes back.
I wash my hands again. Thought comes back. Wash my hands again and what you have is
then
a behavior that develops into a compulsion such that it's engaged in
semi-automatically where the person doesn't feel like they have a lot of control
over it.
Washing your hands five times a day, that's probably good hygiene.
Washing your hands fifty times a day,
that's getting into territory that's obsessive and compulsive. When we're looking at
this
compulsions take up a significant amount of time.
And everybody has normal anxiety provoking thoughts. If you leave the house
and you wonder whether or not you left the stove on
it's a good idea to go back and check, right? All of us have those moments go
back and check.
But for most of us, going back and checking and go, "oh, it was on.
Thank goodness" and I turned it off. Or,
it was off and no worries. That does it. That eliminates the worry because you've
checked
and you're satisfied. But for the person with the obsession now they've going, 'well,
did I really turn it off or did I not?"
And so excessive checking and sometimes it's obvious behavior and
sometimes it's
internal to the parson. I can engage in counting for example.
I can count the lights in the room
without you ever noticing that I'm doing anything unusual, right.
But counting does what? Gives me something very concrete to focus on and distract
me from that obsessive thought I might be having.
So the compulsions may or may not be related to the obsessions.
But what you have is a chained up set of circumstances where a person is now
engaging
a lot of their day doing something that's maladaptive because it takes up time
or causes problems in relationships or in work related situations or school related
situations. Again, you don't need to know that for your test
but they've created a new section called the obsessive-compulsive
and related disorder section because they're other types of behaviors
that same compulsive though they aren't obsessive-compulsive because they don't
contain the obsession part.
It they did, then you're looking at obsessive-compulsive disorder OCD.