Post Traumatic Stress Disorder in Your Character: Info for Writers

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The following information is based on the new diagnostic criteria as it is presented for clinical use in the DSM V. The DSM V is the American  bible for those working in the mental health field. If your character lives in a different country, you can understand the symptoms from this article, but you may want to do a quick search to find out if your country concurs. Also please note, the DSM V is the newest iteration and if your story is not being written in present-time then this will not be the exact information used by your mental health professional.

Video Quick Study (5:39) What is PTSD?

What criteria needs to be met for a PTSD diagnosis?

1. Exposure

In order to be diagnosed with PTSD your character need not have be at the event themselves. Indeed the stressor can be experienced in these ways (only one is required for diagnosis):
* Direct Experience
* Witness to an experience
* Indirectly learning that a relative or someone close to them 
   experienced a trauma - If the event involved a death or a 
   threatened death, it would have to have been violent in nature or
   accidental. So for example someone's spouse dying from cancer
   would not qualify for PTSD.
* Repeated and extreme exposure to aversive details of an event. 
   This is the kind of PTSD that affects so many of our first 
   responders. Events might include repeatedly seeing child abuse 
   cases, or horrific car  accident scenes.

   It does NOT include media exposure. So a character would not be
   diagnosed with PTSD from watching the September 11th event 
   on television, though they might experience a form of anxiety
   following their exposure. That anxiety does not fall under the
   criteria for PTSD.

Here are some events that might happen to your character that would cause PTSD (certainly not inclusive of all)
* Rape
* Criminal attack where one is fear for one's life (blog link)
* Sudden dismemberment - such as from a bomb explosion
* Seeing your spouse die of an unexpected violent act
* Being in a car accident
* Battle



Video Quick Study (4:12) Do different traumas cause different PTSD symptomology?

2. Intrusion Symptoms

(One required)

* Recurrent, involuntary, and intrusive memories

* Traumatic nightmares

* Dissociative reactions - such as flashbacks - these are
   experienced physiologically.

* Intense or prolonged distress after an exposure to a trigger. A
   trigger is anything that reminds the character of the traumatic
   event. It can be a scent, a time of day, a way that the body is
   positioned, a sound...

3. Avoidance - The character will make an effort to avoid triggers

(one of these is required)

* Tries to avoid thoughts or feeling associated with the event(s)

* Tries to avoid external reminders. These might include going to  
    the place of the trauma, having conversations about the trauma,
    attempting the same activity, etc.

4. Elevated changes in your characters cognition or mood that began after the trauma or worsened after the trauma 

Regions of the brain affected by PTSD and stress. (Photo credit: Wikipedia)

(2 of these needed)

* Dissociative amnesia - not being able to 

   recall key parts of the traumatic event.

* Negative beliefs about themselves and the

   world

* Distorted blame of self or others - feeling that

   the trauma could have been avoided.

* Persistent emotions related to the trauma

   including such feelings as: horror, anger, guit,

   shame.

Video Quick Study (1:52) Feeling shame after a trauma is a normal reaction

These last three can be misinterpreted as depression (blog link):

* Significant change in engagement in activities

* Feeling detached or estranged from others -

    family and friends.

* Unable to experience positive emotions.

Video Quick Study (4:12) What PTSD can feel like
Video Quick Study (11:03) Talks about visible brain changes
RELATED ARTCICLE - Honeycombed brain lesions only found in those who survived IED and explosive attacks.

English: Cases of PTSD and Severe Depression Among U.S. Veterans Deployed to Iraq and Afghanistan Between Oct 2001 and Oct 2007 (Photo credit: Wikipedia)

5. Trauma related alterations in arousal and reactivity.

(2 required)

* Irritable and aggressive behaviors

* Recklessness and self-destructive behaviors

* Hypervigilent

* Exaggerated startle responses

* Difficulty concentrating

* Problems sleeping

(these are often self-medicated with alcohol abuse or drug abuse as the result)

Video Quick Study (13:45) Dramatization of PTSD episode. ~ GRAPHIC IN NATURE ~

6. Duration

* The symptoms must be experienced from 2-5 for more than a month.

7. There must be significant distress and impairment to their normal functioning this can be social or occupational in nature.

8. The symptoms cannot be traced back to another issue such as the effect of a medical issue or medications, or substance abuse.

PLEASE NOTE: There is a different set of criteria for young children

PTSD is a physiological and psychological diagnosis which requires the intervention of trained, specialized health providers. 

US Navy 101118-F-5586B-144 Marine Sgt. Brian Jarrell pets his dog (Photo credit: Wikipedia)

* Your character should seek help from a

    proper mental health provider

* Your character's friends and family should be

   educated on the diagnosis and taught what

   helps and what does not.

   `Listening non-judgmentally

   `Not trying to solve the problem

   `Understanding that there is a brain change

    and the character can't "just get over it"

   `Understanding that this can get better

   `Reassuring the character that they are loved,

     appreciated, and important

* PTSD dogs are enormously helpful. They can

   sense the shift in the affected character before

   the character does and can alert the character

   and engage them in a way that lowers stress

   levels.
Video Quick Study (7:02)

LINK US government Veteran's Affairs overview of treatment options and information about complex cases (more than one diagnosis ex. PTSD with drug abuse and panic disprder)

PLEASE NOTE: PTSD can lead to thoughts of suicide. If you are reading this blog and have these feelings, please seek help. 

In the United States, call:

National Suicide Prevention Lifeline: 

800-273-TALK (800-273-8255)

to reach a trained counselor

(press 1 to reach the Veterans' Crisis Line). 

If you feel that you might act on your thoughts now. 

PLEASE STOP and call 911.

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Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.

FREEZE! Information for Writers

Image via WikipediaDo you remember the old cop shows? “Freeze! Police! Put your hands in the air!” Now it’s “Stop Police!” - It’s weird that I have a bone of contention with this change. But I do. I understand why the change was made; “stop” is a universal word, a word that is recognized in most languages - along with “T-shirt,” “cool,” and “okay.”

That last one, “okay,” is why we’re taught to thump our plastic CPR dummy on its shoulder and yell, “Are you okay? Are you okay?” The presumption being that if the possible victim were from Northern Siberia or the African !Kung Tribe, they would still understand what was being asked. And so if the person had just decided to take a nap on the sidewalk, they could open their eyes and say “Okay,” and I would know to leave the napper alone - that an intervention with my crack CPR/Artificial breath skills was not needed. However, I would suggest that if I were being chased by a police officer yelling at me in a language that I did not understand - I’d still get the gist. A figure with the authority to lock me up is yelling at me? I have some choices to make.

The choices that can be made in the cop yelling scenario come down to the limbic system. Your rational brain may be saying one thing, but your primordial self, the self that kept your genes swimming in the pool and not dinner for a mastodon (okay mastodons were herbivores, but you get my point). Your limbic brain can say three things:
1. Flee! In our collective backgrounds, this was a bad, bad idea. We’re slow and weak compared to the other animals on the survival show called Earth. Mostly it was a feline that was trying to eat us and movement set off the “MmmmYummm!” response in our predators that rarely turned out well.
2. Fight! Again, we are slow and weak. What’s a human to do? Even with our incredible brains developing incredible weapons, chances are still bad for the human. The last choice - which is actually our brain’s first choice, since it is the most effective - is…
3. FREEZE!

By yelling FREEZE! The police officer bypasses the intellectual brain (which probably isn’t engaged at this point anyway) and speaks right to the inner caveman (or woman). “Hey. I see you. I’m an authority who can put you in jail. You have three choices. Run. Bad choice. Fight. Really bad choice. Freeze. Ah, that’s the ticket. You freeze and we’ll do things the easy way with no one getting anymore hurt than required.”

STOP! To me sounds like a yellow light - a choice. I could try to run it; I think I have enough momentum to make it. Or, I will put on the brakes and come to the asked for stop. “STOP!“ is an intellectual choice - and the intellect is not engaged, so why do it? Because the !Kung tribesman might not understand? Please. (I’m not picking on !Kung tribesmen - I just love the clicking consonants, and it is as far from English as I think we can get.)

FREEZE! Is not always our friend. I’ve experienced the limbic freeze on occasions when I thought that maybe it was a miracle that my genes made it this far. I remember going to Connecticut to learn how to drive our Land Cruiser over rocks and such. I wasn’t really all that jazzed about doing this, but it was a learning opportunity that had presented itself, and I’m addicted to those. Even though I had been almost a week without sleep, and knew that I was an idiot to go forward, there I was, for six-hours straight, driving down the side of a mountain using the engine brake. At the end of the day, my intellect-self was all used up. I sat at the top of yet another hill. My instructor wanted me to drive between the tree and rock at the bottom. My eyesight was so blurry that I couldn’t see the rock and tree.
”I can’t see. I think I’m done for the day,” I said. “Just this one last run and we’ll be done for the day,” said my instructor.

Bad choice. I started down the hill and my limbic system went into overdrive. I screamed like a girl. My body froze. I remember thinking that I wanted to hand the steering wheel to the instructor, so he could drive. My foot froze on the gas peddle. I tried with every part of my intellect to override my limbic system and lift my foot. The best I could do was to edge my left foot onto the brake slowing us down. My instructor was laughing his head off beside me thinking I was whooping it up as the last hoorah of a productive day of scaling rocks in a car. Yeah. Not so much. As we started to hit trees, it dawned on him. “Hey, this chick is not in control of her body.” He reached over - and this is the part that I don’t get - grabbed my legs and pulled BOTH of my feet off their respective pedals. Now, personally, if I had my brain still functioning, and I was the instructor, I would have left the brake foot down and only pulled up the gas pedal foot. But I have to give the guy a break - he probably was battling his own limbic system as his 50,000$ car hit tree after tree. Sigh. Sometimes these things don’t work out quite like our ancestors might have hoped.

The limbic system does not only engage in instances of imminent danger. Our brains are always searching our environment to try to keep us safe. Our limbic system is always engaged. And to this end is always making little adjustments to our bodies. These show up in our body language. If the limbic concept is interesting to you, may I suggest a book?

What Every BODY is saying - An Ex-FBI Agent’s Guide to Speed-Reading People by Joe Navarro


In his book, he talks about the limbic system and how it controls subtle behaviors. Applying this information would add nuance and authenticity to characters’ reactions.

Fiona Quinn's Newsletter Link, Sign up HERE

Thank you so much for stopping by. And thank you for your support. When you buy my books, you make it possible for me to continue to bring you helpful articles and keep ThrillWriting free and accessible to all.