Showing posts with label DSM V. Show all posts
Showing posts with label DSM V. Show all posts

Wednesday, May 28, 2014

Post Traumatic Stress Disorder in Your Character: Info for Writers

Found publicly on Facebook
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.
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
* 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,
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 A...
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 J...
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
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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