The PTSD Guide

Hi lovely readers,

Happy (? Is this day of the week really though?) Monday. A year or so I wrote a guide to Bipolar 1, and honestly that is something I feel like I have as good of a grip on as I possibly can. I am on a pretty good medication regime, I know what aspects of my health I have to prioritize, I understand self-care for depression, I have gotten pretty good at asking for help when I’m manic or suicidal or just not functioning, etc. But recently I had my first PTSD related episode and it really caught me off guard. PTSD is incredibly difficult to deal with as it can look like so many things, and technically I am diagnosed with Complex PTSD which can be even more confusing. So, when I went into fight-or-flight mode and started having consistent panic attacks for the first time and experienced my PTSD as something that felt utterly foreign to my usual numbness it was unexpectedly difficult to manage. Lately, though, I have been feeling like I’ve explored a lot of the options that exist for treatment and have mastered coping with it in a lot of ways, though honestly, at least when I’m sober, it still verges on being more challenging to cope with than having Bipolar.

The first thing I’ve learned, as I began to explain above, is that PTSD looks like completely different things, at different times, for different people. When I was first diagnosed I was on a lot of recreational drugs, and when I went to therapy and to see my psychiatrist I was exhausted and emotionally stunted from doing drugs. I was diagnosed with PTSD when I was 18 and was admitted to hospital for 2 weeks after being sexually assaulted. Post-release I experienced a variety of other traumatic experiences, from domestic physical and verbal abuse, to the death of a close friend, being harassed and stalked for a few years, to more traumatizing sexual abuses. But I didn’t respond by feeling any kind of fear or anxiety. If anything, I went wildly carolling in the opposite direction. I was completely numb – when things were, in that present moment, happening that were horrific and terrifying, I zoned out. Then I’d talk about them in therapy like they were no big deal. Sometimes I even thought they were funny with hindsight. Then, down the road, I started to seek out situations that reminded me of the trauma and insert myself back into them. A few weeks after these things occurred, I would forget they ever did. I mean, I literally couldn’t remember even when I was prompted. It was like they never happened, except, every night when I went to sleep I had the most disturbing and lucid nightmares, and I’d wake up sobbing or gasping for air. But otherwise, I felt ‘fine’.

Then I got sober, and I guess the whole numbing everything out thing had to come to an end. It is notable that 3 months into my sobriety I started doing trauma work, particularly EMDR (I’ll explain this later), with my therapist, too. Everything felt like it was kind of working out – I started remembering things, my dreams took a more positive direction, I could cry in therapy sessions, and I started recognizing that in these situations, I was not at fault, and I had been wronged. Sometimes. But something else started to happen, too. My self-image took a turn for the worse, and when I looked in the mirror, I felt disgusted. The word I used in therapy over and over again was “gross”. I looked for other things to say about myself and that was the only one that stuck out in my mind. I started thinking a lot about the permanence of the traumatic events in my life: I would never be the same again, I could never go back and do things differently, the people that did those things did NOT feel sorry for them and I could never prove they either didn’t do them intending to hurt me or that they wish they hadn’t hurt me so severely, I would always be a gross, horrible woman who would have to live with the shame of knowing people had sex with me without my consent, and who ‘should have known better than to get into those situations to begin with’. I started doing that thing where I’d put myself back into bad situations and in turn hurt myself all over again, because my brain was trying to find a way to turn my painful memories into a new reality where things felt safe and worked out and no one was a bad person with bad intentions.

Then, suddenly, my PTSD did something fun and wacky and started causing me to feel like I was going to be harmed, sexually or violently, all the time. And it could be by anyone. I didn’t, at first, know that was what was happening; I knew I was thinking so fast that my brain felt like it might explode and my thoughts were very paranoid and irrational, I knew I couldn’t let anything touch me including certain textures and objects, I knew my nightmares had turned into sleep paralysis all the damn time, I couldn’t stop physically shaking and my teeth chattered, and the only time I calmed down was after I sobbed like a maniac. I wasn’t even sobbing because I was sad about the things that had happened and that I ultimately discovered were causing these reactions; I was sobbing because I was the most uncomfortable I have ever been in my life, mentally and physically. Sometimes I became a volcano of rage when something someone did struck me as crossing some boundary I didn’t even know I had. For example: A girl in my house I really like, actually, asked for a cigarette, and when I said no because I only had 2 or 3 left, she persisted, admittedly kind of impolitely but with no malintent. Suddenly the world was moving at lightening speed and I was saying that she was “so fucking rude” and throwing a cigarette at her. I am the most passive person on this planet, typically (which I am working on, too) and that couldn’t have been further from a Liz kind of thing to do.

The final boss stage was dissociating. I was sitting in a Narcotics Anonymous meeting, listening to my friends speak, and what came next is hard to describe because, I wasn’t me, and it’s kind of hard to remember things that happened to you but a version of you floating through another dimension. I looked around the room and I had the thought, “where am I?” Then I looked at my friends and I only recognized the one I’m closest to. Then I started crying but when the tears hit my lap the feeling was foreign, like I was a newborn baby and I’d never cried before in my life. I got scared, and I walked out of the meeting to find something I’d recognize. I went to the washroom, and this was the scariest part – I looked in the mirror, and I didn’t know who was looking back at me. “It’s me, it has to be me” I repeated in my mind, over and over. But I didn’t believe it. And then I wondered what that word meant, and I pondered what it was it to be the girl with brown hair, in the floral dress and dark makeup, who looked so thin and sad. I didn’t know what she’d been through, I didn’t know what her voice sounded like, I remembered the name Liz but I didn’t know who’d named her that or why… and I still didn’t know where the fuck I was. So I walked out of the church, wearing no coat in winter weather, puzzled continuously by the way cold air felt and my surroundings, and wandered to a main road, where I felt possessed by a responsibility to text the friend from NA I felt love towards but no sense of how I knew them. She panicked and asked where I was and I didn’t know how to describe it. I followed her advice and got in a cab and spent the entire ride home crying because I knew something felt really bad and wrong and that, since my friend was telling me I’d dissociated, this must be that and I needed to find a way to stop it and understand myself and the world around me again. I facetimed a really close friend when I got home and they kept telling me things I might remember so that I could re-identify with myself and my life, and I started to feel comfort from things like his voice and the feeling of my blankets on me, but I sat in bed crying my eyes out and shivering under a duvet and wearing a sweater, and mourning what I thought was a permanent loss of self. Even when I woke up the next morning I felt out of place, though I did recognize, looking in the mirror, that the reflection was of me, whatever that meant, and what I did know it meant was something just…bad. This happened 3 nights in a row, and then stopped.

So, the varieties of PTSD I experience were numbness and detachment from emotion, reckless impulsivity, substance abuse disorder as a result of a desire to increase the comfortable numbness, chronic nightmares, preoccupations and obsessions with abusers, reinsertion into traumatic situations, a lot of depression that I couldn’t relate back to anything despite obvious causation, distorted perception of self and a ton of self-hatred, consistently existing in fight or flight mode, rage, altered sensory reactions, and finally, complete dissociation. Honestly, even as I write this I find my fingers trembling because the last three stages came so abruptly and I live in fear that talking about it will somehow make it start again, which is totally the wrong idea but whatever. And then there is an added layer, as while all of our experiences affect and change us, complex PTSD usually refers to post traumatic stress disorder that is a result of a large number of traumatic events occurring close together and literally changing who you are, including your actual personality. Scary stuff. I have no way of really knowing if that has happened to me to an extent that isn’t normal, because I don’t think anyone can notice a longterm change as gradual as a personality shift over multiple years when you live with yourself everyday. Maybe other people notice, but I don’t really feel like asking any time soon.

Symptoms as listed on this site of complex PTSD are as follows:

  • reliving the trauma through flashbacks and nightmares
  • avoiding situations that remind them of the trauma
  • dizziness or nausea when remembering the trauma
  • hyperarousal, which means being in a continual state of high alert
  • the belief that the world is a dangerous place
  • a loss of trust in the self or others
  • difficulty sleeping or concentrating
  • being startled by loud noises
  • A negative self-view. Complex PTSD can cause a person to view themselves negatively and feel helpless, guilty, or ashamed. They often consider themselves to be different from other people.
  • Changes in beliefs and worldview. People with either condition may hold a negative view of the world and the people in it or lose faith in previously held beliefs.
  • Emotional regulation difficulties. These conditions can cause people to lose control over their emotions. They may experience intense anger or sadness or have thoughts of suicide.
  • Relationship issues. Relationships may suffer due to difficulties trusting and interacting, and because of a negative self-view. A person with either condition may develop unhealthy relationships because they are what the person has known in the past.
  • Detachment from the trauma. A person may dissociate, which means feeling detached from emotions or physical sensations. Some people completely forget the trauma.
  • Preoccupation with an abuser. It is not uncommon to fixate on the abuser, the relationship with the abuser, or getting revenge for the abuse.

But there are others people report experiencing that are not listed on any of the generalized sites I have found.

So what is to be done? Well the first thing I’ve learned is that while sometimes you need medication, usually therapy is the biggest proponent of recovery. That is not to say that you can even do the therapy, in some cases, without being medicated. I take lyrica four times a day to alleviate symptoms of my PTSD so that I can attend therapy at all, instead of getting on the subway, dissociating, crying, and then heading right back home. I used to take Proazosin, but this is a medication that works by lowering your blood pressure, and as someone who is a chronic fainter this really isn’t a great med for me. It also never stopped my nightmares like it was supposed to. But these things are temporary fixes, and don’t get to the root of the issue.

Trauma therapy is so difficult, because the timing is both complex to discern and vital to its efficacy. I do Eye Movement Desensitization and Reprocessing, or EMDR, which involves holding two buzzing little balls attached to wires connected to a box your trained therapist holds to control the speed of the buzzing. This activates your brain in several ways, one of which is to trigger rapid, rhythmic eye movements which in some way I don’t understand as I have no background in medical science, removes some of the power held by emotionally charged memories. It is, statistically speaking, highly effective, and worked well for me in a lot of ways, and continues to work, but newly sober and living somewhere with a lot of emphasis on responsibility and life skills and very little on mental health made for a challenge. My psychiatrist theorizes doing this work at what may have been the wrong time could have triggered my recent, more severe PTSD state.

PTSD is not incurable, and there are so many ways to work on it should you find yourself diagnosed with it, but it is not linear, and that whole “things get easier with time” thing doesn’t apply here, which is pretty much the entire point of the diagnosis. The term was created because instead of responding normally to an upsetting or utterly horrific event and being scared or sad in the moment, and sad, too, when you reflect on it, but eventually healing, you feel the same, or even worse, for weeks, months or years post-trauma. I wish I had known this sooner and hadn’t put so many expectations on myself and my recovery, as perhaps the state that occurred recently wouldn’t have been as terrifying, embarrassing and surprising.

I hope I have shed some light on post-traumatic stress disorder for you lovely reader, and that if you share this diagnosis, reading this makes you feel less alone with the immense pain sufferers carry with them. I hope this also gives you ideas and hope for treatment, as I can promise that with a lot of effort, self-compassion, and support, you can get better, too.

Lots of love,

Liz

 

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