PTSD Symptoms Prescribed, But Elusive

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PTSD symptoms – psychological reactions resulting from acute emotional stress – are prescribed in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), a manual published by the American Psychiatric Association. It’s comprehensive… and incomplete.

Post traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event which results in psychological trauma. Not everyone exposed to a particular event or series of events will be affected by PTSD, but in general terms, one in four can be expected to succumb.

Worldwide, that’s a significant number. Yet health professionals, particularly in western countries, consistently under-diagnose it. Resulting in unnecessary waste of years of life for those forced to live with undiagnosed PTSD.

And there’s a second school of thought – usually medical researchers – who believe it is over-diagnosed to the detriment of a cluster of about 15 other related anxiety disorders.

PTSD signs and symptoms tend to cluster into four discrete groups:

– re-experiencing the trauma

– avoidance of any places or situations that might trigger memories of the trauma,

– hyperarousal or hypervigilance, and

– emotional numbing and withdrawal.

But here’s the thing. There’s a large variance within those symptoms, and although those affected are often aware that ‘something’s not right’, they tend to insist that ‘there’s nothing wrong with me!’.

PTSD symptoms include outbursts of unreasonable anger at minor triggers, waking drenched in sweat from nights of nightmarish reliving of traumas in graphic detail, and reacting spectacularly to minor disturbances such as someone passing too close to their face. These symptoms grab the limelight, yet many other ptsd symptoms are buried.

Emotional numbing, for instance. It’s in DSM IV, but medicos rarely check for it, and people living with undiagnosed post tramatic stress rarely even notice it in their own behavior. It’s not spectacular, so it’s easy to ignore or camouflage under generalisations such as ‘that’s just me’. Often, the problem is that they simply can’t trust themselves enough to allow intimacy, let alone trust others at a core level.

And excesses? Alcoholism, drug addiction and occasionally sex addiction could be caused by any number of factors, as could the often unrecognised ism – workaholism. So even though the symptoms may be present, they often go unconnected to post traumatic stress.

The rate of PTSD symptoms reported varies significantly in different parts of the world. The US generally reports some of the highest figures – over 30% for combat stress, for instance – yet few studies have been done in nations where genocide appears endemic. The incidence of PTSD could be expected to be extremely high in such places, and recognition of PTSD symptoms low.