Post Traumatic Stress Disorder – Stats and Facts Part 3

Approximately 25% of those with BPD/ERD also meet the criteria for post traumatic stress disorder.
So let me tell you a story. I had to go to a counseling session because I made a very poor decision concerning alcohol and driving. I had to have a psychological evaluation and talk to a social worker about my past and stuff. First off, let me tell you that I hate, HATE, talking to shrinks that are not of my choosing. I don’t believe it’s any of anyone’s business to ask me such personal questions, intimate, details of my life. Especially when they inevitably make snap decisions and diagnosis because one session is not enough time to understand anyone. So anyways, I had this session. The guy (the only male counselor other than my psych I’ve ever talked to) started asking me questions off of a list of psych questions. It was clear that he cared precisely zero about me as a person. He just needed to get through his checklist. Throughout the interview he ask me questions, then instead of letting me talk, cuts me off and proposes his own theories and tangents. So he’s asking me these questions when he gets to the section on pysical/mental/emotional abuse. It’s at this point I’m debating whether or not I want to tell him the truth or just get him to skim past this. I decided that the truth would work to my benefit as it was part of why I landed there in the first place. So as soon as I start saying yes to some of his questions his eyes light up and he proclaims that I have Post Traumatic Stress Disorder. WTF? He didn’t even ask me to elaborate on the situations he was asking about. He just went on and on about PTSD, cutting me off when I tried to elaborate, and got way to excited about my potential mental disorder. It was clear that PTSD was his pet subject. So while I have technically had a diagnosis of PTSD, I don’t believe it. It makes me wonder how accurate some diagnoses are too. People are human and therefore subject to their own biases.
And while I might fit the technical criteria for PTSD, the incidents that made him jump to this conclusion had less lasting traumatic effect on me than did a really bad car accident I was in while I was at university (years after my BPD emerged).
So let’s take a look at what PTSD is (and how I potentially fit the criteria):
Causes – Psychological trauma:
“PTSD is believed to be caused by either physical trauma or psychological trauma, or more frequently a combination of both. PTSD is more likely to be caused by physical or psychological trauma caused by humans such as rape, war, or terrorist attack than trauma caused by natural disasters. Possible sources of trauma include experiencing or witnessing childhood or adult physical, emotional or sexual abuse. In addition, experiencing or witnessing an event perceived as life-threatening such as physical assault, adult experiences of sexual assault, accidents, drug addiction, illnesses, medical complications, or employment in occupations exposed to war (such as soldiers) or disaster (such as emergency service workers).  Traumatic events that may cause PTSD symptoms to develop include violent assault, kidnapping, sexual assault, torture, being a hostage, prisoner of war or concentration camp victim, experiencing a disaster, violent automobile accidents or getting a diagnosis of a life-threatening illness. Children or adults may develop PTSD symptoms by experiencing bullying or mobbing. Preliminary research suggests that child abuse may interact with mutations in a stress-related gene to increase the risk of PTSD in adults.”
Criteria:
The diagnostic criteria for PTSD, stipulated in the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as.
A: Exposure to a traumatic event
– This must have involved both (a) loss of “physical integrity”, or risk of serious injury or death, to self or others, and (b) a response to the event that involved intense fear, horror or helplessness (an event was “outside the range of usual human experience.”).
Yep. Definitely had a few such instances involving abuse and a particularly bad car accident.
B: Persistent re-experiencing
– One or more of these must be present in the victim: flashback memories, recurring distressing dreams, subjective re-experiencing of the traumatic event(s), or intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event(s).
You be the judge. I often have distressing dreams but they’re no longer terrorizing. Intense negative responses: If you consider an inability to let most guys touch me without utter revulsion, freaking out and regretting any instance where it occurs outside of my comfort zone, constantly disavowing any intimate male companionship (this never sticks) and quickly second guessing, overanalyzing their motives… or… when I’m a passenger in someone else’s vehicle I often have knee jerk reactions with braking too hard, or getting to close to other vehicles. This causes me to pull back, hard knees to chest, my heart rate to speed up, grabbing onto the ‘oh shit’ handle and my breath catching in my throat. I prefer to drive.
C: Persistent avoidance and emotional numbing
This involves a sufficient level of:
– avoidance of stimuli associated with the trauma, such as certain thoughts or feelings, or talking about the event(s);
– avoidance of behaviors, places, or people that might lead to distressing memories;
inability to recall major parts of the trauma(s), or decreased involvement in significant life activities;
– decreased capacity (down to complete inability) to feel certain feelings;
– an expectation that one’s future will be somehow constrained in ways not normal to other people.
Heh. After some such events I severed contact with certain people, wanting nothing to do with them or those that are involved with them. Avoiding situations where I might even have the possibility of running into them. Not places that I was sure they would be (though of course I won’t go there) but places they might be, where there is even a small chance of it. After one incident in my early 20’s I completely repressed events, only recalling it years later after I found a journal that I had written immediately after and then completely forgot about. I still only have flashes of this, not a full recollection. Decreased capacity to feel certain feelings. ::smirk:: I often have a complete inability to feel feelings at all. This problem is what lead to the diagnosis of my Dissociative Disorder. When I have extreme stress, loss, and/or conflict I depersonalize and derealize from my life and even my own body. I do absolutely expect that my future will be constrained. My present is currently constrained in ways not normal to other people. I have a Borderline Personality Disorder. I’m pretty sure, by definition, this qualifies for ways not normal to other people.  I believe this has more to do with my depression than any traumatic experience that I suffered after this problem began.
D: Persistent symptoms of increased arousal not present before
-These are all physiological response issues, such as difficulty falling or staying asleep, or problems with anger, concentration, or hyper vigilance.
Long posts need more pictures
I think they need a better phrase than ‘increased arousal’. This did not immediately inspire thoughts of heightened awareness if you know what I mean. I have always had extreme difficulty with sleep. I had insomnia for years that still occasionally creeps back (last night for example – so freaking tired). Even with the prescribed medication that I’m on specifically to help me sleep I have a hard time falling asleep, staying asleep, and once I wake up, calming my brain down enough to return to sleep.  Anger, hah, see this post. My therapist just brought up my sense of hyper vigilance yesterday as a form of self protection. All of these things, however, were a problem well before any real trauma that I suffered and were not the result of bad experiences that I can recall. I imagine that some of the experiences I’ve had since the onset of this most likely exacerbated the problem.  
E: Duration of symptoms for more than 1 month
– If all other criteria are present, but 30 days have not elapsed, the individual is diagnosed with Acute stress disorder.
How about years? Does years count? Acute stress disorder seems more accurate to me though.  Don’t ask me why. Maybe I just don’t want to have PTSD too.
F: Significant impairment
– The symptoms reported must lead to “clinically significant distress or impairment” of major domains of life activity, such as social relations, occupational activities, or other “important areas of functioning”.
– I’ve had significant distress and impairment in social relations since I was 12 years old. This was at the onset of my clinical depression and anxiety disorder. Both precursors to my BPD. By this point my abandonment issues were also in full swing. But, again, not due to an experiences that could be considered very traumatic. I think it has more do to with a predisposition to feel things in a way that is not normal to most – BPD.
So yeah, after this very long personal assessment, I am still not a psychologist or psychiatrist and am therefore not qualified to diagnosis myself. Thoughts?
Abuse is very common in the lives of people with BPD. It is often one of the root environmental contributors to the emergence of the borderline disorder. I do not have any doubt that many people with BPD also suffer from PTSD. Recognizing this is very important for treatment because it helps understand some of the underlying factors that need to be worked through and healed.
I do wonder if PTSD leads to BPD, or if being predisposed to BPD leads to an increased sensitivity to situations that feel traumatic but would not normally be considered a traumatic event required to define PTSD.  Then again, if something feels a certain way, a situation is perceived a certain way, doesn’t that make it reality for the person experiencing it? Therefore the event occurring is in fact something very traumatic.
I don’t know.  Most likely it is a co-morbid issue building and feeding off of each other.
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What causes BPD? Linehan Theory – Part 4

Continuing my 4 Part series of Dr. Linehan’s theory I’ll now explore Unremitted crisis vs. Inhibited grief.
Unremitted crisisuninterrupted; constant, unpardoned (as a sin) feeling that a condition of instability or danger leading to a decisive change which the trend of all future events, esp. for better or for worse, is determined by a dramatic emotional or circumstantial upheaval in a person’s life. Steadily maintained.

Ok, yes. Especially with my depression and trying to hold onto the thought that people care about me and aren’t going to leave, I always feel like I’m struggling to hold on. Everything feels dire or like there’s impending doom whether it’s externally perceived or battling my own internal thoughts and feelings. I NEED to understand what’s happening and what’s more I need those that care for me to understand, intervene, be there for me to lean on if I need.
What’s more I often feel like people won’t forgive me for any small infraction. I get worked up if I’ve done anything wrong and have a nearly fatalistic attitude that people will walk out of my life. Dissolving in a puddle of self doubt until I can prove that I am not a bad person. Again, this has to do with my inability to believe that one action does not negate all previous actions. That people take me as a whole series of our interactions not just single episodes. I can’t say this is completely unjustified though. I have had people, people that I was very close too, walk out of my life at the first infraction (however big), or once a single mistake was made all further actions were then in question and I was made to feel like I wouldn’t be forgiven no matter what I did to make up for it. While this may be true, it’s not entirely unjustified, but now it permeates my experiences with people.
Fortunately my current apartment and roommate are a safe haven for me, I have some reprieve from the constant upheaval. Some, not always, but it’s at least a calm environment.

Inhibited grief – to restrain, hinder, arrest, or check keen mental suffering or distress over affliction or loss; sharp sorrow; painful regret.

Definitely. I’m at constant odds whether I have a right to feel the way I do about any given situation. I don’t understand what I’m allowed to expect or what I deserve from other people so I constantly question whether my emotional responses are appropriate. Do people really owe me anything? What can I actually expect of them? What do I deserve from people when I need help? Do I have a right to impinge on their time and divert their attention from what they were doing? Especially if it’s from a loss. I’m sure things are often my fault, guilt, and I don’t know if I have the right to believe/expect that others should work things out with me. If I don’t have the right, then my feelings aren’t justified and I need to hold them in. But when I know something isn’t entirely my fault, I feel absolutely no remorse if the contributing party isn’t willing to communicate with me. Black or white.
I may want to pursue the topic, push someone to work things through with me but I restrain myself for feeling like I have no right to do so. I hold back and wait. Which only causes me to get more anxious and allows my thoughts to wander down all the possibilities that may be going through their minds and often come to the worst conclusions in my own mind. I feel the loss, sadness, over something that hasn’t even occurred yet. Or may never occur at all. I can’t quiet the distress that it creates and suffer for it in silence being unable to decide if I’m allowed to pursue a solution just to make myself feel better. Then I regret not being able to rectify whatever it was that occurred. This cycles back to making myself feel guilty for something that may or may not be my fault.