PTSD leads to many arguments; practically all the wars of history.
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Episode 001: Hello world! My name is Elias Diam, MD, but folks know me as Doctor Dan. Welcome to the PTSD Academy Podcast!!

In today’s episode, we will cover the DSM-V criteria, trust, what I call “the Big Three” (PTSD, Major Depression, and Insomnia), and the importance of a safe partner during trauma recovery.

A complete and up-to-date research definition of the term “Posttraumatic Stress Disorder” can be found at

There is an interesting history here regarding what really happened with the creation of the PTSD as an official diagnosis. Vietnam veteran activists, lobbyists and politicians pushed to get it added to the DSM 3 in 1980.

In society, however, PTSD is often mis-attributed to mean things like confusion, anger, and flashbacks. An innumerable amount of conditions could cause these such as trauma, sleep deprivation and memories, but none of them are specifically listed in the research definition of PTSD.

Have no fear. The writers of the DSM were shamed when only two weeks before the scheduled release of the DSM V, the NIH announced it was cutting off funding for DSM-related research in favor of research for the neurobiological mechanisms underlying the symptom complexes. That’s when I was in training, so was never tested on the DSM criteria by the board. Lol.

The reality is that a PTSD survivor has a heightened level of tension and activity in their bodies relative to normal controls. That means that the “fight or flight” mechanism is on – and stays on. If you’re body feels like it’s always in the middle of the worst moment of your life, you can bet it’s going to get worn out eventually. And that’s exactly what happens.

How to treat PTSD

Mainstream USA medicine says the medications and psychotherapy (talk therapy) combined provide the best results, though an ever-increasing number of therapies are getting added to the list of approaches that can reduce certain symptom complexes. For example, yoga, tai chi, Reiki, meditation and acupuncture all have some level of evidence for relief of some of the symptoms related to PTSD. Tools like these attempt to reset the body’s stress point back down to the level it was prior to the trauma. In theory.

It turns out, the effectiveness of any PTSD treatment is intensely dependent on how well the trauma survivor begins to implement trust back into their lives. Forgetting the eager expectation that the worst case scenario will always happen. This means that the trauma caused an alteration to the risk assessment and monitoring tasks being completed by the brain.

PTSD signs and symptoms

The hallmark of good PTSD therapy is to delve deep into how the relationship between PTSD, depression and insomnia work in the survivor’s life in order to help them accomplish their life goals. To start us off in this topic of how the Big Three work together, let’s do a quick primer on the Biology of PTSD.

After the stress of trauma, about 20% of survivors develop PTSD. After a few years, even without any treatment, that number reduces on its own to 4%. (This topic is discussed in more detail in my book, Combat PTSD in America: Toward a Permanent Solution. Available at

Effects of PTSD on the Brain

Figure 1. Cortisol shrinks the hippocampus.

Borrowed from Combat PTSD in America: Toward a Permanent Solution. (Available at

Taking away the shame and stigma of PTSD

Shame is one of the most devastating thought processes to joy, peace of mind, and enjoying a content life. It starts off with a perceived mistake or flaw and takes it way beyond reality. For example, if I stole a piece of gum from a store, I am guilty. Shame takes it much farther than that and says “I am a thief.” While the difference may at first seem subtle, it is a dangerous pitfall to fall into criticizing your own character as a person when you have PTSD. Shame is self-punishment that opens the doorway to a depression that has no end. Because it ends only when you decide you’ve had enough.

Did you know that gaining knowledge can reduce self-criticism? I love taking the shame away in my job on a daily basis. That’s my favorite part of the job as a psychiatrist with a special interest in PTSD. I sure hope learning a little bit about the Biology of PTSD can help you understand the condition better, reducing self-criticism!!

By Doctor Dan

[veteran, physician, psychiatrist]

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