Severe PTSD leads to Fear-Based Living
Read "What is PTSD? (part 3/3) Hypervigilance and Fear-Based Living" offline:

Episode 003: Welcome to the third part of our three part series on “What is PTSD?” You may have run across websites that list the symptoms don’t begin to touch on what it’s really like to have PTSD. We’ll continue this exploratory series on different traits that people wind up with that predict response to treatment quite reliably. As always, I’m trying to talk about PTSD in such a way that you understand how I think and approach it in my clinic.

Fight, flight, or freeze vs. rest and digest.

Once the brain has begun to learn the fear response, it begins to spread to other areas of life.  New anxieties and fears crop up seemingly out of nowhere. It is difficult to “turn it off” and people often turn to PTSD-specialized Psychiatrists for help.

I have had countless patients wake up from uncontrolled obstructive sleep apnea, a condition known to be associated with elevated adrenaline levels. Once they fall back asleep with the elevated adrenaline levels, nightmares that haven’t been present for years return in minutes. Some folks live the trill adrenaline provided and continue to seek high risk-taking behaviors and sometimes hobbies. Sometimes the risk-taking behaviors can be at a sustainable level, other times it’s clearly unhealthy.

Healthy vs. unhealthy coping mechanisms.

PTSD alters one’s ability to assess risk, make a variety of courses of potential action, take steps to mitigate the risk, and monitor a personal safety program mid-stream. It can be quite fun to adventurous activities that make us feel alive. Paragliding, sailing, mountain biking, and motorcycle riding are all exhilarating activities that many survivors of trauma find themselves drawn to. Mitigating risk of bodily harm with equipment, helmets, training and practice can make these activities safe and enjoyable for many years, all while keeping the absolute risk of injuries down. Others have made more progress in settling down their hypervigilant nervous systems so they prefer quite walks, nature, water activities, Yoga and meditation. All of these activities can be safe and healthy provided the proper planning is put into place and one is thinking logical and sober about it all.

Unhealthy coping mechanisms are those that are unsustainable, involve avoidance of responsibilities, or are outright harmful. Examples include using the following coping mechanisms to help you cope with emotionally trying times: alcohol use, street racing, or fighting in public. Toxic activities go one step further in severity and cause harm to self or others, even emotionally through avoidance, upon each consecutive use.

Taming the Hypervigilance of PTSD

Symptoms can generalize to other, unrelated activities or experiences in life through a process called generalization. This is when PTSD is actively getting worse in one’s life. The suffering really starts when the trauma survivor begins to tell themselves stories about what they think their future is going to be like. You know this is happening when you hear yourself say thing like “I’ll never be able to ____”, or “I guess it will always be like this from now on.”

If left unchecked, fear can spread into other areas of life and before you know it, the PTSD sufferer never leaves the house. One’s own inner voice has been silenced so long by the trauma, and the negative reaction to it, the wound is now complete. Like white phosphorous ammunition rounds, it continues to burn and do damage long after the smoke has settled – even if you’re not aware of it.

Going forward we’ll begin to talk about the trait of being hypervigilant, which I like to call Hyper-reactive. There are also traits of being Under-reactive and Normo-reactive (normal-looking from the outside). They are traits because they don’t change, at least not very fast at all. Some emotionally labile types can shift in and out of different mood modes during the course of one psychotherapy session, so it’s important to find a therapist familiar with these facts about life with PTSD to get anywhere.

This is why PTSD Treatment is so complicated: The STAPLE Grid (STate Assessment by Phenotypic LEvel).

News Flash: If your therapist only knows one or two approaches to PTSD that they learned in school, run.

By Doctor Dan

[veteran, physician, psychiatrist]

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