Fight, Flight, Freeze & Submit
In Episode 4 of Trauma Chat Podcast, host Laura Reagan, LCSW-C explains the four responses mammals have. This includes human responses we use to survive traumatic experiences. For example, fight, flight, freeze and submit. In Episode 5, Laura described the diagnostic criteria for PTSD. If you have experienced trauma, you may be curious about the diagnostic criteria. After reading this article, you will understand PTSD diagnosis more clear.
In Healing Trauma, Knowledge Is Power
Trauma survivors commonly express, “I feel like something is wrong with me.” It can be a relief to identify that our history of trauma and the way our brain/body reacted to protect us can explain our mental health symptoms. Once we understand what is affecting us, we can begin the process of healing from trauma. This is done first by finding a competent trauma therapist.
Trauma survivors often describe symptoms of:
- anxiety
- depression
- compulsive and/or self-destructive behaviors
- trust and relationship issues
- hopelessness
- a loss of a sense of meaning in life
If we believe that we are always in control of our actions, we may carry shame and self-blame. This could be about the things we have been through and the ways we have let ourselves and others down.
Trauma can also mess with our memory. This can cause us to feel scattered, unfocused, forgetful, preoccupied, and frustrated. We may have body sensations that we don’t understand which come to us during the day and night.
Is PTSD A Real Mental Health Disorder?
Many people who have experienced trauma are unaware of what is causing their symptoms. Trauma is a normal response to an abnormal situation. This can be argued that unlike the other mental health “disorders” listed in the DSM-5. For that reason, Trauma Chat host Laura argues that:
“[PTSD] is not actually a disorder. It’s a natural reaction to a traumatic experience. When someone is unable to integrate the experience when it happens or in the period afterwards, it has longer term effects.”
Laura Reagan, Trauma Chat Episode 5
That said, it is still helpful to understand the criteria of trauma. This is necessary whether you believe that PTSD should or should not be seen as a disorder.
A trauma therapist, Laura points out that trauma is real and healing is possible. But it’s difficult to heal when you are only treating the symptoms. Symptoms of PTSD include:
- anxiety
- depression
- relationship issues
- low self-worth
- shame
- compulsive behaviors
- insomnia
- anger issues
- eating disorders
- substance misuse, and abuse
This is not an exhaustive list, as there are so many others. However, identifying more than the previous symptoms matters to find the underlying cause.
A Trauma-Informed Perspective Is A Compassionate and De-Pathologizing Approach To Mental Health Treatment
Many people come to therapy after a diagnosis. This includes Major Depressive Disorder, Generalized Anxiety Disorder, Bipolar Disorder, or Borderline Personality Disorder. Oftentimes these diagnoses have been given by a mental health treatment provider. More often than not, this individual does not use a trauma-informed perspective in assessing the person’s symptoms.
The Adverse Childhood Experiences Study revealed that at least 61% of American adults are impacted by trauma related to events in childhood. Considering that fact, mental health providers should be looking for examples of traumatic experience. In doing this, they might explain the symptoms clients and patients present with in PTSD treatment. This is better than simply assigning a diagnosis based on symptoms without assessing for trauma.
To listen to the full episode of Trauma Chat episode 5 click here, or keep reading for an overview of episode 5.
What is the DSM-5?
The Diagnostic and Statistical Manual (DSM) of Mental Disorders, is a manual for mental health practitioners. Therapists use this in diagnosis and assessment. This is published by the American Psychiatric Association. The most up-to-date version of the DSM is currently used by mental health professionals is the 5th Edition. This is called the DSM-5. Listed below are the criteria that must be met to receive a diagnosis of PTSD.
A PTSD Diagnosis May be Helpful, Even if You Don’t Meet Full Criteria
Please note that one can have trauma symptoms without meeting the criteria for PTSD diagnosis, and treatment can be equally effective whether or not one’s symptoms meet the full criteria.
What is the criteria for a PTSD Diagnosis
Criterion A:
Being exposed to one or more events that involved death or threatened death, actual or threatened serious injury, or threatened or actual sexual violence.
To meet the criteria of being considered traumatic for the purpose of this diagnosis, this event must have been experienced in one of the following ways:
- experiencing the event directly
- witnessing this happening to someone else
- learning about such an event happening to a close relative or friend or someone you care about
- exposure to the event as part of your work
Criterion B:
Experiencing at least one or more of the five following intrusive symptoms:
- Recurrent involuntary and intrusive distressing memories of the traumatic events
*In children, repetitive play may occur in which themes or aspects of the traumatic events are re-enacted.
- Recurrent distressing dreams in which the content or affect are related to the traumatic event
*Children may have frightening dreams that don’t necessarily represent the specific event that occurred.
- Dissociative reactions – feeling like you are there but not there; like you are not in your body; like you are outside looking in; feeling frozen, numb or paralyzed; going away in your mind” feeling like you are in a bubble; “seeing red” “everything went black”; – any of these can be examples of dissociative reactions.
*Such reactions may occur on a cycle. Often with the most extreme expression being a complete loss of awareness of present surroundings.
- Intense or prolonged psychological distress at exposure to internal or external cues. This can symbolize or resemble an aspect of the traumatic events. This is another way of saying that trauma reactions get triggered when we consciously or unconsciously remember the event.
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event. This criterion is referring to physiological reactions to triggers.
Criterion C:
Persistent avoidance of stimuli associated with the traumatic event beginning after the traumatic event happens. This is evidenced by one or both of the following:
- Avoidance of, or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events.
- Avoidance of, or efforts to avoid external reminders, i.e.: people, places, conversations, activities, objects, situations that arouse distressing, memories, thoughts, or feelings about, or closely associated with the traumatic event.
Criterion D:
Negative alterations in cognitions and mood associated with the traumatic event beginning or worsening after the event occurred. This can be evidenced by two or more of the following:
- Inability to remember an important aspect of the traumatic event. Typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs.
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world.
- A persistent distorted cognitions, also known as thoughts about the cause or consequences of the traumatic event. This lead the individual to blame himself or herself, themselves, or others.
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
- Markedly diminished interest or participation in significant activities.
- Feelings of detachment, or estrangement from others.
- Persistent inability to experience positive emotions. For example, the inability to experience happiness, satisfaction or loving feelings.
Criterion E:
Marked alterations in arousal and reactivity associated with the traumatic event. The beginning or worsening after the event occurred as evidenced by two or more of the following.
- Irritable behavior and angry outbursts with little or no provocation.This is typically expressed as verbal or physical aggression. Specifically toward people or objects.
- Reckless or self-destructive behavior.
- Hypervigilance
- Exaggerated startle response.
- Problems with concentration.
- Sleep disturbance.
The duration of these symptoms has to have been happening for more than a month. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The criterion also includes a specifier to indicate whether a person has specific symptoms of dissociation. This includes Depersonalization and Derealization.
Depersonalization is described as recurrent experiences of feeling detached from. It is as if one were an outside observer of one’s mental processes or body. For example feeling as though you’re in a dream; feeling a sense of unreality of self or body or of time moving slowly.
Derealization: persistent or recurrent experiences of the unreality of surroundings.
It is important to remember that people can have trauma symptoms that don’t fully meet the PTSD criteria. Trauma therapy is for people who still are very much in need of care, PTSD treatment, support, and certainly compassion.
To listen to the full episode of Trauma Chat that this blog post is based on click here, and stay tuned for next week’s episode which will go more in-depth on the experience of dissociation.
Find a Trauma Therapist in Our Directory for Help with Your PTSD Diagnosis
If you’re ready to find the trauma therapist that is going to help you have a breakthrough then check out our online therapy directory. Know that we are regularly adding therapists to our directory. Therefore, the list will only continue to grow. To get started follow these steps:
- Head to our find a therapist page.
- Begin looking for a therapist in your area and select one that is a good fit.
- Visit their website and learn about our therapists.
- Get in touch and begin finding hope and healing!
*If you’re a trauma therapist who offers support for client’s in need of, or with a PTSD Diagnosis, our directory is for you. If you’re looking to be a resource for individuals needing help, learn about our directory. Then, visit our page to get set up as a therapist today!
Resources for Further Understanding a PTSD Diagnosis:
- Link to DSM Diagnostic Criteria from the United States National Institutes of Health (NIH)
Additional Links:
- Leave a message with a question to be included in a future episode: https://www.speakpipe.com/traumachatpod
- Follow Trauma Chat on Instagram: www.instagram.com/traumachatpod
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- Get more information on Trauma Chat at: www.traumachatpod.com. Sign up for the email list to stay in touch and receive a free gift!
- Find A Trauma Therapist Near You: www.traumatherapistnetwork.com – a community for finding information, resources and help for trauma.
- To listen to Laura’s other podcast, Therapy Chat, go to: www.therapychatpodcast.com
- If you like Trauma Chat please go to iTunes https://podcasts.apple.com/us/podcast/trauma-chat-podcast/id1571301677 and leave a rating and review. Or, subscribe to receive each episode as soon as it comes out.
