Post Traumatic Stress Disorder - there's more than one type

Today is World Mental Health Day for 2018.

CAVEAT: For those who suffer any form of PTSD it is not the intention, in posting this thread, to wake up any demons or to bring on any suffering. I sincerely hope that does not occur for anyone. Mental health issues are more commonly discussed these days, and that is great: the more knowledge that people have (non-sufferers) the more they can understand and empathise with someone else's situation, and the more widely these illnesses and disorders can be accepted as a part of life for some people. *

I suppose that most people are familiar to some extent with PTSD. What many may not know is that there are different forms of it (I know of two, but there may be more than that). In its more familiar form it is usually associated with a single traumatic event, or perhaps a series of them within a short space of time (perhaps up to a week - but that is just my estimation). For this you can think accident victims, warzone survivors (either civilians or military). I know someone who saw her father run over by a car in a car park (at 40kph), and was unable to do anything about it, and she was subsequently diagnosed with PTSD. In her case it is expected to pass with time (her father has somewhat recovered from an extraordinary number of injuries). That is about the extent of my knowledge of this type of PTSD, except to say that the moment itself is relived over and over, and the sufferer can be once more in fear of their life (if that is what happened originally).

Others are far, far more qualified than I am to comment upon that.



The second, and far less well known variant is Complex PTSD, and this is borne out of traumas that are ongoing and repeated for months or years. For this think illegal imprisonment or deprivation of freedom such as kidnapping, sufferers of abuse within a marriage for years, and particularly child abuse in its various forms (either sexual, non-sexual physical, or emotional abuse, or perhaps even all three). No form of PTSD can be considered less important or damaging than another - they are just different, but when it happens through child abuse it is particularly insidious. The reason for this is that the ongoing traumas cause the child's brain to develop in a quite different physical way than an otherwise healthy brain would develop. Different pathways are created within that brain, and these have a profound effect upon behaviour. This "learned" behaviour then becomes ongoing because it has literally become ingrained in the child's brain.

If the C-PTSD is not diagnosed for many years afterwards then the person may have lived half or more of their (expected) life with thoughts and reactions that are governed by incorrect pathways formed in the brain many decades beforehand.

Trying to change that is a helluva job.

The person has to basically unlearn behaviour that has been with them for perhaps decades. This is no easy task, and you'd have to think would take *quite some time* to modify.



* As an example of spreading awareness of a MH issue, a few months ago there was a middle aged woman on the other side of the road walking along giving someone absolute hell - except they were nowhere to be seen - but by crikey she was giving them an earful. A chap walking behind me said "She's in a bad way, talking to herself like that". I said "She's not talking to herself - those voices she's hearing are every bit as real to her as I am to you". Hopefully he had some sort of new appreciation or understanding of what the poor woman was going through. She was probably (at least currently) unmedicated, I would think.

I suspect the second complex type is very common and mostly undiagnosed. Although I no idea what that has with hearing voices.

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Originally Posted by DaveVman

Although I no idea what that has with hearing voices.

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No nothing, I was just making an example of someone perhaps gaining some more understanding of a mental health issue. Probably over-emphasised so I have edited it back somewhat.

Good idea to bring it up FF. I hope we are making progress from the derogatory and general term of "mad", to at least better defining the health issues at play. Unfortunately there's still a fair bit of prejudice associated with it that needs to be addressed.

For 9 months in 2002 I lived in a 40,000 person Belgian town which is the home of hundreds of seriously mentally ill persons from all over Belgium. They live with ~ 200 trained host families who board the MH patients and organised work or activities within the community. There are about a dozen MH nurses that provide support for the patients and host families. I didn't find out about any of this this until we were back in Australia and never noticed anything while I was there. Well, Belgians are a little strange anyway so maybe it was because everyone seemed slightly unusual :).

Closer to home, 3 years after retirement SWMBO is still feeling the effects of serious bullying and repeated covering up by senior administrators at her workplace for 7 years back in the mid naughties. She also suffered from mental/control abuse from her mum, from when she was a kid until not that long ago. For a while her mum even took the workplace's side over the bullying issue and was most unhappy about SWMBO taking early retirement. SWMBO's now 90+ year old mum has finally run out of physical and mental puff so is in a nursing home and has become much less threatening which takes the pressure off. Now SWMBO feels highly guilty - you know the abused is made it feel like it's their fault - plus is physically affected by all the meds she has had to take over the last 30 years. Her mum doesn't believe in any form of mental illnesses with a "you just need to pull your socks up" attitude that made things worse. Interestingly her mum now has some form of depression ("I feel funny", she says) but as she doesn't believe in mental illness she won't admit to it and won't take any meds, so is totally bewildered by it.

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Originally Posted by DaveVman

I suspect the second complex type is very common and mostly undiagnosed. Although I no idea what that has with hearing voices.

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Dave, you are correct about the complex type being common and undiagnosed. I specialise in working with children, and would argue that many kids with disorders such as ADHD could likely qualify for this PTSD diagnosis. This is rarely made in practice, however, and the children are treated as if it were simply a problem with inattention or hyperactivity. It is far more than that.

Regards from Perth

Derek

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Originally Posted by BobL

Closer to home, 3 years after retirement SWMBO is still feeling the effects of serious bullying and repeated covering up by senior administrators at her workplace for 7 years back in the mid naughties. She also suffered from mental/control abuse from her mum, from when she was a kid until not that long ago. For a while her mum even took the workplace's side over the bullying issue and was most unhappy about SWMBO taking early retirement. SWMBO's now 90+ year old mum has finally run out of physical and mental puff so is in a nursing home and has become much less threatening which takes the pressure off. Now SWMBO feels highly guilty - you know the abused is made it feel like it's their fault - plus is physically affected by all the meds she has had to take over the last 30 years. Her mum doesn't believe in any form of mental illnesses with a "you just need to pull your socks up" attitude that made things worse. Interestingly her mum now has some form of depression ("I feel funny", she says) but as she doesn't believe in mental illness she won't admit to it and won't take any meds, so is totally bewildered by it.

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So Bob would you say that she has C-PTSD from either one or the other (or both)?

The childhood story of your wife is not dissimilar to someone else I know. She has Hashimoto Thyroiditis and is also BiPolar 2, but before the HT was diagnosed there were various theories going down, all of which were incorrect. As she says "An idiot psychologist who treated me for a while said something about “living in denial” of my real issues and “acting out”, when what I needed was 150 mcg of thyroxin every day before breakfast, and being monitored twice a year by an endocrinologist."

Her mother reacted in the same way that your wife's did, but ended up having a suicide attempt last year (at age 88). Apparently her outlook has changed a bit since then, and she is not quite so, ahhh, shall we say strident and dismissive of MH issues. Maybe she just reacted against BiPolarity because her FIL and BIL were both BiPolar, but one has to say it's a pretty poor parental effort to be so dismissive of the needs of a child - even once they become an adult, and only come good right at the end of one's life, and only then after one's own trauma.

We should probably be talking about depression and other everyday sort of issues but this topic reminded me of something that happened about 30 years ago with a guy that had more series problems.
He was in his 30s but he had the mental capacity of a child in some respects. He could function OK and was mostly independent I gather. However he couldn't do more complex things like budget so he had to come to the bank frequently to get a little money out at a time. He didn't have many inhibitions and he was there so often us locals knew who he was.

I was in the bank with my manger to do the banking for our company. The account required 2 signatures. Any way there was a very long queue and the hero of our story was also waiting in the queue to get his small withdrawal as usual.

The queue was very slow and taking ages. The hero of our story starts complaining very loudly to no one in particular about how slow and frustrating this is. He was really telling everyone how it was as loudly as possible.
So the bank manger comes out to take our hero into his private office and the manager apologies to us for the disturbance.
In reply we pointed out that there was no need to apologise about him because he was simply saying what all the rest of us were thinking.

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Originally Posted by derekcohen

Dave, you are correct about the complex type being common and undiagnosed. I specialise in working with children, and would argue that many kids with disorders such as ADHD could likely qualify for this PTSD diagnosis. This is rarely made in practice, however, and the children are treated as if it were simply a problem with inattention or hyperactivity. It is far more than that.

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What is dreadfully unfortunate about that is the intervention required to prevent that physical change in the brain occurring. TBH, I only know enough about that to be dangerous, so maybe you could shed some light there Derek?

I have often thought that kids diagnosed as ADHD may well be BiPolar 1 or 2 "in the making" but again, don't have anything like the knowledge needed. What age would you say is the youngest that BiPolarity is diagnosed?

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Originally Posted by DaveVman

In reply we pointed out that there was no need to apologise about him because he was simply saying what all the rest of us were thinking.

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Yes, the honesty of a childlike response can be withering. :roflmao2:

Most link PTSD with warlike service, seeing mutilated bodies and having bullets passing overhead. There are far more causes and types of PTSD than are generally accepted. Working for a psychopathic boss is a very common one. These types tend to bully, insult, threaten and so on and it can be very tiresome and wear you down over time. I worked for a few of these types in defence, luckily I'm not the type to suffer PTSD, that I know of, so it had no lasting affects on me, not so others working for the same people.

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Originally Posted by FenceFurniture

What is dreadfully unfortunate about that is the intervention required to prevent that physical change in the brain occurring. TBH, I only know enough about that to be dangerous, so maybe you could shed some light there Derek?

I have often thought that kids diagnosed as ADHD may well be BiPolar 1 or 2 "in the making" but again, don't have anything like the knowledge needed. What age would you say is the youngest that BiPolarity is diagnosed?

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Brett, ADHD can be comorbid with everything, but it is not the same as bipolar, although 20% of ADHD adults will report bipolar symptoms. In ADHD, the primary issues are not inattention or hyperactivity, although most associate these features and the DSM-V (Diagnostic and Statistical Manual, version 5) diagnoses on the basis of these. The primary issues are poor organisational skills and poor self-regulation. ADHD centres on a limited ability to self-regulate and process information, such as an inability to switch back-and-forth between incoming information. The neuropsychological mechanism here, as I view it, is the difficulty with figure-ground relationships - visual spatial and visual working memory. These affect forward planning, which in turn affects comprehension, and encourages rote learning. Therapy must include training in time management (and awareness) using visual spatial information. This improves self-regulation (or, in more common terms, the ability to suck it up).

Treating bipolar and ADHD together is tricky. It is usually recommended that the bipolar is treated first, such that mood is stabilised, and then one deals with the underlying ADHD.

Regards from Perth

Derek

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Originally Posted by sacc51

Most link PTSD with warlike service, seeing mutilated bodies and having bullets passing overhead.

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Yes indeed! In fact people are surprised or even mildly shocked to learn that there are non-military people with PTSD. As near as I can tell, some ex-military people with PTSD are scornful of others who have been diagnosed with PTSD for other reasons, simply because the causes were nowhere near as literally "explosive" as their own. That is not in any way to diminish the horrors that those military people have and still do, endure. It does highlight what I mentioned before about the various forms of PTSD just being different. They are all very damaging.

The narrative could go a little like this:

• Child is physically and emotionally abused for 4-5 years from an age of around 8, and by a variety of people which includes parents. Having rocks (not stones) thrown at them, that leave various types of scars.
• 50+ years later is diagnosed C-PTSD
• That same story is related to some ex-military people with PTSD from their service, but mis-characterised is the child "having a few stones thrown at them".
• Ex-military people fall about laughing, saying that all boys would then have PTSD, by default. The root cause has been trivialised to them, and they take it up with gusto - because of their own experiences which were far more explosive or dynamic. Of course, they are unaware that the trivialising has taken place because they have only heard a bastardised version, which they accept as true.
• Neither the story-teller nor the ex-military people are aware of the differences between the types of PTSD, or possibly even the fact that non-military people can have it. They are most certainly not aware of the fundamental difference of the child's brain developing in a way that is not at all healthy, but can be lifelong. Again, this is not to diminish the situation of the ex-military people in any way. It is not clear why the story-teller would feel the need to characterise the story in this way, or indeed relate the story to them at all.

Sometimes it doesn't take much for a person to suffer PTSD. As a child I was bullied, in school I was told I was stupid, by the teachers and class peers, later in life several relationship breakdowns, a severe motor vehicle accident, and the loss of my business because of it, led me to severe depression.
Having read this thread, and talking to "Proffesionals" makes me wonder if I'm suffering PTSD instead of Deppression, or both!!!!
Thanks for this, it has opened my eyes a little.
Kryn

I too was told by my parents and sibling that I was useless and would never amount to anything. At school a number tried bullying me, despite being smallish I was fortunate to be a good fighter and soon put them in their place. Thank goodness for World Championship Wrestling from where I picked up my skills, and a brother and father who disliked me with a vengeance. My parents had a rocky relationship amd took it out on us kids. When I look back I'm amazed I don't have PTSD or some underlying condition. My sister is a therapist and probably dealt with her issues wjilst training and is sure I do have underlying issues. I just tell her everyone deals with life in different ways.

The last 5 years of my working life were under two psychopaths who weren't shy in offering me up as collateral damage, these events shaped me and in some way affected me but, I? think my early life helped me deal with any issues I have and I'm happy to say, aside from having nothing good to say about my folks or employers (RAAF) i think I've escaped fairly well. Certainly my brother and a workmate weren't so lucky, the workmate having to undergo treatment and my brother seems to be just drinking the memories away.

Probably because of these events I have great sympathy for people with mental problems and certainly for gays, thinking about it life must have been horrific at certain points in their life.