This page is , as usual, in progress.

Basics

Post-Traumatic Stress Disorder: Identification and Diagnosis. By Babette Rothschild, MSW, LCSW © 1997.  A theory that hyperarousal of the autonomic nervous system is at the core of PTSD.  Contains a brief but useful explanation of the role of the hippocampus in trauma and its aftermath, and how/why PTSD is in part an “illness of memory.”

Coalition of Combat PTSD Bloggers – a lot of first-person stuff, but the first-person stuff can be helpful in a way that a bunch of white coats are not and cannot be.

Operation PTSD – “dedicated to assisting Post Traumatic Stress Disorder (PTSD) Veterans and providing tools for recovery.  Creating awareness and providing educational material is a very simple way of breaking through to Veterans fighting the STIGMA of this destructive and persistent injury.”

Multiple Deployments and the Modern Military.  Unprecedented deployment paces take unprecedented tolls on modern-day soldiers.  Advancements in body armor and weaponry mean we survive shit that we wouldn’t have survived twenty years ago.  What doesn’t kill us does NOT necessarily make us stronger.  The civilian docs don’t always understand and the VA is, well, the VA. Getting an appointment can be a full-time job, and if you’re struggling really bad, finding your damned DD214 can be a little more than you can handle.  A lot of vets won’t seek help at the VA even if they think they need it, and the civilian system (assuming you have insurance) isn’t always trained to help.  Anybody who’s been at the mercy of military medicine knows that there is institutional resistance to giving certain diagnoses and that that resistance is at play in the VA too, though now for budgetary reasons rather than deployability reasons.  This means you have to be your own best advocate.  That’s pretty hard work, esp. since anybody who’s been in the military probably has this part of themselves that says “suck it up and quit whining” and it’s easy to let that part take over.  But this is a good place to look through if you’re considering treatment for PTSD.

Introducing Issues in the Treatment of Complex PTSD — “Compared with the growing base of efficacy research on short-term cognitive behavioral and exposure treatments for PTSD and acute stress disorder (cf, Bryant et al., 1999; Foa et al., 2000), there is a dearth of outcome research on treatment of complex PTSD. Yet, many trauma survivors experience pervasive polysymptomatic impairments that go beyond PTSD. ISTSS recognizes the need for further clinical study and research into the etiology, diagnosis and treatment of complex PTSD.”

Biology
The Body Keeps The Score: Memory & the Evolving Psychobiology of Post Traumatic Stress. by Bessel van der Kolk.  See the same in a version of an article first published in the Harvard Review of Psychiatry, 1994, 1(5), 253-265.  A very dense article (e.g., “cortial lesions prohibit the extinction of conditioned fear responses”), but one I found immensely helpful in understanding something I was having trouble understanding in a way that allowed for actually accepting: traumatic events and chronic stressors can change the way your brain works.  They can change the way your nervous system works, which means changing the way your heart beats, the way  you sweat, the way you sleep, the way you touch and respond to touch.  Something about that made all this real for me in a way that talking about “inhibited affect” and “anxiety” did not (probably because “affect” and “anxiety” are invisible and thus, to some people, “not measurable” and therefore “not real” or even if real are the domain of crystal-hugging hippies and self-help gurus.  And thus something I didn’t have any time for and I should just suck it up etc).

Dissociation often precedes PTSD in sexually abused children.  It is considered a symptom of PTSD, but it may be a predictor.  In any case, it’s all certainly more complicated than a bunch of “yes or no” checklists.

Medication

There have been alarmingly few studies on meds for PTSD, and there is a lot of disagreement about them. Prozac appears to be one of the top choices for many docs, but even in non-PTSD-related anxiety, a lot of folks would rather prescribe SSRIs than benzos.  This is great for some people, as benzo withdrawal can be awful and so avoiding dependence is ideal, but for some, taking SSRIs is a freakin’ roller-coaster, or a game of brain roulette.  Prozac took away the knotted stomach and day-to-day-waking-life somatic stuff for me, but it did it only to save it up in a little sack or box and dump it on me when I tried to sleep.  I never in my life had flashbacks or uncontrollable imagery or intrusive thoughts like that until I was on that med, and so its role in managing anxiety made it, in my case, both a pro and a con.  For me the cons outweighed the pros.  I have never been so afraid of myself as when I was on Prozac.  I personally hated every second of my life that I spent on it; it made me worse and my doc would not hear me that I was having a lot of trouble on it.  I was ready to throw myself under a bus.  Sertraline/Zoloft jacked my somatic responses way up and fucked up my stomach.  I don’t have a lot of faith in meds, which is why I ended up trying DBT.  I got a civilian doc and got a benzo prescription, but they have their own problems and can interfere rather than help in the long-term.  But here are some things to read:

The VA’s page on medications.  The only two FDA-approved medications for the treatment of PTSD are the SSRIs sertraline (Zoloft) and paroxetine (Paxil) (1-4).  But some meds are used “off-label.”  Not all meds are equally effective for all people, and not all meds are equally effective for all types of PTSD.  A brief discussion of why benzos are not usually prescribed by VA docs.

About medications for combat PTSD.  A more in-depth discussion of medication options and the whys and wherefores.  Again, benzos are usually a no-no from these guys.

Treatment Options and Resources

TIR, or Traumatic Incidence Reduction, FAQs.  I respond so negatively to the mere mention of any of this guided visualization stuff that I figure I’d better leave it without any comment.

Back Into the Heart of Darkness, by Tom Joyce.  Refers to Trauma Incidence Reduction, some sort of “grassroots” therapeutic options when VA red tape and checkslists failed, and a short bibliography.

The VA: Problems and Promising Changes

I have some anger issues with the VA and their checklists and bureaucracy and their “not service-related” decisions based on those checklists and that bureaucracy and some persistent BS that circulates about “delayed onset” PTSD.  But things are getting a little bit better.

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