Informational Resources

~ PTSD: Posttraumatic Stress Disorder ~

What Is PTSD?

As defined on U.S. Department of Veteran's Affairs:

PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.

It's normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months.

If it's been longer than a few months and you're still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.

What factors affect who develops PTSD?

PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will have PTSD, many of which are not under that person's control. For example, having a very intense or long-lasting traumatic event or getting injured during the event can make it more likely that a person will develop PTSD. PTSD is also more common after certain types of trauma, like combat and sexual assault.

Personal factors, like previous traumatic exposure, age, and gender, can affect whether or not a person will develop PTSD. What happens after the traumatic event is also important. Stress can make PTSD more likely, while social support can make it less likely.

What are the symptoms of PTSD?

PTSD symptoms usually start soon after the traumatic event, but they may not appear until months or years later. They also may come and go over many years. If the symptoms last longer than four weeks, cause you great distress, or interfere with your work or home life, you might have PTSD.

There are four types of symptoms of PTSD (en Español), but they may not be exactly the same for everyone. Each person experiences symptoms in their own way.

  1. Reliving the event (also called re-experiencing symptoms). You may have bad memories or nightmares. You even may feel like you're going through the event again. This is called a flashback.
  2. Avoiding situations that remind you of the event. You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.
  3. Having more negative beliefs and feelings. The way you think about yourself and others may change because of the trauma. You may feel guilt or shame. Or, you may not be interested in activities you used to enjoy. You may feel that the world is dangerous and you can't trust anyone. You might be numb, or find it hard to feel happy.
  4. Feeling keyed up (also called hyperarousal). You may be jittery, or always alert and on the lookout for danger. Or, you may have trouble concentrating or sleeping. You might suddenly get angry or irritable, startle easily, or act in unhealthy ways (like smoking, using drugs and alcohol, or driving recklessly.

Can children have PTSD?

Children can have PTSD too. They may have symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:

  • Children under 6 may get upset if their parents are not close by, have trouble sleeping, or act out the trauma through play.
  • Children age 7 to 11 may also act out the trauma through play, drawings, or stories. Some have nightmares or become more irritable or aggressive. They may also want to avoid school or have trouble with schoolwork or friends.
  • Children age 12 to 18 have symptoms more similar to adults: depression, anxiety, withdrawal, or reckless behavior like substance abuse or running away.

What other problems do people with PTSD experience?

People with PTSD may also have other problems. These include:

  • Feelings of hopelessness, shame, or despair
  • Depression or anxiety
  • Drinking or drug problems
  • Physical symptoms or chronic pain
  • Employment problems
  • Relationship problems, including divorce

In many cases, treatments for PTSD will also help these other problems, because they are often related. The coping skills you learn in treatment can work for PTSD and these related problems.

Will people with PTSD get better?

"Getting better" means different things for different people. There are many different treatment options for PTSD. For many people, these treatments can get rid of symptoms altogether. Others find they have fewer symptoms or feel that their symptoms are less intense. Your symptoms don't have to interfere with your everyday activities, work, and relationships.

What treatments are available?

There are two main types of treatment, psychotherapy (sometimes called counseling or talk therapy) and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy for PTSD

Psychotherapy, or counseling, involves meeting with a therapist.

  • Trauma-focused psychotherapy, which focuses on the memory of the traumatic event or its meaning, is the most effective treatment for PTSD. There are different types of trauma-focused psychotherapy, such as:
    • Cognitive Processing Therapy (CPT) where you learn skills to understand how trauma changed your thoughts and feelings. Changing how you think about the trauma can change how you feel.
    • Prolonged Exposure (PE) where you talk about your trauma repeatedly until memories are no longer upsetting. This will help you get more control over your thoughts and feelings about the trauma. You also go to places or do things that are safe, but that you have been staying away from because they remind you of the trauma.
  • Eye Movement Desensitization and Reprocessing (EMDR), which involves focusing on sounds or hand movements while you talk about the trauma. This helps your brain work through the traumatic memories.

Medications for PTSD

Medications can be effective too. Some specific SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors), which are used for depression, also work for PTSD. These include sertraline, paroxetine, fluoxetine, and venlafaxine.

IMPORTANT: Benzodiazepines and atypical antipsychotics should generally be avoided for PTSD treatment because they do not treat the core PTSD symptoms and can be addictive.

Post-traumatic stress disorder is PHYSICAL not psychological, study claims: Scans reveal PTSD literally alters the shape of the brain

  • Brain scans reveal veterans with PTSD had different shaped brains from their fellow servicemen who did not suffer PTSD
  • They had a larger right amygdala, which is responsible for fear and emotion
  • The findings published by the University of California, San Diego, on Tuesday open the field to explore physiological treatments for the mental illness

By Reporter

Post-traumatic stress disorder is a physical condition, not a psychological one, a new study claims.

Brain scans reveal veterans who experienced traumatic stress as well as head injuries had different shaped brains from their fellow servicemen who did not suffer PTSD.

Those tormented by their experiences had a larger amygdala - the brain region responsible for emotion and fear - than those that did not.

The findings published by the University of California, San Diego, on Tuesday open the field to explore physiological treatments for the mental illness.

'Many consider PTSD to be a psychological disorder, but our study found a key physical difference in the brains of military-trained individuals with brain injury and PTSD, specifically the size of the right amygdala,' said lead author Dr Joel Pieper.

Brain scans by the University of California reveal veterans who experienced PTSD and head injuries had different shaped brains from their fellow servicemen who did not suffer PTSD

'These findings have the potential to change the way we approach PTSD diagnosis and treatment.'

In the brain there is a right and left amygdala.

Together, they help control emotion, memories, and behavior. Research suggests the right amygdala controls fear and aversion to unpleasant stimuli.

For this study, researchers studied 89 current or former members of the military with mild traumatic brain injury.

Using standard symptom scale ratings, 29 people were identified with significant PTSD. The rest had mild traumatic brain injury without PTSD.

The researchers used brain scans to measure the volume of various brain regions.

The subjects with mild traumatic brain injury and PTSD had 6 percent overall larger amygdala volumes, particularly on the right side, compared to those with mild traumatic brain injury only.

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~ Abuse ~

Lenore E. Walker (1979) - Cycle of Abuse

1: Tension building

Stress builds from the pressures of daily life, like conflict over children, marital issues, misunderstandings, or other family conflicts. It also builds as the result of illness, legal or financial problems, unemployment, or catastrophic events, like floods, rape or war. During this period, the abuser feels ignored, threatened, annoyed or wronged. The feeling lasts on average several minutes to hours, it may last as much as several months.

To prevent violence, the victim may try to reduce the tension by becoming compliant and nurturing. Or, to get the abuse over with, prepare for the violence or lessen the degree of injury, the victim may provoke the batterer. "However, at no time is the batterer justified in engaging in violent or abusive behavior," said Scott Allen Johnson, author of Physical Abusers and Sexual Offenders

2: Acute violence

Characterized by outbursts of violent, abusive incidents which may be preceded by verbal abuse and include psychological abuse.During this stage the abuser attempts to dominate his/her partner (survivor) with the use of domestic violence.

In intimate partner violence, children are negatively affected by having witnessed the violence and the partner's relationship degrades as well. The release of energy reduces the tension, and the abuser may feel or express that the victim "had it coming" to them.

3: Reconciliation/honeymoon

The perpetrator may begin to feel remorse, guilty feelings, or fear that their partner will leave or call the police. The victim feels pain, fear, humiliation, disrespect, confusion, and may mistakenly feel responsible.

Characterized by affection, apology, or, alternatively, ignoring the incident, this phase marks an apparent end of violence, with assurances that it will never happen again, or that the abuser will do his or her best to change. During this stage the abuser may feel or claim to feel overwhelming remorse and sadness. Some abusers walk away from the situation with little comment, but most will eventually shower the survivor with love and affection. The abuser may use self-harm or threats of suicide to gain sympathy and/or prevent the survivor from leaving the relationship. Abusers are frequently so convincing, and survivors so eager for the relationship to improve, that survivors (who are often worn down and confused by longstanding abuse) stay in the relationship.

4: Calm

During this phase (which is often considered an element of the honeymoon/reconciliation phase), the relationship is relatively calm and peaceable. During this period the abuser may agree to engage in counseling, ask for forgiveness, and create a normal atmosphere. In intimate partner relationships, the perpetrator may buy presents or the couple may engage in passionate sex. Over time, the batterer's apologies and requests for forgiveness become less sincere and are generally stated to prevent separation or intervention. However, interpersonal difficulties will inevitably arise, leading again to the tension building phase. The effect of the continual cycle may include loss of love, contempt, distress, and/or physical disability. Intimate partners may separate, divorce or, at the extreme, someone may be killed.

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Violence Wheel

The chart is a way of looking at the behaviors abusers use to get and keep control in their relationships. Battering is a choice. It is used to gain power and control over another person.

Physical abuse is only one part of a system of abusive behaviors.

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Cycle of Violence

The cycle of violence is intergenerational. It not only repeats itself in an abusive relationship, it also repeats itself by emerging later in the relationships of people who experienced and witnessed violence in the home as they grew up.

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Joan McCullough - Broken Glass: My Journey to Pick Up the Pieces

Emotional Abuse: Identifying the Signs, Breaking the Cycle (Jan 27, 2013)

Disclaimer: This post was written from a female’s perspective because the author was writing from personal experience. The piece is informative, but in most ways therapeutic for the writer.

The Breakdown

Emotional abuse is difficult to detect with the untrained eye. The wounds are deep and continually reopened. The abuser usually knows all of your deepest secrets, fears, and passions. She/He knows your strengths, your weaknesses, and your heart’s desire. She/He desperately needs you to need her/him! No matter what you ask of the abuser, those requests will positively remain unanswered. Emotional abusers may be both men and women. Regardless, if you think you are in an abusive relationship, the first thing you must do is identify the signs.

Typically, the abused will endure the pain over a long period of time, and may often try unsuccessfully, to put an end to the vicious cycle. My memoir, Broken Glass, tells the story of little girl (me), trying to find her purpose in life a midst abuse, bereavement, and heartbreak. After my mother died of pneumonia when I was just ten years old, my journey began! Along the way, there were numerous accounts of emotional, verbal, and physical abuse and the anger that came along with it. Naturally, after reaching a breaking point, I’d erupt and wind up landing myself in more trouble than before! The truth is, I still struggle with it today. Adults however, express anger on varying levels. It may arise due to marital problems, quarrelsome family members, trouble at work, or a even an erratic driver who pushes you to the brink of extreme road rage! Most often, the roots of anger and aggression lie within the baggage accumulated during the childhood years. Abused children may grow up to become passive aggressive adults. The question is, how can one unpack that baggage and learn to handle life’s curve balls without having a full-fledged meltdown?

The one thing we all must understand is that in children, the ability to reason and make rational decisions in the face of anger is controlled by the prefrontal cortex. This is the region of the brain located just behind the forehead. In teens, as research suggests, the frontal lobes of the brain are not fully developed until about age 25. This would explain why adolescents can ingest a the slightest conflict and irrationally incite a riot in the school cafeteria! In many cases, they simply cannot deescalate confrontation and minor disputes among peers. Therefore, adolescents are notorious for acting before thinking. A teen who is a victim of emotional abuse is a prime candidate for such behavior.

Abused children may develop a sense of learned helplessness, a psychological condition in which a person or animal has been exposed to a harmful stimulus for so long with no relief, that eventually the victim stops trying to escape. He believes that there is nothing he can do to make his situation better. Left untreated, this can follow children into their adult lives. As a result, the self esteem of abused person is usually low. Knowing no other way of life, victims of childhood abuse continue to find themselves involved in unhealthy, marriages, friendships, and employer/employee relationships. They may even grow up to abuse others in ways that mirror their own experiences.

Here’s my advice on how to identify an emotional abuser. Evaluate your relationships and determine whether the following signs of emotional abuse apply to you or someone you love.

Demeaning – The abuser attacks the victim’s character and humiliates the other in front of family and friends. The abuser makes the victim believe that his/her thoughts and feelings are invalid, and that she is not authorized to make any decisions unless she consults him first.

Gaslighting – The abuser provides false information or denies accounts of previous abuse in an attempt to make the victim doubt her own memory. This crazy-making usually takes the form of a violent argument one night, and a harmonious relationship the next day. The abuser attempts to make the victim believe that things are not happening the way she truly perceives.

Isolating – The victim often feels guilty about spending time with friends and family, or doing any activity that does not include the abuser. The abuser often convinces the victim that other people in her life don’t like or care for him/her the way the abuser does, even suggesting that they side with them about their mate’s flaws. Saying negative things about the people the victim cares about in an effort to deter him/her from nurturing other relationships is common. Any display of emotion shown by the victim related to someone else, such as grieving after the death of a loved one, helping a friend in need, or being available during a family crisis infuriates the abuser. Employers may pressure employees to shun or isolate other co workers simply because he/she does not like that person. Failure to comply could likely result in torment for the victim.

Criticizing – The victim just cannot do anything right in the eyes of the abuser. No matter what good is done at home, in the workplace, or in the community, the abuser accentuates the negative. The abuser may acknowledge accomplishments, only to follow up with a complete list of the victim’s shortcomings. Eventually, the victim begins to devalue his/her own worth, growing accustomed to the negative picture the abuser has painted.

Blaming – If the victim should strike up the nerve to confront the abuser about this behavior, he/she will go to great lengths to convince them that all of his outbursts are their fault. For instance, he/she may say things like, “I would’t have to fuss if you would just do what I tell you to do!” It might also be suggested that, “If you weren’t such a sorry excuse for a wife/secretary/father (insert other titles here), I would spend more time with you!” Thirty seconds into a conversation about the abuser’s behavior, the story is flipped, and the topic has shifted onto how the victim has caused it all.

Threatening – The abuser may threaten to leave the relationship or stop providing support. It is an attempt to keep the victim guessing about what the next move will be. The victim “walks on eggshells” in fear of angering the abuser, and causing further conflict.

The Silent Treatment – The abuser punishes the victim for doing or saying something “wrong.” This type of psychological abuse may continue until the victim changes her behavior by apologizing to the abuser (even if one did not create the conflict), begging for forgiveness, or promising not to make the abuser angry again.

How to Stop It.

1. Love yourself! Remember, the abuser knows you are emotionally spent. He counts on your low self esteem, lack of self confidence, and reluctance to stand up for yourself to keep the cycle of abuse going. The more you allow the abuser to manipulate you through these channels, the longer the abuse will persist. Do not allow yourself to be isolated from friends and family members. Remember, you need support!

2. Know who you’re dealing with. More than likely, the abuser chose you because he recognized your vulnerabilities and had his own insecurities. The abuser needs to surround himself with people whom he feels are of equal or lesser value in order to feel important and respected. Anyone who disagrees with his opinions, points out his weaknesses, or proves him wrong in front of others will surely feel his wrath.

3. Change you! Don’t waste precious time hoping the abuser will wake up one morning and magically stop mistreating you. IT’S NOT GOING TO HAPPEN (unless there’s a miracle)! What you can do however, is change the way you respond to the abuse. This may take some time to master, but once you begin to love yourself, you will see a spike in your self esteem. Seek counseling and educate yourself about emotional abuse. In time, you’ll lose the need to have other’s approval to validate who you are.

4. Forgive, and set yourself free! The biggest reason we fail to move on after devastating abuse is the inability to forgive those who cause the hurt! I know that seems like an insurmountable task, but read what The Lord’s Prayer taught me about forgiveness here.

~ Sleep Deprivation ~

Effects of Sleep Deprivation

Ann Pietrangelo (August 19, 2014)

Medically Reviewed by George Krucik, MD, MBA

Sleep deprivation can cause damage to your body in the short term. Over time, it can lead to chronic health problems and negatively impact your quality of life.

Accidental Death, Yawning, Memory Problems, Hallucinations, Micro Sleep, Weakened Immune Response, Weight Gain, High Blood Pressure, Impaired Brain Activity, Cognitive Dysfunction, Moodiness, Depression, Accident Prone, Cold and Flu, Type 2 Diabetes, Heart Disease

You need sleep as much as you need to breathe and eat. While you’re sleeping, your body is busy tending to your physical and mental health and getting you ready for another day.

In children and adolescents, hormones that promote growth are released during sleep. These hormones help build muscle mass, as well as make repairs to cells and tissues. Sleep is vital to development during puberty.

When you’re deprived of sleep, your brain can’t function properly, affecting your cognitive abilities and emotional state. If it continues long enough, it can lower your body’s defenses, putting you at risk of developing chronic illness. The more obvious signs of sleep deprivation are excessive sleepiness, yawning, and irritability. Chronic sleep deprivation can interfere with balance, coordination, and decision-making abilities. You’re at risk falling asleep during the day, even if you fight it. Stimulants like caffeine are not able to override your body’s profound need for sleep.

When you’re sleep deprived, the effects of alcohol consumption are magnified, as is your risk of being involved in an accident. According to Harvard Medical School, studies show that sleeping less than five hours a night increases the risk of death from all causes by about 15 percent. Sleep deprivation is dangerous to your mental and physical health and can dramatically lower your quality of life.

Central Nervous System

Your central nervous system is the information highway of your body. Sleep is necessary to keep it functioning properly. During sleep, the brain rests busy neurons and forms new pathways so you’re ready to face the world in the morning. In children and young adults, the brain releases growth hormones during sleep. While you’re sleeping, your body is also producing proteins that help cells repair damage.

Sleep deprivation leaves the brain exhausted, so it can’t perform its duties well. The most obvious effect is sleepiness. You may find yourself yawning a lot and feeling sluggish. Lack of sleep interferes with your ability to concentrate and learn new things. It can negatively impact both short-term and long-term memory. It gets in the way of your decision-making process and stifles creativity. Your emotions are also affected, making you more likely to have a short temper and mood swings. Overall cognitive function is impaired.

If sleep deprivation continues long enough, you’re at increased risk of hallucinations, especially if you have narcolepsy or systemic lupus erythematosis. Lack of sleep can trigger mania in people who have manic depression. Other risks include impulsive behavior, depression, paranoia, and suicidal thoughts.

A side effect of sleep deprivation is micro sleep. That’s when you’re asleep for only a few seconds or a few minutes, but you don’t realize it. If you’re sleep deprived, micro sleep is out of your control and can be extremely dangerous if you’re driving. It can also make you more prone to injury due to trips and falls. According to the National Heart, Lung, and Blood Institute, insufficient sleep has played a part in tragic accidents involving airplanes, ships, and even nuclear reactor meltdowns.

Immune System

When you’re sleeping, your immune system produces protective cytokines and infection-fighting antibodies and cells. It uses these tools to fight off foreign substances like bacteria and viruses. These cytokines and other protective substances also help you sleep, giving the immune system more energy to defend against illness.

Sleep deprivation means your immune system doesn’t have a chance to build up its forces. According to the Mayo Clinic, studies show that if you don’t get enough sleep, it’s more likely that your body won’t be able to fend off invaders. It may also take you longer to recover from illness. Long-term sleep deprivation raises your risk of developing chronic illnesses like diabetes and cardiovascular diseases.

Respiratory System

Since sleep deprivation can weaken your immune system, you’re more vulnerable to respiratory problems like the common cold and influenza. If you already have a chronic lung disease, sleep deprivation is likely to make it worse.

Digestive System

According to Harvard Medical School, a few studies have found a link between lack of sleep and weight gain. Along with eating too much and not exercising, sleep deprivation is one of the risk factors for obesity.

Sleep deprivation increases production of the stress hormone cortisol. Lack of sleep lowers your levels of a hormone called leptin, which tells your brain that you’ve had enough to eat. In addition, it raises levels of a biochemical called ghrelin, which is an appetite stimulant.

Sleep deprivation prompts your body to release higher levels of insulin after you eat, promoting fat storage and increasing your risk of developing type 2 diabetes.

Cardiovascular System

Since you’re more likely to gain weight if you’re chronically sleep deprived, you’re also at increased risk of problems with your cardiovascular system.

Sleep plays a vital role in your body’s ability to heal and repair your blood vessels and heart. Sleep deprivation can lead to higher risk of chronic health problems like high blood pressure, heart disease, and stroke. According to Harvard Medical School, for people with hypertension, one night without enough sleep can cause elevated blood pressure all through the next day.

~ Nutrition ~

Is gluten-free a healthy way to eat?

Jennifer K. Nelson, R.D., L.D., (09-15-2016)

I was recently asked "Is a gluten-free diet healthy for someone who doesn't have celiac disease or who isn't gluten sensitive?" The short answer is that it depends.

A gluten-free diet is recommended for people with celiac disease, gluten-sensitivity or dermatitis herpetiformis (a skin disorder). Some evidence suggests that a gluten-free diet may be helpful for some (but not all) people with irritable bowel syndrome, gluten ataxia (a neurological disorder), type 1 diabetes and HIV-associated enteropathy. Beyond this, there's little evidence that a gluten-free diet offers any particular health benefits.

However, a gluten-free diet can still be a healthy way to eat depending on your food choices. Good gluten-free choices include naturally gluten-free foods, such as lean meats, low-fat dairy, vegetables, fruit, whole gluten-free grains and healthy fats.

It's important not to replace gluten-containing foods with more red meat, full-fat dairy, starchy vegetables, sweets and fats, which can lead to a higher intake of cholesterol, saturated fat, sodium and unwanted calories. It's also prudent to limit commercially prepared gluten-free snacks and bakery products, which are typically high in refined carbohydrate, fat, sugar and salt — just like their gluten-containing counterparts.

Studies suggest that the nutritional quality of commercially prepared gluten-free products varies somewhat from similar gluten-containing products. In several countries, for example, commercially prepared gluten-free foods are lower in protein than their conventional counterparts.

In the U.S., gluten-free foods tend to be lower in folate, thiamin, riboflavin and niacin. This may be because in this country most wheat products are enriched with folic acid, thiamin, riboflavin, niacin and iron, while gluten-free flours, cereals and bread products typically are not.

However, gluten-free whole grains, such as amaranth, quinoa, buckwheat, teff, millet, corn and rice, are good sources of protein, fiber, thiamin, riboflavin, niacin, folate and iron.

The bottom line is that whether a gluten-free diet is healthy depends on which gluten-free foods you choose, how often you eat them and whether your other food choices are healthy ones.

~ Caffeine ~

Coffee-induced Anxiety

Gary Vogin

When patients have trouble with panic attacks and come to psychologist Norman B. Schmidt, PhD, he asks if they drink coffee and whether the anxiety strikes shortly afterward, say, in the morning on the way to work.

If their answer is "yes," he has a surprising treatment: More coffee. But now these patients carefully sip their java while noting their physical reactions.

That way, Schmidt hopes, they'll learn to recognize their pounding hearts and quickened pulses for what those symptoms really represent: a caffeine-induced buzz.

With coffeehouses springing up on every street corner, researchers like Schmidt are increasingly concerned about caffeine's role in panic and other anxiety disorders. Indeed, caffeine's power has become so well recognized that the American Psychiatric Association has added three related disorders to its list of official diagnoses: caffeine intoxication, caffeine-related anxiety, and caffeine-related sleep disorders.

"Caffeine is the most widely used mood-altering drug in the world," says Roland Griffiths, PhD, a professor in the departments of psychiatry and neuroscience at the Johns Hopkins University School of Medicine. "People often see coffee, tea, and soft drinks simply as beverages rather than vehicles for a psychoactive drug. But caffeine can exacerbate anxiety and panic disorders."

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