Hello everyone, I am currently doing my Psychiatry clerkship in school and one of the psychiatrists I am working with wanted me to do a small presentation (for her only) on anything of my choosing. I thought it would be a good opportunity to gather some resources on PTSD, learn more for myself, and also possibly learn what other sufferers might really want their doctor to know (the texts I've gathered give nice definitions but unfortunately don't offer a lot of perspective from sufferers).

So I am wondering if you have any important topics that go beyond book definitions that I should read up on and make sure to include... perhaps what is important to us that doctors tend to gloss over?

I'm not asknig for anything personal unless you want to (its an academic paper, not a case study), just things that might have come up with people that are not typically addressed by the standared criteria. Any thoughts would be appreciated. I'm sure this person has read all about it so I was just hoping to provide a more unique perspective.

I suggest incorporating something on why many people are reluctant to take/stay on medication and what alternatives are out there for these people.

Trust issues, fear of the T putting us inpatient against our will, EMDR as treatment, group versus individual therapy, whether PTSD is permanent or not, what to divulge to loved ones about our diagnosis, how PTSD fits into the ADA requirement of employers to provide reasonable accomodation, ...I will keep thinking.

Recently I have been helping someone with issues regarding raising your children and the complications that occur in the relationship between parent and child due to PTSD. There are many concerns regarding the sufferers reactions and the child's (teenager's) perspective of our responses to situations.

The struggle of being demonstrative emotionally when you feel flat. How much do you share with your children regarding your experiences that are appropriate when it is necessary. Not having your children walk on eggshells around you but learning to accomodate your tendencies. Being able to determine the child's safety issues without going overboard.

Communicating with your family both nuclear and extended. Presenting clear expectations when your world is upside down and inside out. Possible implications to family counselling as well as individual for the children. The sensitivity of the sufferer and often misinterpretation of responses from others when information is not clarified.

Adapting to challenges associated with triggers - dentist, dr. exams, driving, etc. Sleep deprivation and its affects on job performance and overall anxiety.
Lack of support groups for non-VA. Transition periods post hospital stay and post therapy w/o support system. The challenges of just having a simple day without anxiety or road bump of any kind. Being able to slide over the road bumps smoothly.

Wearing the mask all the time and hiding our inner self's. Brewing pot inside and the calm exterior (most the time).


If you would like clarification or more detailed information feel free to pm me.

Wow, I think Cindy really touched on a lot of really great subtopics.

Something that is important to me that I've not been able to find a lot of of information on, and I actually brought up in another post, is how I struggle a lot with my own self perception since my traumas happened early in childhood and all I seem to know about myself stems from me having PTSD - the feeling that PTSD has fundamentally shaped who I am, a loss of sense of self without ever knowing who I was.

Good luck with this Lucky and like Cindy, if you would like any specific information about what I posted you can always PM me.

Best,
Rachel

Maybe steer clear of the typical presentation model... history, development, blah blah... and maybe go straight to the impact it has on the sufferer, spouse, family, children, etc etc... impact is always a diverse topic, and with experience it could only be far more accurate than anything a physician could write who doesn't have PTSD.

Thank you so much for all your advice! I am definitely going to stay away from the typical presentation (I doubt a psychiatrist needs me to read off criteria) and focus more on what challenges sufferers actually face.

I've put in a section about responses to medications since compliance is always an issue (great idea Nic!) and included some things about EMDR and other therapies 2quilt mentioned. Trust issues were already in; if only I had a dollar for each patient (not just suffering from PTSD but other things as well) who says something similar to "How can I trust you? I don't even know you!" I'd be able to buy the entire forum dinner. Of course, its understandable!

Cindy and linasmom: also very good topics. So far in my clerkship I have worked with patients but not one family member. Other than the social worker I'm not even sure who talks with the family... but clearly its important for them to be involved and understand the nature of things. I hadn't thought before what kind of impact PTSD would have on a parent/child relationship; that is definitely worth looking into. Wearing a mask to hide how you feel inside (I frequently hear about this going on ~ I do it myself) and extending that even deeper to the self we know and how PTSD has shaped our perceptions of that self are definitely things that should be discussed. I'm not sure they discuss a lot of that in Psychiatry but if the psychiatrist can be aware of those things I think they can tailor their treatments more to match other therapies their patients are experiencing.

Thanks again, I feel like I have a lot more "real" things to work with now.

Something I have just learnt about myself as a challenge to addressing PTSD is a disconnection from self.

I've lost myself, and my identity. The trauma has taken over. I don't have a strong sense of self, and therefore cannot identify what I need, what is helpful and when I'm using defense mechanisms.

The trust issue - something this new wonderful GP said to me that clicked. I don't have a felt experience of being vulnerable and that being a positive experience. So whilst intellectually I know that my psychologist is qualified, safe etc, I've have limited experiences with revealing myself, my trauma and that not being taken advantage of. So I've simply stopped being vulnerable/discussing feelings. And then my therapist is one person for one hour, I step out into the world with lots of people and deliberately not show myself (and my trauma) and even though this is my choice (defence) it reconfirms in my mind that I can't be vulnerable with people and that be a good thing.

So I would suggest 1) Disconnection of Self/Loss of Identity and 2) Building positive felt experiences in discussing trauma/s

Wearing a mask to hide how you feel inside (I frequently hear about this going on ~ I do it myself) and extending that even deeper to the self we know and how PTSD has shaped our perceptions of that self are definitely things that should be discussed.

This struck a chord, Another aspect of this statement is the high sensitivity we have to others and almost immediately reflect it back on ourselves and our 'percieved' flaws. It is so easy for us to interpret others responses and behaviors as a consequence of our PTSD - NOT that the person may be having a bad day and just venting or they appear not to be listening because they don't care - maybe they are preoccupied with having to use the bathroom. Whatever, but we often personallize everything within our own context. This is a real important piece teaching someone to wear the proper filters to accurately determine what the communication was meant to say and in what context.

A short paragraph about the history of PTSD might be good. PTSD is generally associated with combat veterans. But there are infinite types of trauma that can cause a person to have PTSD. You could fill a library discussing the impact PTSD has on the person, and their families. That would be a good area to focus.