The Missed Diagnosis of PTSD

Post-Traumatic Stress Disorder is a constellation of symptoms which results from the experience of extreme trauma. Traditionally, it’s been seen as something which arises after exposure to warfare, natural disasters, motor vehicle accidents or physical assault. Due to the recent events in Iraq and Afghanistan, the condition is becoming better-known, with trusted protocols for the diagnosis and treatment of its sufferers.

The symptoms of PTSD include intrusive memories (occasionally flashbacks) of the traumatic experience; intense distress when reminded of it; avoidance of any reminders of the event; feeling estranged from others; decreased interest in normal activities and a sense that life will be shorter than normal. Other symptoms are sleep difficulties; irritability; hyper vigilance and being easily startled.

Although most people see it as a disorder of combat veterans or survivors of tornadoes and house fires, in my experience as a psychotherapist, PTSD is a condition which arises far more often out of childhood abuse or neglect.

Sadly, there are many families today in which the parents are either too emotionally wounded or simply too busy and stressed to pay enough attention to their children. In some families, the parents’ emotional or psychological problems result in physical, emotional or even sexual abuse of their children.

Children who grow up with abuse or neglect end up believing two things: that they must have done something to deserve what happened to them. (Because it’s a child’s nature to take things personally); and that everyone else in the world will treat them in the same way. Aside from the classical symptoms, my patients suffer from depression, anxiety, hopelessness and a sense of powerlessness. They expect rejection and as a result, fear intimacy in relationships. They hear neutral statements as criticism and may explode angrily when feeling insulted, or they may simply withdraw into social isolation.

These people often neglect their own self-care; choosing instead to help others (in the unconscious hope to win their love); in the workplace they get into inter-personal conflicts or attract bullies. They often end up in overly-intense, destructive intimate relationships with people similar to their parents (because it’s human nature to go for the familiar in the hopes of “fixing” it). PTSD sufferers also frequently have serious problems with one or more addictions, using them to bury their emotional pain.

My patients, and other people with the childhood-acquired version are often not seen as having PTSD, and therefore miss being properly treated. Because of their interpersonal sensitivity and their fears of abandonment they have trouble trusting a therapist, so psychotherapy can be challenging with this group.

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Because their depression, anxiety, substance abuse and social difficulties are the predominant symptoms, health professionals can completely miss the diagnosis of PTSD. It’s important then, when we see this combination of symptoms, to consider this challenging but treatable condition. Much suffering could be alleviated as a result.

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About the Author

Marcia Sirota MD FRCP(C) is a board-certified psychiatrist, that does not ascribe to any one theoretical school. Rather, she has integrated her education and life experiences into a unique approach to the practice of psychotherapy. She considers herself a realist with a healthy measure of optimism. Sign up here for her free monthly wellness newsletter. Listen here to her latest podcast. marciasirotamd.com