Standing up for yourself: When practitioners say your symptoms are "trauma like", is that the cue for "treatment-like" care?
After discovery, we can be confused about our trauma symptoms and by our trauma symptoms. Memory and concentration problems, self-doubt, numbing, intrusive memories, hypervigilance, and unexpected triggers are compounded by gaslighting, denial, lying, personal criticisms, silent treatment, rage, etc., from the man called a sex addict. Then, after a hard-fought battle to have our trauma symptoms correctly identified, we can still face practitioners who call us codependent and co-addict. But when “experts” talk up partner trauma to gain our trust and then tiptoe backwards by saying our symptoms may “sound like” trauma symptoms, or that we have “trauma-like” symptoms…you’ve probably had about as much as you can take.
Research says when things look like traumatic stress symptoms, act like traumatic stress symptoms, and sound like traumatic stress symptoms—they’re traumatic stress symptoms. And in our case if they meet the criteria and last longer than a month, nearly 70% of the time they also indicate Post-Traumatic Stress Disorder. That means we need something a little more than “treatment-like” care. We need informed and competent clinical care. And yes, it also means we’re right back where we were—having to stand up for ourselves and demand a correct assessment of our real symptoms and a correct treatment protocol.
Be proud of your recovery thus far, and don’t let “experts” diminish your achievement!
Even if you are only a month away from dday—well done, sister! I remember that first month. Pat yourself on the back. I’m nearly ten years out from dday. I worked hard to put together what I needed to save my life. PTSD crippled me for a long time, and ten years later I can still be ambushed by its symptoms and sometimes must prepare strategically for them. I stepped away from full-time ministry because of PTSD. But my turn-around recovery time for triggers now is shorter than it was and I can now take short-term assignments. I can read, write and do presentations again. I hope you also are proud of how far along you are in your recovery. And let’s be grateful together for those who stick with us and help us along the way. We don’t imagine our struggle or the cost of this trauma. I don’t exaggerate the care I must take every day to pay attention to what’s going on and how it might affect me. Living my life now is like cooking risotto—you have to pay attention, or else. But it’s less obvious than it was. And I also make a great risotto!
So, after much effort and courage to get to this point, when I read “industry experts” say that I only have “trauma-like” symptoms, or symptoms that “sound-like” trauma I pay attention to that, too. Do you, like me, wonder why they still need to deny and diminish the truth of our lives? Why set our symptoms aside like residue data, instead of the main data that credible research by Dr. B. Steffens shows meets the criteria for PTSD nearly 70% of the time—not occasionally, but nearly 70% of the time??!! We STILL need to know how to stand up for our truth and what we need and deserve. And at the end of this blog there are questions you can use to help you do that.
This past week I wrote a final test for another course I’ve been taking about traumatology. As I geared up for that exam, I had to manage trauma symptom echoes that have affected my ability to succeed in evaluations. I didn’t know about this symptom of my post-traumatic stress until about four years after dday when I attempted to write another exam. When the professor dropped the final exam for the first course of a certification program on my desk, something happened I never saw coming.
The bottom of the trauma iceberg is always bigger than the top
As I looked down that the exam paper with five essay questions, the room began to spin. Letters on the page were moving around. I couldn’t make out words, never mind sentences. I grabbed the edge of the desk as vertigo made me feel like I was falling out of it. I was terrified but after four years of training myself to get through PTSD episodes, I knew that if I asked “why” or tried harder to read the exam, it would worsen. I hung onto the desk and did five cycles of mindfulness breathing. My self-training kicked in. As I grounded myself and slowed the physical signs of panic, my two adult sons came to mind. Love and help came with them. “Ah, yes!” They both had A.D.D. and through trial and error we figured out “work arounds” to their symptoms. Immediately a technique I had suggested they use on their exams came to mind. “Don’t try and read the question. Just find a word in it that you recognize from the course and starting writing everything you know about it. Do that for each question. When you are done, go back and try to piece the question together and tighten up what you wrote to make it more responsive. Whatever happens, at least you have shown that you know what that word is about.” That’s what I told my sons, so that’s what I did.
But the terror didn’t stop there. As I put pen to paper, I didn’t recognize my own handwriting and freaked out again. I did another cycle of breathing and powered through my task with the five questions. Then, I put down my pen to do another breathing cycle before going back to figure out what the questions might be. I glanced up and saw I was the only student in the classroom. Then the clock. It was 40 minutes past the end of the exam. It was too much. I burst out sobbing.
I have to give that professor credit. A lawyer and probably 20 years my junior, he came right over. I wasn’t going to start blathering away about having PTSD, so I just said, “It’s been awhile since I’ve written an exam.” He calmly said, “Diane, I’m not sure what happened, but I want you to know you aren’t going to fail this course. Your questions and discussion in class told me you know this stuff. Don’t worry about it.” Of course (as many of you will understand) his kindness made the tears come again. I handed him my paper and after thanking him, I gathered up my things and left.
I sat for a long time in my car, shaking, crying and wondering who I was, now. Did I want to be that person? In all of life’s struggles and setbacks I had always been able to count on myself as an “A” student. In university I would go for long walks before an exam, enjoying pulling together all the threads of a course into new connections and questions. Now, I couldn’t even read the exam questions, and I wrote with handwriting I didn’t recognize. Four years after dday and I was still discovering how I damaged I was and how much of “me” was gone.
So, “trauma-like”, my ass. Don’t start diminishing my symptoms again, or how much they have cost me, or the courage and hard work it has taken me keep participating in life. Just. Don’t. And if the bottom of the trauma iceberg is too big for your training to manage, hold my beer.
Get the facts from the right resource and know them
We need the right information so we can stand up for ourselves, the symptoms we have, what they mean, and what treatment we should be receiving. We start by learning about the DSM-5. The letters stand for Diagnostic and Statistical Manual of Mental Disorders—5th Edition, a publication of the American Psychiatric Association that “offers common language and standard criteria for the classification of mental disorders.”
We start here because the field of traumatology is developing rapidly through research and growing clinical knowledge. There are significant changes in the DSM-V(5) approach to traumatic stress than in previous editions. (Before this edition, other changes had happened, too.) In the DSM-5, PTSD is no longer in the section on anxiety disorders. It is in a new section for “trauma and stressor related disorders”. New symptoms have been added while others are gone or revised. Symptoms are clustered differently in some cases, and the minimum symptom number for some clusters have changed. Go here to find out more: https://www.brainline.org/article/dsm-5-criteria-ptsd
Why do I need to know this? Can’t I trust the “experts” do?
Unfortunately, no. Not all “experts” keep up with this rapidly developing field of trauma research and care, or the basics of how a correct diagnosis is made. Just last month a collaborating researcher (who prefers anonymity for now) sent me a link to a blog from an “expert” who presents himself as pro-partner and talks “trauma”. But he also seemed to cast doubt on lived partner experience of trauma symptoms. To support his nuanced diminishing of the trauma reality he claimed that a “formal” diagnosis for PTSD required persistent symptoms to last for at least six months. This is not true. The diagnosis for PTSD can be made when the symptom criteria are met for longer than one month, not six months. Spreading misinformation is wrong, if it was done on purpose. If it was a mistake—aren’t you a little alarmed at how wrong he is about such a basic part of correct diagnosis? And that mistake is not one of the recent changes!
What’s also interesting here is that delayed PTSD is something that happens any time after six months. So, even if we don’t meet criteria for a PTSD diagnosis for six months after a traumatic event, it can manifest later. Women are so busy trying to get their husband or boyfriend to get help that they can insulate themselves temporarily from other traumatic impact. Delayed onset is one flag “experts” should always have raised on our client group if they haven’t made a PTSD diagnosis for the first six months. After all, credible research indicates that nearly 70% of us will meet the criteria. So, if most of a practitioner’s clients aren’t meeting that criteria, maybe the practitioner doesn’t know the current criteria, or that even after six months they need to monitor symptoms for delayed PTSD. Do you get the feeling that the industry does not want the impact on you to be that important, or to ask related questions like “What kind of relationship are you in that you have ended up with PTSD?”
We don’t have “trauma-like” symptoms. And “treatment-like” care is not good enough for us. This is true whether we have PTSD or not.
Ask what criteria someone is using when they assess you for PTSD.
If they say it’s from the DSM, ask what edition because you know the most recent edition (5) has significant changes to how it addresses traumatic stress, and request they use it.
If they say most of their wives and partners don’t have PTSD, ask them to explain why Dr. Steffens research showed nearly 70% met the criteria.
Ask what the name is for what you have. PTSD is not the only diagnosis. It’s just the one that fits us nearly 70% of the time. If you don’t have it, you still need your symptoms addressed.
Ask how they will be treating your symptoms. No matter what it is called, you need support right away to keep going.
Ask what their model is for trauma care. Dr. Judith Herman’s tri-phasic approach—Safety, Remembering and Mourning, Reconnection—is foundational. If he/she can’t describe their model and doesn’t know Herman’s work you are probably in the wrong office.
Tell them one or two symptoms that are causing you the most distress and ask for coping tools to help you manage those until your next appointment. If they can’t even teach you one you are in the wrong office.
Ask what treatment modalities they are qualified to use for trauma care. Some include Eye Movement Reprocessing and Desensitization, Time Limited Trauma Therapy, Thought Field Therapy, Cognitive Behavioral Therapy, Art or Expressive Therapy, Mindfulness Practices, Somatic Experiencing. There are others, as well. Some require specific certifications. Ask about that.
If they don’t think you have PTSD, that’s good news. Ask them if they be looking for signs of Delayed Onset PTSD because you have been focussing on his needs more than your own.
Finally, if they answer your questions with details about your husband or boyfriend’s treatment and how you will be participating in that, you are definitely in the wrong office. Your appointment is not another appointment for him. You are not his stand-in. You are you. If they don’t want to take care of you, get out of there and stop payment.
You can do this. Stand up for yourself. Your real trauma symptoms deserve real assessment, real diagnosis, and real treatment. Why? Because you are a real person, too.
Time to talk? Your story is safe here.
With you,
Diane.
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