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PTSD - Not All Wounds Are Visible

As veterans, our greatest enemy is post-traumatic stress disorder. Fortunately, many resources are available to learn more about it, and we have included some of them here. We encourage any veteran who may relate to this information to seek help and start a journey toward understanding and managing PTSD.

 

At RUCK UP, we believe in empowering veterans and their family members to effectively cope with PTSD. We understand that it can be challenging, but we're here to help. Our counseling staff provides both group and one-on-one therapy, offering a sense of belonging and fostering unit cohesion.

 

Our main objective is to provide veterans with the tools and support they need to manage PTSD effectively, as well as the depression and substance abuse issues that often come with it. With over 60 veterans per week benefiting from our 1:1 counseling sessions and PTSD support groups, we're proud to help our veterans on their journey to recovery.

YOU ARE NOT ALONE

PTSD

SUPPORT SCHEDULE

EVEN WEEKS

PTSD

TUE | 2:00-5:00P (A)

WED | 12:00-4:30P (B)

THU | 2:00-5:00P (C)

THU | 5:30-8:00P (M)

ODD WEEKS

COUNSELING

By Appointment

Call us at 603-903-1255

for more info.

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VA RATING

In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 1). PTSD was included in a new category in DSM-5; Trauma and Stressor-Related Disorders. All conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion. DSM-5-TR (Text Revision) was published in March 2022 to include scientific advances since the release of DSM-5. No changes were made to the PTSD diagnostic criteria for adults in this update (2). ​ For a review of the DSM-5 changes to the criteria for PTSD, including resources for DSM-5-TR updates, see the American Psychiatric Association website on educational resources for DSM-5 and DSM-5-TR.

DSM-5 UPDATES

In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5; 1). PTSD was included in a new category in DSM-5; Trauma and Stressor-Related Disorders. All conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion. DSM-5-TR (Text Revision) was published in March 2022 to include scientific advances since the release of DSM-5. No changes were made to the PTSD diagnostic criteria for adults in this update (2). ​ For a review of the DSM-5 changes to the criteria for PTSD, including resources for DSM-5-TR updates, see the American Psychiatric Association website on educational resources for DSM-5 and DSM-5-TR.​ Please note that all assistance grant requests must include a Release Form, Budget Worksheet & copy of DD214, NGB22, orders, or VA confirmation of status.

DSM-5 CRITERIA

Full copyrighted criteria are available from the American Psychiatric Association (1). All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria: Criterion A (1 required): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s): - Direct exposure - Witnessing the trauma - Learning that a relative or close friend was exposed to a trauma - Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, military, medics) Criterion B (1 required): The traumatic event is persistently re-experienced in the following way(s): - Intrusive thoughts Nightmares - Flashbacks - Emotional distress after exposure to traumatic reminders - Physical reactivity after exposure to traumatic reminders Criterion C (1 required): Avoidance of trauma-related stimuli after the trauma in the following way(s): - Trauma-related thoughts or feelings - Trauma-related reminders Criterion D (2 required): Negative thoughts or feelings that began or worsened after the trauma in the following way(s): Inability to recall key features of the trauma - Overly negative thoughts and assumptions about oneself or the world - Exaggerated blame of self or others for causing the trauma - Negative affect Decreased interest in activities - Feeling isolated Difficulty experiencing positive affect Criterion E  (2 required): Trauma-related arousal and reactivity that began or worsened after the trauma in the following way(s): - Irritability or aggression - Difficulty sleeping Risky or destructive behavior - Hypervigilance - Heightened startle reaction - Difficulty concentrating Criterion F (required): Symptoms last for more than 1 month. Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational). Criterion H (required): Symptoms are not due to medication, substance use, or other illness. TWO SPECIFICATIONS 1. Dissociative Specification. In addition to meeting the criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli: - Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream). - Derealization. The experience of unreality, distance, or distortion (e.g., "things are not real"). 2. Delayed Specification. Full diagnostic criteria are not met until at least 6 months after the trauma(s), although onset of symptoms may occur immediately.

WHAT DOES PTSD LOOK LIKE?

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 4 weeks, cause you great distress or interfere with your work or home life, you might have PTSD. ​ There are 4 types of PTSD symptoms. To be diagnosed with PTSD, you need to have each type. That said, everyone experiences symptoms in their own way. ​ 1. Reliving the event (also called re-experiencing symptoms). Memories of the traumatic event can come back at any time. They can feel very real and scary. For example: - You may have nightmares. - You may feel like you are going through the event again. This is called a flashback. - You may see, hear, or smell something that causes you to relive the event. This is called a trauma reminder, cue, or trigger. News reports, seeing an accident, or hearing fireworks are examples of trauma reminders.​ ​2. Avoiding things that remind you of the event. You may try to avoid situations or people who remind you of the trauma event. You may even avoid talking or thinking about the event. For example: - You may avoid crowds because they feel dangerous. - You may avoid driving if you were in a car accident or if your military convoy was bombed. - If you were in an earthquake, you may avoid watching movies about earthquakes. - You may keep very busy or avoid getting help so you don't have to think or talk about the event. 3. Having more negative thoughts and feelings than before the event.The way you think about yourself and others may become more negative because of the trauma. For example:  - You may feel numb—unable to have positive or loving feelings toward other people—and lose interest in things you used to enjoy. - You may forget about parts of the traumatic event or not be able to talk about them. - You may think the world is completely dangerous and no one can be trusted. - You may feel guilt or shame about the event, wishing you had done more to keep it from happening. 4. Feeling on edge or keyed up (also called hyperarousal). You may be jittery or always alert and on the lookout for danger. You might suddenly become angry or irritable. For example: - You may have a hard time sleeping. - You may find it hard to concentrate. - You may be startled by a loud noise or surprise. - You might act in unhealthy ways, like smoking, abusing drugs or alcohol, or driving aggressively.

DO PEOPLE WITH PTSD GET BETTER?

After a traumatic event, it's normal to think, act, and feel differently than usual--but most people start to feel better after a few weeks. Talk to a doctor or mental health care provider (like a psychiatrist, psychologist, counselor or social worker) if your symptoms:

  • Last longer than a month

  • Are very upsetting

  • Disrupt your daily life

"Getting better" means different things to different people. There are 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 and relationships. ​ At RUCK-UP, our main objective is not to "cure" PTSD, but rather to provide veterans with the tools and support they need to manage it effectively, as well as the depression and substance abuse issues that often come with it. Our counseling team meets with over 60 veterans every week for one-on-one (1:1) sessions, and we also have several support groups dedicated to helping those with PTSD.

SUGGESTED READING

Dr. Jonathan Shay

At RUCK-UP, we maintain a reading list of some of the best resources for understanding PTSD. One of our favorites is Dr. Jonathan Shay's work, which we often quote here. A significant part of our PTSD counseling work relies on Dr. Shay's research.

 

2 of our favorites:

  • "Achilles in Vietnam"

  • "Odysseus in America"

NOTE: Shay has a personal preference to avoid using the term "Post-Traumatic Stress Disorder" because of its clinical nature and the belief that it carries a stigma. Instead, Shay suggests using the term "psychological injury" which would place it on an equal footing with any physical injury caused by a bullet or a bomb. Although we subscribe to this analogy, we continue to use the term "PTSD" in our work with the VA and Social Security Administration to assist the veterans we serve.

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