Posttraumatic Stress Disorder

By Jeff Dwarshuis LMSW, ACSW 

Posttraumatic Stress Disorder (PTSD) is a severe mental health problem that can happen to anyone at any age at any time. The origin of PTDS starts with an individual either witnessing or enduring something that is horrific beyond what is typically experienced by a person. Common examples of people with PTSD are war vets, firefighters, victims of domestic violence, people who have been robbed, abducted and children who have been abused. In the workplace, PTSD can happen in many ways but commonly will occur through witnessing an accident or being a part of an accident.

PTSD and Integrated Memory

In order for a negative memory to pass it must go through a process called integration. This means that the mind fully internalizes the memory and makes it an old memory. For example, if someone goes through a typical negative experience it initially will impact the persons feelings, self concept and related body sensation. Once the memory is integrated, those negative associations disappear and the memory is simply an old memory. If someone experiences a traumatic memory, the mind is not able to fully integrate the memory leaving the person to constantly reexperience the negative thoughts, feelings and body sensations. It is as if people were not made to take experiences that are too negative. This is the beginning of the development of PTSD.  Without treatment, this problem could remain for a lifetime.

Symptoms of PTSD

The following symptoms are taken from the DSM (The Diagnostic and Statistical Manual of Mental Disorders.) Only a limited number of symptoms need to exist to make the diagnosis.

  1. Exposure to or witnessing an event that is horrific beyond what is typically endured by a person. (All PTSD cases have this symptom.)
  2. The person experiences intrusive thoughts or flashbacks of the event(s).
  3. The person has nightmares about the event(s).
  4. The person feels as if the event(s) is continuing to happen.
  5. The person has emotional overwhelm when reminded of the event(s).
  6. The person has physical reactions when reminded of the event(s).
  7. The person avoids thoughts and feelings about the event(s).
  8. The person cannot recall all of the event(s).
  9. The person withdrawals from others.

10. The person does not experience the peaks of good or bad emotions.

11. The person believes they will not live long or have a good and productive life.

12. The person has sleep disturbance, hyper vigilance and extreme anger. 

For the outside observer, symptoms of PTSD are not very obvious. Many of the symptoms listed above can be recognized if the individual discusses the trauma. However, the person with PTSD generally wants to avoid the thoughts and feelings related to the trauma(s) and does not discuss the memories or seek therapy. The individual will, however show distinct negative behaviors. First, the person will almost always show symptoms of depression and anxiety. Second, people with PTSD tend to want to be alone and will withdrawal from others. Third, the person can have extreme outbursts of anger and can be set off by only very minor things. Lastly, people with PTSD often times will abuse substances. In fact, more people will actually seek treatment for the substance abuse than for PTSD.

Treatment for PTSD

Only in the past 15 years has psychotherapy been able to fully embrace and effectively treat PTSD. Studies have shown that group debriefing can be an effective way for people to become aware of the possibility of PTSD and it may decrease some minor symptoms. Cognitive Behavioral Therapy (CBT) also has been effective in treating PTSD. Eye Movement Desensitization and Reprocessing (EMDR) is a neurobiological intervention which integrates traumatic memory. Both CBT and EMDR have been shown to effectively treat PTSD. However EMDR is cited as being more effective in reducing symptoms for a greater amount of cases and in a significantly shorter amount of time.

Jeff Dwarshuis LMSW, ACSW is a licensed psychotherapist in private practice specializing in EMDR therapy. For contact call (616) 443-1425 or send an email to jeffsemdr@tds.net.

Also see Dwarshuis’ webpage at http://www.jeffdwarshuis.com/  for free clinical information and blog entries on EMDR, performance strategies, upcoming presentations and family health.

Adjustment Disorders and Symptoms

By Jeff Dwarshuis LMSW ACSW 

Adjustment Disorders are a common problem caused by experiencing a larger than usual life stressor. Examples of these stressors are relational breakups, a move to another city, job loss, divorce or extended family conflict.  Everyone is subject to the possibility of an Adjustment Disorder; however the disorder is more likely if the change is unexpected. Also, individuals may not make the connection between the adjustment issue and the experienced symptoms it creates. Often times being able to make the connection is a cause for relief. 

Types of Adjustment Disorders

The diagnosis of a specific Adjustment Disorder (AD) depends on the types of symptoms the individual presents following the stressor. The possible symptoms fall into the three broad categories of mood, anxiety and behavior. An Adjustment Disorder is given one of the specific diagnoses listed below.

AD with depressed mood: Symptoms are that of a minor depression.

AD with anxious mood: Symptoms of anxiety dominate the clinical picture.

AD with mixed anxiety and depressed mood: Symptoms are a combination of depression and anxiety.

AD with disturbance of conduct: Symptoms are demonstrated in behaviors that break societal norms or violate the rights of others.

AD with mixed disturbance of emotions and conduct: Symptoms include combined mood, anxiety and behavior symptoms.

AD NOS: This residual diagnosis is used when a maladaptive reaction that is not classified under other ADs occurs in response to stress. 

Emotional Symptoms of Adjustment Disorders

The signs and symptoms of an Adjustment Disorder may affect how you feel and think about yourself or life. The list below represents symptoms of depression and anxiety. These are important signs to watch for in yourself, family or coworkers.

Depression – Sadness, hopelessness, lack of enjoyment, crying spells, thoughts of suicide, trouble sleeping or difficulty concentrating.

Anxiety – Excessive worry, feeling on edge, headaches, tightness in the chest, stomach pain, dizziness, nausea, flashes or chills, pacing or irritation. 

Behavioral Symptoms of Adjustment Disorders
Signs and symptoms of an Adjustment Disorder may affect actions or behavior. Again, these are the things to watch for in others.

Fighting, reckless driving, ignoring bills, avoiding family or friends, poor school or work performance, skipping school or vandalism. 

Treating Adjustment Disorders

Adjustment Disorders are generally easy to recognize in a clinical setting because the symptoms begin with a specific event. Adjustment Disorders are usually treated with a combination of medication, problem solving and behavioral empowerment strategies. Also, Adjustment Disorders may diminish alone with time. Psychotherapy is suggested however because the Adjustment Disorder may last longer than six months and if it does the diagnosis changes to a more severe mood or anxiety disorder.

 

The Anger Checklist

By Jeff Dwarshuis LMSW ACSW

People who have quick or extreme levels of anger may also have difficulty recognizing the signs of anger. Fortunately people can increase their recognition of anger by learning the physical, emotional and behavioral signs of anger.

Physical signs of anger 

Clenching of the jaw or grinding of the teeth

Headache or stomach ache

Rapid heart rate, sweating and feeling hot in the face

Shaking, trembling and/or dizziness

Emotional signs or triggers for anger 

A feeling of flight or wanting to get away

Sadness, irritation, or feelings of resentment

Feelings of guilt or a sense of contempt for another or others

Aggression and the desire to strike out verbally or physically

Behavioral signs of anger

Rubbing of one’s head or cupping fists

Pacing, raising one’s voice or beginning to yell, scream or cry

Aggressive behaviors of throwing, name calling or crossing into someone else’s personal space

Craving a drink, a smoke or other substances that relax oneself

Getting Anger under Control 

If you think that you often or occasionally have these warning signs then see the list below for seven steps to manage anger.

1. Take a Timeout – Before reacting in anger count to 10, take deep breaths and allow yourself to leave the situation. Slowing oneself down helps to defuse anger.

2. Express your anger – Use assertive language to express frustration. Keep from being aggressive, controlling or confrontational. Also, think first before speaking to avoid saying something you might regret.

3. Identify solutions for changing what causes anger – Instead of getting angry identify what is causing the anger and create solutions for change.

4. Use “I” statements – Avoid criticizing or blaming others by expressing your anger using “I” statements. For example instead of saying “You never spend time with me.” say “I feel upset because you came home late.”

5. Don’t hold a grudge – It is unreasonable to expect that others will always behave as you want. Forgiveness allows you to not become crowded by your own anger and sense of injustice and makes it easier to see the positive qualities in others.

6. Use relaxation techniques and physical exercise to decease anger – Physical exercise releases chemicals in the brain that can leave one feeling more happy. Relaxation, such as deep breathing, reading, or positive self talk can allow control over anger.

7. Know when to seek help – It can be difficult to manage anger. Consider getting help if you find your anger is out of control, hurts others or causes you to do things you regret. Help can be found through anger management classes or anger management counseling.

 

The Depression Checklist

By Jeff Dwarshuis LMSW ACSW

Depression is a common problem with a specific course and set of symptoms. It is not uncommon for people to feel depressed from time to time but the severity and length of symptoms determine if outside help is needed. The causes for depression might involve stress reactions and biochemical and hormonal complications. Other causes involve negative thinking patterns, poor emotive processing, traumatic memory and delayed emotional development from child abuse. Although depression can be a serious problem, it also is very treatable.

Symptoms of Depression

1. The individual has a depressed mood most of the day, nearly every day, and feels sad, empty or tearful. In children and adolescents, depressed mood can appear as constant irritability.

2. The person has a diminished interest in things that used to give pleasure.

3. The person has significant weight loss when not dieting, weight gain, or a decrease or increase in appetite. In children, failure to gain weight as expected can be a sign of depression.

4. The person sleeps very little or has a desire to sleep most all of the time.

5. The person is either restlessness or has slowed behavior that can be observed by others.

6. The person feels fatigue or loss of energy nearly every day.

7. The person has feelings of worthlessness, or excessive or inappropriate guilt nearly every day.

8. The person has trouble making decisions and concentrating.

9. Recurrent thoughts of death or suicide, or a suicide attempt.

Treatment for Depression 

The treatment for depression usually involves several interventions. Treatment is generally done in psychotherapy sessions, group therapy or in a hospital setting.

 1. Medication – Medication is generally used in moderate and severe cases of depression. In moderate cases, medication is used temporarily to decrease symptoms. Medication use is slowly deceased as other interventions are learned and used. In severe cases the timeline to decease medications may not be as clear. Antidepressants should be taken in conjunction with psychotherapy as this is statistically the best way to end depression.

2. Cognitive Therapy – It is recognized that depression causes people think in a very specific way about themselves, others and the future. Cognitive Therapy is used to recognize unhealthy thinking patterns that contribute to depression and provides exercises to change these patterns.

3. Emotive and Communicative Therapy – Deceasing depression also comes from increased recognition of individual thoughts and feelings and the ability to clearly express them. Communication exercises can assist someone in knowing and sharing emotions that otherwise had been repressed or forgotten.

4. Eye Movement Desensitization and Reprocessing (EMDR) – EMDR is a type of treatment that eliminates the negative thoughts, feelings and body sensations that come from negative memory. Some negative memories such as child abuse contribute to negative self beliefs that contribute to depression.

5. Problem Solving Therapy – Depression can have a negative impact on decisions, self perception and relationships. Problem Solving Therapy consists of problem identification, goal setting and solutions that lead to more productive and rational behavior. Problem Solving Therapy is done in the therapeutic setting and involves therapeutic questions, confrontation and directives.

6. Life style Changes – Treatment for depression might also involve changes in self care and health. Examples include diet, exercise, healthy family time and interaction.

Recognizing and Managing Stress

By Jeff Dwarshuis LMSW ACSW 

The work environment can be very stressful and without proper management of stress the negative impacts on an employee can be surprisingly harmful. Stress, also called anxiety, creates symptoms that are physical, psychological and emotional. Left unmanaged, anxiety can leaving the employee with mild behavioral symptoms to chronic anxiety requiring medical leave and long-term follow-up treatment.

Symptoms and Types of Anxiety

The most common form of anxiety is called Generalized Anxiety Disorder and it has a number of symptoms. First there are physical symptoms of headaches, muscle tension, tightness in the chest, stomach pain, difficulty swallowing, restlessness, being easily tired and tingling in the hands or feet. There are psychological symptoms of excessive worry, feeling on edge, poor concentration and then behavioral symptoms of irritation, having a hard time getting to sleep and pacing. People who are stressed often appear angry, keyed up, directionless, over paced, argumentative, flushed and unhappy.

There are several types of anxiety in addition to Generalized Anxiety Disorder. For example, there are Phobias, Posttraumatic Stress Disorder, Obsessive Compulsive Disorder and Panic Attacks. These have more specific behavioral patterns and are much less common than Generalized Anxiety.

Managing Stress

The most important thing to do is to recognize stress symptoms early and treat them quickly. Anxiety, especially if it has continued for a long time, can be unpredictable with symptoms emerging in a way that seems to be ”for no good reason”.  Unmanaged Generalized Anxiety can lead to Panic Attacks and Major Depression. At this level the person generally requires inpatient psychiatric hospitalization. Early treatment of anxiety ranges from homecare to medication and psychotherapy. Most intensive treatment can be avoided by following the suggestions below. Remember also that managing stress is both a conscious process and a life style.

  1. Recognize the Symptoms – Read and memorize the symptoms listed above. If you have more than a few of these symptoms you should make changes.
  2. Critical Problem Solving – Unsettled problems create stress and completed projects decrease stress. Clearly define unfinished projects, create a list of brainstormed options and come up with the best solution quickly.
  3. Assertiveness – Recognizing and saying or writing one’s feelings will dramatically decrease stress. When self expression is used with people it leads to problem solving and increased quality in the workplace environment.
  4. Time Management – Develop time management skills. Be organized by mapping out tasks and allow a proper amount of time for each task. Stay away from perfectionism while also spending enough time to do a good job. Also, keep clear boundaries between work and home.
  5. Self Care – Maintain a balanced and healthy diet. Avoid excessive caffeine, get proper sleep and keep from substance abuse. Exercise is critical because it has an effect on the body that decreases stress. Also, body relaxation is important and can be done by stretching, breathing exercises, reading, laughing and having fun.
  6. Social Support – A fulfilling family and social life is enjoyable and allows a healthy distraction from routine stress. Social fulfillment helps to keep values in perspective and gives a sense of purpose and belonging. Distraction, perspective and purpose are central to a calm attitude.

Take some time to evaluate if stress is a problem for you. Addressing and decreasing stress will lead to a happy, healthy and more productive life.

Posttraumatic Stress Disorder (PTSD) – Signs and Symptoms

By Jeff Dwarshuis LMSW, ACSW

PTSD can happen to anyone at anytime at any age. Here is a list of symptoms to watch. Not all symptoms need to exist for diagnosis.

  1. Exposure to or witnessing an event that is horrific beyond what is typically endured by a person. (All PTSD cases have this symptom.)
  2. The person experiences intrusive thoughts or flashbacks of the event(s).
  3. The person has nightmares about the event(s).
  4. The person feels as if the event(s) is continuing to happen.
  5. The person has emotional overwhelm when reminded of the event(s).
  6. The person has physical reactions when reminded of the event(s).
  7. The person avoids thoughts and feelings about the event(s).
  8. The person cannot recall all of the event(s).
  9. The person withdrawals from others.

10. The person does not experience the peaks of good or bad emotions.

11. The person believes they will not live long or have a good and productive life.

12. The person has sleep disturbance, hyper vigilance and extreme anger.

Also, because of the PTSD, the person almost always has Major Depression and Generalized Anxiety.

Substance abuse is very common as a self medicating attempt. This is often the initial reason for seeking treatment.

People are fearful of treatment because they think they will have to talk about the traumas.

Recognizing and Managing Stress

By Jeff Dwarshuis LMSW ACSW

The work environment can be very stressful and without proper management of stress the negative impacts on an employee can be surprisingly harmful. Stress, also called anxiety, creates symptoms that are physical, psychological and emotional. Left unmanaged, anxiety can leaving the employee with mild behavioral symptoms to chronic anxiety requiring medical leave and long-term follow-up treatment.

Symptoms and Types of Anxiety

The most common form of anxiety is called Generalized Anxiety Disorder and it has a number of symptoms. First there are physical symptoms of headaches, muscle tension, tightness in the chest, stomach pain, difficulty swallowing, restlessness, being easily tired and tingling in the hands or feet. There are psychological symptoms of excessive worry, feeling on edge, poor concentration and then behavioral symptoms of irritation, having a hard time getting to sleep and pacing. People who are stressed often appear angry, keyed up, directionless, over paced, argumentative, flushed and unhappy.

There are several types of anxiety in addition to Generalized Anxiety Disorder. For example, there are Phobias, Posttraumatic Stress Disorder, Obsessive Compulsive Disorder and Panic Attacks. These have more specific behavioral patterns and are much less common than Generalized Anxiety.

Managing Stress

The most important thing to do is to recognize stress symptoms early and treat them quickly. Anxiety, especially if it has continued for a long time, can be unpredictable with symptoms emerging in a way that seems to be ”for no good reason”.  Unmanaged Generalized Anxiety can lead to Panic Attacks and Major Depression. At this level the person generally requires inpatient psychiatric hospitalization. Early treatment of anxiety ranges from homecare to medication and psychotherapy. Most intensive treatment can be avoided by following the suggestions below. Remember also that managing stress is both a conscious process and a life style.

  1. Recognize the Symptoms – Read and memorize the symptoms listed above. If you have more than a few of these symptoms you should make changes.
  2. Critical Problem Solving – Unsettled problems create stress and completed projects decrease stress. Clearly define unfinished projects, create a list of brainstormed options and come up with the best solution quickly.
  3. Assertiveness – Recognizing and saying or writing one’s feelings will dramatically decrease stress. When self expression is used with people it leads to problem solving and increased quality in the workplace environment.
  4. Time Management – Develop time management skills. Be organized by mapping out tasks and allow a proper amount of time for each task. Stay away from perfectionism while also spending enough time to do a good job. Also, keep clear boundaries between work and home.
  5. Self Care – Maintain a balanced and healthy diet. Avoid excessive caffeine, get proper sleep and keep from substance abuse. Exercise is critical because it has an effect on the body that decreases stress. Also, body relaxation is important and can be done by stretching, breathing exercises, reading, laughing and having fun.
  6. Social Support – A fulfilling family and social life is enjoyable and allows a healthy distraction from routine stress. Social fulfillment helps to keep values in perspective and gives a sense of purpose and belonging. Distraction, perspective and purpose are central to a calm attitude.

Take some time to evaluate if stress is a problem for you. Addressing and decreasing stress will lead to a happy, healthy and more productive life.