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Gift From Within - PTSD Questions & Answers with Frank Ochberg, M.D.
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|PTSD Symptoms: Negativity & Pessimism after Trauma
Q: Dear Frank, Is negativity now a recognized symptom of PTSD? What, exactly, does that mean?
A: Dear Joyce, Yes, Joyce, a negative, pessimistic and self-defeating way of thinking and feeling is so often seen after trauma that the PTSD diagnosis now includes this criterion:
D.2. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., "I am bad," "No one can be trusted," The world is completely dangerous," "My whole nervous system is permanently ruined").
We didn't have that particular dimension in our original formulation of PTSD. We did agree to include "a sense of foreshortened future" in the list and we based that more on Holocaust survivors than on the experience of people who were shot or sexually assaulted or who survived car crashes. The committee that edits the official PTSD definition was not trying to change the meaning of PTSD but rather to drop some items that are infrequently seen and include others that are prevalent.
Becoming more pessimistic is, unfortunately, a common outcome when the impact of trauma lingers. It makes sense. Not only have you suffered a serious blow but, by definition, your mind and body have not rebounded after at least a month has gone by. You have unwanted memories, vivid memories, of the traumatic event. You are in a state of tension and apprehension that robs you of sleep and concentration. You avoid people and places that could trigger a flashback. Your life is different and worse than it was before.
But why have "persistent and exaggerated negative beliefs"?
I think that pessimism after trauma and tragedy is natural and normal - to a certain extent. Remember, this criterion requires that the negativity be extreme and, frankly, unreasonable. Unreasonable negativity is a defense against dashed hope, a way of avoiding social activity, and an expression of depression that too often accompanies PTSD. I've learned not to argue with friends or patients who see the world (and themselves) as beyond redemption. But I do try to help them find sources of meaning and fulfillment. It isn't easy for them and it isn't easy for me.
I assume that most readers of this page are dealing with negativity in themselves or in someone they care about. So how can PTSD negativity be reduced?
First, lets change the way we think of the diagnosis. It is an injury, not a disorder. Many of us are campaigning to change the name to PTSI rather than PTSD -see www.posttraumaticstressinjury.org. PTSI is a blown ear drum, a ruptured Achilles tendon, a lightening strike that altered the rhythm of the heart. It is bad, but it can be fixed. It should not be a source of shame and stigma (but, let's face it, it still is). But whether you prefer to call it an injury or a disorder, remind yourself or your friend or loved one that feeling and being pessimistic is part of the diagnosis.
I often say, "It is a sensation, not a prophesy."
It is hard to argue with your own brain. Here is your injured brain, sensing doom, feeling dread, and it is because of PTSI, not because of a radical change in all of humanity. (Having just written that sentence, I realize that there is plenty of reason to fear for the future of our planet, but let's not confuse a sensible, informed concern for Earth and its inhabitants with a pervasive pessimism that is exaggerated and is part of an injured neurology.)
We once said that PTSD was normal. It may be normative after extreme trauma. 80% of people raped at gunpoint have PTSD for some period of time. Statistically, that means that a PTSD pattern can be expected in certain circumstances, But it still is a medical abnormality and it needs attention. So when negativity is part of your post-traumatic injury, do your best to recognize that fact. Give yourself the time and space to recover.
The well-meaning friend often loses the confidence of the person with PTSI by insisting that "things are not that bad" or, worse yet, that "you have no right to feel that way." Saying, "Cheer up," does not make anyone feel better.
But helping in the search for reasonable sources of relief does help. Most often, the welcome gifts from a caregiving friend or partner are assistance with shopping -since agoraphobia is a frequent companion of PTSI and agoraphobia literally means "fear of the marketplace," or assistance with chores that involve concentration, or a quiet presence when company is welcome but conversation is not.
At some point, a person in recovery from the PTS injury will benefit from meaningful work or from activity that may be uncompensated but that is of service to others. It can take years to rebound from severe PTSI. But there is almost always hope for substantial positive change. The best antidote to negativity is positive change through action and not to only rely on lectures on becoming less pessimistic.
I have a patient who may, indeed, have a foreshortened future due to a rare autoimmune disease. She is a survivor of childhood captivity and torture. Her negativity is rational and not exaggerated. But she has a bucket list of ways to fill her life with significant activities and events. Of course she feels terrible at times and I share that feeling on her behalf. However, she has reason to honor herself and find meaning in every day of her life as a survivor of cruelty who never became cruel herself. She will get back in her truck and drive after being afraid to drive for over a year. She will visit parts of the country that once were familiar and parts she has never seen. She will donate memorabilia to a women's museum.
If you are the one with PTSI, the fact that you are on this page means that you are willing to work on your condition and it is a hopeful and positive sign. Gift From Within is a place that welcomes the wounded and hopes to provide food for thought -- nourishment, not platitudes. The negative thought and feeling that is part of PTSI is now a part of the official diagnosis. It is real. But the real world is not really that dark. And there is good reason to work on overcoming the injury you have suffered.
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