Acknowledge and Heal: A Women-Focused Guide To Understanding PTSD: PTSD Recovery Series, #2

ACKNOWLEDGE & HEAL

A Women-Focused Guide to PTSD

Virginia Cruse & Katie SALIDAS

Acknowledge & Heal

Copyright © 2022 by Virginia Cruse & Katie Salidas

All rights reserved under the International and Pan-American Copyright Conventions. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.

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PRINT ISBN: 978-1-7348067-2-4

First Publication date August 26, 2022

Published by: Military Counseling Center San Antonio, PLLC

MilitaryCounselingSA.com

www.TheSoldiersBlog.com

Interior Layout and Cover Design by: Rising Sign Books

RisingSignBooks.com

KatieSalidas.com

For inquiries contact: [email protected]

Ladies:

What you’re experiencing is a normal reaction to trauma.

What happened was not your fault.

You are not damaged.

You deserve to heal.

Introduction

Hey, Lady -

So, we don’t know each other. I only know that you have picked up this book and, for the moment, you’re reading it. I appreciate that; there are few things I value more than the counsel of wise women. After writing The Soldier’s Guide to PTSD, I heard from many women - both Veterans and civilians - who felt validated once they were armed with the facts. These women knew in their gut that they were experiencing symptoms of PTSD and could not find help. Sometimes, their doctors and mental health professionals would not listen to them.

Unfortunately, I know a bit about that. In 2008, after my third deployment to Iraq, I was at my worst with my own PTSD and my boss directed me to see a psychiatrist. This was at a military treatment facility and the psychiatrist was an active duty military officer, a male colonel. I was overwhelmed, suicidal, and in an extremely vulnerable position. I knew something was seriously wrong with my mental health, and I didn’t understand what was happening to me. It was frightening.

I talked with this psychiatrist for the better part of an hour. I answered his questions and poured my heart out.  At the end of our time he said to me, Virginia, there’s nothing I can do to help you if you can’t be honest with me. I was bewildered. He further qualified his statement and said, we all know women don’t serve in combat, and I can’t help you if you won’t tell me the truth.

I wish I were making this up. This psychiatrist labeled me with a personality disorder and he completely dismissed my experience. I felt like I was kicked while I was already down. Adding insult to injury, I was kicked by another service member who was supposed to have my back.

I remember that day very well even though I was drinking a lot back then; the feeling of betrayal cut deeply. I internalized this hurt and thought  seriously about giving up. In that moment, I realized that if I didn’t figure out how to help myself I was literally going to die, either from insanity or by my own hand. I enrolled in graduate school and, thirteen years later, here I am talking to you.

I’ve talked with hundreds of clients since then and discovered that my experience is not a one-off, and, unfortunately, this goes beyond the Veteran community. Often, women’s experiences are dismissed, belittled, and invalidated – and even more so for women of color or women who identify as a member of the LGBTQIA+ community. It’s not okay.

Ladies: we absolutely have to know our symptoms better than anyone else – this includes our doctors or our therapists. We must be able to advocate for ourselves and sound smart doing it. I’m convinced that when we know the facts about PTSD we make more informed choices and get better faster.

This message is important, which is why I partnered with Katie Salidas to write this Women’s Guide. Katie has a way of communicating that is beyond my scope, and I would be crazy not to tap into her expertise.

When we asked for feedback for The Soldier’s Guide in 2021, many women that I love and respect told us that The Soldier’s Guide has great information, but the tone was too harsh and the jargon too specific. We listened and changed course.

That doesn’t mean that this book will be comfortable, though. PTSD is an unpleasant topic and people don’t like to talk about it. I get that, but that’s not good for us. Your life is at stake, Lady, and I intend to be as straightforward as I know how. We’re going to talk about suicide, gaslighting, depression, relationships, and more.

Because I’m one of those therapists who came to the profession later in life, I’m not here to waste time. I’m going to teach you everything I wish I knew before I walked into that colonel’s office. I know PTSD is exhausting, and I realize you may not be up to reading a book. But maybe you could try this one. We’ll keep it short.

Yours Sincerely,

Virginia Cruse

Table of Contents

Chapter 1 PTSD Rumors

Rumor 1

Rumor 2

Rumor 3

Rumor 4

Chapter 2 What is PTSD?

How is Trauma Defined in the DSM-5?

The Gender Difference with PTSD

C-PTSD

SYMPTOMS OF COMPLEX PTSD

Chapter 3 Types of Trauma

Childhood Trauma

Bullying

Toxic Shame

The Narcissistic Parent

Childhood Sexual Abuse

Emotional Abuse

Sexual Assault

Domestic Abuse

Moral Injury

Institutional Betrayal

Medical Trauma

Work Related Trauma

Overwhelming Emotional Strain

Chapter 4 PTSD: Down and Dirty Facts

Criterion A: Definition

Criterion B: Intrusion Symptoms

Criterion C: Avoidance Symptoms

Criterion D: Negative Alteration in Cognition and Mood.

Criterion E: Significant Changes in Arousal or Reactivity Associated with the Trauma

Chapter 5 How Change Happens

An Introduction to the Big Two

Chapter 6 Real Talk on Suicide

Chapter 7 Solutions

Prolonged Exposure Therapy (PE)

Cognitive Processing Therapy (CPT)

Eye-Movement Desensitization and Reprocessing (EMDR)

Chapter 8 Persistence

Chapter 9 How to Find Help

Chapter 10 Social Support

The Key to Lasting Change

Different Kinds of Friends

Chapter 11 Talking About Our PTSD

We Control the Narrative or the Narrative Controls Us

Opening Up About Our PTSD to Recover Our Relationships

The Elevator Speech

Chapter 12 PTSD and Work

There is a Narrative, and There is an Elephant

Chapter 13 Relapse Prevention

Chapter 1 PTSD Rumors

Rumors that are absolutely not true

and mess with your head!

There is a lot of information out there about PTSD, but most of what’s out there is not user friendly. That’s because most what is out there is written by clinicians for clinicians using psychobabble that reads like IKEA furniture building instructions. It’s meant to help those who help others, and while well-intentioned, it isn’t easily digestible for the rest of us.

That is one of the biggest reasons the PTSD rumor mill is so powerful. If you aren’t able to access the information, you need in a format that makes sense, the only thing you are left with is hearsay.

Rumors and untruths will mess with your head and keep you from getting the treatment you deserve, so we’re going to start off by dispelling a few right off the bat. 

Why? Because knowing is half the battle!

We compiled this list of untruths: (1) from folks with PTSD, and (2) from actual masters and doctoral level clinicians whose job is to treat PTSD. So, if you heard one of these and believed it was true, you’re in good company.

Rumor 1

PTSD Has No Treatment.

Add to this: I’ll always have PTSD, I’ll never get better, and The symptoms may go away, but the PTSD will always be there. These are powerful beliefs so widely held that many folks give up before getting started.

FACT: There are three Evidence-Based Treatments (EBTs) for PTSD that have been given the stamp of approval by the Department of Veterans Affairs (VA). While PTSD is not exclusive to Service Members (we’ll get to that in a minute), the VA puts a ton of money into research, and their stamp of approval means that these EBTs are widely available:

Prolonged Exposure Therapy

Cognitive Processing Therapy

Eye-Movement Desensitization and Reprocessing Therapy

Tons of money has been thrown at PTSD research, and it’s paying off in spades.

All three of the above mentioned EBTs have been proven to work for most people (we will take a deep dive into each of them in a later chapter).

Using an EBT for PTSD is important because EBTs are based on peer-reviewed scientific evidence. Researchers conduct rigorous studies using scientific methods, document their research in peer-reviewed scientific journals, and then other researchers conduct additional scientific studies to see if the treatment is, in fact, successful. It’s a lot like how drugs are tested by the FDA - double-blind randomized trials over a  long period of time with lots of scrutiny.

When a therapy method is recognized as an EBT, it’s a big deal.

There are folks who are labeled as treatment-resistant, meaning that these three types of EBTs haven’t worked for them, but researchers have found alternative treatments for them, like the use of Ketamine, MDMA-assisted psychotherapy, and faith-based treatments.

Rumor 2

PTSD is only for Military Service Members or

I don’t ‘deserve’ to have PTSD.

Many civilians believe that only military members can have PTSD. Within the military, many Service Members believe that only folks who engaged in active combat can have PTSD. Let’s start by making this crystal clear:

PTSD Can Develop In Anyone

Who Experiences Trauma.

Anyone who has experienced, or continues to experience, trauma is at risk of developing PTSD. Period!

Continuing with that theme, we also need to clarify another point.

PTSD is not reserved only for those who have earned it.

It’s not a merit badge. It’s not a punch card. No one wants to develop PTSD. It is a serious condition brought about as the result of dealing with some pretty awful crap.

Some clients make statements like, I don’t deserve to have PTSD. Other people have been through worse.

Let’s have some real talk: No one deserves to have the flu. But flu doesn’t care about that. No one deserves to have malaria or HIV or schizophrenia, but we don’t get a choice. PTSD is same-same.

Adding to that point, we need to understand that trauma comparison is not a valid gauge of individual experience. No two people will experience the same stressful or traumatic situation in the same way. What may traumatize one person may not feel that bad to another. Our experiences and our ability to cope are as individual as we are, so trying to compare traumas is like comparing apples to sports cars.

One of the EBTs for PTSD that focuses on stuck points, or belief systems that keep us from getting better is Cognitive Processing Therapy (CPT).

While working with individual clients and groups doing CPT, many variations of, I don’t deserve to have PTSD, come up, such as:

I don’t deserve to have PTSD because I froze/didn’t fight back.

I don’t deserve to have PTSD because I was a child when my trauma happened.

I don’t deserve PTSD because I could have done something to prevent/stop it.

Rumor 3

People who develop PTSD are not resilient

or damaged goods.

This is the idea that someone gets PTSD because they are not resilient enough, or because they already experienced trauma, addiction, etc. and are damaged goods. This rumor equates PTSD to the flu and opines that PTSD attacks those with compromised mental immune systems. 

It is fantasy to believe that a happy childhood will inoculate us from future trauma. It won’t! There is no quick bounce back for rape, war, or a serious accident, and we would appreciate it if people would stop pretending there was. Moreover, this rumor can have unintended consequences:

If people in need of help feel they will be labeled as weak or damaged, then they will be less likely to seek the help they need. 

Not seeking help can have disastrous effects. The following statistics are based on the U.S. population:1 2

About 6 out of every 100 people (or 6% of the population) will develop PTSD at some point during their life.

About 8 of every 100 women (or 8%) develop PTSD sometime in their lives compared with about 4 of every 100 men (or 4%).

Among people who have had a diagnosis of PTSD in their lifetime, approximately 27% have also attempted suicide.

Women with Post-Traumatic Stress Disorder (PTSD) are nearly seven times more likely than other women to die by suicide .

The average time between PTSD diagnosis and suicide was less than two and a half years.

Rumor 4

People who have a history of trauma cannot be high-functioning members of society.

When we define trauma and what someone with a trauma history looks like, we often miss out on seeing the truth of their personal history. We expect to see someone showing some form of self-destructive behavior in an attempt to self-sooth. But that is not always the case.

Trauma is often thought of as an isolated event: a car crash, Sexual Assault, or maybe something that happened  during military service. While singular events can be traumatic, we’re ignoring a whole host of ongoing situations and relational traumas a person can experience.

When a person is exposed to ongoing trauma, their mind tries to adapt. It’s the brain’s job to keep us alive, so in situations where we cannot escape our trauma, the brain switches from fight, flight, or freeze to a more adaptive tend-and-befriend mode (also known as fawning), allowing us to remain as safe as possible in the ongoing traumatic situation.

In short, we develop coping mechanisms to keep everything peaceful. And, as long as things are relatively calm in our lives, we appear normal.

In some cases, our focus is shifted outward, toward the things we can control: grades, promotions, seeking independence, and financial security. Many trauma survivors become fiercely independent because the betrayal they experienced left them knowing the only person they could rely on was themselves. (e.g. a former child of abusive or neglectful parents). To a spectator, these individuals seem like they have it all together. They couldn’t possibly be struggling with PTSD, right?

Wrong.

If someone has to lean on self-sufficiency for survival, it is likely that by the time they desperately need help, they have perfected their mask of indifference and fortified their emotional barriers to the point that they have become reflexes. No longer aware of the walls they throw up, these people can be very difficult to diagnose.

Either way the pendulum swings, self-destructive or super high-functioning, the person who has experienced trauma (singular or ongoing) is attempting to compensate for it. And that may work for them for many years, until it doesn’t.

Now that we know what PTSD is not, let’s get down to brass tacks. Read on.

Chapter 2 What is PTSD?

Post-Traumatic Stress Disorder is the result of exposure to trauma, where the symptoms of that trauma persist or get worse in the weeks and months after the traumatic event.

Not everyone who is exposed to trauma or traumatic events will develop symptoms of PTSD, but many will.

Common symptoms of PTSD include:

Intrusive thoughts

Avoiding reminders of the trauma

Flashbacks

Startling easily

Hypervigilance

Anxiety

Irritability

Self-destructive behavior

Loss of interest in activities

Emotional detachment

An increased risk for suicide3.

That is the simple explanation for a complicated disorder. We’ve got a lot to cover as we take a deep dive into PTSD. For now, you need to know that exposure to trauma is the root cause. Understanding is the first step in recovery.

FACT: There is only one way to get an official PTSD diagnosis, and that is with a licensed clinician who knows their DSM-5.

How is Trauma Defined in the DSM-5?