Diagnosis spotlight: posttraumatic stress disorder

Life isn’t always kind. No one is immune to twisting an ankle or feeling heartbreak. The difficult aspects of life are just normal a part of the experience. Trauma, on the other hand, is something damaging that is outside the realm of normal human experiences. It’s not something that is expected and it can be very difficult to cope with. War, sexual assault, major natural disasters and life-threatening accidents are all examples of this.

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Traumatic events can leave anyone shaken for a while, but when symptoms won’t go away, it can become an illness. When the aftereffects of the trauma seriously interfere with major areas of your life for an extended time, it might be post traumatic stress disorder (PTSD). According to the guidelines in DSM-5 (a volume used for mental health diagnosis), this is a psychiatric condition that is the result of “exposure to actual or threatened death, serious injury, or sexual violence.” It can be a result of something that you experienced, witnessed or (in a few cases) heard about. Symptoms have to occur in each of four different areas: reexperiencing, avoidance, cognition/mood alteration and hyperarousal.

Reexperiencing is exactly that: experiencing the trauma over and over again. This can happen in lots of different ways. You might have intrusive memories, nightmares, flashbacks or negative reactions to things that remind you of the event. On the extreme end of the spectrum, you may actually think the trauma is happening right then and there.

Another reaction is to avoid anything that is associated with the event. It could be trying to stay away from external reminders or you might avoid your own thoughts and feelings. If someone was in a serious car accident, he might drive different routes – even when longer – in order to not pass the scene of the accident. An assault victim might go to extreme lengths to distract herself from the memory and associated feelings. It can also include avoiding seemingly benign things, such as teddy bears, frying pans or the rain, if they are somehow reminders of the trauma.

  

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There must also be changes in thoughts and/or feelings as a result of the trauma. It could be being plagued by negative feelings (fear, anger, guilt, etc.) while being unable to experience positive emotions (happiness, calm, love, etc.). Others might be unable to remember an important part of the trauma. Distorted thoughts, such as “it’s my fault that I got mugged” or “nowhere is safe,” can also occur. Feeling detached from others and having a decreased interest in significant activities are also signs.

Hyperarousal refers to having very strong negative reactions to your environment. You can’t feel safe, so you respond as if you are always in danger. An increased startle response or hypervigilance (intense and unwarranted efforts to detect threats) are common reactions. Problems sleeping or concentrating are also potential disruptions. You might also become irritable or angry without being seriously provoked. It can even go as far as engaging in self-destructive behavior. 

Psychotherapy is the most common treatment for PTSD. This can take many forms. Sometimes desensitization to the experience through repeated exposure can reduce symptoms. Other times, processing the event and what it means is called for. Medication might help with individual symptoms, but are not meant to treat the condition as a whole. There are also treatment techniques such as hypnotherapy and what is called EMDR (eye movement desensitization and reprocessing). Talk to your clinician about your treatment options because there might be more than you think. 

PTSD is a normal reaction to an abnormal event. It can seriously interfere with all aspects of living, so it’s very important to seek a professional opinion and subsequent treatment if you are experiencing several of the symptoms described. Recovery might seem unthinkable in the midst of the disorder, but it is possible to overcome extremely difficult parts of your life. It might take a long time, but remember that it can be done and working on it is better than allowing it to take over your life. 

Cut your med costs in half (really)

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Here's a quick tip that can potentially cut the cost of your prescription medications in half! I don't use exclamation points often, so this is cool. I learned this trick from a pharmacist, actually, even though it's not necessarily to their advantage. This saved me when I was on a $100/mo. medication without insurance. 

The next time you visit your health care provider, ask if any of your medications are available in pill (not capsule) form. Then see if there's a pill that's double the dose you need. If there is, ask to have that one prescribed instead and then take half a pill instead. This isn't possible with every med; if you have a time-release prescription, it won't work. Your doctor could say no, but it's definitely worth trying – especially if you don't have adequate insurance. I know that you can do this with a fair amount of medications.  

Outside of that, check if your preferred pharmacy does price matching. In general, at least in my area, Costco has the lowest prices (and you don't have to buy in bulk). You can, of course, switch pharmacies. But there are sometimes reasons to stay with the one you use. Making a few calls around town, though, could be a big saver.

Do you have any other money-saving tips when it comes to meds? Share your tricks in the comments.

Mental health myths: violence

When it comes to mental illness, most people are not as well-informed as we'd like to think they are. This is true of both those who have and have not struggled with it. What is thought of as matter-of-fact might not actually be supported by research and common sense doesn't always apply. This is why it's important to reconsider our assumptions.

From time to time, I'll cover different mental health myths and show the facts behind the truth. Today's topic is violence.

Myth: Mentally ill individuals are violent.

Fact: The mentally ill are generally no more violent than anyone else.

  

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Despite what Hollywood movies and the news would have you believe, mental illness does not account for a much violence at all. Only 3-5% of all violent acts are caused by individuals with serious mental illnesses. This isn't much, especially since 6% of the population qualifies as seriously mentally ill. This means that they are actually doing less than their expected share of violent acts.

In addition, mentally ill individuals are at a higher risk for being on the receiving end of violence. This same group of seriously mentally ill individuals are ten times as likely to be the victim of a violent crime than the general population. That is a very significant increase.

When mentally ill individuals do become violent, it is most likely towards themselves. Over 90% of those who lose their lives to suicide can be diagnosed with a mental illness. It's hard to find exact numbers, but it is generally accepted that suicide is far more common than homicide. Self-injury is also a serious mental health concern and another way that the mentally ill turn on themselves.

While the messages we get from the media suggest mental illness as a predecessor to violence, the concern should be more along the lines of protecting the mentally ill from the violence of others. If you are experiencing violence in your interpersonal life – whether related to mental illness or not – visit the National Domestic Violence Hotline at www.thehotline.org or call 1-800-799-7233.


Sources:
http://www.mentalhealth.gov/
http://www.nimh.nih.gov/
http://www.nami.org/

Management 101

Most managers of mental health services get very little training in the business of management itself.  In our academic preparation we hear next to nothing about human resources, marketing, budgeting and funding models, project management and implementation, and paradigm conflict, among other sundry topics involved in this work.  We mostly learn on the job, which is to say through trial and error.  Or trial and success.  Some of us may pick up exposure through continuing education, informal training provided on our campuses, and more rarely through formal education.  Many of us benefit from networks provided for by organizations in the field, many of which I have listed elsewhere in this blog.  I know I have benefited immensely from the consultations provided by more seasoned directors than I, which continues to this day.  I am eternally grateful for these opportunities.  I believe there is an admirable expectation in our field that wisdom is passed down to new generations of leaders, and that this is done freely.

In this way we come to develop skills needed to manage services competently.  One can find a few texts which assist in this process, but there is no substitute for a sort of folk wisdom, if you will, which has been hard-won over time.  Below I make a humble attempt to present one version of this wisdom which I have gathered in over 22 years of labor.

• Counseling or psychotherapy is mostly invisible and under-valued, and if you don't tell its story, loudly, no one will know much about it.
• Just because you believe that college mental health is an oasis of sanity does not mean that others do.
• One would think that mental health professionals who are trained helpers bound to a code of ethics always have the best of intentions and motives.  This is not true.
• You can't please everyone or, alternatively, if you don't make an enemy along the way you are doing something wrong.
• Take nothing personally.
• Admit what talents you do not have, and collaborate with those that do.
• There are people, organizations, and systems that will interfere with your attempts to help students.  There are many reasons why this is so, and not all of them are malevolent.
• Praise in public, correct in private.
• Know when to step away from work for the sake of your sanity.
• Keep your word.  If you don't it can take a long, long while to earn trust back.
• We are always one irrational student/parent/colleague away from disaster.  Unfair as it may be, such individuals can obliterate all the credit and stock which your team has earned.
• Take up a new hobby every other year or so.
• Nurture your relationships even if that doesn't come naturally to you.
• When you are tired or weak, frustrated or angry, fearful or anxious, delay your decision.  You will feel better later.
• Don't get distracted by petty games, fears, and a culture of blame.  Stay focused on what you believe is right and best.
• Assert your authority, but treat this prerogative as you would a very expensive spice.
• Be accountable to those above, below, left and right, but most importantly, to your self.
• Work really hard to remove your ego from all considerations.  This is not easy.
• Ask for help, permission, resources, funding, time to think, limits, forgiveness.  When it is denied ask again anyway.
• Delegate.
• Let go of pet projects when they are not effective.
• Remember your family and friends.
• Stand up to bullies and go to bat for your beliefs.  Others are watching you.
• Play to the assets of your staff and overlook their weaknesses, but only up to a point which does not diminish your mission.
• Many will expect perfection of you but not of themselves.  Get used to that.
• When things get convoluted and you are in doubt, focus on helping the student in the best way you know how.
• Even when things are messy and ugly spend some time recalling the inherent beauty and goodness in nature and human beings.

In subsequent posts I will expand on some of these themes, so please stand by.