309.81 Posttraumatic Stress Disorder

DSM-IV diagnostic criteria for PTSD:

A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2)recurrent distressing dreams of the event. Note: In children there may be frightening dreams without recognizable content.
(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event (5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically signficant distress or impairment in social, occupational, or other important areas of functioning.

Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more

Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

In my case, I already might have been exhibiting some signs of posttraumatic stress before the major event which I associate with triggering it. But after the identifiable trauma, I experienced horrible nightmares and was afraid to go to sleep, and I dropped out of school immediately following the event. I also developed a somewhat agoraphobic response related to body dysmorphic disorder, which had also been triggered by the chain of events, or all the events in total. The symptoms lasted for the better part of a year, with some still existing in milder form considerably longer than a year, some resurfacing within another year or less.

Seven months previously, I already felt so distressed that I had attempted suicide, using my antidepressants. Not long after, I found out I was pregnant, my mother died suddenly, I had an abortion, my father almost died of a fractured skull, my father made a pass at me, I ran away from home, before the incident in which I went to a dance drunk and woke up in a field.

When I woke up in the field (approximately 90 miles from where I was living at the time) with vague memories, it was not of having been raped. I consented to have sex with at least one person, and I am not sure how the rest unfolded, because I can't remember. I can vaguely remember several faces watching. I can't remember how I got cuts on my thighs. I know at one point that my head was dragging on gravel as someone drove the car. Those are things I remember. When I woke up, I was embarrassed about those things more than anything else, feeling that it had happened because I was drunk and it was my fault. But waking up alone so far from where I lived, I felt an incredible amount of fear.

I also had guilt because it wasn't the boys who dumped me in a field - it was actually my own fault as I had run off when my ride home had pulled over so I could pee. The girls I came with, including my best friend, were in that car. I ran and ran through a field - at least this is what I remember. One girl had a curfew and was going to be late, and so they made the decision to leave me. I found it incredibly horrifying that I had put them in that position. I think around dawn my best friend called the police from her home to find out what happened to me. She was worried, and I felt guilty that she was apologizing to me for having left me. I guess this is a side of the story that I tend to skim over because I am ashamed of it.

Another I thing I was ashamed of was that I had again been drinking to the point of blackout and didn't remember a lot of the details. I tried to hide this.

I don't think I have ever felt so much fear as I did walking that night. I also didn't think I had a right to feel sorry for myself - everthing had resulted because of my own irresponsibility. I walked for a long time, very cold and wet, because it was raining. I was scared out of my mind every step, but I kept walking.

Near dawn, I saw a small gas station where it looked like there might be people up, but I was too afraid to go there, and crawled through the ditch until well past. I kept walking until I saw a farmhouse with a light on, and knocked on the door and asked to use the phone. (I made a collect call to my ex-boyfriend). The young couple kept asking me if I wanted them to call the police, and I refused, not really able to process why they were asking that.

When I spoke to both my ex-boyfriend and my father, I kept calm, I kept my voice calm, so as to hide my embarrassment. I felt humiliated having to ask both of them for help (I phoned my father later to ask if I could come home, as this incident had occurred while I was living at age 16 away from home, having run away due to my father's sexual advances). My ex-boyfriend compounded the humiliation by forcing me to call the one I originally agreed to have sex with and ask him if anything had happened. I still don't actually remember having intercourse, oral sex or anything except the original making out - kissing and groping through clothes. The boy seemed to sneer at me as he said 'no'. I then had to tell him that I loved my boyfriend, who until just now had been my ex. When I had flashbacks of the night, or when some returned to me, I pushed them out of my mind as quickly as possible. The scars or scabs on my legs were a problem, because my ex wanted to have sex. For a time I managed somehow to make sure he never got a chance to look or feel.

For about a year I was afraid to go to sleep at night, and when I did try to sleep, I had to have the radio on. I often stayed up all night, snacking and watching TV. I had nightmares that I found horrifying. I think that what may have happened was that the incident of that night combined with or triggered a more severe reaction in relation to the chain of events which had occurred within recent months, including the death of my mother, my abortion, a move from country to city, a serious accident in which my father almost died, my father's sexual advances and my running away from home. My nightmares actually seemed to contain components of many of those events.

It is possible that childhood stress, chronic upheaval, family disharmony increase risk for PTSD after a traumatic event in adulthood, and for attachment problems.

I had gained weight as a result of eating at night when I couldn't sleep or was afraid to sleep, and I was self-conscious about that, very self-conscious, but I was also self-conscious because I had dropped out of 'real' school. Everybody knew that correspondence courses were not worth as much as the 'real' thing. When I look at it now, it seems to me like I was actually behaving as sensibly as possible and at least keeping a kind of hope for the future open. What I did I did completely on my own initiative, and I never had any proddings to complete things - many parents nag their kids to do their homework, etc - I had nothing like that and in fact my father told me there was no need to finish high school (because at that time he believed I would soon be a teacher at his 'psychic school'.)

One thing that should be mentioned: my nightmares seemed to incorporate a lot of different elements. Lots of blood appeared, and situations in fields that were like war, with members of my family fighting in the wars, members of my family being badly injured or killed, guns, machine guns, limb amputations, trying to run from these things and not being able to get away, and also 'psychic' apparitions, or ghostlike 'bad magicians' or 'witches' attacked me. Many of the dreams reminded me of scenes of war/battle, and I was puzzled as well as frightened. I hadn't ever remembered having dreams like that before, and I haven't really since - not nightmares to that extent. I have had nightmares at times over the years, but never as frequently as I did then or with quite similar overt themes constantly. I am not just making this up now - it's only through years of writing and rewriting that I have made connections. I had to become conscious of the details in a way I hadn't before.

The only one who had really shown genuine worry or concern about me was my best friend. When my best friend commented about all the events in my life, all the things that kept happening to me, how it seemed like a lot, I was completely puzzled. It seems possible to me that I didn't think it was much of anything because my father didn't think or wouldn't have thought that it was much of anything.

When I woke up in the field, I had run so far that I had no idea where the road was - I couldn't see anything but field. I had to urinate, I undid and pulled down my jeans and it was sometime around then that I noticed that my thighs were stinging. In the moonlight I could make out the cuts, and I was extremely puzzled. I simply had no idea how they had got there. I was embarrassed, and my reaction was to try to hide that it had happened from everyone. It didn't make sense according to any knowledge I had access to.

I may have made persistent attempts to avoid thinking about the situation or talking about it. It was many years before I started thinking about the 'seriousness' of it, and before that was embarrassed by it, thought of it as my fault, and downplayed or tried to avoid talking about some of the weirder aspects of it, or those that made no sense to me. I did feel intense fear during that night (I was afraid for my life), but that was less to do with the actual incident than with waking up alone with no idea where I was, and then the long walk in cold, wet conditions, not really sure what to do but keep walking.

However, despite what is written about diminished capactity to feel or experience emotion or intimacy following PTS, very soon after I arrived back home I began to notice an increased interest in the lives of my siblings - something I had never experienced before. However, my 'numbness' during the time when my mother died and I had an abortion, may more closely fit that symptom, and in following years, the way I describe the events of my life might seem 'cold' or 'numb', in part because there are just so many things to describe.

My symptoms lasted at least a few months, but not sure how long. By the following summer I still sometimes used the radio to try to fall asleep, but at some point I was able to give that up. I also made the effort to get out into the world, and prepare to reenter a new school in the fall.

I do not know for sure that I had PTSD. Whatever it was, it may have been what triggered Body Dysmorphic Disorder, or changed the precursors or manageable symptoms into fullblown, unmanageable ones. I did manage to 'recover' enough to attempt to go back to school, but within a year I was again dealing with some similar symptoms. Some symptoms, like 'sense of a foreshortened future' might have stayed with me permanently.