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Understanding and Getting Help for PTSD by guest author Keith Valone, Ph.D., Psy.D., M.S.C.P.

sadness PTSDI was recently approached by a California-based psychiatric treatment practice to feature writings by their experts on my blog. I agreed to give it a try. The following may shed some light on the new criteria for being diagnosed with PTSD and provide insight into how children can also be affected by abuse and trauma. We need to take the necessary steps to protect ourselves and our children. Never be ashamed to ask for help.

New Diagnostic Criteria for Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder (PTSD) is a severe psychological condition in which exposure to a traumatic event causes clinically significant symptoms that cause substantial distress or interferes with social, occupational, or developmental functioning.  The criteria that mental health professionals use to diagnose PTSD were recently updated with the release of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May of 2013.

In this article I will briefly review what changes were made and how to understand them.  If you or a loved one has been exposed to a traumatic event, you may recognize some or many of the symptoms below.  Please remember that only a trained mental health professional is qualified to make a diagnosis of PTSD.  If you suspect that you or a loved one has PTSD, please have an evaluation by a psychologist or another mental health professional at your earliest opportunity.

Post-Traumatic Stress Disorder Grouped Within A New Class of Mental Disorders

The DSM-5 has created a new class of mental disorders called “Trauma and stressor related disorders.”  PTSD is now included within this class rather than seen as an Anxiety Disorder as in previous versions.  The diagnostic criteria for PTSD itself have also been revised, as described below.

To diagnose PTSD, an individual must be exposed to the threat or experience of: sexual violence, serious injury, or death.  This exposure can take the form of either direct exposure, direct witnessing, indirect witnessing through hearing of a close friend or relative’s exposure to trauma, or repeated or extreme indirect exposure to details of trauma in the line of professional duty such as members of the armed forces, policemen, and firefighters.  Exposure to trauma via electronic or social media does not alone constitute a basis to develop PTSD.

In addition to having been exposed to a traumatic event, the individual must display symptoms of impairment in four other areas of functioning for a month or longer.  Intrusive Symptoms include recurrent involuntary memories of the trauma, traumatic nightmares, flashbacks, or intense distress when exposed to a reminder of the trauma.  Avoidance includes efforts to avoid trauma-related thoughts and feelings as well as things or situations that may remind the person of the trauma such as objects, locations, situations, people, and places.  Negative changes in thoughts and feelings include difficulties remembering important aspects of the trauma, pervasive negative feelings about oneself related to the trauma, loss of interest in daily activities, ongoing feelings of shame, horror, guilt, or anger, feeling alienated from others, and/or an inability to feel emotions.  Changes in emotional reactivity include increased irritability or aggression, self-destructiveness, startling easily, problems with concentration, sleep disturbance, or being overly fearful.

PTSD in Adolescents

PTSD in children and adolescents is common.  According to the United States Department of Veterans Affairs, the most common form of child abuse in the United States is neglect, followed by physical abuse, sexual abuse, and mental abuse.  Boys and girls are equally likely to be exposed to trauma over the course of their childhoods.  Studies show that between 3-15% of girls and 1-6% of boys develop PTSD at some point in their childhood.

Teenagers with PTSD may show many signs and symptoms that are similar to adults with PTSD.  However, teens with PTSD are more likely to exhibit the following symptoms:

  • Sexually inappropriate behavior, sexual promiscuity
  • Self-harming behavior such as cutting or burning themselves
  • Suicidal thoughts or actions
  • Aggressive behaviors toward others
  • Drug and alcohol abuse
  • Social isolation and withdrawal, few if any friends, poor choice of friends
  • Acting out behavior such as defying authority, petty theft, breaking rules
  • Lack of trust in adults, sexually inappropriate behavior toward adults
  • Excessive fear, anxiety, worry, sadness, low self-worth, exaggerated startle response
  • Excessive shame, avoidance of eye contact, withdrawn body language

It is important to consider these indicators in boys as well as girls, as boys may express their trauma symptoms in a more aggressive fashion and thus may be seen as evidence of delinquency or “bad character” rather than as signs and symptoms of PTSD.

Getting Help

If you suspect that you or your loved one has PTSD, make an appointment to be evaluated at your earliest opportunity with a qualified mental health professional.  There are other psychological conditions that may appear to be similar to PTSD, so getting an accurate diagnosis is essential.  PTSD can also occur along with other conditions such as drug and alcohol abuse, major depression, and bipolar disorder.  Getting an accurate and comprehensive diagnosis through a psychiatric treatment center or a dual diagnosis treatment center is essential.

There are many highly effective treatments for PTSD.  PTSD is primarily treated with psychotherapy.  Medications are not the primary treatment of choice for PTST but they may help with complications of PTSD such as anxiety, nightmares, and depression.

About the Author:  Keith Valone, Ph.D., Psy.D., M.S.C.P. is  clinical psychologist, certified psychoanalyst, and clinical psychopharmacologist.  He is the founder and CEO of The Arroyos® Treatment Centers and The Arroyos® Psychological Associates in Pasadena, California.

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Sociopaths and psychopaths are not fascinating. People who survive them are.


The behaviors of sociopaths, psychopaths and any pathological persons are not fascinating to me and should be collectively judged as bad by society. Why?

We judge everything. Judgement isn’t as bad as people are led to believe.

Judgment encompasses three categories: good, bad and indifferent.

When we revere something, we are judging it as good. When we are indifferent to something, we are judging it as unimportant.

To me, indifference is the same thing as ignorance, and if we keep perpetuating ignorance about the real harm sociopaths, psychopaths and other pathological individuals are capable of inflicting, the problem just gets bigger and more difficult to manage.

So, I guess, I am not really judging anyone as being bad, am I? I am simply providing awareness based on facts and real-world experience.

The American Psychological Association will soon release the updated and revised 5th edition of the Diagnostic and Statistical Manual (DSM). The DSM is basically a glossary of labels and behaviors related to mental health. It’s a glorified dictionary, in my opinion, but a necessary one. The DSM-IV is what I used to determine, once and for all, if the boy in my story was a narcissistic sociopath. That’s where the usefulness of the DSM ended for me.

The DSM stops at the diagnosis, the definition and label. And even the label isn’t easily justified.

Where are the blood tests? What about the standards for reading brain scans of those diagnosed? Are their genetic markers that support whether or not a patient was born that way or nurtured and conditioned to be that way? Or did other societal factors cause the disorder?

And there isn’t much in terms of how to treat the disorders, either.

The DSM does not provide personality disordered individuals with recommendations for healing and recovery. There are no treatment options to cure narcissists or sociopaths and other cluster B disordered individuals.

You laugh at the notion. So do I! We all know from experience that individuals who perpetually and instinctively repeat the behaviors characteristic of having a personality disorder or of being a sociopath or psychopath are, by their very nature, disordered and are not capable of change. Treatment for the personality disordered among us is a moot point.

To make matters worse for us lay persons (and for the inexperienced psychoanalysts and psychiatrists, for that matter), the DSM doesn’t even include a list of measurable effects that personality disordered behavior can have on non-disordered individuals and/or society.

And this is where the lines are blurred and the science behind psychiatry and neuroscience meet:

  1. There are sick people who are born sick and can’t be rewired or fixed. Psychiatry, as it is today, can not help these people. Neuroscience can help strengthen the definitions and classifications of these individuals but also can’t ethically help these people either.
  2. Then there are those individuals born with a healthy and productive mental capacity and balance who are acted upon and broken by individuals born sick and disordered. The people born healthy can be treated with psychiatry and psychoanalysis. Neuroscience can help pinpoint the areas of the brain that need “massaging,” so to say, and allow for complete and full recovery.

Therefore, why do we waste our time studying sociopaths like some newly discovered species of butterfly? The sociopath and the disordered have been around for centuries if not since the beginning of time. Why the fascination and investment?

They harm others. Period. End of story.

Who is going to have the guts to put personality disorders and pathology into a bucket outside of treatable mental health issues and disorders and classify these people instead as the cause of the majority of the harm inflicted upon others?

(Yes. Blame the monsters. Stop blaming the victims!)

Individuals acted upon by pathological people are the real patients who deserve more of our time and efforts. And the way we approach treating the real patients needs to change dramatically.

I don’t think I am alone on this one.

The following was pulled from an article published by The Guardian on Saturday, May 11, 2013: Psychiatrists under fire in mental health battle: British Psychological Society to launch attack on rival profession, casting doubt on biomedical model of mental illness

“There is no scientific evidence that psychiatric diagnoses such as schizophrenia and bipolar disorder are valid or useful, according to the leading body representing Britain’s clinical psychologists.”

“In a groundbreaking move that has already prompted a fierce backlash from psychiatrists, the British Psychological Society’s division of clinical psychology (DCP) will on Monday issue a statement declaring that, given the lack of evidence, it is time for a “paradigm shift” in how the issues of mental health are understood. The statement effectively casts doubt on psychiatry’s predominantly biomedical model of mental distress – the idea that people are suffering from illnesses that are treatable by doctors using drugs. The DCP said its decision to speak out “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems”, used by psychiatry.”

“Dr. Lucy Johnstone, a consultant clinical psychologist who helped draw up the DCP’s statement, said it was unhelpful to see mental health issues as illnesses with biological causes.”

‘On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse,’ Johnstone said.”

Although Johnstone’s statement doesn’t specifically list “exposure to disordered people” as one of the circumstances behind another person’s breakdown, I can’t help not making that connection when I read trauma and abuse.

Bad people are born. People who are born bad hurt others. They inflict trauma and pain on others.

We have this false sense of hope that the bad people can be fixed with medication or a 30-day rehab stint. They can’t. Those born sick will stay sick.

Would you send a child born with Down’s syndrome to a hospital hoping upon the child’s return the child will be cured? Of course not. So why do we think people born with the propensity to inflict physical, emotional and spiritual harm on another can be fixed?

Gone should be the days of saying, “Oh, he can’t help it, he was born that way.” Or “His father beat him when he was young and that’s why he beats his wife and kids.”

We need to stop having pity on these disordered individuals. We need to stop dismissing rapists and child molesters and murderesses who claim childhood trauma and severe mental anguish as the reason behind their behavior.

There are many, many people who have been abused, molested and assaulted as children who do not grow into monsters who prey on others. Assuming such things is highly destructive and counter-productive to the healing and recovery process of victimized individuals born healthy and without pathology.

The reason a person repeatedly hurts another and then another and then another is because that person was born to hurt people–emotionally, mentally spiritually and physically. They have no empathy or conscience. They are not able to be rehabilitated.

Society desperately wants to be fair and reasonable with offenders. Why? Because we know we are all fallible and make mistakes and would want mercy if we screwed up, right?

When healthy people screw up, we don’t weasel our way out of punishment. We say, “Yes, I did that. I am sorry. What is my punishment?”

We don’t blame our past or someone else for our bad decisions. We own our mistakes. We are accountable. We assume everyone is like us: good, fair and accountable.

People born without the capacity to empathize and who lack a conscience are not good, fair or accountable. They have nothing positive to contribute to society and have only the ability to destroy–people, families, institutions, organizations and governments.

(You could probably list a few. I could too.)

As a society and community of mindful thinkers and change agents, we need to stop focusing on fixing the unfixable and instead focus on helping those the unfixables have broken. Trauma patients can survive and they can be healed and society should want to help.

We need to stop putting our time and efforts and our money into research, drugs and facilities focused on understanding, medicating and housing the disordered and unfixable. How absurd!

All of those resources should be put into helping and healing the good people who can be fixed and who can be helped and whose temporary imbalance can be adjusted through mindful and natural approaches.

Stop blaming the trauma patients for their trauma and stop trying to help the disordered who inflict the trauma in the first place.

Trauma patients can be fixed. They can recover. But they can’t do it without our collective understanding and encouragement. They can’t do it if the source of their trauma is getting treated with more care, attention and fascination than they are.

Be fascinated with the people who walked away from the sick and disordered. There must be a super power in them that science has overlooked. I’d like to find out what that is and replicate it, wouldn’t you? A vaccine against the effects of pathology perhaps.

Prevention rather than the preservation of the sick and disordered due to society’s constant fascination. After all, when you pay attention to something, it never goes away.


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