Demystifying Trauma Responses 12 Signs of PTSD You May Not Know

Hey there everybody, and welcome to this video on 12 symptoms of traumatic injury you may not have known. I'm your host, Dr. Donnelly Snipes. Trauma is an event that caused a sense of helplessness and horror. Most of us at some point in our life have experienced some level of trauma about something. Traumatic injury on the other hand, is the physical, emotional, co cognitive and interpersonal effects of that trauma. When that trauma is unresolved, traumatic injuries become more pervasive and long lasting. Not everybody who experiences trauma is going to develop PTSD or cptsd. It's important that we recognize that just like not everybody who gets an A physical injury is going to have complications or longstanding problems as a result of that injury. Some people heal up just fine, thank you very much. But there's a significant portion of people who may have side effects, if you will. The mainstream definition of trauma often overlooks or minimizes chronic or ongoing traumatic stress and the difference in perception of stress between a child and an adult. When we look at the diagnostic agnostic criteria for post traumatic stress disorder, it's feels to me as a clinician very inadequate in terms of defining trauma. Because when you think of trauma you think of things that are super duper horrific when you can have ongoing traumas like a chaotic household or adverse childhood experiences. So it's important to remember that trauma is in the eye of the beholder. If it was traumatic and produced a sense of helplessness and horror for that person at that time. And what's traumatic for a two year old is going to be different than for a 22 year old. A lot of times people with trauma are either misdiagnosed as having some other disorder or it's a missed diagnosis. They may have that disorder and trauma and it's really vital that trauma gets addressed. Many people with addictions are self medicating trauma. Whether it's physical trauma and they're medicating pain or psychological trauma and they're medicating distress, doesn't really matter. Sometimes people with addiction experience things during their addiction, that's true, that are traumatic. So that's another area we need to consider when treating addiction. In my 20 plus years of experience, I have yet to work with somebody who says no, I've got absolutely no trauma. ADHD is another one of those missed or misdiagnosis diagnoses. Symptoms like difficulty with attention, difficulty focusing, irritability and restlessness are also symptoms of PTSD and cptsd. So we really need to look at the history of the person. When did these symptoms Start, was there a precipitating trauma that existed and determine what, whether we're dealing with something like CPTSD or ADHD or both. You can have both. And According to the ICD11 in their diagnosis of CPTSD or complex post Traumatic stress disorder, if the criteria, if the symptoms of CPTSD fully explain what's going on with the person, then they shouldn't have another diagnosis. But if it doesn't fully explain what's going on, then you need to consider whether there are additional diagnoses. People with anxiety, whether it's generalized anxiety, they just feel stressed out and worried about everything all the time, or social anxiety, difficulty in social situations, may have experienced trauma. So we want to look at what is the source of that anxiety and was it precipitated by maybe growing up in a household where there was domestic violence or there was a lot of rejection, where there were, to coin a term, pathological narcissistic parents that were regularly rejecting. So in current life, in adult life, the person feels very anxious around other people because of that attachment trauma, bipolar disorder, depression and, and we'll talk about depression too, while we're talking about bipolar is a very common symptom or effect of experiencing trauma. Feeling hopeless and helpless to change the situation, feeling hopeless and helpless to recover is very common. Feeling a lot of guilt is very common. With bipolar, you also have either hypomania or mania. Now, hypomania especially is interesting to look at because a lot of times that's somebody feeling revved, not needing sleep. This can be an indication of hyperactivation of that stress response system, that HPA axis saying, it's not safe to sleep, we need to stay awake. Now, generally, if the person has hypomanic symptoms or especially manic symptoms, there is going to be the diagnosis of bipolar. But we need to recognize that there also may be a diagnosis of trauma and the person is not going to maximize their recovery if we don't address everything. Personality disorders and attachment disorders are the same way. We need to look at the symptoms and ask ourselves, what is this communicating? Was this behavioral pattern developed as a result of trauma? Was, did this behavioral pattern develop as a way for the child to protect themselves in a very chaotic, stressful, scary situation where they didn't know from one minute to the other if they were safe, if they were going to be provided for? Now, I've mentioned a couple times, ACEs or Adverse Childhood experiences for those of you who are unfamiliar, just a quick recap. In general, they can be lumped into A couple of different categories. Physical, sexual, emotional abuse. You know, that's pretty straightforward that. That would be traumatic neglect. Now, neglect can be intentional or unintentional. Neglect can be a caregiver being so overwhelmed by their own stuff that they can't even notice the child. They can't figure out how to fix themselves. They can barely function themselves. They can't attend to the needs of the child. Or it can be more purposeful where the caregiver doesn't care, doesn't want the child, neglects the child for their own personal gain, if you will. So we see abuse, we see neglect, we see abandonment, including through death or divorce. Now, of course, nobody can. Well, that's not true. But in general, we can't determine whether we're going to live or we're. We're going to die. So we don't want to blame the person for dying who has a heart attack. But that is still exceedingly traumatic to a child who's like, well, my caregiver is not here anymore. What happens if my other caregiver is suddenly not here anymore? That's really scary. Will this happen to me? Am I going to just quit being here anymore? So for a child that feels like abandonment for a child, they may blame themselves for, for what happened, they may be very angry about what happened, but either way, it's very traumatic for the child. And divorce. Some divorces, things end up going better after the caregivers separate. It's just. It's actually better. But the child's life has changed. They didn't have any choice in it. The child's life has changed. They no longer have two parents living in the same household. Even if it's for the better, the child may feel abandoned, the child may feel guilty and think it's their fault. All of these can contribute to trauma or someone in the house with a mental illness or addiction. When there's somebody who has a mental illness or addiction in the house, if it's a caregiver, they're generally not able to be as responsive and nurturing and consistent with the child, which leads to attachment trauma. If it is somebody else, like a brother or a sister, for example, the caregivers are often so focused on trying to fix that person that they may miss what's going on with other, other children. So there is a certain amount of neglect that may happen there. And generally I consider this involuntary neglect. They're not trying to neglect the healthy child. They're not trying to neglect the child be for their own personal benefit. They Just can't. They just don't know how to, to focus on that person. ADHD like symptoms are, as I mentioned, some people will be misdiagnosed with adhd. People who've experienced trauma are often restless or irritable. They're stressed, they're hyper vigilant, they're always on edge because they don't feel safe. Problems in executive functioning that are common to ADHD include attention, problem solving, and impulsivity. Think about how this relates to trauma. If you are hypervigilant, if you don't feel safe, if you're constantly scanning the room to make sure that you're safe, it's going to be hard to pay attention to the math problems on the board or the Excel spreadsheet that you're working on. If you are in fight or flight, if you're hyper vigilant, if you're not feeling safe, I eat trauma. It's going to be more difficult to problem solve. We know when people are in fight or flee that problem solving is way down on the list. The goal of fight or flee is to keep you safe. So executive functioning kind of goes to the back. Back burner and impulsivity. People who have experienced trauma, they're hypervigilant and think about you. If you're walking through a haunted house, for example, you are hyper vigilant. You're looking around, you're waiting to see what's going to pop out. And then when something does pop out, you respond and you respond impulsively. You're trying to protect yourself because suddenly that that threat is right there. And people with trauma histories may be more impulsive. They may react on a more emotional nature because they are thrown so fully into that fight or flight zone that they're trying to protect themselves. Emotional dysregulation is another symptom potentially of trauma. If you have an exaggerated emotional response, and I don't like that word, but I don't, don't know any other word to use. If you think there's something that happens that probably deserved a response of like a level three and you responded with a level eight, that's you looking at that going, okay, in my opinion, in that situation, I had an overly strong emotional response. And that occurs when your HPA axis, your stress response system becomes dysregulated. People who've experienced trauma often become what they call glucocorticoid resistant. Not important. What is important is they often feel flat. They, they don't feel a lot of anything. They're just trying to get through the day. But when something does happen where most people who haven't been traumatized have a trickle of stress hormones to help them deal with it, the person who has had trauma goes from having not a lot to a tsunami of stress hormones. It's like, all right, we know what to do here. We are going to bolt into action. And that is often a learned response. Explosive anger is part of that exaggerated emotional response. People who have emotional disregulation, people who've experienced trauma often feel unsafe. One of our responses to feeling unsafe, one of our responses to threats is anger. We want to push it away, we want to get rid of it, we want to dominate it. So staying with that impulsivity, people who've experienced trauma may have more explosive anger and have more feel like they have more difficulty dealing with it because they're responding from that threat based place. Especially if the trauma took place in childhood. We learn a lot of coping mechanisms when we experience whatever trauma it is. And if the child, if it was a child that experienced the trauma, they may have been more concrete in their thinking. They may not have had the emotional coping skill repertoire that we hope adults have. So we may see that inner child come out when somebody feels threatened and that explosive anger comes out that that child used to protect themselves when they were in that chaotic situation. Interestingly, another study I found indicated that people with trauma have deficient appraisal, resolution and management of, of negative emotional states. So that's, you know, a lot of gobbledygook. Basically. If you've experienced trauma, it's not unlikely that you have difficulty identifying how you feel. You just act and react. You have difficulty labeling those emotions and appraising situations to determine what is actually a threat versus what's not. You just, you know, respond to everything like it's a threat. They have difficulty resolving that emotional response. And we know that people who emotionally dysregulate respond more strongly to stressors and take longer to get back to baseline to resolve that emotional response than people who are non traumatized. And they have difficulty with management of a negative emotional state. Once they get started, they have a hard time breaking that cycle. They've triggered that fight or flight response. And depending on when the trauma took place or the severity of the trauma, the person may not have developed adequate coping skills to help them resolve or manage that negative emotional state. They may not have a lot of response options available to them. So we want to look at that. Help us continue to make practical tools available to everybody by supporting the channel you can donate any amount@docsnipes.com donate or on cash app at Doc Snipes you can become a member of the YouTube channel and get perks@doc snipes.com purchase a super thanks on videos that are particularly helpful or if you're a clinician you can earn ceus@allce.com Another symptom of trauma is apathy or low motivation. Some people will feel bad about themselves because they don't have a lot of motivation, because they feel depressed, because they feel apathetic, they just don't care about much. Emotional numbing is a symptom of PTSD and sometimes it's referred to as blunted affect or again, apathy straight out of the the research and it can serve as a barrier to motivation. My hypotheses when people have experienced trauma, they may blunt that affect because it's too scary or painful to feel. They just don't want to feel anything because they're afraid if they start feeling, they won't be able to stop or that HPA axis may be dysregulated and they're just too exhausted to feel. They're too drained, they're too anything. It's just like I don't have it in me anymore. Depression Depression is different than apathy. Depression has a lot of symptoms associated with it, but depression itself, as we're talking about right here, is that feeling of being blue, of low mood. Chronic repeated exposure to stress impairs the responsivity of the HPA axis. We've already talked about that, and contributes to the development of major depressive disorder. We know that chronic stress can lead to the development of depressive symptoms and post traumatic stress disorder, as I mentioned, a lot of that is because of HPA axis dysregulation. This when a person is stressed for so long, when cortisol is constantly knocking at the door going, hey, we need to be awake. Eventually the door quits opening and the body says, you know what, I just, I can't answer the door right now. I just can't deal with that. And that's what we call glucocorticoid resistance. You know, very simply. But when that happens, it means the person is also going to have difficulty feeling any pleasurable emotions because pleasure and excitement are also part of that HPA axis. If the body cannot respond to excitatory neurochemicals, then not only is the person, you know not going to feel as much anger or anxiety, but they're not going to feel as much joy as Much exhilaration as or any as they could. I already mentioned anxiety. Depression and anxiety disorders are inherently associated with ptsd. When people have experienced trauma, especially if they develop ptsd, but even if they haven't, if they've got what we call sub dromal or not yet diagnosable ptsd, that doesn't mean it doesn't have an effect on per on the person. The person who's experienced trauma, who still feels unsafe and disempowered is going to be a lot more fearful. The person who is fearful, who doesn't feel safe, who feels disempowered, is going to have difficulty relaxing and sometimes difficulty being alone. Some people who've experienced trauma are desperate to have somebody else there to protect them. Others who've experienced trauma are on the other end. They have no use for other people because other people is what caused their trauma in the first place. So not everybody has that difficulty being alone. But with any of your behaviors or any of your symptoms, it's important to ask yourself, what function is this serving? When did it develop and in what way might it have developed in order to help me stay safe? Avoidance. People with PTSD may have avoidance symptoms that last for more than a month. However, we generally associate that avoidance with reminders of the trauma. Well, if you grew up with adverse childhood experiences, there's going to be a lot of reminders of the trauma. Avoidant or anxious attachment is not uncommon because if that trauma is attachment trauma, then attaching to any individual may trigger that stress response. As I mentioned, some people will have a lack of a use. For most people they just whatever, leave me alone. And that can be because people were the precipitators of that trauma. And the same thing for social withdrawal. Sometimes it can can be because people cause the trauma. Other times it can be that being in environments where there's a lot of activity is just too stressful. The person's hyper vigilance meter just kind of pegs out and they're just like overwhelmed. So there can be a lot of different manifestations of unsafeness. High interpersonal sensitivity is another one of those things that we don't talk a lot about. And it's not a traditional symptom of ptsd. But a lot of people who've experienced trauma, especially attachment trauma, tend to have high rejection sensitivity. They feel like they need to walk on eggshells all the time in order to avoid angering anyone, in order to avoid punishment from other people, rejection or abandonment. So their life is characterized by being hypervigilant. To every micro expression that people make by being hypervigilant to everybody around them. And. And part of this may also be in order to try to make sure, quote, unquote, that they've got people there to support them because they were abandoned when they were unable to take care of themselves. So the high interpersonal sensitivity is there as a protective measure. And then we have sensory hypersensitivity, people who are more alert to sights, smells, and sounds. Research has shown that people with PTSD may feel flooded by sensation and that people with PTSD and CPTSD also have what we call impaired sensory gating. And I think this is phenomenally interesting. This is something. Impaired sensory gating occurs in people with ADHD and people with schizophrenia, interestingly enough. But what it means is the brain has difficulty filtering out the important from the unimportant. And it just gets flooded with every sight, sound, smell in the environment. And it can make it difficulty to pay attention. But people can also who've experienced trauma may also be hypersensitive to particular reminders of the trauma. So people that look like the offender or smells that remind them of the trauma or sounds that remind them of the trauma. You know, if they were alerted, for example, to their house being on fire by the fire alarm, they may be hypersensitive to sounds from then on out. And every time there's a sound that's even remotely like a fire alarm, it triggers that stress response. Illnesses and autoimmune disorders are also directly correlated with trauma. Trauma dysregulates that HPA axis, that stress response system which inextricably impacts the immune system when it initially happens. In the acute aftermath of the trauma, the immune system is suppressed. Why is this? The immune system suppressed so the body can focus its energy on fight or flee. However, if the stress continues to go on, eventually the immune system says, hey, we need to send out our workers to repair anything that's breaking down. So the immune system becomes hyperactivated. We start to see systemic inflammation where the immune system sending out workers and trying to repair all this damage that was done while they were waiting for the trauma to pass that never stopped. We recognize that autoimmune issues, including diabetes, may be related to the experience of trauma, to the experience of chronic, unpredictable stress that dysregulated the HPA axis, which made regulating blood sugar a lot more difficult, which led to insulin resistance, which may lead to the development of diabetes. We also recognize that there are other forms of diabetes, especially type 1 diabetes, that are autoimmune. In nature, that may not have to do with trauma, but it's interesting to note that especially type 2 diabetes is strongly associated with trauma as well. Immune system dysfunction and traumatic stress reciprocally impact each other. When the immune system starts to becoming hyperactivated, there is increased inflammation throughout the body. That increased inflammation is associated with increasing anxiety, increasing depression, and that increased anxiety and depression triggers even more stress, which triggers even more that immune system and cardiovascular disease. Traumatic injury can lead to biological changes such as as increased HPA axis activity and autonomic nervous system reactivity, inflammation, oxidative stress, and endothelial dysfunction, which may contribute to the development of cardiovascular disorder events with and without chest pain. And I thought that was interesting as well. Not everybody who is having a cardiac event is going to have, you know, that excruciating chest pain. However, they found that there is, there are a lot of changes in the microvasculature of people who've experienced chronic ongoing stress and chronic trauma sleep problems. I've already alluded to these a little bit, but some people, this may be one of their only symptoms. But circadian misalignment is very common in PTSD and glucocorticoid resistance. That difficulty with the body responding to cortisol, the circadian rhythms work in part by starting with that awakening response. Cortisol's highest in the morning and then decreases throughout the day. Well, if your body's not responding to cortisol anymore, then that circadian rhythm gets out of whack, because then none of the rest of the systems. No, if you, if you think of your body as a factory, none of the rest of the departments know when they're supposed to come to work and when they're supposed to go home. So this is linked to neuroendocrine, immune, metabolic, autonomic dysregulation and sleep disruption. They found that people with PTSD have a much higher rate, independent of their physiological weight. They have a much higher rate of sleep apnea as well as insomnia. And that can mean difficulty falling asleep or difficulty staying asleep. Many people who've experienced trauma may not even realize it because it was those adverse childhood experiences. They grew up in a really crappy environment. And that isn't by our society, typically labeled as traumatic. It's awful, but it's not traumatic. And we need to start putting that label on it. Traumatic so people can understand the impact that it had physiologically on that child, on that person. Many symptoms can be traced back to either the development of behavior to survive or the result of physical changes due to HPA axis dysregulation. Remember I said that people start to emotionally dysregulate and may be more impulsive when that HPA axis has become dysregulated? Recognizing how a chaotic childhood, adverse childhood experiences, and or chronic stress can directly contribute to symptoms in the present day may help people plan a more effective recovery process.