I Have PTSD And I Feel Nothing

I’ll start with a technical note just to get it out of the way. These days, everyone has heard of Post Traumatic Stress Disorder (PTSD), but not so many have heard of PTSD’s sibling, Acute Stress Disorder or ASD. These two disorders are roughly identical in terms of how they are caused and how they manifest, but there is one important difference: time. Technically, if less than six months have elapsed between the time of diagnosis and the time of the trauma, a person’s condition should be diagnosed as Acute Stress Disorder, and if six months or more have elapsed since the trauma, the proper diagnosis is PTSD. It’s a small difference, but one that is there to separate out those trauma reactions which are intense but short acting from those which truly become chronic. Any case of Acute Stress Disorder which passes the six month mark automatically converts to a PTSD diagnosis if the symptoms are still present at that point in time.

People throw around the term “trauma” fairly loosely these days. It seems whenever we’re exposed to anything shocking we talk about being “traumatized for life”, but the way mental health professionals use the term, it has a much more specific meaning. To be traumatized, as in Post Traumatic Stress Disorder traumatized, means to be exposed to an event that involves death or the very real possibility of death (either your own, or someone else’s), when this sort of exposure is out of the realm of your experience. For you, seeing your boyfriend post-suicide qualified as a trauma and has traumatized you. For the police who were almost certainly called to the scene and the coroner who signed the death certificate, the event was probably not traumatic, but only because they have seen this sort of thing many times before, and because for them the death was not personal.

PTSD and ASD are anxiety disorders, and exposure to trauma qualifies as an event that people need to grieve. In fact, the process of PTSD is very much a grief process that has been interrupted and caused to grind to a halt because the material being processed is too intense and too vivid (too “hot”) to work on. In normal grief, a pattern of alternation between engagement and disengagement is normal. People experience bouts of intense sadness interspersed with bouts of normal feeling or numb feeling (that they may feel guilty about). Neither the sadness or the numb feeling is so overwhelming though that people have to run from it on a permanent basis. Not so PTSD. In PTSD, the wound stays very fresh and very vivid, and the emotions do not lose the power to move you. The images, the memory is so very intense that what people try to do is to escape from it rather than risk experiencing it, and that causes a whole host of problems. The pattern of PTSD is characterized by avoidance of trauma memories, exaggerated reactions to events and objects that trigger trauma memories, and intrusive trauma memories that come unbidden and unwanted despite your best attempts at avoidance.

It seems weird to me that you’d be diagnosed with both generalized anxiety disorder and major depression if you were also diagnosed with PTSD in the wake of a clear trauma and significant interpersonal loss. PTSD alone, and the interrupted grief that it contains, are enough to account for the symptoms you have reported. It’s not terrible that you have these additional diagnosis, but they may be unnecessary, just the same.

On to your actual question. You’re feeling numb and you’re acting impulsively which is out of character and you’re scared that you’ll stay this way. It’s been about six months since the trauma happened (being now the verge of May, 2008). You want to know if you’ll stay this way or if you’ll return to the old you.

The answer is complex and I cannot give you a really good answer. I can speak in generalities, though. If you’ve crossed the six month barrier from ASD into PTSD, and your symptoms are as fresh and strong as ever, the chances are reasonable that they will persist and that you will not return to your old way of being in the world. If you seek treatment for your PTSD, you greatly improve the chances that you will get more back to normal. You probably won’t ever get to be the person you were before the trauma occurred, but a good deal of the fear and avoidance and intensity can be “removed” from the trauma, freeing you to become a more relaxed person again.

Medication therapy is an adjunct therapy in cases of PTSD. Medication helps with sleep and provides mood support. However, it cannot “cure” by itself. It cannot remove the memory, and more importantly, it cannot help to remove the intensity from the memory. Only psychotherapy can do that, and when I say “cure” I do not mean a perfect cure – only a significant symptom reduction. The memory will remain, but some of the intensity can be worked out of the memory. Contact a psychotherapist near you who specializes in working with traumatized patients if you can, as this will be the fastest path towards normalcy. Specifically, look for EMDR therapy as it may prove helpful for your needs.

The numbness is consistent with PTSD and can be thought of as a sort of cognitive insulation, a little dissociation that has occurred to shield you from the rawness of the highly emotional event you’ve experienced. Dissociation isn’t generally a good thing, but it isn’t the end of the world either. Your capacity for feelings is still there, it is just suppressed for a while until you find a way to come to grips with the trauma memories. That is what therapy is for – finding a way to get you in touch with the trauma memories without freaking out so that you can learn to tolerate them better. Once you can learn to do that, feelings will start re-entering your life.

The promiscuity you report is also consistent with PTSD, and it is harder to say how to interpret it. Some people say that it is a way to create an intense but superficial experience you can inhabit for a while which distracts you from the stuff you’re avoiding. Some others say that people do this sort of thing to punish themselves and create a sense of self-shame, because they feel responsible for causing the stuff they are avoiding. Some others say that risk taking occurs because of the numbness. We all of us have random sexual urges, but most of the time we suppress acting on them. However, traumatized people may find that that part of themselves that would normally show restraint has been temporarily compromised and they act on their urges almost like a patient with frontal brain damage might. All of these explanations can be true at the same time, by the way.

So – hopefully I’ve answered your questions. The important thing for you to do is to get yourself into psychotherapy for your traumatic experience, and hopefully, that will include a course of EMDR, as EMDR is supposed to be very good at knocking the intensity out of trauma memories (I’m not a trained EMDR therapist so I can’t say that I’ve seen this happen, but that isn’t a reason not to try it out).