October 2013 – Coming Back Home

PTSD Triggers: Crowds

Published on October 29, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych3 Comments

So – while we’re on the topic of triggers, let’s talk about crowds. From what I gather, most of you are not big fans of crowds.

Like I keep saying, PTSD is basically your brain’s threat-alert system, kicked into high gear without an “off” button. So – you’re constantly trying to size up all possible threats.

Say you’re in a room with one door, one window, and one other person. That’s not bad; you can scan window-door-person, to look for possible threats.

Now say you’re in a bigger room, with ten people. Keeping track is much harder, and it’s easier to get overwhelmed.

It goes up to a whole new level if you’re in a grocery store, a mall, or a football stadium. Now, there’s just no way to keep track of it all. Just thinking about it, you might start to feel your heart rate speeding up a bit – that’s your reflex, getting ready to fight or flee.

Take a moment. Breathe. You’re not there right now.

See what just happened there? That feeling started, even though you were just thinking. Thinking is not dangerous – but your survival reflex is so strong, that just thinking about it makes the danger feel SO real.

When we start to feel like that, we interpret that feeling itself as a sign that there’s danger. If we can’t quickly scan our entire environment, we start thinking the danger must be real, only we can’t see it.

Feeling tense/nervous/uneasy does NOT mean that you’re in danger – it just means that your threat-detection system is reminded of danger.

…That little fact right there folks – that is the key to the universe.

When you’re dealing with PTSD, having that feeling that tells you, “Oh no, major danger is coming” does NOT actually mean that anything is coming.

It just means that your threat-response system was reminded of danger.

Remember Dave the Zebra, and his red flowers? Well – crowds are sort of like your red flowers.

So – how do you cope?

Remind yourself that, as soon as you start to think about crowds, your PTSD will start to act up. This is not because thinking is dangerous, or because crowds are dangerous; it’s because PTSD reacts to reminders of danger.

Heading into a crowd, you’re going to feel anxious/tense/wound up. You may even start imagining all kinds of horrible things that could go wrong, and all those things might feel very, very real. Feeling and thinking this way does not mean that you’re in danger, or that awful things will happen. This is a normal part of PTSD; it is to be expected. This is unpleasant, but not dangerous.

Repeat this information to yourself frequently; with consistent practice, it will get easier. (You’ll probably still not like being in crowds, but it will get easier to cope with it.)

I’d love to have you share your thoughts, comments, and questions. If you do post a comment, please don’t give specific details of your trauma – these may be triggering to another reader. If you’d like to offer criticism, I’ll take it – I know I’m not perfect, and I’m always willing to learn. If you do offer criticism though, I’d really appreciate it if you could do so constructively (ie., no name-calling, please). Thanks…

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

*Fine print: Please feel free to share the link to this blog wherever you think it might be helpful! Reading this blog is a good start, but it’s no substitute for professional help. It takes a different kind of courage to admit to yourself that you’re struggling. PTSD is not a sign of failure – it’s a sign that you’ve been through a lot, and have tried to stay strong for too long. If you need help – you’re in some pretty great company. Reach out, and give yourself a chance to feel better.

PTSD Triggers: Trauma Anniversaries

Published on October 29, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych1 Comment

As far as triggers go, few are as powerful as the anniversary of your trauma.

You probably start to tense up a bit just thinking about it. As the date gets closer, you might get this sinking feeling, like you’re a sitting duck and there’s no escape.

To cope with that feeling, you have to realize that even though you can’t stop the calendar, there are things you can do to cope.

Whether you feel uneasy, tense, nervous, anxious… You’re feeling that way because an anniversary is a reminder. Realize that your feelings are unpleasant but not dangerous.

Use your grounding skills to ground yourself in the here-and-now:

– What year did that stuff happen? What year is it now? How long has it been since this happened? Asking these three questions is an important part of reminding yourself that the memory is “back then”, and you are in the “right now”, and there is lots of time separating you from that memory. The memory is a painful one, but it can’t hurt you. Your memory is back then. You are here now. It’s over, and you are no longer in danger.

– Where are you now, as compared to where you were back then? What’s different in your life now, as compared to back then? These are different ways of making the point in your head: That was back then. I am here now; now is different from then; and I am no longer in danger.

It helps to do things to keep busy, especially things that are different from what you were doing on the day when it happened. When the memory starts to creep up, remind yourself: “Right now, I’m home, the year is [now], and I am [doing whatever you’re doing right now]. That happened back in [whatever year], and I was [wherever], and I was [doing whatever]. Right now is different from back then. That’s a memory. I dislike remembering it, but it can’t hurt me anymore. It’s in the past. It’s over.”

Sometimes, your trauma anniversary is not just about something awful that happened to you – it may also involve the loss of someone you care about. If that’s the case, then you may also be overwhelmed with feelings of loss and grief for the person or people you lost on that day. You may think about all the good things that have happened since that they missed out on.

It’s healthy and natural to have feelings of grief. Too often, we think that acknowledging a loss is the same as depression, so we try to avoid healthy, appropriate grief.

So give yourself permission to grieve. Realize that the day will be hard on you; take it easy on yourself. Plan ahead of time to do things that ground you and give you comfort.

When it’s over, take an inventory: what did you do that helped, and what will you do differently next year? That way, hopefully coping might get a little easier from one year to the next.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

This post is shared to mark my own trauma anniversary, and dedicated to the memory of my cousin Pete. We miss you buddy.

PTSD: Dissociative Symptoms

Published on October 19, 2013July 19, 2022 by Dr. Dee Rajska, C. Psych7 Comments

Holy feedback!

As soon as I put up the last blog post, there was a stampede of comments and emails saying, “Yes! Talk about this more!!!”

Okay.

So we left off talking about how the “freeze” response is part of the fight/flight/freeze reflex. It’s how we defend ourselves when we can’t fight or run away; it dulls the pain of whatever is happening.

Let’s put this together with some information we have from before, about how reflex learns: it learns that any reminder of the trauma is a sign of danger.

So – a reminder of your trauma might set off a “freeze” reaction.

Here’s what it feels like: you might feel like you’re not really in your body so it’s not really happening to you (this is called depersonalization); or you might feel like the whole thing is a dream, a movie, or happening in slow motion like it’s not real (this is called derealization). You might feel like you’re just losing chunks of time – ‘waking up’ and not knowing how you got to be wherever you are.

Here’s what it feels like to have PTSD do this to your life: it’s terrifying. You feel like you have no control over your mind or body. You want to do everything you can to grip onto reality, but you get sucked into this rabbit hole. You might feel angry at your mind for betraying you this way. You might feel guilty, weak, and ashamed for not being “strong enough” to somehow hang on tighter and not let this happen to you. It can leave you feeling traumatized again and again, every time it happens, because being helpless to stop yourself from dissociating can remind you of being helpless to stop your trauma when it happened. You might feel depressed, useless, worthless.

…Boy, sounds like fun, doesn’t it?

Look – I won’t try and tell you that getting out of this is going to be quick or easy. If your PTSD includes dissociation, research suggests that, as far as PTSD goes, yours is bigger and harder to heal.

What makes it worse is, every time it happens, you might feel disappointed in yourself, like you should be stronger. This just erodes whatever self-respect you have left. You’d never say stuff like that to a buddy to encourage them when they’re struggling…

You need to start by realizing that this happens to you because you don’t feel safe; so, how you start to fix it, is to work on increasing your sense of safety.

The ability to feel safe is like a muscle – and yours is, well… It’s not so strong. You strengthen it with exercises – stuff like relaxation. Grounding skills. These are your drills: practice this stuff. Be patient with yourself: this might mean that, for now, don’t purposely put yourself in circumstances that you know will be overwhelming for you. What you’re trying to accomplish here is very hard work, so give it time.

Finally – you know that fine print I put at the end of every post? You know, the stuff that you never read, because you don’t think there’s anything important under the pretty picture?

Yeah; it says that this blog is not a substitute for therapy. If you’re dealing with PTSD with dissociative symptoms, it’s extremely difficult to try and heal that on your own. Please consider getting help to give yourself the best chance of recovery.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

PTSD: Reflex and The “Freeze” Response

Published on October 17, 2013July 12, 2022 by Dr. Dee Rajska, C. Psych11 Comments

…You know I’m all about feedback, right? You know this is YOUR blog, and I’ll write about whatever you need?

Well – my stats tracker thingy tells me somebody ended up on Coming Back Home by Googling “PTSD + Freeze response”.

And I thought, Huh – I don’t really have a good article on that. I mean, if I was Random Google Person, I’d be a little disappointed.

So – good suggestion, Random Google Person! This post is for you!

If you recall from previous discussions, PTSD is basically a survival reflex stuck in a loop with no off switch. This reflex has three parts, depending on what kind of threat you’re up against:

– fight is where you respond to a threat by beating up on it. Military training works to strengthen this part of your survival reflex.

– flight is where you run for the hills to get away from the threat.

– freeze is what you do when neither of the above is an option.

In this post, we’re going to discuss the freeze response, the way it happens in the face of an actual threat. Next post, we’ll talk about dissociation, which is what happens when the “freeze” reaction gets stuck, like in PTSD or dissociative disorder.

It’s like this: imagine a goldfish.

It’s in a fishbowl. The cat just jumped on the table and stuck his paw into the bowl. What’s the fishy gonna do?

He’s can’t fight off the cat, and he can’t run away, because he’s in a fishbowl. Poor little fishy. The cat is about to enjoy some fresh sushi.

So – what does the fish do? He freezes; freezing helps him feel less pain, both physically and emotionally.

Freezing might feel like time has slowed down; like what’s happening isn’t real; or like he isn’t really there. The goldfish might feel like he’s floating above his body, watching the cat enjoy his sushi.

Feeling this way is a normal reaction to a situation of extreme, life-threatening danger, where you can’t fight and can’t get away.

If you’re a goldfish who’s about to get eaten by a cat, feeling like you’re floating above your body and the whole thing is not really happening is less terrifying, which is why our reflex is built this way.

But – suppose just as the cat is scooping up the goldfish, someone comes along and screams, startling the cat. Poor little fishy lives, but is scarred by this near-death experience: he might get stuck in this “freeze” reaction. He might end up with severe PTSD, and symptoms that we call dissociation. We’ll talk a bit more about that in the next post.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Your Deployment, Your Family, and… THEIR Trauma

Published on October 15, 2013August 2, 2022 by Dr. Dee Rajska, C. PsychLeave a comment

Since we’re already on the topic of all the different kinds of trauma that can result in PTSD, I was thinking… let’s talk about families.

As we were discussing in the last post – a “traumatic event” is any situation where you’re exposed to actual or threatened harm.

As we discussed, “actual or threatened” means that even if it doesn’t end up happening, being genuinely scared that it would happen can still impact you.

It doesn’t have to happen to you; it can be something that happens to someone else, while you’re helpless to stop it.

Even if you aren’t there when it happened, learning the gory details of what happened to someone else can mess with you.

So – let’s take a minute to put this together:

Say you’re deployed. Your family stays behind. They spend months on end being bombarded with media reports about the horrible events happening in the place where you went.

You face dangers every day; they’re too far away to be able to do anything other than feel helpless and hope that you come home in one piece.

…what’s happening to your family here – that’s trauma. It’s not the sexy kind of trauma that makes for a great story, but it’s still trauma.

Now, that does NOT mean that your family will automatically get PTSD just because you were deployed – but, it’s trauma, so it certainly might impact them.

Your family might feel pressured to outwardly say nothing other than how proud they are of your service. They might face a barrage of well-meaning friends and strangers offering all sorts of comments – everything from, “You must be so proud!”, to, “That’s crazy! Don’t you watch the news? They get blown up all the time over there!” (This was actually said to the spouse of someone I know…)

To you, deployment is part of your job; to them, it’s hard not to take personally. Privately, your loved ones might feel rejected and abandoned. They might feel angry and resentful that you would leave them behind, to go to some far-away place and risk getting hurt or killed, and leave them worried about your safety for months on end. They might also feel guilt if you made it home safe and other families weren’t so lucky.

So – on top of the emotions that you might bring home – your family members may have some concerns of their own to throw into the mix.

All that can make for a challenging adjustment to family life.

So – how do you get through it?

You try to be understanding of each other. You went through a lot; so did they. It’s not a competition. You’re a team; adjusting to life after deployment is teamwork. Communication is important; try to talk about your feelings. Try to listen to family members talking about their feelings, without getting angry or defensive.

Most importantly, recognize when you need help adjusting, and reach out for it – whether you need individual therapy, family or couples therapy, or a bit of each.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by Wojtek Rajski, and I’d like to thank him for generously allowing me to use his work. Please do not copy photographs from Coming Back Home without permission.

The many flavours of PTSD: It’s not a competition!

Published on October 11, 2013July 29, 2022 by Dr. Dee Rajska, C. Psych14 Comments

Today – by request – we’re going to talk a bit about what trauma actually is.

It turns out, different people have different ideas about what’s awful enough to be “real trauma”.

You might have a buddy who went through some really messed up stuff. You might think, he or she “earned” their right to have PTSD because of what they went through.

In comparison, what you went through might not seem as bad. Maybe you have nightmares, and you avoid things that remind you of what happened. And you get angry at yourself. You start telling yourself that if you should be able to handle it, and what’s wrong with you that you can’t.

Worse still – it might be other people telling you this stuff. They might they have a different flavour of PTSD than yours, because they went through different stuff. Somehow they might think that their trauma is bigger and better than yours, and yours isn’t “real” enough.

… It’s not a competition.

To put it in perspective, imagine it was a broken leg. You could break your leg getting hit by a stampeding hippopotamus. (Hey, you never know). Or, you could trip over your kid’s toy and fall down the stairs. The difference is, with scenario #1 you get an awesome story… story #2 doesn’t sound as cool. Leg’s still messed up though.

Trauma that causes PTSD is sort of like that too – sometimes, it’s a hippopotamus – it comes with the type of “Rambo” story that movies are made of. Other times, it doesn’t make for a great story.

(HEADS UP: I’m going to describe the kinds of stuff that might cause PTSD. I’m NOT going to use examples, but it still might be tough to read. If you get unsettled, remind yourself that what happened is over. If you need more help coping, try these. )

A “traumatic event” is any situation where you’re exposed to actual or threatened death, serious injury, or sexual violence.

Actual or threatened means that even if it doesn’t end up happening, if you were scared because there was a real risk that it was going to happen, that can still mess you up.

It doesn’t have to happen to you; you can witness it happening to someone else, and be helpless to stop it.

Even if you aren’t there when it happened, learning the gory details of what happened to someone else can mess with you.

This is the way your brain works; trauma comes in many different flavours.

Maybe you didn’t get your PTSD from combat. Maybe you weren’t even deployed. So, it might seem that your trauma isn’t quite as “sexy” as someone else’s.

Really, people: It’s trauma. It ain’t lingerie. It don’t need to be sexy.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

**Really fine print: The content of Coming Back Home is copyrighted; please feel free to share the link, but do not copy and paste content. Unless otherwise noted, all original photography on Coming Back Home is copyrighted. The photo gracing today’s post was taken by M&C Charbonneau, and I’d like to thank them for generously allowing me to use their work. Please do not copy photographs from Coming Back Home without permission.

Sexual Dysfunction and Relationships, Part II

Published on October 2, 2013August 2, 2022 by Dr. Dee Rajska, C. Psych3 Comments

*Disclaimer: This is a really broad topic, and I’m not a sex therapy expert, so I won’t be able to cover everything that’s relevant. Most of my patients are male and heterosexual, so I’m addressing the topic from that perspective. I don’t mean to leave anyone else out, I just try to stick to writing about what I know.

Last post, we discussed how sexual dysfunction can impact how you feel about yourself, and how it might impact your thoughts about getting into a new relationship if you’re single.

If you’re already in a relationship, then that’s a whole different kind of situation: for one thing, you and your significant other probably have some sense of what you can expect of your sex life: how often, where, for how long, and so on.

When your body suddenly decides it’s not going to go along with your established norm, it can be frustrating and confusing to both of you. It’s easy to get sucked into feelings of guilt, shame, embarrassment… And those feelings just make it more likely that you pull away from your partner even more. The more you pull away, the more disconnected from each other you feel, and the more difficult it can be to work on this.

So – it’s important for both of you to realize that it’s not your fault, or your partner’s fault either. It’s just another part of PTSD. You’re a team. You will deal with this as a team.

Don’t allow this issue to stop you from showing affection to each other. Take time to hold hands, look each other in the eye, and smile at each other; cuddle, or drive out to a nice peaceful spot and have a lovely, romantic picnic. These are all examples of ways to feel more connected with each other, and that’s likely to help.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Sexual Dysfunction and Relationships, Part I

Published on October 2, 2013August 2, 2022 by Dr. Dee Rajska, C. Psych3 Comments

*Disclaimer: This is a really broad topic, and I’m not a sex therapy expert, so unfortunately, I won’t be able to cover everything that’s relevant. Most of my patients are male and heterosexual, so I’m addressing the topic from that perspective. I don’t mean to leave anyone else out, I just try to stick to writing about what I know.

So… Judging by the number of pageviews on the last post, it looks like some of you find it less awkward to discuss sexual dysfunction on the blog than in person.

Good – you need to have access to this information, even if you feel too embarrassed to ask about it face-to-face.

You know, I briefly considered writing the last post about Dave the Zebra. I thought, maybe that would be less awkward for people?

However – Dave the Zebra is actually named after Dave the Dude. I value my friendship with Dave the Dude. Somehow, he didn’t like the idea of putting his name in the same sentence as sexual dysfunction, in a blog read by thousands of people. Go figure, eh?

Well – let’s talk about it. (Dave the Dude, you can relax. I’m keeping you totally out of this…)

In the last post, we talked about how and why PTSD can mess up your sex life.

Today, we’re going to discuss how the mess in your sex life can have a ripple effect on the rest of your life.

Sexual dysfunction messes up your relationships, starting with the relationship that you have with yourself.

(Hey – can we try to focus please? I’m talking about the emotional relationship with yourself – not the five-knuckle-shuffle relationship with yourself! …Not that there’s anything wrong with that…)

Look – who you are in bed is part of your identity. You don’t need to go through life being Mr. Don Juan – even if you’re a relatively vanilla kind of dude, you have a sense of how your plumbing works and what you enjoy doing with it.

When that changes, it can have a big impact on how you feel about yourself. We live in a culture where, as a guy, you’re supposed to be obsessed with sex, or so the media would have you believe. So a lot of guys end up feeling like they’re somehow less of a man when stuff like this happens. You might feel angry and ashamed, and try not to think about it.

If you’re a single dude, this might really have an impact on your confidence about getting into a new relationship. You might question whether a woman would want to be with you, if things don’t quite work the way they used to.

(Answer: yes, the right woman would still want to be with you. The right woman would love you for your sense of humour, your smile, and whatever else it is that makes you awesome in her eyes. And you can sweep her off her feet with flowers and chocolates and kisses and dancing and backrubs and… Well, when it actually comes to sex, most women like all that stuff that most guys rush through to get to the main course. So, serve up a really good appetizer, and she won’t really miss the main course, you catch my drift?)

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.

Spouses want to know: PTSD and Sexual Dysfunction

Published on October 1, 2013August 2, 2022 by Dr. Dee Rajska, C. Psych4 Comments

So – guess what we’re talking about today? (Go ahead, check the title again). That’s right.

*Disclaimer: This is a really broad topic, so I won’t be able to cover everything that’s relevant. The question was originally asked by a female spouse of a male veteran. Most of my patients are male and heterosexual, so I’m addressing the topic from that perspective. I don’t mean to leave anyone else out, I just try to stick to writing about what I know.

In person, some of the patients that I work with find this really awkward to discuss.

Well – look on the bright side: this is a blog! You don’t have to ask this stuff in person! All the answers, none of the awkwardness!

The research is pretty clear that there’s a link between PTSD and sexual dysfunction. Most studies show that in veterans with PTSD, about 8 to 9 out of every 10 have some sort of sexual dysfunction. That’s much higher than combat veterans without PTSD, and higher than veterans with other mental health diagnoses. “Sexual dysfunction” can be a whole list of different problems – including having less sexual desire; erectile dysfunction; premature ejaculation, or inability to reach orgasm.

8 to 9 out of every ten. That means that, if you have PTSD and you don’t have some sort of sexual dysfunction – you’re the exception.

If you didn’t know that before, then it’s important that you know this about your body, and what PTSD can do to it. It’s not you, it’s not your fault, it’s not because you’re doing something wrong. It’s not your partner’s fault either. Add it to the long list of things you dislike about PTSD.

But – let’s talk about how and why this happens, and then, most importantly, let’s talk about what to do about it.

First, the “why”: remember that PTSD is survival reflex on overdrive; remember how we talked about reflex making all your big muscle groups tense up? Yeah – apparently, your survival reflex doesn’t consider that part of your body as a big muscle… Go figure.

Basically, reflex thinks that anything that doesn’t help you fight or flee is a waste of energy.

PTSD also makes you feel anxious and hyper-alert pretty much all the time, and that makes it hard to get in the mood and stay in the mood for long enough. Many people who have PTSD also feel disconnected and detached from loved ones, and that can make it hard for both partners to get in the right headspace. Increased anger and irritability can also put a damper on your relationship, and that can make the physical part of your relationship suffer too.

…Sounds pretty bad, huh?

Yeah… I know…

It can get better. Not magically, overnight better, but slowly and with some work – it can get better.

(Yes, pills can help. Talk to your doctor about getting some. But don’t expect pills to be a quick, easy, magic cure-all.)

First – go to therapy, and work on learning to manage your PTSD. When you learn more about how to manage your symptoms, this will make a difference.

Next – consider couples therapy. Especially if you’ve been struggling with this stuff for a long time, chances are there’s a lot of misunderstandings and hurt feelings from both of you that are driving a wedge between you. Couples therapy may help you to reconnect and feel closer, and that might help.

Third – don’t give up. Don’t lose hope. As long as you’re willing to try, things can get better.

You can find me on Twitter and on Facebook.

~ Dr. Dee Rajska, C. Psych.