Post Traumatic Stress Disorder (PTSD)

Increasingly, we hear more and more about PTSD as our veterans return from overseas.   However, PTSD as a psychological diagnosis is not unique to combat veterans.  Anyone who has suffered a severe personal trauma may develop PTSD.   I have represented soldiers, marines, first responders, and victims rape, child abuse, spousal abuse, long-term incarceration, physical assault, accident survivors and other individuals who have developed PTSD after having been exposed to life altering traumatic events.

What people with PTSD and the people in their lives often fail to understand is that an individual with PTSD has had their brain chemistry permanently altered as a consequence of the traumatic event(s).  “Brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Traumatic stress can be associated with lasting changes in these brain areas. Traumatic stress is associated with increased cortisol and norepinephrine responses to subsequent stressors. ” [1]   Essentially, the brain gets flooded with chemicals while an individual is experiencing trauma and the person is confronted with “fight or flight” options in dealing with the stressor.  Once the chemicals are released, the person’s brain chemistry often becomes permanently altered and the same chemicals are triggered and released when dealing with future stressful situations.

Obviously, seeking the help and input of a mental health professional such as a psychiatrist or psychologist is essential to properly diagnosing the condition.  In 2013, the American Psychiatric Association revised the PTSD diagnostic criteria in the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (1).

Diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition.

Criterion A: stressor The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, as follows: (1 required) 1. Direct exposure. 2. Witnessing, in person.  Indirectly, by learning that a close relative or close friend was exposed to trauma.  If the event involved actual or threatened death, it must have been violent or accidental. 3. Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (e.g., first responders, collecting body parts; professionals repeatedly exposed to details of child abuse). 4. Criterion B: intrusion symptoms The traumatic event is persistently re-experienced in the following way(s): (1 required) Recurrent, involuntary, and intrusive memories. Note: Children older than 6 may express this symptom in repetitive play. 1. Traumatic nightmares. Note: Children may have frightening dreams without content related to the trauma(s). 2. Dissociative reactions (e.g., flashbacks) which may occur on a continuum from brief episodes to complete loss of consciousness. Note: Children may reenact the event in play. 3. 4. Intense or prolonged distress after exposure to traumatic reminders. 5. Marked physiologic reactivity after exposure to trauma-related stimuli. Criterion C: avoidance Persistent effortful avoidance of distressing trauma-related stimuli after the event: (1 required) 1. Trauma-related thoughts or feelings. Trauma-related external reminders (e.g., people, places, conversations, activities, objects, or situations). 2. Criterion D: negative alterations in cognitions and mood Negative alterations in cognitions and mood that began or worsened after the traumatic event: (2 required) Inability to recall key features of the traumatic event (usually dissociative amnesia; not due to head injury, alcohol or drugs). 1. Persistent (and often distorted) negative beliefs and expectations about oneself or the world (e.g., “I am bad,” “The world is completely dangerous.”). 2. Persistent distorted blame of self or others for causing the traumatic event or for resulting consequences. 3. 4. Persistent negative trauma-related emotions (e.g., fear, horror, anger, guilt or shame). 5. Markedly diminished interest in (pre-traumatic) significant activities. 6. Feeling alienated from others (e.g., detachment or estrangement). 7. Constricted affect: persistent inability to experience positive emotions. Criterion E: alterations in arousal and reactivity Trauma-related alterations in arousal and reactivity that began or worsened after the traumatic event: (2 required) 1. Irritable or aggressive behavior. 2. Self-destructive or reckless behavior. 3. Hypervigilance. 4. Exaggerated startle response. 5. Problems in concentration. 6. Sleep disturbance. Criterion F: duration Persistence of symptoms (in Criteria B, C, D and E) for more than one month. Criterion G: functional significance Significant symptom-related distress or functional impairment (e.g., social, occupational). Criterion H: exclusion Disturbance is not due to medication, substance use, or other illness. [2]

In order to meet the new Social Security Listing for PTSD a claimant’s condition  must meet the following definition:

12.15 Trauma- and stressor-related disorders (see 12.00B11), satisfied by A and B, or A and C:

1. Medical documentation of allof the following:
   1. Exposure to actual or threatened death, serious injury, or violence;
   2. Subsequent involuntary re-experiencing of the traumatic event (for example, intrusive memories, dreams, or flashbacks);
   3. Avoidance of external reminders of the event;
   4. Disturbance in mood and behavior; and
   5. Increases in arousal and reactivity (for example, exaggerated startle response, sleep disturbance).

AND

12. Extreme limitation of one, or marked limitation of two, of the following areas of mental functioning (see 12.00F):
    1. Understand, remember, or apply information (see 12.00E1).
    2. Interact with others (see 12.00E2).
    3. Concentrate, persist, or maintain pace (see 12.00E3).
    4. Adapt or manage oneself (see 12.00E4).

OR

1. Your mental disorder in this listing category is “serious and persistent;” that is, you have a medically documented history of the existence of the disorder over a period of at least 2 years, and there is evidence of both:
   1. Medical treatment, mental health therapy, psychosocial support(s), or a highly structured setting(s) that is ongoing and that diminishes the symptoms and signs of your mental disorder (see 12.00G2b); and
   2. Marginal adjustment, that is, you have minimal capacity to adapt to changes in your environment or to demands that are not already part of your daily life (see 12.00G2c).[3]

If you have been diagnosed with PTSD and can no longer cope with the mental demands of the workplace, you may be eligible for Social Security disability insurance (SSDI) of Supplemental Security Income (SSI) benefits.  The law office of Byron Broun PA possesses the knowledge and experience necessary to help you with your claim.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181836/

[2] https://www.ptsd.va.gov/professional/pages/dsm5_criteria_ptsd.asp

[3] https://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm