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  • Sahar Abdulaziz, MS

The Masking of PSTD


The way a person appears to the outside world and the way they truly feel on the inside can be at opposite ends of the spectrum. Even if someone is suffering from post-traumatic stress disorder [PTSD], the outside world often draws conclusions based solely on the person’s appearance. The person may appear calm, content and even joyful. The underlying symptoms of PTSD do not readily present themselves in a person’s appearance, so these types of assumptions are often inaccurate. Those who live with PTSD often appear problem-free, carefree, and upbeat to family, neighbors, and co-workers, but on the inside, where no one can observe or see, lurks the true story; an amalgamation of debilitating symptoms that can cause psychological pain, fatigue, panic and profound loneliness. The struggle of those who live with easily concealed mood disorders often struggle to hide their painful symptoms, but this conflict has consequences. Hiding in this manner can alter the self-image or self-worth of the sufferer. It colors their perception of who they really are and how they see and experience the world around them. PTSD and the stress in hiding the symptoms can impact and interfere with every aspect of their life, including career and personal relationships. “My symptoms come and go,” says Rachel W. who lives with PTSD. “The toughest, most recent episode was when my child reached the age I was when I was molested. It triggered an extreme amount of anxiety, nightmares, and insomnia. [My family] act as if they need to deny me in order to not admit that all the secrecy and hiding was detrimental. I truly believe that although they acted according to their best ability and knowledge at the time, it was very likely the secrecy and hiding caused me more long-term damage than the actual molestation.” For those who must face the challenges that PTSD presents each day, can result in a “face-off” of the dichotomy between image and reality. Those who feel anxious, gloomy, or panicked often find ways to mask their symptoms, juggle their responsibilities, and present a vision of pleasantness so that they can appear ‘just fine’ to those around them. However, the discovery of how to utilize a new set of coping techniques can make daily struggles more manageable.

Dr. Cassandra Friedman, a psychotherapist with a thirty-year practice, understands and speaks about the tremendous impact depression and anxiety disorders such as PTSD have on family and relationships. “Any time one has a chronic issue, the condition becomes a family affair, bringing about anger and exhaustion.” Besides feeling fatigued, the concoction of extreme highs and lows experienced below the surface run contrary to how the person feels inside and feels the separateness they feel from those around them. It also feeds their shame and guilt about having a condition that they feel must be hidden from others. Managing their lives becomes overwhelming and what was easily managed before now appears impossible. Grappling with a new set of norms is not easy to accomplish, even when you are not suffering from a mood or anxiety disorder. Learning to accept the limitations of having a chronic mood or anxiety disorder, and embracing a new method of approaching daily decisions and actions is a challenge infused with change; change is not always easy to accept or handle. Exactly how an individual will respond to their ‘new norm’ cannot be predicted. Each individual will react differently just like each individual suffers differently. What is predictable however is that with help- is recovery. PART II Many people do not receive their diagnosis immediately, despite suffering from their PTSD for weeks, months or even years. Some feel a sense of relief when their condition finally has a name, as it offers them validation that a disorder is actually present. Others who hear their diagnosis for the first time become frightened and experience a personal crisis. They question whether or not the diagnosis is correct and what it will mean going forward. How will I cope? It is difficult to think and act proactively when it comes to self-care, yet people with depression and anxiety disorders are expected to navigate the medical system, possible remedies, insurance companies, as well as other mental health resources. Sifting through a plethora of treatments, speaking with a variety of healthcare providers, and jumping through medical claim forms, can leave a person feeling even more anxious and vulnerable. It can be a very scary time, laden with a multitude of changes and challenges. Another hoop to jump through is the “disclosure hoop” -- Should I or shouldn’t I tell others about my condition? What will they think of me? Will they believe me? The dilemma of disclosing is about having control or losing control. The stakes are high. With disclosure comes possible judgment, stigma, or perhaps rejection. If one is looking serene and trouble-free on the outside, who is going to believe this is a genuine mood disorder? On the other hand, disclosure can be an extremely positive step. Disclosure can help family members, coworkers and friends to understand or empathize with the disorder and existing needs. It can keep them from feeling helpless or useless when it comes to caring for you. Disclosure can also help family and friends better understand those difficult times when a depressed individual turns inward, preoccupied and distant. For many, the stigma of having PTSD is not acceptable. Those individuals dread the idea of being “found out” or being labeled with a mood or anxiety disorder. Because of the long list of myths and misunderstandings that surround these disorders, society still views them as something that can be willed away or ignored and pushed through. Nothing could be further from the truth. Psychological pain can be described as one of the most intense and significant types of pain any human being can possibly endure. PTSD can literally strike out and attack the strongest of the strong and trauma can be experienced by anyone, young or old, weak or strong. There is nothing that can fully and completely prepare any individual from the shock and remnants of certain traumatic experiences. PTSD cannot be simply willed away, wished away, nor ignored into submission. The good news is that times are changing and there are many reasons to feel hopeful. PTSD is very treatable and recovery is possible! Awareness is growing and so are the number of resources and the amount of help available. There are support groups for specific mood and anxiety disorders like PTSD, which meet regularly, both in person and online. Information and education is readily accessible, and is often a phone call or click of the computer away. Research is underway to help find treatments that can better control the severity of the episodes and the symptoms, while healthcare providers are becoming more astute at recognizing what is hidden behind the well-worn masks of their patients. Below are a few coping tools: * Learn as much as possible about your disorder. * Locate a considerate and knowledgeable mental health-care team. * Find a trusted doctor or counselor that you feel comfortable communicating with. Feeling comfortable communicating with your chosen practitioner is absolutely critical for the treatments to work effectively. * Realize that you are more than your PTSD symptoms. * Use what you have learned about your disorder to assist others if you are able. * Pay attention to your limitations and honor them. What can families of trauma survivors with PTSD do to help care for themselves and their loved ones? · Learn as much accurate information as you can about PTSD, either by attending classes, reading books, or viewing films. · Be encouraging but do not pressure the survivor to seek out counseling from a PTSD specialist. · Be open to taking classes on stress and anger management, couples communication, parenting. · Seek personal, child, couples, or family counseling if troubled by “secondary” trauma reactions such as anxiety, fear, anger, addiction, or problems with school, work, or intimacy. · Stay involved in positive relationships, in productive work and education, and with enjoyable pastimes. *Note: If physical, verbal, or sexual violence is occurring, family members such as spouses, children, or elders must be protected from harm. Behind every face is a story, and behind every story is a person with a lifetime of experience and a tale to tell. And while looks can be deceiving, we must never think that a smile or a calm exterior means that everything is ‘Just Fine’. Certainly not when it comes to PTSD.

Helpful Links:

  • NIMH: National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml <http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

  • 1-800-273-TALK (1-800-273-8255) - National Suicide Prevention Lifeline

  • Department of Veteran's Affairs/National Center for PTSD: http://www.ptsd.va.gov/index.asp <http://www.ptsd.va.gov/index.asp


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