My latest book, The General’s Princess, is a suspense-filled ride in which the main character, Cara Florés Hart, accepts a job in Saudi Arabia as the personal trainer to a Princess at the palace in Riyadh. She soon finds herself in the cross-hairs of a human trafficking ring, necessitating the US government and military to intercede and rescue not one, but two, American women on palace grounds.
As a psychotherapist with over thirty years experience, I developed complex characters, rich in human emotion, and further scrutinized for authenticity by my consultant, Brigadier General Ed Dyer, (ret.) Every character was crafted utilizing psychological training and knowledge, and they each suffered varying forms of PTSD. The origins were different, as were how the diagnosis showed itself in their behaviors.
After thirty years of listening to and treating my clients, PTSD is close to my soul, as it is with General Dyer and his concern for soldiers with combat stress. We worked together to expose the inner-workings of this condition.
It’s common to hear people talk about PTSD, or post-traumatic stress disorder, often in reference to a friend or family member who has undergone significant stress. However, this term is frequently misused, as many individuals are unaware that the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria that must be met to accurately apply this label. Understanding its complexity and utilizing the criteria step-by-step is essential for establishing a proper diagnosis and creating a treatment plan.
Let’s explore each of the eight categories to gain a clearer understanding of this significant diagnosis.
A Triggering Event Must Be Present
First, the individual must have experienced a significant event involving death or the threat of death, violence (whether sexual or physical), or the threat of such, or even indirect exposure to the event through shared details, witnessing the event, or experiencing it through the emotional pain of someone close to them.
In this first category, one major stressor must be identified.
One Intrusive Symptom Must Be Noted
Next, the second category requires at least one intrusive symptom to be present. This means that the traumatic event must be re-experienced through one of the following:
– Nightmares
– Flashbacks
– Recurrent and unwanted memories
– Emotional distress after exposure to reminders of the trauma
– Physical reactions when exposed to reminders of the trauma
Are you following so far? Good, there’s more.
An Avoidance of Trauma-Related Stimuli Must be Present
In the third category, the individual must avoid trauma-related stimuli, whether in thoughts and feelings or through concrete external reminders.
If you’ve checked that box, we can proceed.
Two Changes in Thoughts or Mood
The fourth category requires that two changes in thoughts and/or mood be documented, specifically negative thoughts or feelings that began or worsened after the trauma. These may manifest as:
– Inability to recall key features of the trauma
– Overly negative thoughts and assumptions about oneself or the world
– Exaggerated self-blame or blame directed at others related to the trauma
– Showing negative emotional states
– Decreased interest in activities
– Feeling isolated
– Difficulty experiencing happiness
But we’re not done yet; there is a fifth category to consider.
Alteration in Arousal and Reactivity
This category involves noting alterations in arousal and reactivity that began or worsened after the trauma. The individual may display:
– Irritability or aggression
– Risky or destructive behavior
– Hyper-vigilance
– Heightened startle response
– Difficulty concentrating
– Trouble sleeping
Finally, it’s essential that the symptoms last more than a month, cause social or occupational impairment, and are not a result of drugs or medications.
Look for these indications on the pages of The General’s Princess and in the lives of your family, loved ones and of course in yourself. I honor all of you through my writing or this and other traumas.
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