You are not alone.

As previously mentioned, a diagnosis of PTSD is arrived at based on the symptoms a person exhibits after having been exposed to a life/death situation. PTSD symptoms (intrusion, avoidance, arousal, and somatic problems) are all about feelings. The feelings are not real to others, but they are very real to us with PTSD. Imagine existing day to day with life/death feelings invading much of your life, both awake and asleep. Imagine trying to emotionally and physically cope with the memories and/or constant feelings that you and/or one of your loved ones are about to die. We may realize on a mental non-feeling level that it's not really happening, but the feelings win out every time.

Following are a few basic ideas for surviving the feelings caused by PTSD. This is not all-inclusive. Following are experiences I have encountered from my PTSD, and watching and discussing PTSD with others, and what has helped them. Others may have slightly different experiences.

Some things work for some people but do not work for others. It will take time for you to find what will work best for you.

8 BASIC STEPS FOR SURVIVAL

1. Remove yourself from exposure to further trauma - stabilize your situation

2. Find a therapist who really knows PTSD

• A therapist who knows and has background in YOUR kind of trauma
• Therapist shopping is the last thing we want to do, but exactly what we need to do
• Be truthful with your therapist, what you don't reveal will only hurt you in your wish to control the triggers that sets off your flashbacks, reliving the events or produces anger about the event.

3. Find a psychiatrist, with the help of your therapist, to determine if you would benefit from prescription meds.

• TAKE the meds if they are prescribed, and don't play with the doses ...

4. Find a medical doctor to examine you for any and all medical problems

5. Stop unhealthy behavior and unhealthy coping

• addictions, drug and non-drug alike

6. Find a support group

• PTSD support group
• other Support Groups
• Remove yourself from people and situations that are not supportive
• 12 step program(s) [Look for the new 8 step program coming soon!]
• Reconnect Spiritually

7. Learn about PTSD

• Check out the sites linked to my Home Page, or better yet, pick up a book on PTSD
• Learn about memories
• Keep an open mind
• Get second and third opinions from those who have "been there"

8. Learn New Healthy Coping Tools to deal with your feelings.

• fear of dying, anxiety, depression, anger, rage, ...
• triggers
• panic attacks

9. A PTSD "cure"? Afraid not if it happened sometime ago. Possible if in recent history!!

Remove yourself from exposure to further trauma!

This may not be as simple as it sounds. If you are a police officer or an emergency worker, this means getting out of the assignment that is exposing you to further life threatening trauma. This includes assignments where you witness life threatening trauma and assignments that "trigger" memories of trauma you have already experienced. When you have PTSD, "normal" amounts of stress can quickly become major stress, so moving to a low stress assignment is also required.

This may be as "simple" as changing job assignments, but it may mean leaving your job.

You don't have to do everything at once, and you may not have to leave your job. A healthy short term goal, depending on your situation, would be to move to a low stress assignment away from trauma and triggers (if you can find one), and work with a therapist on your long term goals. Some people with PTSD are able to continue their careers, some cannot.

Eighteen months before I was retired with PTSD, I was told by a therapist experienced with PTSD that I was "done" with law enforcement, I had to get out or the further trauma and triggers would kill me. I had already changed assignments to a low stress area, six months prior. The entire eighteen months I fought with myself not to leave the job. It was all I knew and it was who I am. Even though I was having panic attacks and being triggered on a regular basis, the eventual loss of my job, even though it was a disability retirement, was a major blow to me.

If you elect to remain in an assignment that continues to traumatize you, eventually it will catch up with you and the "price" you will pay for it will increase dramatically. You have to weigh your situation and make your decisions for yourself. If you are looking to survive PTSD, the quicker you get away from trauma, the better it will be for you. Remember the battered wife who refuses to leave her violent husband, and goes back into his environment after leaving the hospital with a broken jaw he gave her. What can she expect? What can we expect if we have PTSD and remain in an environment that traumatizes us?

Find a therapist who really knows PTSD

There are a number of therapists and doctors who will attempt to treat this disorder without being familiar with it, and can do more harm than good. There are a number of therapists and doctors who have treated people and, for long periods of time, missed a diagnosis of Post Trauma Stress Disorder, instead, treating people for their symptoms versus the cause.

There are differences of opinion within the psychology and psychiatry communities as to how PTSD should be treated, and there are different opinions as to what works and what doesn't.  Part of the frustration myself and others have experienced has been the varying opinions from different doctors and therapists, which are often in conflict with each other.

Further complicating this is that some things work for some people, but not for others, and some treatments make the symptoms of PTSD incredibly worse for some people, but not for others. It's not always the therapist's fault. When it comes to PTSD treatment, it is not uncommon for a therapist to have to resort to trial and error to find what works best for you.

Part of the reason for this is that not all PTSD is the same. For some people it is from a one time event, for others it's a

The last thing many of us want to do when we first look for help is "therapist shop". However, you need to find someone who knows what they are doing, otherwise they may do more harm than good. My suggestion to you is to find someone who works specifically with your type of trauma and ask for a resume. Interview the therapist before you start treatment. Ask them about specific treatments they use, how many people they've worked with with your type of PTSD, and for how long.

Certain therapists work with various types of PTSD trauma, but know little about cops. Our PTSD can be unique, and certain characteristics can easily be misjudged by certain therapists as symptoms of something other than a normal day in the life. Likewise, if you are dealing with childhood incest issues, you may not want to work with someone who only knows PTSD from working with police officers.

If you're not comfortable with who you start with, switch, you don't have to stay with them. There needs to be that therapist patient bonding and trust. Depending on what you are working on, you may be with this person for years. Hopefully you'll find the right person the first time. Unfortunately, this isn't always the case. Taking the effort to find the right therapist is extremely important, and can effect everything you will do in treatment. Don't give up if this happens to you. It happens to many of us.

Also know that of all the different types of trauma therapy, there are those of us who believe focus on body-oriented work works best with PTSD, and that just "talking about it", by itself, works the least.

And remember, you will only get back what you put into therapy. If you hold things back (which we all tend to do), it will only hurt you.

Find a psychiatrist, with the help of your therapist, to determine if you would benefit from prescription meds

Therapists cannot prescribe medication. You'll need a doctor to do that. Most therapists recognize when medication will be of assistance to a client, and, after discussing this with the client, will refer their client to a specific psychiatrist they work with on a regular basis. The psychiatrist usually will usually only be involved in your medications, not your therapy. Your therapist should be coordinating with the psychiatrist about your medications and the affects.

Some therapists do not believe in the use of medications for PTSD or any of the related symptoms. They will usually let you know this up front in the first few visits.

The decision to take or not take medications is up to you. Like many people, I resisted them for over a year. I was afraid of the long and short term effects, along with the knowledge I would have to notify my employer I was taking medication that could impact on my ability to drive or operate machinery/equipment. My PTSD digressed and I eventually gave in to the meds. Within 3-4 weeks the cloud of depression lifted, and I was able to start functioning in ways I hadn't been able too for several years. This also allowed my therapy to progress in more better and healthier ways than when I was dealing with the depression. Looking back, I now realize I impeded my progress in therapy by not starting the meds sooner. In my case, I believe the meds helped me greatly. I've had no side affects or drowsiness. No one knows I'm on medication, unless I elect to tell them.

The two most common medicine types prescribed for PTSD are the anti-depressants and anti-anxiety drugs. Beta blockers (i.e. Atenolol) are also becoming popular, to help control adrenaline rushes, especially during anxiety and panic attacks.

The anti-depressants usually take several weeks (up to a month depending on which one) to start working. Psychiatrists normally start off with a low dose, and gradually increase the dosage over the first couple months until they obtain the desired effect. Sometimes one type of anti-depressant will not work, and they may have to try several different types over several months. This is, unfortunately, not unusual. Don't give up if the first two anti-depressants don't work for you. Keep trying until your doctor finds the right one for you. The relief you will gain is worth the patience. When the time comes that you decide to stop taking the anti-depressants, discuss this with your therapist and psychiatrist first. If you decide to quit on your own, don't stop taking the anti-depressants overnight. I did that once and will never do it again, it almost made me take my life. The dosage needs to be tapered down over several weeks or even a month. Also be sure to talk to your psychiatrist about drug interactions. Certain anti-depressants, most notably the MAO inhibitors, will cause adverse reactions when mixed with certain other meds, and even some foods. There are other anti-depressants that are much safer that your doctor will probably try first.

There are numerous anti-anxiety type drugs that a doctor can prescribe to help anxiety. The most affective and most common for PTSD are the benzodiazapines Ativan, Alprazolam, and Klonopin. Unlike the anti-depressants, you will feel a benzodiazapine working within the first hour after you take it (usually even sooner). Most of the anti-anxiety drugs have a potential for abuse, addiction, and chemical dependency. Your doctor will discuss this with you before they are prescribed. If you have a potential for addiction, especially to alcohol, you will want to advise your doctor. In a controlled dose these drugs can be very helpful. In an uncontrolled dose they can do much more damage than good. Abusing benzodiazapines will not help your PTSD.

Be aware that different psychiatrists have different opinions about which of these drugs work best. If you temporarily (or permanently) change psychiatrists, such as a short hospital stay, you need to make it very clear you do not want your meds changed, if they are working for you. Some psychiatrists don't hear this message well, so you need to say it loud and clear. If you don't, you may find yourself going through drug related emotional problems until the new medicines start working, then you'll get to do it again when you go back to your regular psychiatrist.

Some people and therapists believe in alternatives to medications, using natural herbs instead. Be careful in using herbs instead of prescribed medications. The FDA in the United States does not monitor herbs, therefore the quality control tends to be poor and the actual dose of the herb you are seeking can vary greatly, and often there will be other herbs mixed in with it that could cause an undesirable affect.

Find a medical doctor to examine you for any and all medical problems

It is very common to experience physical related problems if you have PTSD. These include irritable bowel syndrome, other digestive tract disorders, headaches, respiratory disorders, etc. While PTSD may be one of the causes for these problems, don't assume it. Our bodies are very good at delivering messages to us that something is mentally wrong by making other parts of our body sick. Leave it to a qualified medical doctor to determine how and why.

Listening to your body is one of the ways you will learn to survive PTSD. Many of us with PTSD have found that our mind and our body had/have become two separate people. This is a very normal symptom of PTSD, especially if you have suffered physical trauma. Bringing the mind and body back together as one is part of healing from PTSD, as is taking care of ourselves when we are sick.

Stop unhealthy behavior and unhealthy coping

In our effort to survive the feelings and symptoms that happen with PTSD, often we find ways to cope on our own. Many times these coping behaviors are part of what led to our diagnosis of PTSD. Look at unhealthy behavior and unhealthy coping as being kind of the same as trauma, except that with this behavior we traumatize ourselves. These behaviors compound our PTSD problems.

For some people these behaviors may be chemical dependency. The most common unhealthy behaviors in law enforcement and emergency workers are alcoholism and/or sexual relationships. In law enforcement alcohol/alcoholism and extramarital affairs are frequently more socially acceptable than seeing a psychologist.

For some people these behaviors may be addictions. Alcoholism and/or drugs can be a person's addiction, but so can sex, relationships, gambling, spending money, adrenaline and/or intensity, eating or not eating, religion, etc.

In order to survive PTSD, these behaviors have to be stopped. They mask and conceal the PTSD, medicate and numb the feelings. They are like ice covering the lake we are drowning in. The ice needs to be dealt with before we can be pulled out of the freezing waters.

For most of us we cannot stop these behaviors without help, which brings us to the support groups.

Find a Support Group

Support groups have been rated by a number of professional sources as the #1 survival tool for people with PTSD. Reaching out to others is one of the most difficult things to do for many of us with PTSD. Quite frequently we have become loners who isolate, which is common with the feelings associated with PTSD. One of the things we are afraid of the most is more people who can hurt us, or trigger our PTSD feelings. This is exactly why we need to search for groups of people who can and will support us, and us them.

Unfortunately, support groups that are PTSD specific are not that common. Groups that are specific to law enforcement and emergency personnel who have PTSD are virtually non-existent. The good news, however, is that most people with PTSD find support within various non-trauma specific programs as many of the people within the various support groups and 12 step programs are also survivors of trauma.

Internet PTSD Support Newsgroup

Having knowledge about traumatic stress is important because:
Trauma often leads to PTSD and other impairment

PTSD often presents to primary care providers, but goes unrecognized

Screening and Referral Procedure Overview

• A. Screen administration. A practitioner can distribute a traumatic stress self-report screening instrument prior to a medical appointment. Completed screens are collected and reviewed by the physician, nurse, physician's assistant, or a mental-health consultant to identify patients who are likely to be experiencing distressing post trauma reactions. Screening items can also be added to the standard medical history forms that patients complete at first visits.
• B. Discussion and referral. After a review of the screen results and a discussion with the patient, the provider can decide whether the patient may benefit from further specialized mental-health evaluations. Patients with positive screens may be referred, depending on availability, to specialized PTSD treatment, behavioral medicine, or more general mental-health services for further evaluation and possible treatment.

It is important to understand the reason for screening instruments. Some patients who screen "positive" will not actually be diagnosed with PTSD after a detailed clinical evaluation by a mental-health professional. However, screening instruments increase a primary care provider's ability to detect PTSD and to initiate appropriate referral. Patients who screen positive for PTSD should be explicitly screened for suicidal ideation as well.
• C. Educational materials. Patients who screen positive for PTSD (and their families) may also benefit from educational materials about trauma and PTSD, such as those in the National Center for PTSD website Fact Sheets section.
• D. Follow-up. At the patient's next visit, it is important to ask whether he or she followed through with the referral for mental-health evaluation or care. If the patient did follow through, the practitioner can ask if the referral was perceived as helpful. If the patient did not follow through with the referral and is still in need of care, the provider can try to learn what the obstacles to obtaining care were.

If the Patient Refuses Referral to Mental-Health Care

The Use of a Primary Care Screen

4. Felt numb or detached from others, activities, or your surroundings?
YES [ ] NO [ ]

________________________________________________________________________________ Current research suggests that the results of the PC-PTSD should be considered "positive" if a patient answers "yes" to any three items.

• Discussing Screening Results with Patients
• Provide an appropriate context for the discussion
• Ensure privacy by closing the door and keeping family members out of the room.
• Inform patients that traumatic events and the distress they create can have important effects on the body and on health as well as on the patient's psychological functioning.
• Explain that you are opening this discussion as part of an effort to provide more comprehensive health care and that a greater understanding and recognition of symptoms of posttraumatic stress may be of benefit, both psychologically and physically.
• Ask about traumatic events
• Make no assumptions about the meaning or impact of traumatic events for an individual; your assumptions may be inconsistent with the patient's feelings and experience.
• As the patient is responding to your questions:
• Acknowledge any reported distress (e.g., "I'm sorry you have had such terrible nightmares").
• Show interest and concern, and tell the patient that you are glad that he or she has told you about the symptoms.
• Offer empathic support.
• Unless you have appropriate mental-health training and will be the person to evaluate or treat the patient, it is not advisable to elicit a detailed account of the trauma or to challenge the patient's report in any way.
• The practitioner may say: "At some point in their lives, many people have experienced extremely distressing events such as combat, physical or sexual assault, or a bad accident. Have you ever had any experiences like that?"

If the PC-PTSD screening instrument is utilized, clarify responses to determine:

• a. Whether the patient has had a traumatic experience
• "I notice from your answers to our questionnaire that you experience some symptoms of stress. At some point in their lives, many people have experienced extremely distressing events such as combat, physical or sexual assault, or a bad accident, and sometimes those events lead to the kinds of symptoms you have. Have you ever had any experiences like that?"

The practitioner might ask:

If ongoing threats to safety are present:

Make a recommendation for further evaluation and provide a referral.

• Explain why the screen results lead you to recommend that he or she seek further evaluation and/or treatment.
• Encourage the patient to voice any reservations or concerns he or she might have about seeking treatment. You may be able to facilitate pursuit of treatment by listening to these concerns, acknowledging their validity, and addressing some of the patient's questions about what to expect during mental-health evaluation and treatment.
• Make sure the patient understands that he or she is not crazy.
• Explain to patients that although a wish to avoid reminders of the trauma is natural and common, this avoidance may actually interfere with recovery. This avoidance may prohibit helpful processes that can result from talking through the experience, receiving social support, or receiving specialized treatment.
• After discussion with the patient, if possible, invite family members to participate in a brief discussion and enlist their support for a mental-health evaluation by a specialist.
• Provide the patient with a written referral to a mental-health professional.
• Provide information to the mental-health professional

Provide the mental-health professional with:

1. A copy of the PC-PTSD results.
2. Any relevant information about health events or injuries that might have been traumatic.
3. Information about any suspected negative impact of the patient's post-traumatic symptoms on health or medical compliance.
4. Schedule a follow-up appointment before leaving.
5. Consider scheduling in-person or telephone follow-ups and/or relatively frequent brief office visits. Regular check-ins with patients about their current functioning and follow-ups with referrals is crucial for keeping patients involved in their own recovery process.

[I would offer my total support for all returning troops, no matter the MOS to take this test!] Then I get that gut reaction of where's the money to make forms, administer the test and correct them!]