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Jan 20 2016

How PTSD Can Block Successful, Effective Outcomes in Life – Overview of 10 Ways

black and white illustration, drawing, of a girl leaning on a big piece of wood blocking her from a nice sun and hill with trees. For article How PTSD Can Block Successful, Effective Outcomes in Life - Part 1PTSD can be Detrimental to Physical Health

PTSD can contribute to the development of health problems.

The muscular, chemical, nervous system and hormonal stresses caused by PTSD – the chronically hyped-up state due to the over-activation of the reptilian brain 24/7 – along with repressed rage and emotional pain, can cause stress.

I would characterize PTSD as a disorder of extreme stress. As such, theoretically any stress-related health issue could result.

Also, in cases in which hospitals and medical personnel are triggers – reminders of an earlier trauma – the terror around going to treatment can prevent a person from getting treated.

Delays in treatment can cause the condition to worsen and become much more serious than if it had been treated right away.

What used to be an easy, even routine, activity – for example, going to the doctor for a health related concern – can become an almost impossible feat with PTSD.

PTSD Undermined my Dental Health

This is what happened to me in regards to dental treatment.

PTSD contributed to my developing very serious tooth decay. The overwhelming stress of PTSD caused nighttime clenching which damaged my teeth for 8 years. The incredible stress and pressure being exerted on the teeth nightly resulted in structural damage that ultimately caused decay in 21 teeth. Clenching also caused internal decay, which was something I had never experienced before I had PTSD. Most likely all the microscopic cracks broke apart the inside of 4 teeth creating huge decay caves inside the teeth that were undetectable on the outside of the teeth. I only understood the scope of the damage when I finally was capable of allowing a dentist to treat me last month.

Up until 2007, the year I developed PTSD, I had absolutely no problem going to see the dentist regularly for treatment. I went to the dentist like a normal person; I was not overtaken by terror to the point of wanting to cry or vomit at the thought of seeing a dentist. After I developed PTSD in the Fall of 2007 I was unable to continue to go to the dentist.

My teeth were relatively OK for a while, but the clenching took its toll and by August 2012 the decay had reached the nerve so I was in a lot of pain. I would endure this pain off and on for 3 years as I emailed and called dentists attempting to find one I could handle being treated by. The pain was very debilitating at times.

PTSD created a host of problems with getting proper dental care, from terror at the thought of going to a dentist, to problems with communication, information processing and decision making. I even contemplated suicide at one point because I was in considerable pain and I simply could not figure out how to get treated. There was a huge wall between me and getting the treatment I desperately needed.

I finally was able to get treated December 10-18, 2015. This was 8 years of being unable to have a dentist treat me, and 3 years 4 months after I began to have episodes of severe dental pain.

PTSD sabotaged my efforts to get dental treatment for 8 years.

Why was I unable to get an effective outcome – having all my cavities treated – for so long?

Something so simple before PTSD became an insurmountable mountain afterwards. Why?

Following is a list that summarizes 10 issues I faced.

Each of the 10 items will be expanded upon more in Parts 2,3 and 4 of this article.

Ten Ways PTSD Can Block Successful, Effective Outcomes in Life

Activation of the Nervous System

1. Stuck in Threat Response – Physiological Effects

In terms of making effective life decisions, there can be multiple things about the decision that the body is interpreting and responding to as threats based on past traumatic experiences. This can happen on a noticeable level or a subtle, unconscious level. Because the person knows subconsciously that in order to face the decision they will experience sheer terror accompanied by all the challenging physiological effects of being activated, they may have a strong tendency to avoid the decision without understanding why they are doing so.

Example: When I eventually went to a check up with a dentist, I experienced dizziness, nausea, feeling like vomiting, feeling ill, shivering, shallow breathing, feeling like crying etc. on and off for about a day and a half. Knowing (even just knowing subconsciously) that I would have to go through this experience to see a dentist led me to avoid making a decision. (Although I did plenty of information gathering from various dental practices I managed to avoid actually going to a dentist for many months.)

2. Stuck in Threat Response – Effects on Perceptions

When the body is responding to a threat, it has a narrow focus on the danger in order to assess what to do to survive. A person with PTSD can get stuck in the “danger assessment” part of the threat response. When stuck in the threat response while trying to make decisions, a person will experience an exaggerated perception of danger and the inability to perceive the actual amount of danger present. Perception can be distorted to a degree that the person may have a lot of trouble navigating the decision-making process effectively.

Example: I perceived all dentists as dangerous. I was unable to perceive dentists or dental treatments as safe. This made it very difficult to get myself to allow myself to go for treatment. I ultimately had to shift my perceptions and force myself to rationally evaluate the true dangers and risks involved in order to be treated.

3. Stuck in Threat Response – Problems With Being Able to Process and Organize Information

Being stuck in the threat response means the animal/reptilian brain dominates. This cuts the person with PTSD off from higher brain functions that organize, categorize and prioritize information. The person may have great difficulty analyzing anything intellectually and rationally. Thus, the person may remain swimming helplessly in all the information coming their way, without a way to process it to an effective decision.

Example: There are numerous factors to consider when choosing a health care provider. I was keen on getting all details to ensure safety and not experience another horrifying accident of any kind, so I generated piles of information. I would be surrounded by papers and my mind would at a certain point not be able to put it into any kind of sensible order to come out with a decision. I would feel triggered by so many things that would come up at the same time as I was trying to wade through the information, and I wasn’t totally aware of what all the triggers were, that all the dentists simply became completely unacceptable.

4. The Goodness Aperture

People with trauma histories may close themselves off to goodness. Being stuck in the threat response creates an intense focus on badness in order to survive. The tendency to go into feedback loops and downward spirals of trauma can lead to repeating negative experiences. The person may develop familiar, comfortable patterns related to trauma that can perpetuate it. Having the “aperture” to their lens to goodness closed in this manner causes problems with seeing and opening up to good opportunities and with feeling any agency to take the actions necessary to get good opportunities.

Example: There can be a certain point, after being traumatized significantly, where “goodness” – the concept of having a positive, safe experience – just is not real anymore. I did not believe that there was any dentist that would be good. It’s hard to explain. I think I was just so impacted by the absolute horror of the previous two medical traumas – which was not just a one-time incident but lasted for, in total, about 30 days of being in pure terror and several years of physical pain – such that all medical people became bad. This created a big hurdle to cross. I could feel my body little by little open to the idea of a good experience, but it was reluctant. The somatic therapy helped to some degree.

Communication Problems

5. Communication Problems due to Not Knowing How One is Coming Across

Having many unusual safety concerns about a decision may seem strange and nonsensical to others involved, but the person with PTSD will not know that they are coming across in an unusually paranoid way. The person with PTSD may not know how to effectively communicate their safety concerns because of how exaggerated a reaction their animal brain and nervous system are having. Translating their intense activation into a question that they can verbalize and that will both be understood and answered by the recipient is challenging. The higher brain functions used in communication are subdued somewhat during the threat response. The person listening will be quick to dismiss and disregard the concerns because the communication is not making any sense. This trouble communicating could lead the person to never get any of their safety questions answered and resolved, keeping the decision forever in limbo. The person will not understand why their communication is not getting any results which can lead to a build-up of frustration which leads to more communication problems.

Example: The saddest part of this entire struggle to see a dentist was the frequent breakdowns in communication. I contacted around 40 dentists. I had a list of questions that would verify that they were safe, but I almost never could get through all of them with any dentist. I felt heartbroken at certain points in time, with certain dentists who – in some cases I rejected because I couldn’t get answers and in other cases they refused to treat me as I made them nervous with all my questions. In some cases I actually communicated fine, but the number and kinds of questions seemed to turn them off. In any case, it just didn’t work and I’ve been realizing I was perhaps not acting like the typical patient.

6. Communication Problems due to Sensitivity

The nervous system activation, and inability to trust others, can create extreme sensitivity to any hint of things being “off.” The person with PTSD may cut off communication with another person at the slightest infraction, for example if the other person has underlying irritation in the tone of their voice or doesn’t know something they should know. These things can be either triggers (conscious or unconscious reminders of past traumatic experiences) or subtle signals to the person with PTSD to not trust the other person. This level of sensitivity leads the person with PTSD to suddenly cut off the very people who could bring solutions and opportunities their way, until nobody is left.

Example: A dentist receptionist sounded irritated when I was talking to her and I discounted the dental practice because of that. A receptionist was unaware of several developments in dentistry I thought she should be aware of and I felt like this was unacceptable. In that case I actually continued anyway to attempt to get treated there and the receptionist cut me off because of my numerous questions. But also she may have felt irritated at the fact that I kept bringing up things she was ignorant about that was continuously making me annoyed with her. Another receptionist was ignorant about one thing and I would have nothing to do with that dental practice. PTSD made me many times more sensitive, fragile and touchy than I was before.

7. Communication Problems due to Anger

There is an internal well or volcano of rage, sometimes completely suppressed, in many who have experienced a lot of trauma and mistreatment. This rage can come bubbling up to the surface at small problems. The rage is an over-reaction to the issue at hand, but it’s a perfect expression of the emotions related to the cumulative problems the person has faced. It’s easier to feel the rage in response to less important people than the perpetrator in some cases; the rage at the original perpetrator could even be completely repressed so the only way it can come out is in relation to other, smaller issues. This rage can cause the person to get in fights and arguments they would not have gotten in prior to PTSD. These fights can cause a breakdown in communication with the very people that could help the person find effective solutions and good opportunities.

Example: I never expressed anger to dentists directly, but I could be seething after getting off the phone and have to take a time out, watch a video or lie down to try to settle down. I did get in arguments at times and the anger probably made it harder for me to be patient and flexible and understanding – rather I would just end the conversation there when I would feel the rage begin to surface.

Lack of Agency

8. Apathy and Helplessness

A central theme of trauma is loss of agency. The feeling of profound helplessness experienced during trauma can persist and affect other areas of life. People with PTSD can feel: like they should be dead, like they are dead, like they don’t belong, useless, not understood, an outcast, suicidal, exhausted. Their body may go into immobility (the freeze response) a lot without them realizing that’s what’s happening. Learned helplessness can also be in the mix. All this combined together can create a profound paralysis of agency – a feeling of pervasive apathy, a void of access to willpower, like being the walking dead – which prevents taking any actions or making any decisions.

Example: There were a number of cases in which if I had been more assertive I probably could have been treated. For example, a couple dentists answered all my questions except just one. I emailed a couple times on this one, last question and never got a satisfactory reply. All I would have had to do is call and say – look, you don’t realize it but all I have is one question between me and getting treated for all my dental issues with you. If you just give me this one answer, which is really simple by the way, I will come and everything can be taken care of!” But I didn’t have the energy or impetus to do that – it seemed like the cases were closed. I was just too exhausted. The solution seems so obvious now but it was like being held down – I couldn’t even lift my pinky to make the call and the whole issue faded away. Actually at the time I didn’t even think of calling as a possibility. They didn’t respond to my email and that was the end of that. This is so strange because I know that before I had PTSD I probably would have just called – I had to have had a totally different attitude back then because I know I had to be assertive at work with co-workers and vendors and whoever. So this whole walking dead thing seems really strange to me when I think about it. (This apathy/helplessness symptom is also related to depression, not just PTSD, so if you have both you get a double whammy)

9. Lack of Sense of Self

PTSD can create various types of memory impairments. Not having access to memories related to one’s past and past self can impair ones inner knowing/embodiment of their: willpower, boundaries, defenses, personal rights, personality characteristics. It can also block access to pertinent information from past experiences that could really help with the present decision. These issues can create the following: sense of being empty, sense of not knowing who one is, sense of not knowing what one wants, confusion. These memory loss issues combine to create a profound loss of agency around decisions because access to the “decider” has been lost.

Example: I have little memory of previously having gone to the dentist. I mean, I do have vague memories of going, but nothing that seems related to me now. I also have not felt connected to parts of my “self” that are confident and assertive, as it seems they faded into the past. This feels like being someone who just arrived from another planet. It just makes it harder to grasp the situation at hand and feel confident based on past experiences that would inform the current decision. There is a lost, empty, floaty feeling that makes it very hard to be grounded and focused.

10. The “Never Again!” Vow / Need for Absolute Control – Extreme Attempts to Regain Agency

In response to not having had any agency during trauma, a person with PTSD may go to the other extreme and insist on being in control of every single detail of a specific situation (while strangely remaining helpless around other parts of life). Having to be the one in complete control can create a block to ever having an effective outcome because some things require handing some control over to another person.

There is also a rigid insistence that everything be predetermined to be safe – everything has to be verified as safe. But in life, it’s impossible to absolutely verify safety. In many decisions, there is calculated risk. The problem is, the capacity to calculate risk is gone. If there is any risk at all, it’s a no go. This insistence on knowing everything will be perfectly safe can completely prevent any decision – because none of the available options can be absolutely 100% certain to be safe.

Insisting on having 100% control and 100% verification of safety will basically put a big wall to every single option that is available, because all options require some trust and some risk. Until the person with PTSD decides to allow for some lack of control and some danger, they will stay stuck and unable to take action.

Example: I insisted on being completely in control of every single aspect of the dental treatment and to verify safety of every tiny thing in order to prevent ANY bad thing from happening. In November, there was a day when I made a conscious decision which led to a big internal shift. I decided to allow a little room to not be in control and to allow for some risk to be present. That was the only way I was ultimately able to go through with treatment.

I will be writing more in-depth about these issues as well as my long journey to getting dental treatment in Parts 2-4:

For a more in-depth discussion of activation of the nervous system, go to article: How PTSD Can Block Successful, Effective Outcomes in Life, Part 2 – Activation of the Nervous System

For a more in-depth discussion of the goodness aperture, go to article: PTSD Challenges – Perceiving and Experiencing Goodness

For a more in-depth discussion of communication problems, go to article: PTSD Challenges – Communication

Note: This article is based on my personal experiences recovering from PTSD.

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Heidi Hanson is an artist and writer in Asheville, North Carolina currently working on an illustrated book chronicling her journey healing from Post Traumatic Stress Disorder.