Italicized text is updated on 20230628

I am a Soldier with a history of psychological distress who works in the Army. Naturally, I have filled out a lot of PTSD screening questionnaires, but I never qualified for a PTSD diagnosis through them. However, when I went out into the civilian world and met mental health professionals who saw me as a person, not as a number in a social medicine system, I was immediately diagnosed with PTSD. The right diagnosis eventually helped me to get the right treatment, and I have been getting better ever since. So, how did that gross oversight in Army medicine happen???

Not All Trauma is Created Equal

Well, as I have mentioned in a previous post, not all trauma is created equal, but many of our Army behavioral health professionals do not know that. As a result, they choose screening tools devised by American psychologists who also don’t know that (thanks to problems in the DSM-5). These screening tools end up asking questions that only apply to people with acute PTSD including questions about:

• A singular experience that is perceived or actually threatening to one’s own life
• Intrusive, conscious memories (AKA visual flashbacks) about this singular experience
• Avoiding situations or people (AKA triggers) that remind you of that singular experience
• Scanning your environment for threats like that singular experience (AKA hypervigilance)

Well, I’ve been to war a few times where I’ve had to run from rockets and hit the ground when bombs exploded near me, but weirdly, those memories never bothered me. That’s because of the way I processed those experiences: I figured I had voluntarily signed up for the Army, and part of signing up included going to combat, and part of combat included the possibility of death. That made the possibility of death my free-will choice and therefore, not an imposed threat upon me. As a result, I never struggled with those memories. This is mainly why I always answered “no” to these PTSD screening questions that asked me about whether the most life-threatening situations I experienced bothered me. After all, I didn’t have dreams or flashbacks of running for my life, and after a little while, loud noises no longer made me look around for the nearest bunker, either.

Thank God for These Professors

Yet, I remained in severe psychological distress to the point of my body shutting down when I went to seminary six years after I last redeployed (er—MEDEVAC’d) from Iraq. An emotionally abusive relationship became the straw that broke the camel’s back. Fortunately, I was surrounded by several gracious professors, advisors, and counselors when this happened and one of them insisted I speak with the trauma counseling professor. Despite both of us having very tight schedules, we made it happen.

When I told her my brief life history (like I had done countless times to countless other mental health professionals) I heard something I’d never heard before: “Well, it’s clear—you’ve had multiple traumas,” she said. “Like PTSD? But war didn’t bother me,” I replied. “War might not have bothered you, but being a child of divorced parents, being a child of alcoholism, being an immigrant, moving all the time, and being in an emotionally abusive relationships are reason enough to have PTSD,” she answered. “But I was told I only have depression and anxiety,” I told her. She pulled out a list of trauma symptoms, with more than 50 other symptoms on it, including depression and anxiety. “It’s very common for people with PTSD to be misdiagnosed as having depression or anxiety,” she said, “I mean, why wouldn’t you be depressed or anxious with a history like yours?” I was shocked.

“How do I get better?” I asked. “You have to process the traumatic memories,” she said. “There are somatic therapies, like physical exercises, that can help you. Also EMDR and exposure therapies have been known to be effective. Whatever you do, you need to take care of this. God wants you to.”

It’s very common for people with PTSD to be misdiagnosed as having depression or anxiety,” she said… “you need to take care of this. God wants you to.”

TenayBenes.com

Only One of Six Mental Health Professionals Knew the Truth

I walked out of that office bewildered. I had been in psychiatric care and counseling with at least five different professionals for 12 years by that point but no one had ever mentioned PTSD to me. They just told me there was no cure for my “biochemical imbalance” (what does that even mean) and I had to take medication for the rest of my life. Well, they were wrong—on both accounts. It turns out that I did have perceived life-threatening experiences, but they were due much more to my dysfunctional childhood including emotional neglect and abuse than due to a singular traumatic event. That’s the difference: complex PTSD (C-PTSD) is from a continuously traumatizing situation (like a neglectful or abusive childhood, poverty, or being raised in a war-torn country) but acute PTSD is from a singular traumatic experience (like a car crash, a rape, or an exploding bomb).

That’s the difference: complex PTSD (CPTSD) is from a continuously traumatizing situation (like a neglectful or abusive childhood, poverty, or being raised in a war-torn country) but acute PTSD is from a singular traumatic experience (like a car crash, a rape, or an exploding bomb).

TenayBenes.com

The PTSD Screening Tools the military gave me only asked about acute PTSD—not C-PTSD. Had they worded their questions more broadly, I may have realized that:

• I did re-experience the fear of emotionally neglectful and abusive life situations similar to those I had in my childhood (like when I got a new boss, would he or she be kind, normal-amount-of-military-mean, or destroy me?) –> AKA flashbacks (often emotional, not visual)
• I did try to avoid situations that felt like my childhood experiences (like avoiding conflict to enable abuse or exploding in conflict to protect myself) –> AKA triggers
• I did scan my environment for hints that a relationship or interaction may become abusive like my childhood experiences (testing friends, testing coworkers, testing bosses) –> AKA hypervigilance
• I did have PTSD—but not the kind the military was asking about.

Learn More About C-PTSD

If you are looking to understand whether my story applies to you or someone you love, below are several resources to help you understand if you have one or more types of PTSD. I will update this post as I discover more and would love to hear your recommendations in the comments, too!

• Forbes Health Article on C-PTSD vs PTSD – added 20230505
• Patrick Teahen’s YouTube Channel
  • Tricky Families, Childhood PTSD and Questionnaire
  • Childhood Questionnaire Explained
  • Are You Hypervigilant?
• Adverse Childhood Experiences Questionnaire
• Intergenerational Trauma and Questionnaire
• Overcoming Historical Trauma – I only skimmed through this video because I couldn’t find a publicly available questionnaire. Thus, I can’t vouch for its full content until I get a chance to watch it in full, but it looks promising…
• The Recovery Village CPTSD condition for long-term trauma sufferers including domestic violence, human trafficking, repeated sexual abuse, living in a war zone.

Just a note: the terms complex PTSD, chronic PTSD, and childhood PTSD are often used interchangeably. Some authors also prefer to say post-traumatic stress (PTS) instead of post-traumatic stress disorder (PTSD) in order to reduce the stigma of being labeled as “disordered”. Feel free to Google all of these terms, as well as trauma, childhood trauma, and chronic trauma, to find out more.

Just one more note: Lately, Dr. Van der Kolk, the New York Times Best Selling Author of “The Body Keeps the Score” has been trying to get the diagnosis of Developmental Trauma Disorder as a unique type of C-PTSD, which his research suggests is caused primarily by infant attachment problems and caregiver emotional abuse. This concept is supported by Shirley Jean at the Developmental Needs Meeting Strategy Institute, whose life-changing psychoeducation recommends addressing developmental trauma BEFORE the traumatizing experiences that trigger acute or complex trauma responses.