The Importance of Accurate Diagnosis of Post Traumatic Stress.


As a specialist in trauma and Post Traumatic Stress, I read and research constantly for new information and treatment options in order to provide the best possible options for each person I have the fortune of working with.
 
The difficulty can be is that most individuals with PTSD suffer from other mental disorders as well. Studies of the prevalence of PTSD in large samples have found the following mental disorders are most likely to be co-morbid with PTSD:
 
  • Major Depression
  • Substance Use Disorders
  • Dysthymia – persistent mild depression
  • Agoraphobia
  • Obsessive-Compulsive Disorder
  • Generalised Anxiety Disorder
  • Panic Disorder
  • Somatisation Disorder – extreme anxiety about physical symptoms such as pain or fatigue
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Adjustment Disorder
  • Phobias
 
It can be challenging to determine whether overlapping symptoms are best conceptualised as being a part of the PTSD constellation of symptoms or whether they should be attributed to another disorder. Differential diagnosis can be especially difficult when disorders other than PTSD are preceded by exposure to traumatic stress.
 
Despite some symptom overlap between PTSD and other disorders, PTSD has a number of unique features that distinguish it from other disorders. DSM-5 provides specific differential diagnosis guidelines in order to help clinicians assign the most appropriate diagnoses. I know there is much controversy over the DSM, however it is useful to have some form of benchmark to work from.
 
The following elements are useful in distinguishing symptoms of PTSD from symptoms of other disorders:
 
  • PTSD symptoms start or get worse after exposure to a traumatic event.
  • Stimuli reminiscent of traumatic events that activate PTSD symptoms are often pervasive and wide ranging, as opposed to singular or highly specific as in the case of phobias.
 
Disorders other than PTSD may be caused, in part, by exposure to traumatic stress. Although stressor exposure is part of the PTSD diagnostic criteria, PTSD is by no means the only mental disorder that may develop in the wake of trauma exposure. Examples of disorders that may develop after or be exacerbated by trauma exposure include adjustment disorder and phobias. Other highly prevalent disorders, such as depression and panic disorder, may also be potentiated by a traumatic stressor.
 
It is important to look at the guidelines for making a differential diagnosis of PTSD versus other conditions that are commonly associated with traumatic stress exposure. PTSD can be distinguished from these disorders by its defining symptom criteria (i.e., to meet criteria for PTSD, individuals must demonstrate a symptom profile that is consistent with the guidelines for PTSD). Additionally, exposure to traumatic stress is a requirement for a diagnosis of PTSD; in contrast, for disorders such as depression, panic disorder and phobias, although symptoms may be associated with a traumatic event, this is not a requirement.
 
This is why it is important to gather information from varying sources using a variety of methods in order to ensure an accurate diagnosis which will enable the best possible treatment for all symptoms for each individual.

Forces & Veterans Mental Health Helpline


It’s been a busy time since before Christmas in my house with a trip to New York to speak for the NYPD Hostage Negotiation Unit and the New York Association of Hostage Negotiators and the FBI/NYPD Joint Terrorism Task Force. This month I’m speaking as part of the Seton Hall School of Law in Newark’s Spring 18 Crisis Negotiation Course, to talk about hostage survival.

We also sold our house and found a new one just before I left for New York, so straight after Christmas and New Year, it was all hands on deck to pack up the house ready to move on the 19th January so it’s been a tad crazy, to say the least.

In amongst all this, I have been discussing, planning and beginning the creation of two new initiatives with a very good friend of mine and fellow psychotherapist and hypnotherapist, David Bellamy, read all about his work here: www.davidbellamy.org

Through David, we have connected with three former Generals; Peter Currie, John McColl, and Andrew Graham. We also have onboard former Colonel David Richmond CBE who is about to finish working as Recovery Director at Help 4 Heroes and chairman of the Contact Group.

The first initiative is to update the working structure of the military charity sector. At present it is unregulated, there are no minimum standards of operation required for start-up and ongoing and this has lead to many people being neglected, ignored and falling by the wayside. Over the last ten years, these are the people I have treated for PTSD and all it’s associated conditions and this working group that has come together is in complete agreement that things must change. The irony is that the system is not failing people because of a lack of funding, it is failing them because there is far too much bureaucracy, red tape, and BS.

I am not by any means saying that it’s all bad, there are some great people doing great work for many people, however, as with any system there is always room for improvement and it is now time to implement changes that mean more people can benefit from those positive changes.

Some of the changes being discussed are:

  • a national standard on military charities that require them to furnish proof of certain minimum standards and accessibility in return for which they become approved on a national list.
  • sharing of resources, information, and learning because at present this does not happen. There are 350+ military charities and mostly working in isolation which is crazy considering what could be achieved with total collaboration and cooperation. This would entail national sharing of resources, treatment, response and technical ability.
  • run both initiatives as a not-for-profit organisation

The second initiative which has been easier to get going is a national free phone number for serving and veterans to access advice, help, and guidance on mental health issues.  Ironically, while I was looking into setting something like this up, Lord Dannatt wrote an article in the Daily Mail on 14th January, you can read the full article here, Lord Dannatt’s article in the Daily Mail

In the article, he states that the government had declined the option to set up a 24/7 mental health helpline for serving personnel because it would not be cost-effective. The outcome of their assessment of needs concluded that it would require 40 therapists, cost £2m and attract less than 50 calls per year. This does not make sense because if they needed 40 therapists then they would be expecting far more than 50 calls a year surely?

My own research into costs showed that it is cheap to get started and can be increased as demand requires, so we have set up a freephone number 0800 6890864 for all serving and veterans to call should they have mental health concerns for themselves or someone they know. The company we chose to provide the phone service has given us 90 days free trial and then its £24.99 +VAT per month, we have two therapists available at present and we are building a list of volunteers to help as demand grows. So the cost is far from prohibitive as the government suggested.

Our aim for this is to provide unbiased, impartial, confidential, free advice, guidance and help for people serving in the British Armed Forces and veterans with mental health issues. We no longer want people to feel ashamed, afraid, embarrassed about asking for help, and as we are not connected with the MoD or government in any way we offer complete confidentiality. A large part of what we aim to achieve is to create a network of charities and organisations that we can steer people towards to access the specialist help they need that’s local to them. We also provide counseling, therapy, and coaching as part of our service.

I emailed Lord Dannatt and through his PA I now have a telephone conversation booked for Monday 12th February to discuss what we have done so far, what our future plans are and take advice and guidance from Lord Dannatt to ensure that we at least match his expectations of this sort of service.

I have also been in touch with ITV’s This Morning and my email is with the planning team who do the scheduling so I am keeping my fingers crossed. On top of this, a new friend Stephen Finlayson is helping by speaking to his connections at the BBC who he dealt with for a programme about him from a couple of years ago and also introducing me to people he knows at the CTP, (Careers Transition Partnership) who organise resettlement for people leaving the forces.

We are looking for funding and support across the board, so if you have any ideas or would like to help us in any way then please get in touch via my email simon@simonmaryan.com or via the facebook page which is Forces & Veterans Mental Health Helpline Facebook Page 

Please share this with your friends, family, colleagues etc and help us to spread the word about the service we offer and what we are striving to achieve.

Here’s to a very successful 2018 for all of us.

Simon