PTSD

[Emergent, RN]

What is your opinion? Is it over diagnosed? I'll ask some of my ER patients "What caused your PTSD?" Sometimes they'll say things like "My grandma and my aunt both died in the same year". In other words, regular life events. People do died. It's normal

In my opinion, it's the latest fad, it's used to exploit the system by weak people, and that abuse will hurt true sufferers. PTSD is real, I have no doubt, but it's diagnosis is free money for some.

[Ruby Vee, BSN]

I think a lot of issues that drive people to the ER.are just issues of people being weak, dramatic or attention-seeking. I temper my opinion with the caveat that I have never worked in ER; my entire experience consists of being a patient in one. But you kind of have to wonder what goes through people's minds with there are eight visitors accompanying an eighteen year old who his hear for a pimple evaluation. And those visitors were VOCAL -- they interrupted the triage nurse when she was with patients several times to demand "when he gonna be seen, because we don't have all night!"

I don't know if ERs have always been like this, but it seems that on certain nights of the week, certain segments of the population all go hang out in the ER and have a picnic.

PTSD is a real issue, but I don't understand how two aunts dying the same year is a trigger. It's an issue I don't fully understand. My childhood was violent, and I went into an early and disastrous first marriage and then to a domestic violence situation, and I guess I'm just lucky I never had a full blown PTSD issue. I occaisionally have flashes of memory -- a too-tight scarf will trigger a memory of being strangled, for example, and I panic if I'm in a small room and the exit is blocked. I still have dreams of being trapped, and knowing my husband was due to explode . . . Do some folks just process the events differently so that they can move on without getting stuck in PTSD? Is there are personality type that succumbs more easily? Do folks walk around with a maladaptive syndrome where they just don't cope with things as well as they should and slowly run their lives into the ground while they don't even know what's wrong?

I'm sure I haven't answered the question you're posing, but I'd like to read the answers.

[nutella, MSN, RN]

There have been some articles in the last few years that suggest that PTSD is over diagnosed. It seems that the reason for it is that people do not always get diagnosed by a person that has the credentials to do so or self-diagnose, the cultural "need" to have a label, the cultural idea that an event that leads to a normal response is seen as "sick", and the insurance requiring a billing code.

Our culture does not always seem to acknowledge that there are normal reactions to events and not everybody will develop PTSD - the D stands for disorder and that means that there is some ongoing impairment. Also, traumatic events do not need to end in a lifelong disorder or struggle - people can get better and labels are not always helpful. Recently there has been much more talk about "resilience" and to teach people how to cope and to re-label their behavior. Instead of looking at a reaction as "sick" to look at it as a "challenging but normal" thing that happens.

OP - I do not know why you ask about the traumatic event or the reason for PTSD. I usually do not ask unless it is very relevant to my work or care. And even then I do not ask directly about the event, I usually ask something like "is there anything we should know about your PTSD or is there anything we can do to help you with it ?"- that leaves it up to the person to reveal what they feel comfortable with. It has been my experience that most people with true PTSD do not wish to talk about it, not casually, and not necessarily with healthcare workers. Often, they will avoid talking about it for obvious reasons including the potential for triggering and stigma. Especially people who have been dealing with PTSD for a while and who focus on coping in a positive way often just want to get through a hospitalization without too much attention.

As somebody who has PTSD I will not bring it up when I see a physician or when I have procedures done because I do not wish to talk about it and there is nothing anybody can do for me - I have to cope with it myself and deal with it. Being uncomfortable is part of life and psychological discomfort sometimes needs to be endured.

By not asking about the traumatic event I also avoid getting annoyed by people who seem to just use the system with a diagnosis like that.

[twinmommy+2, ADN, BSN, MSN]

I work in the VA, am a vet with PTSD, and see this all the time. There are some that are working the system definitely. On the other hand, those that do have PTSD don't want to relive their past trauma by being asked by someone so casually. In an ER situation, it would be more pertinent to ask "What happened today/this week to make your symptoms worse?" Then aggravating factors can be avoided like spouses that are arguing or lowering the noise level when possible.

[KatieMI, BSN, MSN, RN]

Emergent,

I totally shared your belief till one beautiful day I faced the fact. I got PTSD and fibromyalgia, both within a week or so. Trust me, I am not a weakie. And I was not gang-raped or robbed under gun. I just lost my first nursing job due to classic NETY. Just pretty common life situation, but for some reason my whole body just gave up (there was also stress cardiomyopathy with classic ultrasound presentation, diagnosed a few weeks later).

It was my ultimate luck that I still had enough brain cells left functioning to realize what happened and seek right kund of help immediately. I went through all with nothing at all but antiarrythmics but only because I had more knowledge, resources and money than 95% of US population. I do not think that these 95% can be blamed for just not being up to upper 5% standards.

The problem is in massive lack of educated and trusted providers who could spend an hour teaching new patient why he or she feels so lousy and cries every time driving that street 2 months after burying the second dear auntie, that it is ok and it WILL pass with time, and that it would be a good idea to drop everything for a week, pack the bags, hit I-75 and go all the way south to the Key West and spend a whole week there, watching dolphins and picking up shells. 95% of patients just can't afford it, or think that they can't, valuing their this-minute issues way above anything that might, or might not, happen in the future. 95% providers have approved 12 min. for everything, from H&P to completed paperwork. Therefore, here come the scripts for Xanax, Ativan, Flexeril and Norco, and everybody gets happy. For now, that is.