Post Traumatic Stress Disorder

jruddy [subject #515], First car accident, May 2007. "The big black blob represents the Semi-trailer truck, the little black blob my car, the long line a concrete barrier." © 2007 jruddy

Tamster0125's 12-year-old son (subject #498), the 17-year-old GoodbyeHalcyondays (subject #526) and her 13-year-old cousin (subject #534) each developed the 1st episode of persistent aura without infarction between ca. 1 week and ca. 2½ months after they experienced a traumatic event (witnessing of burglary and murdering of uncle or father, respectively) which led to the development of a Post Traumatic Stress Disorder (PTSD). The increased stress level associated with a trauma leading to PTSD can trigger an episode of persistent aura, mimicking the phenomenon of blank hallucinations as conceived by Stern (1961).

Young Male (subject #457) got an episode of persistent aura and subsyndromal PTSD (Grubaugh et al., 2005) immediately after an assault with multiple midfacial fractures.

SopuliSusie (subject #405), developed PTSD after an adequate trauma (assault) in September 1993, ca. 4 years before and thus unrelated to her 1st episode of persistent aura in summer 1997. Similarly, starlitsky86's (subject's #537) PTSD following assault preceded her 1st episode of persistent aura for over 2½ years and darkprince86's (subject's #540) PTSD following assault (being shot at by gang members) and bad car crash accident had its onset 1 year before the onset of his 1st episode of persistent aura, respectively. Jruddy's (subject's #515) subsyndromal PTSD following two motor vehicle accidents preceded his 2nd episode of persistent aura for 7 (retraumatization by 2nd accident) and 11 months (exposure to 1st accident), respectively. Both the low severity of his PTSD symptoms and the long latencies between the traumatic events and the onset of the persistent aura episode suggest that the traumas didn't play a role as a trigger of persistent aura here.

Appropriate psychiatric therapy of PTSD by cognitive-behavioral psychotherapy and pharmacopsychiatric treatment (e.g. SSRI) can be expected to reduce the increased stress level and thus set the stage for a recovery of the persistent aura symptoms.

tamster0125's son

"Last May (2007)", reported tamster0125 (subject's #498 mother), "my son stayed home from school sick. I left that morning to go to work, appx. 15 minutes after I left, someone attempted to break in our house. They did break into the garage, and gained access to my youngest son's bedroom. My son called me and 911, and we reached the house scaring the intruder off before he made it further than the one bedroom. The individuals involved we caught and put in jail. This was obviously very traumatic, and I believe caused some anxiety. After this, he would not stay in the house alone, and being 12, couldn't go to daycare either. During [July 2007], he would have a look of fear on his face when the door bell would ring. (The intruder rang the door bell several times, and banged on the door before heading to the back yard. My son did look out the door and saw the individual, at the time not know what was going on.) This is when I spoke to his father about going to California for a month or so, try to help recover from the situation.

His vs started 3 days before he left to come [back] home [from California], and his depersonalization feeling started when he was on the plane flying home. [He] started complaining of a t.v. static in his eyes [when he got back from his trip to California]. [He] has stated, SEVERAL TIMES, he feels like he is 'not himself, on the outside looking in'. He is telling me the [t.v. static and the] depersonalization is constant, he has felt like this since his trip back.

Even to this day [February 2008], when the dog starts barking, he get nervous. He will stay home by himself after school now, but if he is in one room on the computer, he would have the t.v. on in the other room. He does express wanting to get over his fears.

Yes, that is the order of events. I can not help but wonder if this has been brought on psychologically, rather than physically. He is a really healthy, outgoing, good kid. I wonder if proper professional counseling could help his physical symptoms."

GoodbyeHalcyondays

"April 13th 2007 was when my uncle died", recalled GoodbyeHalcyondays (subject #526) whose pseudonym (see here) denotes her sense of a foreshortened future, having abandoned with expectations of joy, liberation, or tranquillity ever since her traumatization by the murdering of her beloved uncle. "I'm really close to my aunt's family, so to me her husband was almost like a dad to me. I heard about what happened the day the attack. He was in a coma then but I didn't learn he died until the next day. I didn't witness the event, but the details of what happened scared me since I had been in the apartment just a few months before and seen that guy downstairs of their apartment. He was really weird and thinking back I wish I knew what I know now. I get lots of nightmares even today about what could have occurred that day. One time I was trying to go to sleep when I heard a slam and scream. I thought I was going nuts!

Symptoms:

Suddenly become angry or irritable
Have a hard time sleeping
Have trouble concentrating
Fear for your safety and always feel on guard
Be very startled when someone surprises you

I think I started noticing [an increase in floaters and static] after I went back to school a week later. (I was on spring break when I heard the news.) I never use to see floaters inside, only outside, so it alarmed me. I could see my floaters better on white walls and it looked like similar to static.

I think [my PTSD] has been getting better over time. I haven't had therapy because my real dad refuses anything is wrong with me and that everything is just in my head. He told me to grow up, LOL."

GoodbyeHalcyondays's cousin

GoodbyeHalcyondays's cousin (subject #534), who had "heard what happened from upstairs" in the afternoon her father was murdered, had developed PTSD and persistent aura without infarction, too; the latter manifesting with persisting visual snow that fully remitted within ca. 2 months.

Young Male's [subject's #457] midfacial fractures sustained in assault.

Young Male

On March 12, 2008, alcohol-intoxicated Young Male (subject #457) became the victim of an assault which resulted in multiple midfacial fractures, triggered an episode of persistent aura with significant worsening of pre-existing persisting symptoms ("my eyes are MUCH more blurry than usual... more DP/DR than usual") and caused a subsyndromal PTSD with recurrent and intrusive distressing recollections of the event ("I still think about it"), efforts to avoid activities that arouse recollections of the trauma ("if anything it makes me MUCH more careful when I am drinking when I'm out"), inability to recall an important aspect of the trauma ("I can't remember much of it as I was incredibly intoxicated, but I was assaulted for no reason other than a small argument"), markedly diminished participation in significant activities (socializing, dating girls) and restricted range of affect with predominant anxiety, disregarding the chronic feling of detachment and estrangement from others with which he was acquainted already before the trauma as a persisting symptom brought on by his persistent aura without infarction. In accordance with the criteria of other authors, Young Male could be diagnosed with subsyndromal PTSD as he met the symptomatic criteria (DSM-IV) for criterion B plus either C or D (i.e., in Young Male's case, C) but not C and D (Blanchard et al., 1995; Stein et al., 1997; Schnyder et al., 2001).

SopuliSusie [subject #405], My favorite aura, 2005. © 2005 SopuliSusie (larger image see here)

SopuliSusie

"I had PTSD for years, but it is mostly gone now. I wish I could remember time lines of aura symptoms in more detail that far back. I mostly remember debilitating migraines, and seeing things move around a lot, and seeing things in the dark. I had a pretty bad relapse after 9/11 though. I had a lot of sleep disturbances at that time (sleep walking and such).

Now that I think about it, I had another HUGE worsening of PTSD symptoms right about when a previous persistent aura was occurring (2003). Those symptoms had a trigger also, but it's uncomfortably personal to write the details here.

I still have a super exaggerated startle response. Pointless factoid, but fruit flies have a startle response too- cool, huh?"

"Yes. 1993 reaches further back than my memory for visual details. I was having very bad migraines, but not with visual auras. It also definitely pre-dated my vertigo attacks. I did end up with actual stress-induced ulcers (no bacteria) in Fall 1993, and fell apart physiologically. At the time, my doctor told me I'd have to learn to manage stress or it was going to kill me. The professor in charge of my scholarship told me the same thing one month later and referred me to therapy. I must have looked like a mess!

I think you're right about the unrelatedness of the disorders."

"It seems funny to me. I had stuff happen to me, but have a hard time seeing myself as a victim of trauma. Except for head trauma - I definitely had too many concussions as a kid. I was a clumsy kid."

"It is an odd dichotomy in my own head. No matter what happens to me, I always think, 'Well, it could have been worse, so I can't complain.' I had these very distinct responses to the event, textbook PTSD, but have long since shut down most of the affective part. I couldn't sleep for years, was constantly paranoid someone was going to break into my house, and would cry at nothing, but at the same time, I did eventually fight off the assault that triggered the whole thing. Odd. It is all odd. I am weird. I know."

After having been referred by her GP to a psychiatrist for another checkup in April 2008, SopuliSusie related: "So I finally have my official diagnoses from the psychiatric clinic. I do have generalized anxiety disorder, I am not depressed, and I do not have obsessive-compulsive disorder. I might still have vestiges of the PTSD... maybe I should get my hippocampus measured (has anyone seen that paper? so cool!)."

starlitsky86 [subject #537], Green scotoma (duration 30 minutes), 2008. "At times there is a green blob in my vision that goes away... it only stays to the left side of my vision where the rectangle is." © 2008 starlitsky86

starlitsky86

"I had symptoms of PTSD, 2004, very bad experience... now bits and pieces of that time are completely gone from my memory. I've seen pictures, places, MY OWN DIARY written then, I read it and 100% believed that I did not write it, it did not sound familiar, it was like reading someone else's diary... Avoided names of the people involved, felt sick to my stomach when anything was brought up during that time period. Mood problems, some of this still occurs to this day... I don't know if this is relevant but ah well..."

"Actually now that I 'think' about it, PTSD began March 2005 - so 2 years 10 months before the first episode of persistant aura?"

"I do believe it has affected me more than I know... Really in short, I still feel emotionless, confused, I can't attach myself in a girlfriend-boyfriend relationship, and I have memory problems. I guess I need to seek professional help about my past experiences.

So from this on: I guess I'd pick the words

Assault
Guilt."

darkprince86

"I have many PTSD symptoms... but I've never bothered telling any doctors... mainly because of how bad my doctors are! Car accident was in [October 27] 2003, started with being shot at (wrong place wrong time)... 2 bullets hit side of the car, 1 skimmed side of my head (left permanent scaring) and half of one (after it hit the car?) managed to hit me in the face and jam itself fracturing my bottom jaw... followed by car chase... then me crashing (clocked at 112 MPH at time of crash)... then a 4 hour ordeal with the police (interview, cell, finger prints, drug check) before I was allowed home... and didn't get to hospital till the next morning (police wouldn't let me go... ambulance men were stood right there when police said 'he isn't going anywhere')... left a huge mark on me... I had nightmares for months after... on top of that I got taken to court for twok [taking without owner's consent] (was my dad's car, I wasn't actually driving it, just listening to music as no stereo in the house due to house fire)... all this happened on my own drive way (private land)... was facing up to 6 months inside... very stressful upsetting and depressing time for me... luckily got found not guilty (whole case took a good 8 months)...after all that I rarely left the house (too scared those guys might come back and finish me off)... and lived with a baseball bat at both doors... and one by my bed... I was on edge for a really long time..."

jruddy [subject #515], Second car accident, May 2007. © 2007 jruddy (larger image see here)

jruddy

In 2007, jruddy (subject #515) had two motor vehicle accidents within half a year, tangling with a Semi-trailer truck in a snow storm (ca. January 2007) and being taken out by a pick-up truck in a parking lot (ca. May 2007), respectively. On his 1st accident, "The Semi changed lanes into me, quick thinking and I got mostly out of his way, but he did a little damage to my rear bumper... I'm sure a lot of people would have ended up crunched into the barrier or under the front of the truck... somehow I didn't spin out, I just kept on the power and luckely I grew up doing stupid car tricks in the winter in mall parking lots, so I recovered." On his 2nd accident, "The pick-up didn't stop at a stop point in a parking lot and totalled my car..." In both accidents, he experienced a traumatic event that involved threatened death or serious injury and his response involved intense fear and helplessness. "I admit I was acting weirdly after the accident, all I could think of was, yay, now I get to go car shopping..." Following a psychiatric assessment about a year after the 2nd accident, jruddy related that "I do not meet any of criterion C or F" of the DSM-IV criteria for Post Traumatic Stress Disorder, "but other than that I meet the rest. We did discuss criterion B: intrusive recollection at length, it was much worse closer to the accidents, but I do still occasionally have the occasional flashback. The intrusive recollections [criterion B.1] were fairly immediate after each accident. I'd say within 24 hours. They would be triggered though, by being in a similar situation." As he met the symptomatic criteria (DSM-IV) for criterion B plus either C or D (i.e., D) but not C and D, jruddy could be diagnosed with subsyndromal PTSD. "It was explained as similar to PTSD, but not quite", jruddy confirmed.

References

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Stern MM. Blank Hallucinations: Remarks About Trauma and Perceptual Disturbances. International Journal of Psychoanalysis 1961; 42: 205-215.

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