Ask a Psychiatrist and Get Answers to Mental Health Questions ASAP
Hi! I believe I can be of help with this issue.
First let me say that I can imagine how distressing and frustrating this situation must be for you. Your story is really rather amazing and I'm sorry you've gone through this. That you are seeking help is a very good thing. I will also at the end of the posting give you a technique you can use to help with your anxiety from the PTSD you are indeed suffering. It will help you find some temporary relief with your anxiety.
Your immediate question is whether your symptoms sound consistent with PTSD as opposed to Bipolar Disorder (BD). There are a number of factors we have to keep in mind at the same time as we discuss this. First off, we have to remember that PTSD and BD can be comorbid, meaning that a person can be suffering from both. They are not mutually exclusive. However, the manic symptoms as well as the depressive symptoms of BD can indeed be mimicked by PTSD episodes. That complicates things.
The way you and your psychiatrist and psychologist/therapist would determine what is the correct diagnosis or diagnoses will be based on how the manic episodes have their onset. You are indicating that the onset is based on an external trigger that causes an anxiety reaction based on your past war experiences. That would indeed imply a PTSD episode as opposed to a manic phase onset.
However, that only partially rules out the manic phase of BD. While most often in BD, manic phases are cyclical and respond to internal cycling, they can indeed be triggered by environmental factors. Therefore, you and the doctor and therapist need to determine if the behavior of the mania is more consistent with a BD manic episode (no need for sleep, grandiose behavior, etc.) or if it is more consistent with the panic/anger/excitable PTSD state.
It will take a serious effort at keeping mood charts and discussions with your doctor and therapist to really sort this out. You might consider making mood charts to get started on your own to see if you are correct that you are experiencing PTSD anxiety/panic episodes rather than BD manic states. It sounds very possible from what you report. Here are three resources: the first are computer programs for tracking moods:
They are both popular; Moodtracker is perhaps more well known, at least here in the US. Here, though, is a simple printout with charts that you can copy and fill in by hand and that may be enough:
I'd like to state here, though, that whatever the decision will ultimately be on keeping the BD diagnosis or deleting it, one thing is clear: there is definitely PTSD and it has been present for a long time and not adequately addressed; the PTSD needs to be addressed directly. There are no medications for the direct treatment of PTSD, only the anxiety that comes with it. So that needs to be considered as well.
Psychotherapy that is helpful for PTSD is some form of Exposure Therapy. I have found EMDR can be very useful especially for one time traumas. It is a type of therapy specifically for PTSD originally. Here is the International Society's website:
On the web you will find many opinions on EMDR both for and against. I am trained in it and have found it useful. Exposure therapy is also very helpful. I have found that you need to combine these types of therapy with a more introspective, humanistic or psychodynamic approach. If we actually look inside, we can find great relief and meaning. And we can feel whole in ourselves in ways that we haven't for decades. But many EMDR practitioners and therapist working with Exposure Therapy do not take the time to insure the emotional safety of the patient and so that's why you need someone who is more humanistic or psychodynamic in approach.
If you don't have a good referral source, here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful (you can see a photo of the therapist!) look at the listing and see if they list working with PTSD and EMDR and also some form of psychodynamic or humanistic therapy in their orientations. You will need this for the work on the self worth problems as well that you need to address. And make sure you are confident in them as a therapist and they share your values.
I wish you the very best!
Finally, I am going to put here a protocol that is used for anxiety. You're experiencing a lot of it. So I want to give you this technique to help you!
Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum. And this is good also for just general anxiety without panic attacks as well.
I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety and negative thinking is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help. So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?
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Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.
What You Need:
Thanks Dr. Mark. Being a serial entrepreneur on top of all this makes life interesting.
Appreciate the help.
Mark J. Linkhorst