Living with an OSI.

[SeanNewman]

SFB,

See, now we are making progress! 

I think what the problem may have been was the way I was wording it in my ignorant medical terminology, the same was as Bruce mentioned that someone who didn't know about Infantry tactics could be trying to explain something but be using words that made him wrong by the "expert's" opinion.

Me using the term scale and mixing it with "diagnosis" may have upset you if you thought I was implying that someone could be diagnosed as having a different scale of PTSD, which I was not trying to do.

I don't want to confuse the matter anymore with analogies that obviously have missed the mark in the past.

As I understand what I have read, what I have been trying to articulate is that when I say "scale", I mean on the complete scale of where a human can be, from 0 being no symptoms or reason to suspect anything, to a worst-case scenario 100 where someone suffers from every possible unfortunate way he can.

I did not mean to imply that could someone could be diagnosed as a 40% PTSD or a 90% PTSD, which by your argument of "a diagnosis is black and white" leads me to believe you thought that is where I was going.

What I meant by "scale" and how I interpret that reference, is that a bar has to be set at some point where a diagnosis is made (I know I'm oversimplifying it with finite numbers as I understand that it is very complex), and that is where I was coming from with the "scoring" system from that reference. 

I never meant to challenge your "black and white diagnosis" once it is made, but I have been trying to understand the placement of that bar in that some people still have symptoms but didn't cross the bar and get diagnosed, some people may (?) be borderline, and some are well passed it.

So to complete than handshake, is it right to say that the complete range of symptoms that make up PTSD are what the "scale" part of it is, but once a person is deemed to have enough of them that the diagnosis is finite?  He "has it".  And someone might have similar symptoms but perhaps not as many of them but still not enough to warrant a diagnosis.

 

[Armymedic]

Yes, I think we are moving closer to understanding.
As for the "bar", as I add it below. It is very specific as you will see. If you do not meet all the criteria, you may fit the criteria of other mental disorders as PTSD is just one of many different Anxiety disorders.  Or you fit into the criteria for other mental distress that does not fit into a proper Axis I or Axis II diagnosis.
But you should know that not a single patient I saw on clinical rotations are not or ever were members of the CF or members of the emergency services, and only 1 was exposed to their traumatic experience in a war zone. Hence, the diagnostic criteria for mental illness in the DSM-IV must be very specific, yet all encompassing.

309.81    DSM-IV Criteria for Posttraumatic Stress Disorder
A. The person has been exposed to a traumatic event in which both of the following have been present:
(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently reexperienced in one (or more) of the following ways:
(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma
(2) efforts to avoid activities, places, or people that arouse recollections of the trauma
(3) inability to recall an important aspect of the trauma
(4) markedly diminished interest or participation in significant activities
(5) feeling of detachment or estrangement from others
(6) restricted range of affect (e.g., unable to have loving feelings)
(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:
(1) difficulty falling or staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.
F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Specify if:
Acute: if duration of symptoms is less than 3 months
Chronic: if duration of symptoms is 3 months or more
Specify if:
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

 

[SeanNewman]

Geez...that is a massive list.

And if I understand you correctly, a patient has to have every one of those "checks in the box" criteria before a diagnosis?

That does then fundamentally change my understanding of it then, because never before have I seen it shown as an "all inclusive" type of list before.

Not just the references, but with every MD speaker/social worker I've ever heard talk on the matter...I don't ever remember hearing it before as an all-or-nothing diagnosis.

Thank you for your time and effort on this, and once again my apologies if my ignorant medical wording caused my meaning to be misunderstood which resulted in frustrating you.  I owe you a beer.

 

[Another Mom]

Petamocto, You did not read the criteria carefully. In each category, there is a minimum  of symptoms necessary for diagnosis so the individual does not have to have  every symptom. Re-read: Under B, the patients needs at least one symptom. Under C, the patient needs at least 3 or more symptoms. Under D, it is 2 or more.    So, presentations for 2 people could be quite different, but both individuals could meet criteria for PTSD.  And it could be acute, chronic or late onset. Again could look very different between people.

To add to the fun, the DSM-IV is soon to be replaced by the DSM-V.  I am not aware of what the changes might be to the criteria, if any. 
 

 

[SeanNewman]

... If you do not meet all the criteria...

Another Mom,

That's closer to the reference I had quoted, but I was now going by what SFB wrote.

 

[Armymedic]

If you referring to the checked boxed as being criteria A-F, then yes, each one must be met, as defined by the subcriteria (1), (2), etc, which are actually symptoms of the condition.

This is where your scale you referenced comes into play. It provides the questions we ask of our patients IOT define if they fit the subcriteria. so that we can see if they fit the diagnostic criteria.

In the process of diagnosing mental illness, there are several different "scales", "indexes" and mnemonic tools we use as to which questions to ask to tease out proper symptoms so we can diagnose the proper condition.

 

[Chico M]

A further comment.

Knowing how expensive it is to see one of these Specialists....I think we can all agree on one thing.

If you have been sent for an evaluation on this topic you are probably not having too many excellent days in your life. Just like many other major illnesses , if you have known someone with true full on PTSD ...  you know that you do not ever want to suffer from it ...never mind faking it.

Cheers  :yellow:

 

[mariomike]

Re: "Faking" PTSD.

Regretably, there is evidence of some, not all, "faking" during the war.:
"(Bomber) Command was enraged when stories emerged at couts-martial of doctors in Glascow or Manchester who for five pounds would brief a man on the symptoms necessary to get him taken off operations: insomnia, waking screaming in his quarters, bed-wetting, headaches, nightmares."
Ref: see reply #77.

 

[the 48th regulator]

I also hear that if Put your underpants on your head, stick two pencils up your nose, and answered everything with "Wooble" They'd think you have gone mad, and send you back home to Blighty

Leaste that's what they did in the Sudan, so I'm told....

dileas

tess

 

[dogger1936]

Believe me if I could concentrate long enough to count checks in the box or concentrate long enough to do so I wouldn't be seeing anyone.

It's dam frustrating. Trying to continue on with the NORMAL workload, which feels like I'm being buried alive. I can't think strait 3 or 4 days of the week. The nightmares are almost nightly, therefore I end up catching up on sleep after work. Missing out on ALL the time I should be spending with my kids. I freak out inside in public places. I cant go and enjoy a movie with my wife.

I plain don't care about my work. I am slack,  I avoid work, and for the first time in my career I am actually getting in crap at work for poor performance......even though I'm new in this rank and "MOI" already. Thankfully the old me did a awesome job, and that's who I am leaning on now. The past experiences between me and people I am providing crap work to.

There are good days since I started this medication. Few, but there are good days.

I've gotten real sick of talking to different shrinks about the same thing only to get referred to someone else. I'm sick of having to go in on a "good" day and talk about everything thus ending such a good day.

I miss having passion for anything. All my sports activities, my social life (which is non existent or forced by work or wife.)

It is EMBARASSING to have "mental health" written next to my name at work in appointments.

But there comes a point in time where you finally realise "I've let this go too far".I needed help and I seek ed it. It hasn't been a easy road thusfar. And as for the faking I would love to see someone try and fake this system. How the heck do you figure a person can fake it to so far I've seen:

2 MO's
3 shrinks
and a PANEL of shrinks.

And besides WHY would anyone? It's not the "cool" thing to do. It isn't  a stellar career path. Infact it's hurting mine right now. As finally after the regiment has sent me away and sent me away and I've had to cancel appointments it appears the regiment really doesn't care too much. I WAS the guy telling the Dr's to not put me on TCAT, I wanted to do my job. Well I can tell you all it's all coming to a head where the burden of simple tasks for a SNR NCO is becoming too great.

And I get to be the guy on TCAT and I get to be the guy who messes up someone Else's plans as they will have to take over MY JOB.

please tell me why anyone would EVER FAKE THIS!

I came very close to just releasing and "dealing" with it on my own. As I am embarrassed. If it wasn't for my wife and the warrior support center I would have fallen through the cracks and I know where I would have ended up.


As for people joking around about it, I do as well. I openly call em my "not stabbling people pills" etcc.Why do I joke around like that? cause I know everyone knows anyway and joking aroun dkeeps it in good light instead of whispering that has been going on with others.

regards

 

[the 48th regulator]

Keep up the effort brother.

As for "mental health" written next to your name at work in appointments, remove it, as there is absolutely no reason it should be there.  Would they put "Sexually Transmitted Disease Health" beside another person's name having to deal with it?  PM me if you would like some details how you can do this, without any challenges.

One question, what is the warrior support center?

dileas

tess

 

[SeanNewman]

Dogger,

I don't think anyone on here is accusing the people who really have it of faking it or doing anything dishonourable.

I think what the original poster is asking about are the kinds of people who don't care about the CF or who are thinking about getting out anyway so they try to make up a story about having it with the motive of money.

 

[Chico M]

Dogger 1936.

I can only give you my own experience.

I had to try a number of medications prescribed to me before I found the one that worked . It took almost a year of trying things, and a whole lot of counselling. Once I found what was right it worked very quickly and very good.

There were some side effects to deal with that were not so great...but compared to the nightmares, startle responce, shaking , etc.

Hang in there...it will get better with help...you will be glad you did.  :yellow:
 

 

[dogger1936]

Keep up the effort brother.

As for "mental health" written next to your name at work in appointments, remove it, as there is absolutely no reason it should be there.  Would they put "Sexually Transmitted Disease Health" beside another person's name having to deal with it?  PM me if you would like some details how you can do this, without any challenges.

One question, what is the warrior support center?

dileas

tess

Roger that and thanks. The Warrior support center is a building set up for intake of people with OSI's into treatment. Honestly From the front desk workers to the social workers to the shrinks they have been excellent people. Honestly if  I walked in there and got a "NPF I've been working on this base for eons" attitude at the front desk (as I was expecting) I would have left. From the moment I walked into that center I felt like things were improving.

Dogger,

I don't think anyone on here is accusing the people who really have it of faking it or doing anything dishonourable.

I think what the original poster is asking about are the kinds of people who don't care about the CF or who are thinking about getting out anyway so they try to make up a story about having it with the motive of money.

No worries. I just can't see someone getting away with it. One thing I keep hearing at my place of work is people comparing person X's tour to Person Y's tour and what he/she did and why someone who seen less got PTSD. I can tell you honestly while no one in my unit will ever comment negativly on what I did,seen I have friends who went through more than myself. And I feel guilty for that.
And I cant tell yah money is the furthest thing from my mind. Hoping to get a full night sleep, and hoping to be able to take my boys to the park soon is though.

Dogger 1936.

I can only give you my own experience.

I had to try a number of medications prescribed to me before I found the one that worked . It took almost a year of trying things, and a whole lot of counselling. Once I found what was right it worked very quickly and very good.

There were some side effects to deal with that were not so great...but compared to the nightmares, startle responce, shaking , etc.

Hang in there...it will get better with help...you will be glad you did.  :yellow:
 

Glad to hear some good news. Im honestly worried about getting shipped off to SPHL honestly. However Im having issues doing my job....so we shall see. They have me on effectuer and plan on giving me a pill to stop dreams. Fingers crossed I can punch through this and carry on. However roght now that feels pretty far off and impossiable right now. Like I have two brains.

 

[the 48th regulator]

Roger that and thanks. The Warrior support center is a building set up for intake of people with OSI's into treatment. Honestly From the front desk workers to the social workers to the shrinks they have been excellent people. Honestly if  I walked in there and got a "NPF I've been working on this base for eons" attitude at the front desk (as I was expecting) I would have left. From the moment I walked into that center I felt like things were improving.

Things have improved since I was wounded, and and suffered from my Mental Injury.

Where is it located?  I would love to direct more people to a place like that.

dileas

tess

 

[SeanNewman]

And I cant tell yah money is the furthest thing from my mind...

That's because you actually have it.  Some malicious people may just want the money.

Now that you've gone through the system though, I am happy to see that you think it couldn't be "faked" though.

It means that more resources are going to those who need it.

 

[Armymedic]

Just to answer some points:

Warrior center, is the base mental health clinic separate from the CDU's. Great idea, nice to hear its working.

Medications: they are a crap shoot. No one med works for everyone with a specific condition. When it comes to brain chemicals, think about it as spicing up food. You need to try different ones to find the taste thats suits you specifically.

And finally, new treatment protocol within the CF is that you are encouraged back to work. It has been found that avoidance makes the condition worse, and the CF really does want you to return to be the highly functioning soldiers you were before you were wounded.

 

[Kat Stevens]

They tried four different meds on me, at the best they did nothing, at the worst they just made me stupid and sad, instead of just sad.  I took myself off everything, if I'm going to be depressed, I'd rather at least have what's left of my wits about me.

 

[the 48th regulator]

I was lucky, as the first Medication I was put on worked for me.  Went through the normal 3 month period of adjustment, but have been on them for the last 6 years without a challenge.  I am glad for them, and the therapy I did.

dileas

tess

 

[OldSolduer]

Just to answer some points:

Warrior center, is the base mental health clinic separate from the CDU's. Great idea, nice to hear its working.

Medications: they are a crap shoot. No one med works for everyone with a specific condition. When it comes to brain chemicals, think about it as spicing up food. You need to try different ones to find the taste thats suits you specifically.

And finally, new treatment protocol within the CF is that you are encouraged back to work. It has been found that avoidance makes the condition worse, and the CF really does want you to return to be the highly functioning soldiers you were before you were wounded.

Bang On!! Well said!