The Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 published in 2013 defines diagnostic measures for Post Traumatic Stress Disorder (PTSD). This article will explore these measures in how our massage clientele have acquired such measures during the time frame of March-May 2020. Also, massage recommendations will be offered to aid PTSD clients.
4 Primary Measures for PTSD Diagnosis
According to DSM-5, there are four primary measures for PTSD diagnosis (1). These criteria apply to adults, adolescents, and children older than six years of age.
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it occurred to others.
Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threated death of a family member or friend, the event(s) must have been violent or accidental.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s).
Take a moment to consider the average person’s level of exposure to traumatic events during the March-May 2020 time frame. With the constant flood of information from social media and news outlets, the average person faced potentially constant exposure to news which gripped the nation in fear.
All media outlets have engaged us myopically for several months upon COVID-19. Understandably so as this viral condition is novel, meaning scientists do not fully understand this coronavirus to the extent of other coronaviruses. Being fixated upon the latest developments and findings can leave the average person dazed and confused, especially with no prior anatomy or pathology study.
The Physical and Mental Tolls
While social distancing and self-quarantines have progressed, every client has experienced this time of trial differently. Physically, many people have become unhealthy as movement and activity were greatly diminished. This resulted in poor lymphatic system operation and waning immunity.
Our body’s lymphatic system is our waste management system. Working congruently with our immune system, if waste cannot be processed and eliminated, the body will retain metabolic waste within adipose and connective tissue matrix. This waste retention will make clients feel fatigue, lethargy, sore, achy and malaise.
Mentally, without healthy lymphatic movement and immunity many people will experience “brain fog,” a condition featuring lack of focus or memory and clients indicating they feel they cannot think properly. Metabolic waste retention can accumulate within the brain accelerating the brain’s aging processes.
The physical and mental tolls can discombobulate a person emotionally. As our brains attempt to process and comprehend current events, emotional ease has been challenged in many people. People already diagnosed with PTSD may easily be tested emotionally. Many others may have developed PTSD unbeknownst due to the steady stream of traumatic exposure to the negative news.
According to Loud Cloud Health (2), in 2019, over 8 million Americans are living with PTSD annually. Studies of veterans report between 15-20% of returning war veterans were diagnosed with PTSD. First responders and police officers report 20-30% of PTSD acquisition.
As we listen actively to our clients, remember that there are varying levels of PTSD. The DSM-5 distinguishes Normal Stress Response (the patient experiences a single traumatic event and recovers quickly) and Acute Stress Disorder (the patient experiences panic attacks, insomnia, paranoia and self-care wanes, as separate conditions from PTSD).
3 Levels of PTSD
The three levels of PTSD as presented by DSM-5 are:
Uncomplicated PTSD – Patient experiences same/similar trauma repeatedly. Emotional numbing and/or symptoms of increased arousal arise.
Comorbid PTSD – Patient experiences same/similar trauma repeatedly. Depression, substance/alcohol abuse, panic and anxiety attacks present.
Complex PTSD – Patient experiences prolonged traumatic circumstances. Behavioral challenges, self-destructive behaviors, disassociation, manic behaviors, cognitive breakdowns and shut-downs present.
11 Signs and Symptoms
Here are classic signs and symptoms of PTSD. According to DSM-5, these manifestations need to be present for at least one month and disrupt normal daily living for a PTSD diagnosis.
As you survey this list, consider if you know anyone experiencing these symptoms:
Flashbacks of events
Nightmares or disturbing thoughts
Severe anxiety and/or panic attacks
Severe emotional distress
Severe physical reactions
Avoiding places (being in public)
Feeling emotionally numb
Negative feelings about one’s self and/or others
Obsessive compulsive disorder
Complications such as depression, anxiety, eating disorders, alcohol/drug abuse and suicidal tendencies may arise if PTSD progresses. The National Suicide Prevention Lifeline, 1-800-273-8255, is a resource one can be provided if suicidal tendencies present. In addition, the QPR Institute is an excellent online resource to provide anyone willing to complete online training on suicide prevention.
Medications for PTSD
Common medications administered to PTSD patients include the following:
Antipsychotics such as Risperdal, Zyprexa and Seroquel are provided to treat more severe cases to ease manic behaviors and psychosis.
Benzodiazepines such as Xanax, Klonopin, Valium and Serax are provided to treat phobias and anxiety in connection with other symptoms.
Monoamine Oxidase Inhibitors (MAOI) such as Nardil and Parnate are used for obsessive compulsive disorder (OCD) symptoms.
Selective Serotonin Reuptake Inhibitors (SSRI) which are antidepressants such as Zoloft, Luvox, Paxil and Prozac to reduce pain, anxiety and depression.
Massage Considerations for PTSD Patients
There are many massage considerations to examine with our PTSD patients. Consider potential distractions that may interrupt sessions. Some may not be easy to control such as vehicle noise outside or neighbors in your building. Some may be easier to control such as keeping cell phones on silent, removing visual items that are overly stimulating, and reducing other noise-making devices.
With classic massage application, perform massage techniques slower than usual. Keeping a slow, rhythmic pace to Swedish style work will more easily induce a parasympathetic response to ease the patient’s nervous system.
I will often include a meditation at the beginning of a session. While applying gentle compression upon a region, I will dictate either aloud or silently in my mind affirmation statements such “you are safe,” “you are protected,” “you are endeared,” “you are loved.” This further facilitates the desired parasympathetic response within the client’s body.
Energy-focused modalities showing effectiveness with restoring calm and balance with PTSD patients include Polarity Therapy, Chakra Alignment, Reiki, Reflexology, Cranial Sacral Therapy and Acupressure.
In Chinese medicine practice, PTSD can be described as Wood-Fire destruction imbalance. Sedating Fire tendencies of hysteria and anxiety along with supplementing Wood tendencies of determination and confidence can harmonize this imbalance.
Be ready for Somatic Emotional Releasing by PTSD patients. A good mental framework to interact with a client undergoing such a release is a three-step method I often present in classes:
Acknowledge the palpable shift in the room energetically.
Validate to the patient that it is normal to experience such releasing.
Continue as directed by patient.
Especially for our male PTSD patients, it is important to move beyond the archaic mindset that “men don’t like energy work or soft, relaxing touch.” Anyone, including men, can benefit from the induction of a parasympathetic response within the body. The modality chosen will not matter as much as the mindful approach taken to restore calm and ease within the patient’s nervous system.
Information presented is never intended to replace advice from a medical professional. Please honor requests of the physician and complimentary practitioners in the care of one’s health condition.
June 16th, 2020