What's missing from PTSD?
Updated: Aug 11, 2019
I work with a lot of people recovering from traumatic events. I see all the classic PTSD symptoms, based on the DSM-V criteria list. Flashbacks, avoidance, nightmares, hypervigilance, and hyperarousal/hypoarousal are all common experiences in someone with PTSD. Exaggerated startle responses, sleep issues (such as insomnia, night sweats, and sleep paralysis), and reckless behaviors are all symptoms I have come across in my practice.
One symptom that I encounter frequently in clients -- and one that is not considered a part of the diagnostic criteria -- is a profound feeling of confusion. It is confusion that, to the clients, feels deeply rooted. It is as if the confusion does not reside in the mind, but deeper in the soul. It is as much a part of the post traumatic experience than the other recognized symptoms noted above.
The confusion relates to many aspects of the traumatic event. One is the reality of the event itself (did this really happen to me?). Another is the role of the survivor in the traumatic event, particularly as it pertains to the freeze response ("why didn't I move/fight/scream/leave?"). The intent of the perpetrator ("he was so nice, why would he do that?") is another aspect of the profound confusion. Yet another is why the survivor would want to have anything to do with the person who traumatized them in the case of interpersonal assaults ("why do I want to talk to him/be with him?").
I find it quite necessary to help resolve the confusion as a part of the treatment process. The growth and healing that needs to happen after trauma seems, in my experience, to be stuck behind this formidable wall of profound confusion. It is the type of confusion that seems to need a deep-seeded style of therapy to unravel. As with all therapy, connection is the most important part of helping resolve confusion. If I am not a trusted ally, I won't be deemed credible, either. And, while cognitive trauma processing helps to makes some sense of the confusion, I find that techniques that address bodily confusion and disconnection also work quite well. I suspect the seat of this profound confusion comes from the physiological disconnection and dysregulation that occurs with PTSD. Getting the nervous system back online has, for me, shown to be successful.
If you have PTSD or work with people who do, I hope this post brought some clarity to the experience and treatment process. Profound confusion -- the unnoticed but powerful aspect of the post-traumatic experience.