Lifestyle Changes to Manage Post-traumatic Stress Disorder (PTSD)

PTSD symptoms usually do not completely disappear. Therefore, you will likely need to continue coping with the symptoms and the problems they cause. Recovery is an ongoing and gradual daily process. The following lifestyle changes can help reduce your symptoms and improve your quality of life:

Join a PTSD Support Group

Many communities have support groups for survivors of trauma with PTSD. Though it may be difficult for you to take that first step and attend a meeting, groups can provide additional emotional support and help you cope with your symptoms and other problems related to PTSD. It may feel awkward to meet new people and talk about yourself, but with regular attendance, many people find that they eventually feel more trusting and open. You’ll likely also feel better that you’re taking positive steps in your recovery.

Make Contact With Other Trauma Survivors

You need the companionship of those who can provide support and understanding. Increase your contact with other trauma survivors, possibly by joining a group of trauma survivors or a veteran’s organization. Increased contact with other survivors can help you to feel more trusting, more satisfied with your life, and can help reduce your symptoms.

Keep in Touch With Family and Friends

Work at improving your relationships with your partner or spouse, family, and friends. The mutual support will aid in your healing. You will feel more “normal” as you increase your social support.

Relocate to a Safer Neighborhood

After surviving a trauma, you are likely to feel that the world is a dangerous place and that your chances of being harmed are high. If you live in a high-crime area, your beliefs and fears will be even worse. If possible, move to a quieter and safer neighborhood.

Join an Alcohol or Drug Treatment Program

Many survivors of trauma use alcohol or drugs for relief of PTSD symptoms. While this may seem to have some benefits in the short-term, it always makes things worse in the long-term. If you are using alcohol or drugs to cope with PTSD, it’s important to get some help so that you can stop. A treatment program or group program is often the most effective way to stop using alcohol or drugs. Ask your doctor for referrals to services to help you stop using alcohol and/or drugs.

Begin a Regular Exercise Program

Walking, jogging, swimming, weight lifting, and other forms of exercise can help reduce physical tension. Exercise can also provide an outlet for your emotions, distract you from worries and disturbing memories, and can help increase your self-esteem and feelings of control. Be sure to talk to your healthcare provider before you start an exercise program.

Get Involved With Your Community

Get involved in a community activity such as volunteering, especially if you’re not working. Whether you choose to work with youth programs, the elderly, literacy programs, or hospital services, or to take part in community sports, it’s important to feel that you are making a contribution.

Life Is Difficult

This is a great truth, one of the greatest truths. It is a great truth because once we truly see this truth, we transcend it. Once we truly know that life is difficult--once we truly understand and accept it--then life is no longer difficult. Because once it is accepted, the fact that life is difficult no longer matters.

Most do not fully see this truth, that life is difficult.

Instead they moan more or less incessantly, noisily or subtly, about the enormity of their problems, their burdens, and their difficulties as if life were generally easy, as if life should be easy. They voice their belief, noisily or subtly, that their difficulties represent a unique kind of affliction that should not be and that has somehow been especially visited upon them, or else upon their families, their tribe, their class, their nation, their race, or even their species, and not upon others. I know about this moaning because I have done my share.

Life is a series of problems. Do we want to moan about them or solve them? Do we want to teach our children to solve them?

Discipline is the basic set of tools we require to solve life's problems. Without discipline we can solve nothing. With only some discipline we can solve only some problems. With total discipline we can solve all problems.

What makes life difficult is that the process of confronting and solving problems is a painful one. Problems, depending upon their nature, evoke in us frustration of grief or sadness or loneliness or guilt or regret or anger or fear or anxiety or anguish or despair. These are uncomfortable feelings, often very uncomfortable, often as painful as any kind of physical pain, sometimes equaling the very worst kind of physical pain. Indeed, it is because of the pain that events or conflicts engender in us all that we can call them problems. And since life poses an endless series of problems, life is always difficult and is full of pain as well as joy.

Yet it is in this whole process of meeting and solving problems that life has its meaning. Problems are the cutting edge that distinguishes between success and failure. Problems call forth our courage and our wisdom; indeed, they create our courage and our wisdom. It is only because of problems that we grow mentally and spiritually. When we desire to encourage the growth of the human spirit, we challenge and encourage the human capacity to solve problems, just as in school we deliberately set problems for our children to solve. It is through the pain of confronting and resolving that we learn. As Benjamin Franklin said, "Those things that hurt, instruct." It is for this reason that wise people learn not to dread but actually to welcome problems and actually to welcome the pain of problems.

Rethinking the Term, "Borderline"

One of the best books out about borderline personality disorder is "The Siren's Dance: My Marriage to a Borderline," by Anthony Walker, a psychiatrist. The detailed descriptions of events will give you a strong appreciation for those persons who live with this mood disorder, or suffer from it on a daily basis.

In the book is an appendix about the term, "borderline." The author writes:

The term borderline is a historical term that many people argue should be changed. These patients were first described in the 1940s by psychoanalysts who theorized that this is a form of pathology lying on the border between psychosis and neurosis. Some clinicians see it as the border between sanity and insanity. Nevertheless, the term is confusing and further has increasingly and unfortunately been used as a pejorative for difficult patients, in particular difficult female patients. In my opinion, a far better term would be self-destructive personality disorder, which would be the psychological equivalent of a autoimmune disorder. Others have proposed emotionally dysregulated personality disorder.

Sadly, it is common--and wrong--to call any woman who is seen as manipulative, especially one who has emotional problems, a "borderline." We have to be careful so as not to misuse the diagnosis. Also, at the end of the day, we all manipulate at some level, and manipulation alone is certainly not enough to make a BPD diagnosis.

Tips for Caregivers

Six Tips for Caregivers

Caring for another doesn't mean you should forget to care for yourself. Take good care of yourself, and you'll be able to give your family member the loving care he or she deserves. Follow these tips to make sure you don't neglect your health.

Tip #1: Recognize the Signs of Stress

If you are experiencing irritability, feelings of resentment, loss of sleep, increased susceptibility to colds and flu, or if you feel guilty about taking time for yourself, then chances are that you need to re-evaluate your situation.

Tip #2: Acknowledge the Pressure

Ilana Nossel, M.D., a psychiatrist at Columbia University Medical Center, says, "It's okay to be upset that your loved one is ill and recognize that it takes a toll on you." That's a normal--and healthy--reaction. Nossel recommends reaching out to your own support network and keeping a journal to help you cope, and seeking professional and spiritual advice if you're overwhelmed.

Tip #3: Take a Break

In The Fearless Caregiver, author Gary Berg establishes some ground rules for caregivers. At the top of the list: time away. Meaning you should participate in activities that don't include the person you're caring for. At age 30, Rachel Weber found herself taking care of her ailing father. "You have to take time for yourself," she says, "or you won't be able to help anyone else." Get regular exercise--it's good for your physical and mental health. Stay involved in the activities you enjoyed before your family member got sick.

Tip #4: Ask for Help

Often people who know your situation want to lend a hand, but they don't know how. Ask them to do specific tasks. Tell a friend you could really use a home-cooked dinner on Wednesday, or have a neighbor pick up your family member's medication from the drugstore.

Tip #5: Try Respite Care

Hiring someone to help can reduce the burden on the regular caregiver. It doesn't have to be expensive: Respite care is when someone comes to give you a few hours off, and it's usually covered in part by insurance. If you're anxious about leaving your family member with someone else, make a checklist for the respite worker to understand everything that must be done.

Tip #6: Take Pride in What You're Doing

One way to take pride in what you're doing is to have a goal in mind. Aaron Brodie, a medical student at Hebrew University in Jerusalem, notes that "caregiving goals can motivate you when you feel frustrated or saddened by your loved one's condition. Maybe your aim is simply to enjoy your precious time together, or maybe it's to help him get adjusted to a new medical regimen."

Caregiver Stress: The Impact of Chronic Disease on the Family

The Institute for Health & Aging reports that virtually one half of the US population suffers from a chronic condition—defined as a problem that lasts for a long time or one that will never go away, such as Parkinson’s disease , AIDS , cancer, or Alzheimer’s disease . This includes a growing aging population, many of whom need assistance with routine aspects of everyday life.

The responsibilities of caregiving, added to the routine pressures of maintaining a family and professional life, can naturally lead to stress. Stress, in turn, creates a ripple effect on the health and well-being of not only the caregiver, but everyone from family members to friends and co-workers.

Bearing Extra Burdens

Living with a chronic illness—and caring for a person with a chronic illness—can lead to physical and emotional stress. The symptoms of this stress may look similar in both the person dealing with the condition and the caregiver. The symptoms include:

• Anger, sometimes leading to physical violence
• Anxiety
• Denial
• Depression
• Dissatisfaction with life
• Exhaustion
• Guilt
• Irritability
• Stress-related physical conditions

For the person with the chronic condition, the level and type of stress may vary depending on the specific illness and its prognosis. Common causes of physical and emotional stress include:

• Changes in ability to work
• Changes in personal and professional relationships
• Physical changes and side effects
• Management of symptoms and medications
• Financial demands of healthcare needs

For caregivers who offer a wide range of help, stressors also depend on the intensity of their involvement and their relationship to the person in need. These stressors often include:

• Extra demands on time and energy
• Changes in family roles and responsibilities
• Changes in ability to perform work and professional responsibilities
• Pressure of trying to keep up with the caregiving and still having a life outside the home

In fact, according to the Alzheimer’s Association, many caregivers say they experience stress and feel depressed. Also, if the elderly caregivers have a chronic illness, they have a higher mortality rate to compared to peers who aren't caregivers. This leads some doctors to refer to caregivers as "hidden patients."

Adapted Lives

Because of the levels and types of stress involved, the impact of chronic illness can extend far beyond the sufferers and their caregivers. Nearly always, it affects the household of the person with the chronic condition. And as those household members are affected, the people who love, care for, and work with them can experience effects as well. A recent study of grown children with chronically ill parents revealed that even non-caregiver children showed an increased risk of depression.

In every chronic condition, strong support systems benefit everyone. A study of AIDS caregivers, for example, connected strong social support with better coping skills. Plans for research include looking at the coping mechanisms that caregivers use and finding better ways to support caregivers.

While the caregiver typically serves as a primary support system for the chronically ill person, friends and family members can also play important roles. This can be children taking on more responsibilities or friends ensuring that caregivers take time off to relax. These steps help lower the stress level.

Signs and Solutions

Because of the relentless demands associated with chronic illness, understanding positive methods of coping can greatly benefit everyone affected by the condition.

Helpful coping strategies include:

• Take breaks. Schedule quiet time, visit with friends who can offer positive reinforcement, or take regular days off from routine. Home health agencies may offer “respite care” or adult day care programs that can give you a break.
• Take care. Eat balanced meals, get an adequate amount of sleep, and check with a doctor about any continuing problems.
• Understand your limits. Find local resources that can offer physical, emotional, and psychological support to you as a caregiver. Realize that you can’t do everything for everyone. Find out if your state offers helpful programs.
• Getting help. Relieve feelings of isolation, anger, and frustration by seeking out the help of counselors or support groups.
• Ask about palliative care. These professionals are specially trained to treat symptoms of chronic illnesses. They can also provide support for family members and help you find resources in your community.

Diagnosis of Bipolar Disorder

Like other mental illnesses, bipolar disorder cannot yet be identified physiologically—for example, through a blood test or a brain scan. A diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).

Bipolar disorder is often diagnosed based on the following:

* Initial assessment—Your doctor will ask about your symptoms: when they started, how long they have lasted, how severe they are, whether you have had them before, and if so, whether the symptoms were treated and what treatment was given. You will also be asked about your medical and family history. In addition, your doctor may wish to interview your family members and/or other persons close to you.
* Physical exam—Your doctor should give you a thorough physical exam. You may be given several lab tests to rule out other causes for your moods and behavior, such as hyperthyroidism or hypothyroidism. If a physical cause for your symptoms is ruled out, you may be referred to a psychiatrist for a psychological evaluation.
* Psychological evaluation—After you see your regular doctor, a psychiatrist is probably the best healthcare professional to evaluate your symptoms. Diagnosis of bipolar disorder is based on:
o Presence of symptoms over time
o Absence of medications that could cause mood symptoms or medical or neurological illness that may look like bipolar disorder
o Family history of bipolar disorder

Mania is diagnosed if abnormally elevated mood (lasting at least one week) occurs with three or more of the other symptoms of mania. If your mood is irritable, four additional symptoms must be present.

Depression is diagnosed if depressed mood or loss of interest in pleasure occurs every day (or nearly every day) over the last two weeks, and it is accompanied by five or more of the symptoms.

A diagnostic evaluation may include a mental status exam to determine if your speech, thought patterns, or memory have been affected, as sometimes happens in the case of bipolar disorder.

You may also be evaluated for other psychiatric conditions, such as anxiety disorders and alcohol or drug abuse.

Loving a Manic Depressive

Among my favorite essays on loving someone with a mental illness are those penned by Anna Bishop, my blogging buddy James's wife. She's written five outstanding posts on what it's like to be a passenger on the rollercoaster of a marriage with a person diagnosed with bipolar disorder.

Here are the links to her first four articles:

"The Depression Dialog"

"Know the Enemy"

"Trigger Unhappy"

"Keeping Your Mind Together"

The fifth piece in the series is called "Loving the Person You Care For," and I have excerpted from it below.


I’ve written a lot about being a carer in my last 4 posts, but in this one I’d like to share with you the book that really saved my own sanity. It is “Loving Someone with Bipolar Disorder” by Julie A. Fast and John D. Preston.

In the first few months after James’ diagnosis I read a lot of material to educate myself. The problem was that most of it was factual information on depression and bipolar, but it didn’t tell me how to manage practical things like James’ irritability. The info simply described the symptom without ideas for its management.

From pages 1 to 2: “This book can provide you with the tools you need to be a resource and support for your partner instead of a crisis manager and constant caretaker.” This is exactly what I needed!

The book was written specifically for carers. Julie Fast has bipolar disorder, as does her partner of 10 years, and the result is a book with real insight.

At its heart is the idea of creating a holistic treatment plan.

The first aim is to develop a symptom list that you can use to identify when your partner’s behavior starts to change. Once that has been worked out the second aim is to create a “what works list” to treat those symptoms before they progress to a full blown episode. The third step is to work out what triggers the symptoms in the first place. These are often outside events, situations or behaviors that once modified or eliminated really make your partner far more stable. Once you understand the triggers well, then the goal is to stop the mood swing from starting in the first place. If it does start then the “what works list” comes into play.

Of course this strategy requires recording your partner’s behavior over time e.g. by keeping a journal.

The rest of the book focuses on the needs of the carer. (Obviously your partner achieving greater stability is already a significant help).

The chapter on “Your Emotional Response” starts you on the road of looking after your own needs. It discusses issues like anger, grief, guilt and feeling trapped. For me, it was almost a springboard for seeing a counselor.

The chapters on work, money and sex cover practical issues that cause distress. They were all helpful chapters, but for me the chapter “The Hard Truths” had more impact. This chapter really lays it on the line and forces you to face the reality of your relationship. Are you prepared to stay with your partner if things don’t change? Tough reading.

My favorite chapter is “The Bipolar Conversation”, which teaches you how to avoid pointless fights when you partner is baiting you. The book ends with “Laughter and Joy”, an inspiration to leading a normal life again. From this I learned to structure in happy times in our lives.

A brilliant book. It may be about bipolar, but the application is much wider and relevant to all mood disorders. It would greatly help any carer living with a depressed partner.