Bipolar/PTSD Recovery Glossary

3 Feb

I started this in an attempt to better understand my mental malfunctions. This glossary is a work-in-progress and I encourage and appreciate constructive feedback (key word being “constructive” — please don’t call me retarded or compare me to Hitler).

anxiety disorder psychiatric disorder characterized by excessive and sustained anxiety, worry, and stress and a fight-or-flight response disproportionate to the potential for danger. Anxiety disorder can occur when the fight-or-flight response is repeatedly triggered or triggered over a prolonged period of time. It may manifest as constant anxiety, panic attacks, aversion to certain activities such as social engagements, a need to exert control over one’s surroundings and/or relationships, and addictive behaviors stemming from attempts to self-medicate. There are many types of anxiety disorders including obsessive-compulsive disorder, social anxiety, and post-traumatic stress disorder.

Cognitive Behavioral Therapy (CBT): a form of psychotherapy that focuses on altering one’s thinking to change and manage emotions. CBT emphasizes identifying the internal (mental illness, trauma, etc.) and external (stress, interpersonal issues, etc.) triggers of emotions and creating constructive strategies for diffusing negative emotional responses and states.  It includes asking oneself questions (Socratic Method) about what real-life circumstances, prior traumas, or other factors could be causing or feeding into current emotional suffering or clouded judgment.

CBT is effective because it is practical and encourages the practitioner to counteract emotional tidal waves by applying logic to his or her emotional responses. This does not mean disqualifying the emotions or pretending that they don’t exist, but understanding their real-life causes in an effort to gain or maintain perspective. For example, a common symptom of depression is the sufferer feeling that he or she is worthless. If this sentiment is prevalent, the CBT practitioner would look to what traumas and/or recent events could be causing or magnifying this feeling, remember ways in which he or she is not worthless, compare his or her assessments of self to assessments of other people in similar circumstances, and point out logical flaws in his or her assumptions and conclusions.

CBT includes changes in behavior and activities to counteract negative emotions. Practitioners of CBT will often create a “toolkit” for themselves that consists of activity-based coping strategies to manage negative emotional responses. In the aforementioned example, the sufferer of depression would create a list of constructive activities that relieve stress and improve self-esteem, which he or she could turn to when hitting an emotional low.  Another facet of the toolkit is identifying people, activities, situations, and patterns in thinking that trigger or exacerbate negative emotional responses and states and figuring out how to avoid them or, if that’s not possible, how to assert oneself, anticipate the emotional responses, and have an action plan on hand to manage them.

dissociation: temporary alteration in identity, memory, or consciousness; a temporary disconnection from one’s body and/or physical surroundings. Dissociation exists on a spectrum. It can be caused by stress, depression, sleep deprivation, or trauma. When induced by trauma, dissociation can be seen as the mind’s way of protecting itself from fully experiencing the causative violence or abuse. People who dissociate describe it as an out-of-body experience, as being lost inside themselves, or as simply blanking out and losing chunks of time.

fight-or-flight response: a physiological response to real or perceived danger intended to equip one with the ability to flee from or fight the threat by increasing propensities for awareness, speed, strength, and withstanding pain (pain threshold). It is also known as hyperarousal and acute stress response.

The fight-or-flight response is a product of evolution. It is a function of the sympathetic nervous system. This is part of the autonomic nervous system, which controls the basic visceral functions of the body including heart rate, respiratory rate, pupil dilation, perspiration, and sexual arousal. As such, the fight-or-flight response is automatic and involuntary.

When the response is triggered, the sympathetic nervous system goes into high alert as nerve cells fire signals to other parts of the body. The brain produces neurotransmitters known as endorphins, which diminish sensitivity to pain. The adrenal gland ups production of the hormones adrenaline and cortisol and releases them into the bloodstream. Adrenaline boosts heart rate and blood pressure. Cortisol, also known as the “stress hormone,” increases the amount of glucose in the bloodstream and intensifies the brain’s use of glucose. Cortisol also redirects energy from non-vital bodily functions. All of this results in heightened senses, energy, and strength for fighting or fleeing.

This spike in nervous center activity and hormone production creates numerous physiological changes. Heart rate escalates, veins expand, and arteries constrict, increasing blood pressure and circulation. The lungs and breathing passages expand to maximize oxygen intake. Pupils dilate and hair stands on end to improve perception. The digestive system is suppressed as energy is redirected, resulting in a decrease in saliva production known as “dry mouth.” Blood vessels under the skin contract to prevent blood loss from injuries, while perspiration increases in response to heat produced by the metabolic stimulation and in anticipation of physical exertion; this is what causes the skin to feel cold and clammy.

Obviously, all of this enables the physical efforts necessary for survival and safety. Once the danger is thwarted or averted, the amounts of adrenaline and cortisol level off. However, if the fight-or-flight response is repeatedly triggered or triggered for more than a short length of time, it takes an enormous toll on the body. It taxes the cardiovascular system, which can result in hypertension and heart attacks. Cortisol redirects energy from other bodily functions, which in the long term can have many adverse effects. It redirects energy from the immune system, so repeated triggering of the response will diminish the body’s ability to fight illness and repair itself. Because it redirects energy from the digestive system, heightened amounts of cortisol can cause weight gain and digestion problems such as Irritable Bowel Syndrome.

Over-stimulating the fight-or-flight response also negatively affects the brain. Too much adrenaline creates a state of hyper-awareness and exaggerated perceptions of danger; the mind literally cannot be calm. This can cause anxiety and insomnia. Cortisol redirects energy from the hippocampus, which controls the brain’s ability to make memories. In addition, heightened cortisol levels interfere with neurotransmitter activity, which can further hinder the brain’s efforts to make and retain memories.

hedonic set point: standard level of happiness and contentment when not manic or depressed. Hedonic set points can be positively influenced by regular cognitive behavioral and/or dialectical behavioral exercises.

panic attack: an intense episode of extreme fear and panic lasting from around ten minutes to a few hours. The body’s sympathetic nervous system produces the same physiological changes seen in fight-or-flight response, the difference being that panic attacks are not necessarily triggered by perceived danger and may not abate after a short length of time. Unlike the fight-or-flight response, panic attacks serve no evolutionary function.

Physical symptoms include rapid heart rate, hyperventilation, clammy skin, tunnel vision, tightness in the chest, and light-headedness. The mind is on high alert with racing thoughts and exaggerated perceptions of danger. The sufferer may dissociate or feel disconnected from reality. Many people experiencing their first panic attack assume they are having a heart attack or nervous breakdown.

There is no one known cause of panic attacks. They can be triggered by extreme stress or a perception of danger, but they can also occur seemingly out of nowhere. Heredity, stress, previous experiences of psychological trauma, and exposure to danger over extended lengths of time increase the risk of panic attacks. Being predisposed to passivity in communication and interpersonal relationships may also be a factor, with the attack occurring as a manifestation of internalized anger and anxiety. It is possible to have a single panic attack without recurrence, but most sufferers are likely to experience repeat attacks. Women are more likely than men to experience panic attacks.

Diaphragmatic breathing and tranquilizers such as Lorazepam can mitigate panic attacks. Cognitive behavioral techniques, dialectical behavioral techniques, meditation, and exercise can reduce intensity and recurrences. The sufferer should identify likely triggers and sources of stress and take the necessary steps to avoid or minimize them. Besides stress management and reduction, a key factor in counteracting panic attacks is awareness of the physical symptoms and racing thoughts that signal the onset of an attack. When implemented early, breathing techniques and therapeutic exercises may stave off panic attacks.

Post-Traumatic Stress Disorder (PTSD) an anxiety disorder caused by experiences or witnessing events that result in psychological trauma. Symptoms of PTSD include increased anxiety, emotional sensitivity, panic attacks, dissociation, night terrors, phobias, and flashbacks.

Sufferers of PTSD include survivors of physical, sexual, and emotional abuse and people whose professions involve constant danger such as soldiers, fire fighters, and law enforcement officers. People who have survived calamities such as natural disasters and car accidents can also suffer from PTSD. Not everyone who experiences these things will suffer from PTSD, nor will everyone who does suffer from it do so in the same way or to the same extent.  How PTSD manifests depends on a variety of factors including temperament, previous experiences, the presence or absence of emotional support and safety, and mental health.

trauma psychological damage caused by seeing or experiencing something that intensely threatens one’s sense of safety and overwhelms their ability to integrate an emotional response. From the Greek word trauma, meaning “wound.”

Trauma can be caused by singular occurrences such as violent assaults, natural disasters, or car accidents. Events are more likely to cause trauma if they happen during childhood, befall someone who already has a history of trauma, are unpredictable, or are repeated. Man-made catastrophes and acts of violence, especially those involving caregivers, loved ones, and authority figures, are more likely to cause trauma than natural ones.

Trauma is highly subjective in that it depends on a person’s perception of an event. While two people may undergo the same experience, one may have a traumatic reaction to it while the other may not. This depends not only on the aforementioned variables but also on the degree to which one feels endangered; the stronger the sense of vulnerability, the more likely the trauma.

Effects of trauma include increased anxiety, emotional sensitivity, panic attacks, dissociation, night terrors, phobias, and flashbacks. People suffering from trauma may engage in self-injurious behavior or reenact the experienced abuse against others. Extended, severe reactions to trauma manifest as an anxiety disorder called post-traumatic stress disorder (PTSD).

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