This Issue

Post-traumatic stress disorder

For the young, overcoming trauma requires a safe place

Anxiety: When you need to worry

Q & A

Signs and Symptoms


Generally, the symptoms of post-traumatic stress disorder are
subdivided into three main categories.

Re-experiencing the traumatic event

• Flashbacks or repeated reliving of the event
• Intrusive, upsetting memories of the trauma
• Repeated nightmares or bad dreams
• Intense physical reactions to reminders of the event
(e.g. pounding heart, sweating)

Avoidance and numbing

• Avoiding activities, places, thoughts or feelings that remind you of the trauma
• Inability to remember important aspects of the trauma
• Loss of interest in general activities
• Feeling detached from others and emotionally numb
• Hopelessness about the future

Increased anxiety and emotional arousal

• Difficulty falling or staying asleep
• Irritability or outbursts of anger
• Difficulty concentrating
• Hypervigilance – on constant alert
• Feeling jumpy and easily startled


Diagnosis

According to the National Mental Health Institute, to be diagnosed with PTSD a person demonstrates symptoms in all three categories for at least one month:

• At least one symptom in the
re-experiencing category
• At least three avoidance symptoms
• At least two symptoms of increased arousal
• Additional symptoms that interfere with normal activities
of daily living

A mental health professional should confirm the diagnosis

Signs and Symptoms

Risk Factors

Do you think you have PTSD?

Ask yourself a few questions

In your life, have you ever had any experience that was so frightening, horrible or upsetting that, in the past month, you:

1. Have had nightmares about it or thought about it when you did not
want to?

YES
NO

2. Tried hard not to think about it or went out of your way to avoid
situations that reminded you of it?

YES
NO

3. Were constantly on guard, watchful or easily startled?

YES
NO

4. Felt numb or detached from others, activities or your surroundings?

YES
NO

Current research suggests that if you answered “yes” to any three questions, you might have PTSD. If so, it may be helpful to talk to a mental health professional. PTSD is highly treatable with psychotherapy (talk therapy), drug therapy or a combination of both.

Source: Prins et alia, (2004). The primary care PTSD screen (PC–PTSD): Corrigendum. Primary Care Psychiatry, 9, 151

When the stress is too much
to handle alone ask for help


If PTSD is not diagnosed and treated it can lead to other mental health disorders, such as depression and alcohol or drug abuse. In some cases the person suffering from trauma has thoughts of suicide. If you are having thoughts of harming yourself or ending your life, or if you know someone who is having these thoughts, seek help right away. Call your doctor, 911 or the National Suicide Prevention Lifeline at 800-273-TALK.

Need more information?

• National Center for
Trauma-Informed Care
866-254-4819
nctic@nasmhpd.org

• National Institute of
Mental Health
866-615-6464
nimhinfo@nih.gov

• Anxiety Disorders Association of America
240-485-1001
www.adaa.org

• National Mental Health Association
800-969-NMHA
www.nmha.org

• Mental Health America
800-969-6642
www.nmha.org

For more information on suicide

Do you think you have PTSD?

When the stress is too much to handle alone ask for help

DANA-FARBER/HARVARD CANCER CENTER
Initiative to Eliminate Cancer Disparities
2011 National Minority Cancer Awareness


April 17 - April 23

Boston Public Library Cancer
Awareness Display


• Codman Square Branch Library
690 Washington Street

• Mattapan Branch Library
1350 Blue Hill Avenue

• Brighton Branch Library
40 Academy Hill Road

April 28: 12 - 1 p.m.

Secondhand Smoke Exposure
Harvard Street Neighborhood
Health Center
632 Blue Hill Avenue


May 16: 11 a.m. - 1 p.m.
Skin Cancer Prevention
Roxbury YMCA
285 Martin Luther King Boulevard


April 21:
9 a.m. – 4 p.m.

Reducing Cancer Disparities & Promoting Health Equity Among Socioeconomically Disadvantaged Populations
Beth Israel Deaconess Medical Center
Riesman Lecture Hall, 330 Brookline Avenue

Registration is required: http://sesrcdbostonapril2011.eventbrite.com

All events are open to the public
For any additional information contact
Athene Wilson Glover at 617-632-4860

Another good reason to visit the dentist


“All you have to do is open your mouth.”

— The Head and Neck Cancer Alliance


The oral cancer examination is painless and quick … and life-saving. When cancers of the head and neck are found early, the cure rate is high. Annual screenings by a doctor or dentist should be a part of your regular physical or dental checkup. The provider:

• Inspects your face, neck, lips and mouth.

• Feels the area under your jaw and the sides of your neck, checking for unusual lumps.

• Asks you to stick out your tongue to check for swelling, color and texture.

• Using gauze, lifts your tongue and pulls it from one side, then the other.

• Checks the roof and floor of your mouth and the back of your throat.

• Feels and examines the insides of your lips and cheeks for red or white patches.

• Places one finger on the floor of your mouth and, with the other hand under your chin, presses down to check for unusual lumps or sensitivity.

Source: National Institute of Dental and Craniofacial Research

Oral, Head and Neck Cancer
Awareness Week is May 8 – 14.


Photo by Vannessa Carrington/Mass. Eye and Ear

Get screened for head and neck
cancer. It’s free, quick and painless.

Boston Medical Center
Moakley Building Lobby
830 Harrison Avenue
Date: April 2
Time: 8 a.m. - noon
617-638-8260

Tufts Medical Center
860 Washington Street
Date: May 12
Time: 2:30 – 4:30 p.m.
617-636-1664
Mass Eye and Ear
243 Charles Street
Date: May 13
Time: TBA
617-573-3340
Dedham Family Dental
Dr. Helaine Smith
30 Milton Street, Dedham
Date: May 11
Time: 9 a.m. – 1 p.m.
781-326-4600

Mass General Hospital
Voice Center

One Bowdoin Square,
11th Floor
Date: May 13
Time: 9 a.m. – 1 p.m.
617-726-0218
Remember to call ahead to confirm
time and date
of screenings.

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Risk Factors

It’s not possible to predict who will get PTSD; it occurs in people of all ages and races. Some factors, however, may increase its risk:

• Gender – more common in females

• Intensity and length of trauma

• A previous trauma earlier in life

• Existence of other mental health problems, such as anxiety or depression

• Family history of depression or PTSD

• Abuse or neglect as a child

• Lack of a good support system of family and friends

• Lack of coping skills


For the young, overcoming trauma requires a safe place

To this day, Alexis doesn’t remember how she ended up on Massachusetts Avenue in the middle of the night, high on drugs, wandering aimlessly along one of Boston’s busiest thoroughfares.

Nor does Alexis recall how her mother and grandmother ended up there as well, ordering her to get into their car.

But it happened and, as it turned out, it was the best thing to ever happen to Alexis.

As a college freshman nine years ago, Alexis was enjoying her life and making plans for a career in criminal justice. All of that changed when she was raped by an acquaintance. She was 19 years old at the time and had little idea how to deal with the trauma. She kept the attack to herself.

“At first I wanted to act like everything was fine,” she said. “But eventually, things started to crumble.”

Though she considered herself just a recreational user of drugs, the next thing anyone knows, Alexis is on Massachusetts Avenue. “I just lost it,” she said.

Alexis had never heard of post-traumatic stress disorder (PTSD). She says she knew she had a problem but “had no idea what I was going through at the time.”

According to Kathleen Monahan, a licensed mental health counselor at Dorchester House Multi-Service Center, Alexis’ story is all too typical of teenagers suffering from PTSD.

“Some kids are reactive,” Monahan said. “They get tough and fight. They get scared when they are triggered. Others can close down. [But] if a person cannot put it [trauma] away, the problem is that at some point in time, something will trigger it.”

Even now, more than nine years later, Alexis still has triggers. “I do not associate with people who remind me of my attacker,” she admitted.

For instance, if she sees a rapper who looks like the man, she won’t watch his videos. If someone grabs her, especially by the wrist, she has a reaction.

Some causes of PTSD are harder to treat, according to Marie Pierre-Victor, the clinical manager of the behavioral health department at Codman Square Health Center. For instance, physical trauma and sexual abuse — trauma during which a person is invaded — pack a stronger emotional toll. “It affects trust,” she said. “It affects everything else in a relationship.”


Kathleen Monahan, M.Ed.
Licensed Mental Health Counselor
Dorchester House Multi-Service Center

Monahan agrees and takes it a step further. PTSD is even worse in sexual abuse cases if the attacker is a family member. “If they tell, they cause problems,” she said. “They are torn. Their trust is destroyed.”

Alexis readily admits that therapy has helped. After the night on Massachusetts Avenue, Alexis finally broke down and — a year after her attack — told her mother what had happened. Her mother quickly took her to a doctor. After a referral to a therapist Alexis was diagnosed with PTSD.

She says that her life has changed completely since the incident. “The person I was before no longer exists,” she said. “I am more guarded.”

Monahan emphasized the need to attack the problem sooner rather than later, especially with teens. But she also stressed the need to be patient. “If you go too fast and they’re not ready, they won’t come back,” she said. “It could lead to a crisis. You have to set up a safe place for them.”

Parents play an important role. First of all, Monahan explains, they have to be on high alert for telltale signs. “If kids stay in their room too much or they’re irritable or their grades are falling, that’s a clear sign that something’s wrong,” said Monahan. “Kids that are scared, have poor eye contact and are anxious or depressed for no known cause make me suspect PTSD.”

Parents also play into the healing process. “They’re the most important thing in a kid’s life,” she said.

Such was the case with Alexis. Though Alexis never completed her degree, she’s not complaining. And she’s not keeping quiet now. She says she knows what it was like to suffer in silence, and she wants to make sure others do not. She volunteers at the Boston Area Rape Crisis Center where she helps train other volunteers. “People feel shame [when they’re raped],” she said. “They need to know that it is not their fault and that they are not alone. Support is available to them.”

She remains in therapy and says she is grateful for what it has done for her.

“I’m in a happy place now,” she said.