Tag Archives: Post Traumatic Stress Disorder

Comparing PTSD and Somatization Disorder

Comparing PTSD and Somatization Disorder shows that there are some similarities in the symptoms but for the most part they are different.  Somatization Disorder has a lot more physical symptoms while PTSD has more symptoms leaning toward emotional.  The symptoms the two disorders have in common are headaches and stomachaches.  In both cases symptoms can be so severe and last so long that it completely disrupts the person’s life.

Do you have medically unexplained physical, or somatic, symptoms?

Somatization disorder can cause a person towards an emotional reaction such as depression or even suicide because they feel so much pain and can never get a diagnosis for it.  The symptoms often lead to substance abuse.  Thereby leaving them to feel hopeless, as if they will never get the help they need.  Somatization disorder has a wide range of physical symptoms.  A person with this disorder will report many different symptoms over a period of time with no real medical explanation.  These symptoms are often pain throughout the body, but not usually all at the same time.  Pain in the form of headaches, stomach ache, joint or muscle pain.  It could also be internal, such as vomiting, or it could come about as a sexual or menstrual problem.  Neurological symptoms are also common, often occurring as problems with balance or vision and even paralysis.

Generally for a patient to be diagnosed they will have experienced a minimum of eight symptoms.  There will be a minimum number of symptoms from a given category.  An example of this is that a patient will experience four or more symptoms from the pain category, two or more symptoms from the gastrointestinal category, one or more symptoms from the sexual symptoms category, and one or more symptoms from the pseudoneurological symptoms.  When a person is showing signs of these symptoms they will be unexplainable and a medical diagnosis is not usually possible.  Generally the person will explain the pain they are having in a fashion that makes it seem as if they are in more pain than you think they should be in, as if they are over exaggerating the symptoms.

Somatization Disorder lasts for a very long time which is one thing this disorder has in common with PTSD.  PTSD symptoms can last anywhere from months to years.   Most PTSD symptoms are different from Somatization Disorder because they come from more of a psychological background than a physical background.  PTSD symptoms are generally geared more towards an emotional aspect, some examples are worry over dying, acting younger than the chronological age, having an impaired memory or obsessiveness.  It seems that PTSD actually transforms a person’s behavior instead of changing them physically.  This is because when traumatic experiences occur, the feelings they experience, such as shock, nervousness or fear continue on for a length of time and gradually get stronger.  The stronger they get the less of a normal life the person is able to lead.

These increased symptoms can include nightmares or night terrors, hypervigilance, panic attacks, hypersensitivity, low self-esteem and shattered self-confidence or a physical or mental paralysis.  There are three categories often used by clinicians in order to type or group people who are diagnosed with PTSD.  The categories used are re-living, avoiding, and increased arousal.  The people in the re-living group are people who suffer from living through the trauma they have been through over and over again.  This can happen through a flashback or a hallucination or just by being reminded even in small ways.  The people in the avoiding group tend to try to stay away from people, places or things that can remind them of the event.  Unfortunately the person can start to isolate themselves and eventually can turn completely inward from detachment.  The people in the increased arousal group lean towards either having difficulty showing their emotions or on the other end of the spectrum showing overly exaggerated emotions.  This group is also the group who has some physical symptoms such as higher blood pressure, muscle tension and nausea.

In conclusion, it has become very apparent to me that while there are some similarities between PTSD and Somatization Disorder, there are a lot more differences.  It has also become very apparent to me that the people who suffer from these disorders are dealing with a lot of pain, and whether it is physical or emotional, this pain can cause the person suffering from it to shut down and disable them from enjoying the life they were meant to lead.


Netherton, S.D., Holmes, D., Walker, C.E. (1999). Child and Adolescent Psychological Disorders.   New York, NY: Oxford University Press.

Blaney, P.H., Millon, T. (2009). Oxford Textbook of Psychopathology.

New York, NY: Oxford University Press.

(2009, February 9). Anxiety & Panic Disorders Guide. WebMD.com. Retrieved October 5, 2009, from http://www.webmd.com/anxiety-panic/guide/post-traumatic-stress-disorder

(Retrieved 2009, October 5). Somatization Disorder. Intelihealth.com.  http://www.intelihealth.com/IH/ihtPrint/W/8271/25759/187986.html?d=dmtHealthAZ&hide=t&k=base

(Retrieved 2009, October 5). Posttraumatic Stress Disorder. American Academy of Child & Adolescent Psychiatry. AACAP.org


(Retrieved 2009, October 5). Somatization Disorder. PsychNet-UK.


Kinchin, D. (2005). Post Traumatic Stress Disorder The Invisible Injury.

Didcot, Oxfordshire OX11 9YS, UK.  Retrieved October 5, 2009, from http://www.successunlimited.co.uk/books/ptsympt.htm


Examining the Relationships between PTSD, Somatization, and Disassociation

There are clinically significant relationships that can be drawn between PTSD and Somatization Disorder, first and foremost because dissociative symptoms are included in the criteria for both.  The disassociation spectrum of disorders culminates in Dissociative Identity Disorder, where an individual has two or more distinct personalities that serve different functions in a person’s life.  Although pure cases of Dissociative Identity Disorder are extremely rare, the occurrence of dissociative-like symptoms is relatively common (especially in patients that are diagnosed with Somatization Disorder and PTSD).  We can visualize these symptoms as a form of psychological defense mechanism which results in an inability to recall events; a selective memory of sorts.  Reports of “disturbances in time” are not uncommon, for example when someone is unable to remember how they arrived at a certain location.  Disassociation sometimes manifests in depersonalization, or the sensation of “not being in one’s own body.”  (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 519)

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Although the DSM-IV-TR has conveniently compartmentalized diagnoses into categorical systems, we should “apply skilled clinical judgment to establish functional relationships among various symptom clusters in any given patient.”  (Van Der Kolk, Pelcovitz, Roth, & Mandel, 1996, expression DISCUSSION)  There is no better forum to explore functional relationships between and among specific diagnosis than the exploration of the interrelationship between PTSD, Somatization Disorder, and Dissociative Disorders.  After all, the disassociations associated with these disorders will frequently present at the same time to the extent that it may be difficult to distinguish where one begins and the other ends.

The DSM-IV-TR diagnostic criteria for 309.81 Posttraumatic Stress Disorder (PTSD) include being exposed to a traumatic event that involved a threat to the physical integrity of self or others.  Secondly, the event must be persistently experienced through recurrent recollections, dreams, flashbacks, illusions, or hallucinations.  Third, the client should demonstrate active and persistent avoidance of stimuli associated with the trauma, and/or a general numbing of general responsiveness.  This frequently manifests in dissociative symptoms, serving as a conscious or unconscious effort to avoid thoughts, feelings, conversations, activities, places, or people.  The resulting disassociation results in feelings of detachment or estrangement, restricted range of affect, or a sense of a foreshortened future.  Finally, the client may present with symptoms of increased arousal including difficulty sleeping, irritability, outbursts of anger, difficulty concentrating, hypervigilance, and/or exaggerated startle response.  (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 467-468)

In contrast, the DSM-IV-TR diagnostic criterions for 300.81 Somatization Disorder are characterized by a pattern of recurring clinically significant somatic complaints.  The somatic complaints cannot be fully explained by any known general medical condition or the direct effects of a substance.  If they occur in the presence of a general medical condition, the resulting impairment is in excess of what would be expected based on the norm for the general medical condition.  Finally, there are criterions regarding the quantitative and qualitative aspects of the somatic complaints, requiring that individuals present with a relatively wide variance of physical effects.  We could describe this disorder as a form of “somatic dissociation” whereby the client has lost their ability to perceive somatic sensory information, ultimately resulting in a distorted sense of self.  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 486)

In a controlled study of Vietnam-era combat veterans, researchers found that combat veterans with PTSD reported and were rated as having a greater number of health problems than combat veterans without PTSD.  They had a greater number of total illnesses across a wider number of medical categories, contributing to the belief that as part of their PTSD, “PTSD patients have difficulty determining the salience of information and that this deficit in information processing may contribute to a patient’s focus on and misinterpretation of somatic sensations.”  (Beckham, Moore, Feldman, & Hertzberg, 1998, expression DISCUSSION)

In another study, researchers attempted to investigate the relationships between exposure to extreme stress, the emergence of PTSD, and the symptoms traditionally associated with “hysteria.”  They found that exposure to extreme stress may result in a variety of combinations of symptoms over time, including symptoms characteristic of somatization disorder and PTSD.  (Van Der Kolk, Pelcovitz, Roth, & Mandel, 1996, expression MODERN TRENDS)

In yet another study that focused primarily on pediatric cancer survivors, researchers found empirical support for the “trauma spectrum model” within which “somatic symptoms may play an instrumental role in the presentation and subsequent detection” of PTSD.  Although we cannot eliminate the possibility that somatic complaints represent true physical symptoms, children with chronic illness typical report higher levels of somatic complaints than healthy peers.  Researchers concluded that “long-term pediatric cancer survivors appear to exhibit somatic symptoms,” as well as PTSD-like symptoms, years after treatment completion.  (Erickson & Steiner, 2000)

Without, all three of these studies strengthen the argument for an interrelationship between stress, the presentation of unexplained physical symptoms, and dissociation.  Despite our best effort to compartmentalize disorders in the DSM-IV-TR, it is critical for us as clinicians to recognize and interrelationships between and among these disorders.  Despite an abundance of applicable research, more study is needed to establish the definitive relationship between and among PTSD, somatization disorder, and the spectrum of disassociation disorders.

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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Beckham, J. C., Moore, S. D., Feldman, M. E., & Hertzberg, M. A. (1998, Nov). Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder.  The American Journal of Psychiatry, 155(11), 1565-1570. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=36011996&sid=3&Fmt=4&clientId=4683&RQT=309&VName=PQD

Erickson, S. J., & Steiner, H. (2000, Jul/Aug). Trauma spectrum adaptation: Somatic symptoms in long-term pediatric cancer survivors. Psychosomatics, 41(4), 339-347. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=56303410&sid=3&Fmt=3&clientId=4683&RQT=309&VName=PQD

Van Der Kolk, B. A., Pelcovitz, D., Roth, S., & Mandel, F. S. (1996, Jul). Dissociation, somatization, and affect dysregulation. The American Journal of Psychiatry, 153(7), 83-94. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=9840989&sid=3&Fmt=2&clientId=4683&RQT=309&VName=PQD

A Personal Narrative on Burnout: PTSD, Balancing Risks and Rewards in the Profession of Counseling

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I have resisted the temptation to share this up until now because it is a very personal article I wrote some time ago… this one goes out to Rey, my only subscriber.

Counseling is a risky and rewarding business.  While counseling invites mental health counselors to participate with their clients in the awesome process of human growth and healing, it also may threaten their well being through exposure to their clients’ trauma and its painful consequences.  (Meyer & Ponton, 2006)  The consequences frequently manifest themselves in adverse and maladaptive reactions to ongoing stress; peaking as a condition we call “burnout.”  The symbolism involved with the word burnout relates to the extinguished flame, which is the motivational force in the caring professions.  Burnout can be defined as a syndrome of emotional exhaustion, depersonalization, and reduced accomplishment which can occur among individuals who do “people work” of some kind.  (Garske, 2007)  Although exact figures are unknown, it is estimated that approximately 10-15% of practicing mental health professionals will succumb to burnout during the course of their careers.  (Clark, 2009)  Due to the emotional stresses involved with caring for others, and my own personal history of dealing with stress and trauma, there is good reason for us to explore strategies to thwart the effects of professional burnout.

I anticipate that I will be particularly prone to what has been described as “vicarious traumatization.”  Vicarious traumatization is conceptually realized through “the development of empathic relationships with traumatized clients,” ultimately leading some therapists to become traumatized themselves.  The impact of this traumatization is not limited to the therapeutic environment and may trickle into other aspects of the therapist’s life.  (Meyer & Ponton, 2006)  Although I have not yet assumed a role as a professional counselor, on occasion I am called upon to be a shoulder to cry on when traumatic events unfold.  On one such occasion, it would suffice to say that my shoulder was soaked.

I wouldn’t describe my relationship with my cousin Josh as “close.”  I saw him a couple times a year, usually around the holidays or for a week or so on summer vacation.  Josh was 6 years younger than me.  I was one of the people he “looked up to” when he was growing up; I guess you could say I was one of his role models.  Josh always wanted to be in law enforcement, mostly because he enjoyed the “action.”  He, too, had an intense desire to help people.  Josh joined the Army Reserves to leverage the GI Bill and pay for college.  Specifically, he joined the 339th Military Police Company based in Davenport, IA.  When he joined, it had been 30 years since that company was activated.  After a short deployment to Cuba, officials activated the 339th once again in December 2003 and the company deployed to Iraq in February 2004.  His mission included guarding people and enemy munitions located at a “forward operating base.”  When he came back, he was a wreck.  Haunted by visions of Iraqi people he had killed, and plagued by Post Traumatic Stress Disorder (PTSD), he took his own life in front of his mother (my aunt) on December 22, 2005.  Because the depth and detail of the situation is beyond the scope of this essay, I would point the interested reader to the award winning essay by Dennis Magee of The Des Moines Register, reproduced on the following site… http://joshua-omvig.memory-of.com/legacy.aspx

Although it is difficult to assess how work as a mental health professional will affect me, I can infer that vicarious traumatization might cause me to react much like I reacted to the second hand accounts of Josh’s suicide.  I did my best to assume as much of the burden as I was able; in hindsight, I probably took too much.  My natural inclination to withdraw took root weeks after the funeral, mostly as a reaction to shouldering the weight of my family and their grieving process.  I couldn’t sleep.  I couldn’t eat.  It’s difficult even writing about this now, nearly 5 years later.  As a counselor, I believe second hand accounts of a traumatic nature have the potential to reproduce that effect in me.  As a result, I have a sense of urgency creating a plan to deal with it.

Inherent in my plan to prevent burnout is continually access my level of competency and adjust the scope of my practice accordingly.  It is imperative for my success as a practitioner that I know my limits.  Due to my traumatic experience with PTSD veterans, I don’t anticipate working with this population in the immediate future.  I bestow all due respect to the women and men who have fought and died for our country, but my personal experience would prevent me from being fully effective as a therapist for our veterans.  Someday I hope to overcome this.

In addition to suffering vicarious symptoms of traumatic stress, therapists have to struggle with the same disruptions in relationships as their patients.  (Canfield, 2005)  I have experienced a wide range of difficult situations in my life, and I have little reason to believe that it will be “clear sailing” from here.  Although I have grieved for the loss of both friends and family, I have yet to endure the loss of any member of my immediate family.  I am the eldest son of a mother thrice divorced, but thus far I have managed to avoid the missteps that could cause the collapse of my own marriage.  Raising my daughter has not been without trials, but in her 8 years she has never been sick or injured without reasonable expectation of full recovery.  In the end, any or all of the above is possible (hopefully not likely).  It would suffice to say that my ability to maintain balance in my personal life will continue to have direct effects on my ability to provide effective counsel.

To that end, I endeavor to continually invest in myself and my personal well being through my family life.  My personal life begins and ends with my family, and to what degree it is possible, I spend as much quality time as I can with them.  It’s as simple as taking the time to read to my daughter every night, or surprising my wife with flowers for no apparent reason.  My father once told me that I should “cherish every day like it was my last.”  That realization, that process, is at the core of my personal burnout plan.

Third and finally, I believe one area of significant vulnerability for me is my excessively preoccupation being successful.  Work tends to play a central role in people’s physical and psychological well-being, I am no exception. “Not only does it provide income and other tangible resources, but also it may be a source of status, social support, life satisfaction, and self-identity.”  (Garske, 2007, expression Nature)  No one likes to fail.  Too often, being anything less than the best is failure in my eyes.  Competitiveness is in my nature; the chase causes me a great deal of stress.

An integral part of my burnout plan involves individual therapy.  My persistent and unrelenting determination occasionally causes me a great deal of stress.  In the end, like our clients, it helps to talk about it.  Therapists cannot take clients any further than they have taken themselves; therefore ongoing self-exploration is important.  (Corey, Schneider-Corey, & Callanan, 2007, p. 73)  I am an advocate of counseling for counselors.  Without, I wouldn’t be writing this paper if not for my successes in individual therapy; I’d probably be burned out.

In closing, I believe we all struggle to balance the risks and rewards of life.  For every day I have spent grieving over a fallen solider, I should spend a reciprocal day defining my limits and reducing potential risks of transference.  For every hour I have spent mulling over the tragedies of yesterday and tomorrow, I should spend a reciprocal hour appreciating today.  For every minute I spend rushing to the destination, I should spend a reciprocal minute examining the road.  In the end, it’s all about achieving balance.  Balancing the risks and rewards could mean the difference between success and failure, not just for me as a clinician, but for the clients I endeavor to help.

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Canfield, J. (2005). Secondary traumatization, burnout, and vicarious traumatization: A review of the literature as it relates to therapists who treat trauma. Smith College Studies in Social Work, 75(2), 81-102. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1061959531&sid=3&Fmt=3&clientId=4683&RQT=309&VName=PQD

Clark, P. (2009, Apr). Resiliency in the practicing marriage and family therapist. Journal of Marital and Family Therapy, 35(2), 231-248. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1680596541&sid=3&Fmt=3&clientId=4683&RQT=309&VName=PQD

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th  ed.). Belmont, CA: Brooks/Cole.

Garske, G. G. (2007, Winter). Managing occupational stress: A challenge for rehabilitation counselors. Journal of Applied Rehabilitation Counseling, 38(4), 34-42. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1418538171&sid=3&Fmt=4&clientId=4683&RQT=309&VName=PQD

Meyer, D., & Ponton, R. (2006, Jul). The healthy tree: A metaphorical perspective of counselor well-being. Journal of Mental Health Counseling, 28(3), 189-202. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1086418421&sid=3&Fmt=4&clientId=4683&RQT=309&VName=PQD

Skovholt, T. M., & Ronnestad, M. H. (2003, Fall). Struggles of the novice counselor and therapist. Journal of Career Development, 30(1), 45. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=420397201&sid=1&Fmt=2&clientId=4683&RQT=309&VName=PQD

Post Traumatic Stress Disorder (PTSD)

Because of my young age, I was wholly unaware of the political struggle that surrounded the Vietnam War (as it relates to the inclusion of PTSD).  I am confounded by the statement “PTSD was a normal response to an abnormal stressor that would evoke marked distress in nearly everyone, regardless of his or her preexisting vulnerabilities.”  (Blaney & Millon, 2009, p. 189)  The above statement is basically the reason it was included in the first place, and not 30 years later it has been refuted entirely.

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I was floored by the fact that “one epidemiological study of Michigan residents indicated that 89.6% of American adults now qualify as trauma survivors.”  (Blaney & Millon, 2009, p. 177)  I can’t believe that watching the evening news is considered trauma.  I could possibly comprehend assigning that status to someone who was directly involved in the 9-11 events, but if you had no connections (lost no immediate family members, etc) how can that be considered trauma?  Despite the fact that it is undoubtedly good for our profession (makes our market bigger), I can’t say I agree with this “bracket creep” that has been occurring.  To be quite honest, it’s approaching the “ridiculous.”

I am always drawn to the sex ratio comparisons for some reason, and I was especially drawn to the statement “men are exposed to traumatic events more often than women are, yet the rate of PTSD is twice as great in women as in men.”  (Blaney & Millon, 2009, p. 178)

The ongoing debate about the “definition of impairment” was really interesting since it had such a marked effect on the prevalence rates.  I really took this home as evidence that you really can “create the scenario you want to prove” if you manipulate the variables enough.

I can confirm the “reluctance to seek mental health care because of possible stigma” in the military community.

“The modal veteran in this cohort continued to deteriorate psychiatrically despite remaining in treatment, but then terminated treatment once 100% service-connected disability status had been achieved.”  All due respect to our veterans because they deserve that money in my opinion, but it’s the slightest bit amazing how much better $750/month can make me feel.  I am surprised that the VA Inspector General came to that conclusion; usually they sweep stuff like that “under the rug.”

Evidently it’s difficult to find someone who has pure PTSD, which I was wholly unaware of.  It’s not that it’s comorbid with that many different disorders (Major Depression, GAD, Alcohol/Substance Abuse), but it would appear that comorbidity is an issue in up to 84% of cases.  (Blaney & Millon, 2009, p. 181)  It really makes me question the validity of the diagnosis, given the current definition of “impairment,” and “trauma.”  While I am confident that this is a legitimate issue, I am inclined to align myself with the proponents of differential diagnosis on this one.

The Stroop Paradigm is ingenious.  I need to learn how to administer this test.  Is this commonly administered in private practice?

The suggestion that “being above average cognitively can protect you from the effects of PTSD” reminded me of my mother saying “your smarter than that” every time I got in trouble.  I called my mom tonight and told her she was right… she laughed.

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Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.