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Ask the Doctor: Diagnosing PTSD and Treating with Cannabis

Question: How is PTSD diagnosed and can cannabis help treat it?

Answer

Post-Traumatic Stress Disorder (PTSD) is a relatively new label attached to an age-old condition. However, diagnosing PTSD and treating with cannabis is a newer treatment yeilding some great results. Even as early as the 5th century B.C., its core symptoms were described at the battles of Marathon, and later, Thermopylae.

As military doctors attempted to understand more about the condition, the term “nostalgia” was used in 1688, by Johannes Hofer. By the time of the Seven Year War, the term “longing to return home;’ was used. With little understanding of the psychological symptoms, the Civil War was devastating. Due to public outcry, the first American Military Hospital for the Insane was established in 1863.

As we entered the modern era of PTSD, World War I arrived with it’s trench warfare. The outcome brought with it use of the term, “shell shock,” for what is now commonly referred to as PTSD. Medicines did not improve through World War IL Of the 800,000 American troops who saw combat and displayed PTSD symptoms, 37.5% were permanently discharged. The term then became “battle fatigue;’ and “combat exhaustion:’ By the end of the Korean Conflict, PTSD was termed “operational exhaustion.”

The Vietnam War unfortunately requires a paragraph of its own. Vietnam from a psychological perspective, was likely America’s most intense combat. It acted as a catalyst of new understanding from the medical community. It had to. In 1980, The American Psychiatric Association codified PTSD, and it was included in the DSM-3 later that year.

Footnote: The above is a synopsis of an article written by Joshua J. Jones and is available, in full, at the website. www.military.com.

So how is PTSD currently defined?

PTSD and DSM-5

The diagnosis of PTSD is as complex as the originating trauma. There are multiple levels of symptom understanding that are referred to as “criteria.” The criteria are divided among categories designated a letter (A, B, C … H, and two additional specifications). Sorting through these intrigues is what the psychiatrist should be expected to accomplish. Below is an excerpt of criteria parameters:

Criteria A (one required): The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following ways:

  • Direct exposure
  • Witnessing the trauma
  • Learning that a relative or close friend was exposed to a trauma
  • Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criteria B (one required): The traumatic event is persistently re­experienced, in the following ways:

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

Criteria C (one required): Avoidance of trauma related stimuli after the trauma, in the following ways:

  • Trauma-related thoughts or feelings
  • Trauma-related reminders

Criteria D (two required): Negative thoughts that began, or worsened after the trauma, in the following ways:

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

Criteria E (two required): Trauma related arousal or reactivity that began or worsened after the trauma, in the following ways:

  • Irritability or aggression
  • Risky or destructive behavior
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

Criterion F (required): Symptoms last for more than 1 month.

Criterion G (required): Symptoms create distress or functional impairment (e.g., social, occupational).

Criterion H (required): Symptoms are not due to medication, substance use, or other illness.

Two specifications:

  • Dissociative Specification: In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli.
  • Depersonalization: Experience of being an outside observer of or detached from oneself ( e.g., feeling as if “this is not happening to me” or one were in a dream).
  • Derealization: Experience of unreality, distance, or distortion (e.g., “things are not real”).
  • Delayed Specification: Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

Current Treatments For PTSD:

Clinical studies and outcomes suggest a multimodal approach:

  • Psychotherapy: CBT (Cognitive Behavioral Therapy) with some goal of mobilizing the locked-in trauma sequalae.
  • Antidepressants: This is frequently the coexistence of depression and PTSD. There is much research to elucidate their relationship and possibly which one came first.
  • Alternative Drugs: Unfortunate but popular these compounds tend to mask but do provide what seems like temporary relief.

Below is a synopsis for the VA’s National Center For PTSD findings for 2002 through 2014:

  • Cocaine: Use has risen from 13% to 24%
  • Opioids: Use has risen from 10% to 14%
  • Cannabis: Use has fallen from 19% to 15%
  • Amphetamines: Use has risen from 3% to 5%

Using medical cannabis for PTSD:

Sativa (THC): Stimulating and activating. These strains are best used by persons with low energy or fatigue. Will cause a high. Indica (THC): Calming and even slightly sedating. These strains are best used for anxiety and sleeplessness. Will cause a high.

Hybrid (THC): A mix of the above. Will cause a high.

CBD: Anti-inflammatory and pain reliever. There is no associated high.

1:1: One part THC to one part CBD. Available in sativa, indica, and hybrid. May cause a slight high. (CBD counteracts the high that THC produces.)

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