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I'm Katie. I'm Garrett. And this is the bar is ankle high. We have a ton of new listeners. Um, that's pretty exciting. Yeah. So exciting. So if you're new, welcome. That's cool. Share us with everyone you know they don't care. Um, they just like to hear from you. I love the statements that you're making about other people's interpersonal relationships. Yeah, such confidence. I mean, it's right. They won't care. They'll love it. Yeah. They love hearing from you and especially stuff that you're interested in, like this super cool podcast. Um, also remember our merch is at bit.ly slash ankle high merch. All one word. And you can join our patreon at patreon.com slash the bar is ankle high. I can only person who thinks bitly when they see that. Yeah. Okay. I mean, no, I mean, you're not the only person like. Am I the only one? Yes. I mean, no. I do that to you constantly on this podcast. I don't have the problem with this. Oh, it just killed me. I think it's supposed to be like bitly, but there's a dot in the middle. Yeah, bit dot li. In li. Right. Yeah. How else would you pronounce it? Biddle? No, it'd be bitly. Biddle. E. That's going to cut this out. It's like we can sense it too. As soon as it happens, we're like, we've reached the point where it's going to get cut. I did get a commentary the other day. Hey, just so you know, I did cut a line. You said gangrenous, flappy doodles. And I was like, I got really offended. Why did you cut that? And he was like, oh, first of all, it didn't have to do with what you were talking about. Second of all, it was disgusting. Well, whatever you're about to say, I had the same attitude. I was like, yeah, well, you know what? Doesn't matter. He can't cut it out this time because gangrenous, flappy doodles just got sentenced to another 16 years in prison. Yeah. The same thing that our Kelly got sentenced. Yeah. What then doodles? It was a good day to not be a gangrenous, flappy doodle, which is every day. Yeah, it was a good day for women for sure. Yeah. I got pretty upset when I was reading that our Kelly's defense team was arguing that anything more than like whatever, five-year sentence would be tantamount to a life sentence because, quote, most of his crimes were committed when he was much younger. And I was like, that's the case. In fact, I would argue that he's even more of a predator if you don't punish him after convicting him of something like the fuck. The guy doesn't care that he can't own guns or vote. And it's not like he was 10 when he was committing these, I mean, he probably was when he was, I mean, doing sketchy shit, but it yeah, the that's no. Yeah, I got really mad. I was like, I'm playing up. Yeah, I was salty AF, but anyway, what a day to be gangrene. And yeah, so today we are talking about PTSD. So I'm not going to be going into like I personally have PTSD. I'm not going to be describing my own situation that caused PTSD, but we will be touching on some things that can cause PTSD. So if you're not comfortable with discussions of violence or intimate partner violence in particular, totally fine. I get it. But just, you know, trigger warning at the top. And if you're in a dangerous relationship or you know somebody who's in a dangerous relationship, you can go to the hotline.org. That doesn't leave a digital footprint at all. Or you can text start to 888 788 in the US, or you can call 1 800 799 7233. Okay. Onto the content. Here we go. PTSD is a disorder that, well, first of all, it stands for post-traumatic stress disorder, but it develops in some people who have experienced a shocking, scary, or dangerous event. The national or the PTSD alliance estimates that 70% of all adults have experienced at least one traumatic event in their lives. And of those 70% 20% will develop PTSD. Wow. That's a lot. Yeah. Only about half of those individuals who develop PTSD will ever reach out for help. Oh my god. I'm sorry. I'll let you finish. No, the numbers are wild. The National Center for PTSD. That's nestled within the Department of Veterans Affairs in the US reports that 7 to 8% of all people will experience PTSD at some point in their lives. Women are more likely to develop, women are more likely to develop PTSD than men. And genetics can play a part in determining whether you're more likely than not to develop PTSD. So I didn't see anything specific, but that stat that women are more likely to develop PTSD. I'm just wondering if it's just that women are more likely to report that they're struggling with it, rather than actually being more likely to develop it. And how often are women more likely to be a survivor of something that would cause PTSD versus being the party to cause the PTSD? Right. And I also just like while we're setting this up, I read actually, you know what it was is after the incident after January 6th, AOC was talking about she described trauma as too much too fast too soon. And I thought that was just like a really good way to summarize because there's such like an array of things that can cause traumatic events from people that that was just like a good way of yes. For sure. And in preparation for this episode, I've been listening to the audio book of The Gift of Fear by Gavin DeBecker highly recommend. So so good. That is about kind of relying on that intuition where you're like something off like I don't know what it is. Like I just don't like that person and it's like talking about how the author Gavin DeBecker has this company where he helps I like helps people overcome their trauma and identify like kind of learn how to trust themselves again and realize that like it's not their fault what happened to them of course, but also there were different things along the way that tipped off their like lizard brain that this wasn't okay and that something else was wrong. And they just ignored it either because they know that they're expected to smile and be nice or whatever. Or they're just being paranoid or somebody else that they know told them that this person was okay and that they trust them. Right. And also I mean he's obviously only talking to survivors. So he's also talking people through how they got to a point where they actually ended up trusting that intuition and that's how they managed to survive. Yeah. And and he starts the book off with the story of this woman Kelly I think is the name he gives her. And she's attacked by somebody who got into her secured apartment building. And he when he was done attacking her, he got up and he had a gun with him the whole time and closed her bedroom window and said I'm just going to go to the kitchen and get a drink but I'm not going to like I'm not going to hurt you I promise. And for whatever reason she got up she was like okay I trust you and got up and like tiptoed along with him in the hallway behind him. And then when he went into the kitchen she went out the door to her neighbor's apartment that she knew wouldn't have a locked door and like went in. And that's how she survived because he was in the kitchen looking for a knife. And he like talked her yeah he'd like talked her through like why like he said I promise. And one of the things is like making a superfluous promise because normal people don't need to promise you that they're not going to hurt you. Right. Right. After I just broke into your apartment. Right. Yeah. And assaulted you for three hours. Right. Like sir why else are you here? But it was that he closed the window and he had a gun. So he's like I'm not going to hurt you with the gun like don't worry and closes the window. And like that even though she didn't acknowledge it in the moment her brain was like we're out of here. Like yeah absolutely not. But I'll get to kind of healing in the at the end. But it's just such an amazing book I can't recommend it enough and it's he does the narration for the audiobook. So it's really nice to kind of hear it told the way the author wants it to be told. I love when the author does their own audiobook recording. Yeah. It's very well done and he did a the audiobook in particular has a like newer forward that he wrote in 2021. So it talks about like the pandemic and like lockdown trauma and stuff like that. And so but he says like the he's like you know yes it's 2021 but I'm going to be using gendered language because that what he originally wrote the book in like the 90s he's like I wrote this book. That's really far ahead of like when those conversations really started happening. Right. He's like I wrote this book 25 years ago but the stats are not different women or women presenting individuals are overwhelmingly the victim of violence by men or male presenting of individuals. So those are the pronouns that I'm using. Right exactly except for you know in all the statistics. Yeah so in any event it's just an excellent book. I highly recommend it if you want if you're listening you want some more information or you just kind of want to delve into that. I think it's just a great resource and that idea of like you know like you're not crazy like to just be like having a weird experience and it kind of just like validates. I think especially as women like that feeling of like no don't help me with my bags. Like you know if there's a different like and he says at some point in the book like men who don't hurt women don't bother to help you because they know you probably don't need help. Right. And if they are offering to help you they're not fucking weird about it. Like they don't insist that you accept their help. Right. Because that's crazy. Right. So um but yeah so it's just anyway. So anyway only 7 to 8% of all people will experience PTSD at some point in their lives but it's not just the result of a physical assault. It can be a car accident. It can be you know a traumatic medical event if you have like a sudden health crisis. But the fear you experience in that moment triggers a split second change in your body's chemistry to help you defend against the danger. However, people who develop PTSD can also or people who develop PTSD can also develop it after a friend or family member experiences the danger. So um if I'm sure that some of my family has some unresolved trauma from what happened to me. But not everyone who lives through a dangerous event will develop PTSD. So just because um and I'll go through like what the actual diagnostic criteria for PTSD is a little bit later on. So as I said the it's that split second change in your body to help you defend against the perceived danger which is what we all know is the fight or flight response. It's an automatic physiological reaction to an event that is perceived as stressful or frightening. Perception of a threat activates the sympathetic nervous system and triggers an acute stress response that prepares the body to fight or flee. So we talked about it I mean like episode one um the amygdala uh the part of the brain that's responsible for emotional processing and for interpreting images and sounds sends a distressed a distrust signal to the hypothalamus when danger is perceived. The hypothalamus is like a command center for your body and controls your involuntary bodily functions like breathing and digestion. The automatic nervous system has a sympathetic part which is like the gas pedal for the human body which is responsible for burst of energy and the parasympathetic nervous system is like the brake pedal that focuses on the rest and digest functions and calms the body down after danger has passed. So fighter flight was actually first uh described and coined by this is a hell of a title. American physiologist Walter Bradford Cannon in the book titled the bodily changes in pain, hunger, fear and rage to publish. That also sounds like my autobiography. A memoir of when I'm angry. Published in 1915 when he noted yeah he was studying actually animals and he noted that when animals were threatened their bodies released more adrenaline epinephrine which then caused a series of bodily changes including increased heart rate and respiration. He noted that these reactions happened automatically and served the purpose of helping the animal survive the threatening situation by readying the body for fighting or running. That's what Sophie just did. I like to eat myself across the room or do I want to jump off the bed. All right well I tried. Don't worry in like 30 seconds she's gonna be like pick me Hey, I have arms arms up like a toddler. I love my life anyway. And it is like you think about times where you get in a adrenaline rush like you're driving and you almost get to an accident or something like when it's a near miss how long it takes you to come down from that. Right let alone when there's a more enduring threat where it wasn't like I did this and I missed it but when it's something that it's not an avoidant and you have that experience you think about that adrenaline rush is like so much more intense and like for sure for a long like of course that leaves like an imprint. Yeah I mean and I've had actual car accidents before and you feel really shaky afterwards. Yeah and it's the adrenaline that just is because you're not really in generally immediate physical danger where you know if you're out walking around none of my car accidents anyway have been like that but you still have that like trembling thing and like it's it can be very overwhelming very quickly. Yelling or fleshing and pounding heart I mean it's it's your pupils getting really big like you think about all the things like from an evolutionary standpoint your body doing all these things to like make sure you're hearing everything seeing everything assessing everything around you to like save yourself it's just like it's a really just from like a biology perspective it's like very interesting. Oh yes I have a full list. Oh yeah. Excellent. Segu. You know me and my Segu's. Oh that's a new one I love that by the way. Thank God. Physiologically I know it's Segway guys I'm not an idiot. Oh no. Oh. Physiologically speaking though when you trigger that sympathetic nervous system the the things that your body takes care of that are involuntary that will mark it's marked by an increased heart rate dilation of the blood vessels that serve muscles and construction of blood vessels serving digestion blood shunted from skeletal to the skeletal muscles and brain increased oxygen to the heart and lungs dilation of bronchi and increased respiration rate your skin can become pale or flush depending on where your blood is flowing and like you said dilation of the pupils which is attributed to allowing you to see better and have better visual acuity. That's just amazing to me that your body like like they all happen like it's secondously yeah like that is just so amazing to me. Oh totally. Your body just handles it basically. Yeah yeah. One way. Yeah so all of that happens though because the hypothalamus activates the adrenal glands are old friends from hormones. Yeah we've been. And Dirty bitch. Which respond by pumping epinephrine aka adrenaline into the bloodstream epinephrine also triggers the release of glucose and fats from temporary storage sites in the body. So physiologically you can experience or psychologically rather you can experience racing thoughts and attentional focus on salient targets to identify the source of the threat and avenues of escape. Secondarily you can also start apprising your physiological responses which for folks with panic disorders that means that you can like feel your heart racing and then take that as a sign that you're having a cardiac event. So you'll have like that secondary B roll of thoughts of like okay I already ate I don't need to eat I can keep running um my heart's pounding if I don't stop running my heart will explode like you can have a whole sorts all sorts of things. Uh so as that initial surge of adrenaline subsides the hypothalamus will then activate the second component of the stress response system known as the HPA axis. It's a network made up of the hypothalamus pituitary gland and adrenal glands. This network relies on a series of hormonal signals to keep the sympathetic nervous system aka gas pedal stressed out pressed down. So if your brain is continuing to perceive that threat if it's not just a car accident or getting scared at a haunted house. If your brain is continuing to perceive a threat this HPA axis is activated and releases the corticotropin releasing hormone uh which travels to the pituitary gland and triggers the release of adrenocortico tropic hormone. That hormone then goes to the adrenal glands and causes them to produce cortisol which allows the body to stay on high alert. Cortisol. Hey plossum pronunciation by the way. Thank you. I absolutely wrote it out. Camera with that one that I couldn't remember the uh somebody writing with a pen named pseudanonymous. Oh yeah. Fuck that word. Yeah. Well it's not real. It's fake. Made up. Stupid word. Anyway. Good job on hormone pronuncy. Thank you. Um um. Cortisol is that essential hormone that affects almost every organ and tissue in your body actually. It's a type of steroid hormone and it suppresses inflammation but also affects your sleep cycles. In addition to regulating your stress response cortisol triggers your liver to release glucose stores for fast energy during times of stress. But this also means that cortisol is the opposite of insulin and the work your pancreas does. Meaning that crottingly high cortisol levels can lead to persistent high blood sugar and potentially cause type 2 diabetes. Extended periods of high cortisol levels can cause weight gain especially in your face and abdomen. Fatty deposits between your shoulder blades, wide stretch marks on your abdomen, muscle weakness in your arms and thighs, high blood sugar, high blood pressure, excessive hair growth in a fab individuals and osteoporosis and fractures. God damn you. And I mean on like a shorter term basis what we were talking about in other episodes were causing water retention. Yes. So um in addition because it in addition to triggering your liver to release those glucose stores it also increases storage of unused nutrients as fat. So even as you're eating food normally your body is poised to store it all leading to weight gain which of course you know doesn't make you feel any less stressed at all. Like why? Right and then you get this nice little feedback loop of exactly stress water retention, weight gain, right. Yeah until you give yourself diabetes. Basically. Yeah. That's good. So persistent effedrine surges, epinephrine surges like a firefighter having to constantly run into burning buildings for example can damage blood vessels and arteries increase blood pressure and raise the risk of heart attack and stroke. Wow. I know. Like sustained stress is that's why you know when you go to the doctor and they're asking about your stress level you're kind of like roll your eyes like no I'm not stressed but like you really think about the long term like that but I think you like the best examples when you see a portion of a president on the like the beginning of their term versus like the end of a two term presidency. How much it ages them like the high stress does it's like smoking or being in the sun a lot like it really ages you significantly. Yeah. Oh absolutely. And plus physiological stress on your body. Exactly. So you know there's also that idea of when you are putting on weight your heart is just going to be working harder anyway to do basic things like carry your groceries inside the house or whatever. If you're like me right now going up the stairs. Any number of stairs really. I don't know if that's because of the cortisol levels. Yeah. Or just the bibbib. Baby Shrek. We're shopping names for Garrett's baby if you haven't guessed by that little interaction folks and apparently don't get was overruled by her spouse as well as Piona because Princess Piona is a little bit different. After an ogre which is fair like I get it fine whatever I'll let go but for a hot minute there. Don't get. Shrek was also overruled but you know whatever if she's green I don't know what to tell him. Well so it is girl. Yeah I guess. Actually she's green I guess there's like a slew of problems. Yeah it's like um extra jaundice when you turn green. You're like a brand new banana name it banana. Okay what's that? Banana is getting out into the list of no thank you. Well I don't know what to tell you. We're already vetoed Gandalf and Shack. So apparently you can't name her child Gangrenous Flappy Doodles either but okay. Okay so chronic low level stress like hating your job or taking care of a sick family member keeps that HPA access. I keep saying it we are HPA access activated which can result in suffering from health problems associated with chronic stress as well. In 2010 shower and Albert posted a more modern interpretation of the fight or flight response which provided a more elaborate model of the physiological psychological and behavioral responses to threat and coined the term defense cascade. These researchers expanded on fighter flight to include freeze flight fight fright flag and faint. So I definitely wouldn't have been able to get through that list good job. Woof. Okay a note on fainting. I found a paper referring to fainting as a party of the quote paleolithic threat hypothesis which argued that the site of blood or sharp sharp object coming towards you as is the case in the fear of needles that can cause fainting as an evolutionary response for what it's hard to mean either but I know that it's a common thing when people see blood or like a fear of needles. Yeah like basically they were saying like it's just evolution like like it's just like it makes sense why your life's go stiff and you tip over. In the Steve Carell and Paul Rudd movie dinner for schmucks Steve Carell was getting attacked by a woman and he pretended to like pass out and she stopped attacking him and his explanation was that it's instinctual humans don't want to hit something that's already dead. And without going to details can confirm that that works. So yeah I wonder if that's why they tell you to like play dead like if there's a bear. Yep I'll tell you to do that. I don't know that I'd necessarily I think it depends on that. So don't use this advice to survive a bear attack. Yeah that's not advice. You're thinking out loud. Yeah. I think it depends on the bear because a like polar bear or a grizzly bear will eat scavenged meals. So I'm sorry that's a cartoon. If I look like a picture. You're asking me if the man the man who wanted a picnic basket would eat a human playing dead. Is that what you're asking me? Oh god. Oh I'm trying to make a dark topic funny. You did good. I really didn't think Yogi bear was gonna come up. Oh my god. So no I have no fucking clue if you're supposed to play dead for a bear. I'm pretty sure you're not. So did you google this solution? Or were you willing to do that? I definitely didn't. You mean about bears? How to survive a bear attack? No I didn't. Should you play dead in front of a bear? I feel like one is you're supposed to make yourself look big and not run because they can run super fast. According to the National Park Service and an article called staying safe around bears. This is wild. Okay once a bear has noticed you and is paying attention to you. Additional strategies can help prevent the situation from escalating. One. Identify yourself. I am guaranteed to make you. By talking calmly so the bear knows you are a human and not a prey animal. Okay but I feel like the whole setup here is that I am prey even as a human. Yes remain still. Stand your ground but slowly wave your arms. So I think you have to do the angels in the outfield sign. Okay perfect. Perfect. And then you have Danny Glover saying you got an angel with you right now. And then. And it may come closer or help the bear recognize you as a human. It may come closer or stand on a time legs to get a better look or smell. A standing bear is usually curious not threatening. I disagree. Yeah point two stay calm and remember that most bears do not want to attack you. They usually just want to be left alone. Um bears may bluff their way out of an encounter by charging and then turning away at the last second. Tell you what that's an excellent way to bluff my underwear and to holding a bunch of shit inside of it 100%. How do you not like and that's that's where I would definitely die from a bear attack because I would immediately run and they're super fast. A scream or some movement may trigger an attack. I never never imitate bear sounds or make high pitch squeals. Oh up small children immediately. I'm absolute toast. It says slowly wave your arms above your head and then tell the bear to back off. But don't grow at it and don't say it in a high pitch voice. Right. Also it says do not run but if the bear follows stop and hold your ground. A bears can run as fast as a racehorse both uphill and down. Absolutely not. I feel like I read a thing they said that they can run fast or uphill than they can like on flat land. That's fucking nuts. Yeah. Holy shit. Holy holy holy crap. If you are attacked oh they also said don't drop your pack as it can provide protection for your. Yeah and then specifically for brown and grizzly bears if you're attacked leave your pack on and play dead. Lay flat on your stomach with your hands clashed behind your back. Yeah. Yeah. So you like to make it. Oh yeah that makes sense. Yeah. Um I feel like I I don't know why I read bear attacks or rival tips like fairly recently so I don't know why you did that either. Um I thought you said you were on Zola. How did it come up? I don't know but you're supposed to also spread your legs to make it harder for the bear to turn you over and remain still until the bear leaves the area. Fighting usually increases the intensity of such attacks but if the attack persists fight back vigorously use whatever you have at hand to hit the bear in the face. Well I don't know where else I would hit it because it's I imagine if a bear opens its mouth it's covering my whole head like I just assume it can just swallow me in one bite. I feel like my only thing and for black bears do not play dead. By the way so my parents were camping one time and a bear came onto the campsite during the night so they're like sleeping in a tent and my mom said that like the bear's nose like they sniffed all along the edge of the tent. So they're like asleep and she said the bear is like sniffing like completely around like the whole thing. She's like they had to just stay like perfectly still and she said she was like cold sweat. That's a that's how fight or flight where you can do neither. Right. Completely still and quiet. Holy shit. That's wild. So anyway I guess yeah if you see a brown bear play dead and if you see a black bear run for your life is the tip and bears didn't fuck with people. Apparently they were. If any bear attacks you in your tent or stalks you and then attacks you do not play dead fight back. If they are stuck. This kind of attack is very rare but can be serious because it often means the bear is looking for food and sees you as prey and that concludes the National Geographic Hour of the bar's ankle. I am. That's I'm way more afraid of bears now that I was. Yeah I wish I can remember why I was looking at bear survival tips not that long ago. I don't know man you'll think about it later on when you're like making mac and cheese or something random. Yeah. That's something I will probably be doing today so. I am. I am. The exact right amount of time together. If I'm not a bagel I'm a mac and cheese. That's the only two options. Oh my goodness. Okay so. Oh yeah we were talking about fainting I think that's how we got here. Oh yeah no we were talking about PTSD and stuff. My bad. I had a little bit of a run to it. I clearly thought that we would have some sort of side quest because my next note literally reads so going back to how the brain works. Oh no. Almost like we've been here before. Oh interesting. Hey Chappu. The amygdala to hypothalamus discussion happens so quickly that the defense cascade thing starts before your vision center has finished fully processing what is happening. So on the one hand this is how people can pull their hand off of a hot pan right away without having to think about it. Like and without necessarily registering that they touch the hot pan. Right. Like you didn't see themselves touch it or whatever. On the other hand when you've experienced a traumatic event like a violent car crash and your brain continues to perceive a threat when there isn't one that's when you end up with the long-term physical and psychological issues. Right. So according to the National Institute of Mental Health to be diagnosed with PTSD an adult must have all of the following symptoms for at least one month. One at least one re-experiencing symptom like a flashback bad dreams or frightening thoughts. Two at least one avoidance since avoidance. I'll get it. You came in strong with the hormone names and now I did. I did. You definitely know. You doomed. Two at least one avoidance symptom like staying away from places events or objects that are reminders of the traumatic experience or avoiding thoughts or feelings related to that event. Three at least two arousal and reactivity symptoms such as being startled easily, feeling tense or on edge, having difficulty sleeping or having angry outbursts. And four at least two cognition and mood symptoms like trouble remembering key features of the traumatic event. Negative thoughts about yourself or the world, distorted feelings like guilt or blame and loss of interest and enjoyable activities. So you have to have all of those symptoms for at least a month. I don't, I mean the way I'm reading this it's like in a four week period you have to have one flashback, one instance of avoiding a place or event. Two moments of angry outbursts or difficulty sleeping into feelings of guilt in a four week period. Which really is like when you think about it, a four week period is not a super. I mean if you're experiencing these can feel so much longer than right or weeks, but really is not that long period of time. No, and all of these things like if you have been in a traumatic car accident or something or had a traumatic medical event, you can have all those things in the week immediately following everything. Yeah. And that's totally normal. A girl that I went to law school with had a car accident last fall. And she posted, I think she was T-bone or something like she was pushed into somebody else and ended up getting T-bone. I don't know. But it was like it totaled her car and she was and she posted something to her Instagram stories about like and she was like all splotchy and have been crying and she was like I just keep crying on an awful day. And that's like a totally normal response though because your body is trying to regulate the idea that you're not in trouble, but you're so hyped up that it takes time to come down from it. So in order to kind of like flush out those hormones, you have to like give yourself time to get through it. But also side note children can also have PTSD but their symptoms look different. It can look like bed wetting, forgetting how or being unable to talk, acting out the scary event during playtime and being unusually clingy with a parent or other adult. Sometimes that gets misdiagnosed as ADHD also on kids. Yes. Yep. Yep. You will get there. Oh, sorry. Hi, my name is spoiler alert. Nice to meet you, Mr. Bear. You said it was yogi was your first name. Huh. Interesting. Like lugi but with a why? Okay. Why do you say picnic like that? Oh, God. Um, the thing with PTSD is that some are all of these symptoms like I was saying are normal for a few weeks after any traumatic event. But it's when they are persistent and last for more than a month are not due to substance abuse, medical illness or anything other than event event itself that it could be PTSD. Some people with PTSD also report not displaying any symptoms for weeks or months after the event. So you may not have that initial, you may not feel like you're having that initial physiological reaction but then later on it kind of sinks in. And then you'll have those for symptoms of like flashbacks and avoiding places and being really startled easily and like not being able to enjoy stuff that usually did before the event. And PTSD is also frequently accompanied by depression, substance abuse or one or more other anxiety disorders. So as I said at the beginning, I was listening to the gift of fear by Gavin DeBecker in preparation for this episode. And he mentions that it's that initial triggering of your fight or flight response that gives you that gut feeling that something is wrong. But when like when you're walking at night and you already have your head on the swivel because you know the statistics. But when you have that feeling in the grocery store in the middle of the day, it's the same thing. It's just whether you're consciously choosing to be more alert or not. It's like it's like physiologically not that much of a difference. But it's still your brain acknowledging that like something like what's the cause is the cause because you're making a conscious choice that yes, it could happen at any time. Are you doing it because you're constantly on edge and always in that state. Right. And I think one of the things that I really had to learn because PTSD is also not necessarily a life sentence, it you can get over it for kind of lack of a better phrase. Like you can process. Yeah, you can process it and move on. And I think like the feeling that you somehow caused whatever happened to you, this fucking cat. I swear, I'm watching her like and like related to what we're talking about. And I know I've mentioned it before, but Nicole sacks the podcast, the cure for chronic pain. Yeah. One of the things that she talks about is that the like ragy feelings that you can get or the always being on edge are like highly reactionary responses to things can be caused by having like unresolved trauma, unresolved like something that was triggering for you or if there's something that was causing you a lot of stress or anxiety that you haven't processed until you process it, your body is just always going to be in that heightened state where you're kind of always on a fight or flight and you're kind of always in that highly reactive reactionary state, which I know like for me personally, because I had a very, I wouldn't say I had PTSD, but I had a extremely difficult stressful job situation that really took a toll on my mental health for a while. Really like the pandemic kind of gave me the quiet space to work through that a little bit, and it helped using kind of her guidance on her podcast kind of helped with that because processing it made it. So I was like really able to like work through some of that when you know life is busy and it's hard to find quiet space to process things I think sometimes. Oh totally, I think it's it's really hard to give yourself permission to take the space you need to process that stuff. And I also think, at least for me, what I really had to learn how to do was how to forgive myself. And I think a lot of times with a traumatic event, particularly you know like intimate partner violence, I think a lot of the advice from people, meaning well, is like well you can't carry that with you forever, you have to forgive them eventually. And like I'm sorry, but no I fucking don't and no I won't. I won't forgive people for doing what they did to me when I didn't deserve it, but I did need to learn how to forgive myself. And once I figured out that and how to do that, then I was able to really move out of having my primary PTSD symptoms constantly. Which is a hard thing to do like you think about it on even like simplistic levels. Like you find something at home and you have to go back and get it and how mad do you get it yourself. Oh totally. And I think you know having ADHD makes it so much worse. Yeah. Especially being undiagnosed I think you know because the masking that we do makes it so much easier to blame yourself when she's attacking my hair. And I think also the rumination. Yes. And that's just like looping. Yes, because you just think like it's that guilt blame cycle of if I had just done this one thing differently that never would have happened. If I had just done X instead of Y. Yeah. This would have happened. It's harder about this or if I had been more attention to that. If I had stopped at the yellow light instead of trying to make it or you know whatever it is. And it's the kind of thing where it's like you know you can't you know it's it's natural to want to because I think there's also this proclivity to saying well if if it's if it comes down to it was my fault then I can control that in the future. And the reality of it is and I think part of that like rumination loop is that you know it's not your fault. You know that there's other drivers on the road that are outside of your control. There's people in your apartment building who leave the front door unlocked instead of making sure it closes securely. There's all sorts of things that you are not in control of and realistically and like where you exist in the world you're in control of like 0.5% of things. So and with with the high anxiety that can be triggered by that. It's like when we're talking about the the justice sensitivity and then like the bullets with the circle of control. Yes and the circle of influence and like understanding and not even understanding but like like coming to terms with being out of control of so many factors. Yeah in that whole process of you know forgiving yourself and knowing that certain things weren't your fault. Like that's a when you're in a heightened state is so hard to do. Yes because it is so logical. Yeah like intellectually I knew right. Right. Like I knew intellectually it wasn't my fault. Like and that's the other thing of you know like everybody would say it's you know this isn't your fault. You know you're a good person. This wasn't your fault and that was the resounding chorus but then there was also like well you just can't harbor that because that'll do more harm to you if you don't forgive them. No I think it's perfectly fine that I don't forgive that. That's totally not about like forgiveness of them. Yeah no I hope I hope that that person gets chronic butthole spiders and you know chokes yeah and like chokes on uh genital warts that clog their throat. Like that's what I hope for that person. Chef's guess. Thank you. Yeah I don't wish anything good for them. Yeah and I mean realistically I'm sure that they don't wish anything good for me either. But again you know what that's not within my access of control. Yeah right yeah it's not and I think you know again like I mean I was going to therapy weekly um technically I was only diagnosed with a cute traumatic stress disorder because I got into a therapist's office within two weeks of what was my experience so I wasn't within that post one month thing. But that's wild too. Two weeks is like an eternity when you think about something like that. Oh my god it was a rough two weeks because all I could think was like I'll never find somebody with an opening because this was pre-pandemic like way pre-pandemic. Yeah so um it's always been hard to find somebody with an opening. Yeah yeah yeah right and like telehealth wasn't an option then. Yeah so it wasn't um but yeah no it was wild so um yeah finally getting in somewhere so technically I guess I don't officially have a PTSD diagnosis but the fact that I get triggered every now and again yeah tells me everything I need to know. Guess what in four weeks? um but that being said I mean I'm almost five years post incident personally and I'm doing very very well um so it thanks um except for this fucking cat um it's waiting for her to turn and squint at the camera again. I don't know what she's staring like she she's just Lord. She's just Lord. Yeah I mean there's a tree outside that window but I don't think there's anything on it but whatever what do I know um I also can't clean the windows in my apartment because they're old timey. Oh they don't fold in so you can't clean the others right yeah so they're there's no getting no clean right yeah so it's just it always looks like it's snowing because it's just yeah I mean mine are dirty enough right now but same. Yeah I don't know what she's looking at. But anyway um yeah the gift of fear by Gavin DeBecker I highly recommend it um it's an easy listen um I usually will have like old episodes of podcasts that I've already listened to on in the background and I'm like cleaning and stuff but that's been a good one and one that I can listen to like and like do laundry or leave my apartment without like risking having like a breakdown and like really getting in my feelings. But yeah I know highly recommend um so yeah also again as I said at the beginning if you or someone you know is in a dangerous relationship um you can visit the hotline.org um from your computer or mobile device without leaving a digital footprint or you can text start st-a-r-t to 888-788 or you can call 1-800-799-7233 uh in the US if you're struggling uh with thoughts of hurting yourself or others you can call 988 to be put in touch with a trained crisis counselor um any day 24-7 this cat she's with the girls she's on one today I wonder like when you mentioned genetics playing a factor I wonder if like generational trauma if that also then makes people like more susceptible to PTSD uh it does yeah yeah exactly oh do you yes captain spoiler does it again yeah help me um like hire me to spoil an event for you uh just let me know reach out to me on Instagram um yeah so as uh you astute least sagued for us at least there wasn't bears in this sagu that's true there's almost bear-free um oh my god returning to like Dwight True and so beats I do love beats bears beats PTSD uh uh so yeah so why am I discussing this on an ADHD podcast so some studies have actually found that when you have ADHD you're four times more likely to also experience PTSD at some point in your life four times I know that's significant yes damn oh I agree I was surprised by that yeah I found one article that reported comorbidity uh for ADHD and PTSD to range range from 12 to 36% across the lifespan so if you have ADHD you're 12 to 36% more likely to also have PTSD it totally makes sense though because you think about like things that obviously we've discussed before but that shortened response to things um yeah that makes sense that like you figure that adrenaline response which is already like instantaneous yeah combine that with like a brain that already has like a hair trigger with something like that and then the inability to like settle after and then being caught in that loop of rumination like it 100% makes sense and for to have a underdeveloped or late developing prefrontal cortex yep that affects your ability to visually interpret what's happening around you so you could be perceiving something as you know a threat like like you said with RSD like you're perceiving something as a threat that's not a threat and so you're having a symptom of my friend doesn't want to be my friend anymore they don't they don't want to hang out with me anymore and like the reality is like their aunt is in town and they just have to spend time with their aunt like it's not yep you know like it's actually watching an episode of Bob's burgers this morning and it was one of the Thanksgiving episodes where Gail thought that Mr. Frond broke up with her because she was going to spend Thanksgiving with his aunt and she was like it's just an excuse he hates me I mean who spends Thanksgiving with their aunt and Tina's like oh you know that you're our aunt right she was like oh do you think he was telling the truth Gail that episode where she's they go to their spending time in her apartment and then Bob goes to like get them in the snowstorm that was the one oh was it oh yeah and she has to like bring her cat in a box yeah so that he doesn't get lonely or something and she's pretending to have broken her leg yeah oh my god yeah that was the one that's a funny one yeah I was I was cracking up um but yeah so symptoms of ADHD and symptoms of PTSD that can make getting a diagnosis for either really difficult include difficulty concentrating and learning easily distracted trouble listening or seems like you're not listening disorganization hyper activity restlessness and difficulty sleeping so um especially among children that are potentially being diagnosed for ADHD which could be valid they could also just be dealing with PTSD right so studies have found that those of us with ADHD have a significantly greater quote insular cortex activation on quote during fear conditioning and extinction protocols and greater hippocampal activation indicating abnormality in the fear circuits in the brain meaning the ADHD brain already mimics the PTSD brain at baseline yeah that that totally makes sense to me right yeah no I read it and I was like oh yeah that I get it for sure and studies um that studies researchers positive that this could help explain ADHD emotional dysregulation as well as the increased diagnosis of PTSD and people who already have ADHD uh because as you just said the ADHD brain is operating at a higher frequency to begin with so once our amygdala is triggered through a traumatic event our baseline is so significantly increased that it makes it so much harder for our brains to get back to a healthy baseline without suffering those physiological and psychological long-term effects woof so you're a wizard I guess I don't know you didn't just call me spoiler um children as I said can experience trauma that results in an ADHD diagnosis but it could be PTSD disguised as ADHD and could be caused by living with an emotionally or physically abusive person addiction in the home physical conflict in the home sustained physical hardship such as housing or food insecurity witnessing or experiencing violence in your neighborhood or school upsetting a separation from or the loss of a parent due to an overseas deployment incarceration cps involvement or death suffering recurrent racism and discrimination as a minority or disabled individual uh refer you back to our episodes on racial medical bias where we discuss that a little bit and the emotional aftermath of a divorce so the continuous activation of an alarm state is harmful for your health but for a child it can overwhelm their developing emotional capacity so they can't achieve a level of self-regulation that they otherwise might be and as a result the child grows into an adult and tends to over interpret problems or challenges as much more serious than they are so the child as an adult can over react to a mild insult or offhand remark easily startle have poor sleep chronic anxiety and overall poor health and if this is you it can feel like poor attention impulsivity up and down emotions and you can feel easily overwhelmed by additional or unexpected stress and then again children with ADHD can also be subjected to additional trauma if they're not diagnosed and their impulsivity hyperactivity emotional dysregulation can lead to them being over disciplined thereby creating another cycle of trauma and stress response in their brain and as we discussed in our medical bias medical racial bias episode especially black and brown children at least in the US are more often diagnosed with conduct disorders rather than ADHD or potentially PTSD and so the interventions for those things are markedly different than the interventions for therapeutic exactly so treatments treatments is complex and it really varies depending on the patient and what your goals are the important part of treating anxiety is to help the patient understand the purpose of the fight or flight response so that the patient can understand what is happening to their body and assess whether there is a genuine threat or a perceived threat and that they can work on talking themselves off of that ledge medications of course speak to your doctor if you think that you're struggling with PTSD it's plausible that they will what's going on over there I have a like contractor bag of clothing that I've been like slowly compiling and Sophie just goes spulunken checks it out I swear shape me from my shelf I feel like I did read something about like when you experience a traumatic event that your like it stops your brain development so you wind up like stuck in that stage where that occurred I think based on what I read that can be what happens I think of it more based on everything that I read it's almost like the rings on a tree where they can see whether there was like a period of drought or something so it's not necessarily that like you just stop developing altogether but they're if for whatever reason they could do that with the human brain they would see a period where there was like an excessive deposit of adrenaline in your brain or something or if you're looking like an EKG like that you can see when there's a spike or when something was different right yeah um I think it's more like that so it's and I that being said though the longer that period persists you would in a tree you know those rings would be thinner so the tree won't be as strong or as big as it could be so at that same age or at the same age of its peers that are at that same age so yes and no it doesn't I don't think it necessarily stops if this if you're a child who's experienced trauma I don't think it stops your development but I do think that it perhaps stunts it for that period that you're experiencing the trauma and then the rest of your life you are kind of potentially working at a little bit of a deficit and you have to make it up which like same thing with ADHD where they talk about how like parts of your brain are a little bit underdeveloped so you wind up kind of playing catch up with peers right man there is a lot of overlap that's wild yeah no totally and I think um for me I mean I know that I always had ADHD but I think when I experienced PTSD it made my ADHD symptoms so much more obvious pronounced and I was way yeah I just wasn't able to mask them the way I used to I wasn't able to cover up my inattentiveness an inattentiveness and my impulsivity yeah um because I was already just at such a high frequency that I I didn't have the bandwidth to say like okay Katie put down your fucking phone yeah your brain's like I do want enough right exactly and like my brain was just like I just need to not think about anything right now yeah unfortunately it was saying that to me hmm 20 hours a day yeah um so yeah as we were saying talk to your doctor if you think that um an anti-depressant or anti-anxiety medication would help you um your doctor might also prescribe specific medications to address other symptoms like a sleep medication if you're really struggling with sleep um which if you have ADHD also you may also be struggling with sleep right and of course um you know it's also I think worth also talking to your doctor about whether you are self-medicating with alcohol or cannabis or some other um recreational uh substance because not only do they need to know that before they start prescribing these stuff but it's possible that maybe you just need a uh support group to separate yourself from using that stuff for the time being while you get everything else under control um so you know no t no shade I mean I still have wine but um there's definitely times where I've been like I need to not drink wine that is yes getting to be online and that's also something that you can discuss with your therapist because we love CBT here um I saw something that said talk therapy for PTSD usually last six to 12 weeks um yeah I'm absolutely not I don't know if they meant like an inpatient situation yeah I mean if you're putting me in Britney Spears therapy and I'm there for eight hours a day yeah maybe six to two yeah it was very I was like um I've never seen something with a time frame model I like I don't know yeah it was very strange and there wasn't like a um like an explanation of like there's a specific course of treatment for PTSD that your therapist should be working on you with I have no idea but it was just one of those things it's like okay that's going on the same list as those ADHD tips that we read where it was like like huh recipes out of magazines and get your bug out bag ready for the end of days yeah make sure you have cash on hand it's important um because you know if the world ends cash will be king uh yeah I rolled my eyes when I said that just for context if you couldn't hear it yeah if you couldn't hear my eye roll there was an eye roll of it um according to the National Institute of Mental Health Effective Therapy tends to emphasize a few key components including education about your symptoms teaching skills to help you identify triggers of symptoms and teaching skills to manage those symptoms and control your reaction to those triggers um can confirm I had to have my therapist actually say to me like I was describing a situation and she was like so you were triggered that's what that was that's why you like scream cried in your car afterwards you're like for like all rude I was like oh that's what triggering means got it I still experience things and I'm like why did that make me so mad so fast yeah totally which I find it's one of those things where it gets me so irritated when oftentimes conservatives on social media would be like oh you triggered and it's like I don't know it's it's kind of like a dog whistle thing obviously but it's just like calling people woke yeah but it's it's one of those things where I feel like it's like that's a real thing and so like on the one hand people are who say it kind of nonchalantly where they were like lol I was triggered so I had to do some shopping and they don't mean it as a dog whistle as well are doing like just as much of a disservice to that phrase and to the the acceptance of PTSD is like a real thing that happens to a lot of fucking people it's like a it's like OCD yes he's like oh I'm really OCD so I got a clean like oh you just like do you like a clean space right that's not OCD and um you know we'll cover that as well in the future um because I think that that's a common comorbidity with ADHD um but yeah so it's just one of those things where I was like I actually I really did need somebody to point out to me that that was a trigger yeah it's what I realized what it was yeah that's a hard thing to unpack too because you're not just saying like oh okay this event this stimulus happened and it caused me to react this way it's you immediately have to have an understanding of why because you don't have that context it's not gonna make sense you know somebody said something to you and it upset you you're not gonna understand until you really have that full picture I personally feel like just identifying triggers is that alone is like major growth because that's a really hard thing to do oh for sure absolutely and it does sneak up on you like when PK and I first met I was triggered by like him playing with me like he like made a motion and it just caught me off guard and startled me and like I was not okay for a few minutes and it was not something that it would have even occurred to me to mention to him right because like I mean he knew my past but it wasn't something where I was like okay make sure that you don't do this around me now he knows because he saw it in real time but it wasn't something that I had encountered before because I don't go to haunted houses and I don't I don't go to things where people sneak up on me yeah I've never liked that right turns out now I really don't like it yeah um that's the other thing too like there's sometimes even like on very on a very mundane level you know like my spouse will say something to me and I'm immediately like in a foul mood just like this little offhand of comment and I really have to like take time to think about I'm like oh okay because of this person used to say something just like that to me but they meant it this way right so it's yeah that's a that's a hard thing it's hard to put your finger on and I mean it also like evolves too as you get older yeah there's things that you forgot about or things like really it's it's like that what is that Supreme Court decision where they're like I can't describe pornography but I know when I see it yeah that's it's kind of like the same concept yeah I think it was Scalia that said that actually oh I take a piece of shit um sorry sorry for sorry yeah talk about like a walking flappy doodle yeah um and so CBT can also include exposure therapy which can mean that you're imagining writing about or physically visiting the place where the traumatic event happened and cognitive restructuring helps people make sense of the bad memories which is especially helpful if you're struggling with guilt or shame around the event um in general therapy you can teach people about trauma and its effects teach anger and relaxation control provide tips for better sleep diet and exercise habits and help you identify and deal with guilt shame and other feelings about the event and its aftermath and can just help you change how you and the people around you react to your PTSD symptoms also engaging in mild physical activity can help reduce stress like going for a walk or doing like a youtube yoga class if you're not comfortable being outside right now setting realistic goals for yourself breaking up larger tasks into small ones um which we talked about I think it was in our procrastination or time management episode um how we put like the littlest things on our to-do list like well like for me it's like laundry where I'm like put laundry in washing machine put laundry in dryer fold laundry put laundry away and like I break it down into all these little tasks so that I can like cross them off one at a time yes but it just helps your brain see it all planned out so that you don't have to ask your question of how am I going to do XYZ yeah like it's it's not just the task it's all these other little tasks and I can handle the little tasks yeah because I definitely have a tendency to procrastinate and avoid when something seems like totally yeah yeah um and you know identifying seek out your comfort places and situations and people and um this tip was from what something I read but it was like expect your your symptoms to improve gradually not immediately and I don't think that that only applies to PTSD I think it applies to basically everything I think healing whether it's healing a broken bone or healing from a traumatic event is almost never linear um healing isn't linear neither is growth in general when a child learns to walk they still fall down like all the time like they immediately fall down they're real bad at it uh when they first let's just suck it walking stupid baby that baby's an idiot I can't even walk um but I mean consider like even adults fall down sometimes and theoretically they've been walking for years um decades even and but you still like we'll just get back up and continue walking like even if you scrape your knee you're like oh fuck but you continue to do it and so when it comes to healing from an injury I think it's just really easy to forget that you will have moments where you feel like you're back at square water like you're not making any progress and that's fully normal um but in my personal experience especially healing with PTSD it it will never be a linear process like you will like day to day even within the same day have like really big highs and then you could have a low and just as what it is and it's just part of like kind of the grieving process I think yeah um you know you have to go through those stages of grief and get to the point of acceptance but it takes a long time especially when it's not something I guess as simple as like a grandparent passing away from old age like that's sad but easy enough to accept when they're 90 and like right and the stages of grief really shouldn't be numbered because they don't necessarily happen in that order exactly yeah um and yeah it's pretty much all I have um if you have had an experience with PTSD let us know um you know we can share it anonymously or keep your name in it it's up to you um our default if you message us on Instagram is uh we'll share your your story or your statement but we'll redact your name or the names of people just in case um so you don't have to worry about somebody seeing it or whatever um but yeah that's all I have on PTSD and you know I was happy nice to yourself if you're going through this there's no blueprint for how it's supposed to look or shake out and um you know you'll come out this other side you know the same as you were before but maybe even a little bit better and that's okay too yeah that's nice well and like and not that like this does not apply to all situations but even like bad experiences that I've had this is gonna sound like really shitty but it totally doesn't apply to like really bad situations but things that I've gone through like I don't have a feeling of regret about them because I know that ultimately I grew from them like even if it was horrific or even if it was sad or hard or really stressful or temporarily felt like it was like damaging I think long term knowing that I grew and evolved after it or because of it or in spite of it um that it ultimately helped me become like who I am now yeah I think um another phrase that I heard a lot was like well everything happens for a reason yeah which I don't think that one yeah it thankfully people didn't say that to me like day two but um I I do agree with it in that same vein of what you said like you know you you grew from it and you know I'm I'm a completely different person than I was five years ago um personally and professionally I I and I never would have met pk if it what happened to me hadn't happened to me and my life hadn't taken the turn that it took so um as frustrating as it is and as much as I am dealing with the sequelae constantly um I don't you know I think you can regret what happened to you without um shitting on who you are because of it right like I I wish that there was a different way that I could have grown right like if I could have ended up exactly where I am now without having to go through all that right I would have taken that option like absolutely right um that's just not how it worked out for me this time and I have you ever seen the Robin Williams movie what dreams may come no it is excellent it is one of my favorite movies and in that movie he um finds his soulmate and they go through this whole journey and the at the very beginning of the movie it's him as a younger guy and his would-be wife and he's like oh we met at the beach um she was sailing her boat and she was wearing this red sweater and like that's what I remember is like her in this red sweater and that smile and then at the end of the movie because they're soulmates they're like well do you want to try it again and it was like it whatever screen fades and then it comes back and they're like children and it's a voiceover saying like I met her at the lake on the beach and she was sailing her boat and she's got like a toy boat that she's sailing and like she was wearing a red a red dress or something so like all of those like key details were the same it was just like a different location so it was just one of those I think it provided great perspective and continues to provide great perspective but it's that sort of thing where I'm like I wonder if in another life I'll still end up with who I'm supposed to be with just in a different way and it's okay like I came out the other side but you know I also worked really hard yeah I was you know I was in weekly therapy for a year and a half basically and you know you got to do what you got to do yeah I also took a second job so that I had like no time to be alone with my thoughts for a while which was definitely not healthy but it got me no but it's like sometimes it's getting yourself through it's not like I need to do what is the most because sometimes I do have a tendency to approach something from like such a practical perspective that it's like you're you're being just let yourself do what you need to do and don't try and do everything perfectly yeah definitely um um so yeah you know if you're going through this um you know my heart goes out to you it doesn't have to be forever just know that you can get over it um and it'll probably happen when you don't realize it's happening and you also don't have to forgive everybody and you can wish them a lifetime of bucklespiders yeah or bear attacks or bear attacks because the bar is ankle high sometimes bars and hell sometimes along with that bar can spot hole spiders and gangrenous laughy doodles thanks for tuning in we'll be here next Thursday with a brand new episode to delight your brain juices in the meantime the best way to support us is to leave us a five star review on apple podcast Spotify or your favorite podcast streaming platform you can keep up with us during the week on instagram and facebook at the bar is ankle high and on twitter at ankle high pod if you want even more ankle high hot takes in your life and have a few dollars to spare consider joining our patreon at patreon.com slash the bar is ankle high we post bonus episodes there full of our karaoke attempts and my the asshole discussions and wondering how we even managed to survive this long patreon subscribers also get 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