One of the challenges with PTSD when you see that long laundry list of different types of symptoms that somebody may have is that it can be hard to figure out, am I treating PTSD or is this a different presenting concern? So the importance of a good differential diagnosis. What makes it even more challenging is that PTSD is a sticky disorder. What I mean by that is that it is more likely to present with comorbidities than it is to present all by itself. So what you're trying to figure out is do I have something else?
Do I have PTSD or do I have PTSD plus something else? So for example, I might see someone who's coming in who's having panic attacks. It may be that the person has PTSD plus a comorbid panic disorder, or it may be that as I am asking about the context of the panic attacks and the kinds of symptoms the person is having, they're only occurring in response to a event. At that point what I may have is PTSD where the person is experiencing high physiological arousal. The point of this is that that differential diagnosis is going to help you with picking the right path for treatment.
You may find that if it's PTSD, you're gonna choose a trauma focused therapy and often these comorbidities may improve as you are helping the person recover from PTSD. On the other hand, if what you're seeing is that it is a different disorder, better course of treatment would be treating that other primary disorder instead of putting the person in a trauma focused therapy if it genuinely is not the trauma that's driving the symptoms. Some of the questions I may have in terms of a differential diagnosis because they are so commonly misdiagnosed as PTSD or vice versa are things like bipolar illness, panic disorder, generalized anxiety disorder, attention deficit disorder, sleep disorder, or depression. Often these symptoms overlap with PTSD or are commonly comorbid with PTSD. So that's part of what I'm trying to determine. So let's take for an example, a patient walks in the door.
You don't have much of a history from them. You just know that they're presenting to you for concerns, let's say in this case about their drinking. How do you figure out this question of what do I do or how do I even know if there's been a trauma? I think some of the ways that you'll do that, first of all, is getting a good history from the person about the onset of the symptoms. So for this drinking case, I might ask tell me about when you first started drinking. Tell me what that was like. At what point did this become a little bit more of a concern for you?
What I'm looking for are places where a traumatic event may have altered the course of that behavior. Even if they drank before a trauma, did it get worse as a result of that traumatic event? Then I may be asking some questions once I hear that there's been some type of a traumatic event about common symptoms of PTSD so that I can get a sense of whether that may have played a role in the exacerbation of this other presenting concern. Let's say the person tells me that this happened after they were in a terrible car accident.
I may ask some questions about did you have any particular reactions, strong responses after the accident. What I'm listening for are those classic PTSD symptoms around memories, around intrusive thoughts, distress at reminders, or attempts to escape those symptoms, and the role that alcohol in this case may have played after that event.