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PTSD and the Polyvagal Theory / ep47 show notes

Updated: Mar 27, 2020

**Disclaimer: This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of bipolar disorder, consult with a mental health or medical professional. We are speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider.


First - PVT defines “trauma” as being in a stuck defensive state

And now the DSM criteria -

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

i. Directly experiencing the traumatic event(s).

ii. Witnessing, in person, the event(s) as it occurred to others.

iii. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

iv. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.

  • Part A1-3 is about the acute traumatic event. There are two paths to trauma according to PVT. This is one of the paths.

  • So far this has covered the source of the PTSD

  • Different than most dx since they cover sx and not sources of why, like bipolar disorder

B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:

i. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.

  • It’s not just the memory

  • A reliving of the polyvagal state during the event

  • freeze/panic energy

  • flight/fight energy

ii. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.

  • Briefly - I think dreams are the stories of the state we are in during sleep, along with the days’ events and along with

  • And I think our state changes during our sleep without our consciousness to block or subdue or minimize it

  • So the past comes forward

iii. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.

  • Severe triggering to the past or the past to the present

  • Loss of executive functioning and being in the present moment

  • What happens when we drop down the ladder into a defensive state

iv. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

  • Being triggered by stimuli that is often unpredictable

  • Due to becoming hyper focused on the most salient aspect of the event, like a small detail

  • We focus on what might help us to survive the next time

  • So the scents or the textures of the event become imprinted in the survivor and then get triggered next time

v. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).

  • Autonomic shifts in breathing, focus, perspiration, facial muscles usage

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:

i. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

ii. Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).

  • These are where behavioral adaptations come in

  • Doing these to avoid, adapting our behavior to deal with the defensive state

  • Substance use, ticks, compulsions, self harm

D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

i. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).

  • Hyper focused on one aspect of the event

  • Dissociate during the event, which evolved as an aid to survival

ii. Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).

  • Story follows state

  • These negative, persistent or exaggerated beliefs about the self or others are a reflection of the survivor’s own autonomic state

iii. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.

  • Story follows state

  • Brain attempts to mase sense of the situation

  • Blaming self, “I shouldn’t have” done this or that

iv. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

  • Sx of the polyvagal state

  • Feelings stem from the state

  • Reinforced by the thoughts and consequences of the bx acted on from the feelings

v. Markedly diminished interest or participation in significant activities.

  • Might be due to shutdown

  • Might be due to avoiding triggers, like avoiding family

vi. Feelings of detachment or estrangement from others.

  • When in shutdown, people isolate

  • Biological drive to hide and then emerge into safety

vii. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).

  • Again. Due to stuck state.

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:

i. Irritable behavior and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.

ii. Reckless or self-destructive behavior.

iii. Hypervigilance.

iv. Exaggerated startle response.

v. Problems with concentration.

vi. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).

  • These are all stemming from sympathetic state

  • But a few of these are in relation to the mixed freeze state

  • Large outbursts, exaggerated responses, hypervigilance

  • Weaker vagal brake

F. Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.

  • Of the intrusions, persistent avoidance of stimuli associated with the event(s), negative alterations in cognitions or mood, marked alterations in arousal and reactivity

G. The disturbance causes clinically significant distress or impairment in social,

occupational, or other important areas of functioning.

H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Specify whether:

With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:

Depersonalization feeling detached from your own body

Derealization: surroundings don’t feel real



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Hi, I am writing to say that the episode on Bipolar from Polyvagal theory perspective was really eye opening. One thing got me thinking. Apart from the fact that I could find myself in most of the descriptions of manic phase, I was really struck by the fact that when you are in shutdown your intellectual potential is less than optimal. I remember my son who struggles with reading and writing... since we started Work, my husband and me, got more regulation... And dedicated some time to connect with him... He's improved so much. Just wanted to share this realization and small success with You in appreciation of your Work. -Danijela

DSM Criteria -

Intro/Outro music & Transition Sounds by Benjo Beats -

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