![\"Woman](\"https:\/\/www.goodtherapy.org\/blog\/blog\/wp-content\/uploads\/2011\/12\/woman-sitting-looking-sad-300x199.gif\" "\\"externalization-trauma-ptsd-symptoms-healthy\\"")
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Individuals who are \u201csymptomatic\u201d of post-traumatic stress disorder (PTSD<\/a>) may seem sick, crazy, or irrational. They might appear\u00a0dissociative, clinically\u00a0depressed<\/a>,\u00a0anxious, highly reactive, or rageful (or all of the above).\u00a0In addition, it\u2019s common for an individual to cultivate a sense of self-loathing for displaying these characteristics. During treatment, both therapist and survivor may agree that these symptoms are a mark of disease, making it their goal to alleviate the symptoms. Alternatively, both may choose to believe that these symptoms are an expression of health versus illness. This could enable more directed treatment, internal compassion, decreasing fear of symptoms, and a relationship between survivor, therapist, and trauma.<\/p>\n According to the DSM IV (American Psychiatric Association, 1994) criteria for diagnosing PTSD includes intrusive memories, thoughts, or dreams of an event, a sense of reliving the event,\u00a0and intense distress in response to both internal and external cues that resemble an event(s).\u00a0 Individuals may thus avoid triggers or cues, increase isolation or have a sense of \u2018waiting for the other shoe to drop\u2019 (a foreshortened future), and detachment.\u00a0\u00a0Sleep difficulties\u00a0are common; mood liabiality, and hyper vigilance are also common (American Psychiatric Association[DSM-IV], 1994). When a survivor feels hopeless, confused, and self-loathing because of the manifestations of their trauma, the initial layer of treatment is frequently the unraveling of self-loathing for the expression of symptoms themselves.<\/p>\n To begin to evaluate trauma and develop a relationship with its influence on survivors, we can draw from the practice of\u00a0narrative therapy<\/a>\u00a0and the concept of externalizing a problem, which recognizes that the person is not the problem; the problem is the problem (Playful approaches to serious problems: Narrative therapy with children and their families. Freeman, Jennifer C.; Epston, David; Lobovits, Dean New York, NY, US: W W Norton & Co. (1997). xvii, 321 pp.). PTSD, as a character in a survivor\u2019s life, uses\u00a0symptoms as tools to protect us, remind us of our core values, and ensure that what happened before won\u2019t happen again. The trauma response could even correspond to the level of violation on self and values; from this perspective, a profoundly disturbing event calls for a profoundly disturbing response. Flashbacks, dreams, invasive thoughts, and triggers provide specific information about the violation the client\u2019s event(s) infringed upon them. These also exemplify the concept of \u201cstuck points\u201d in\u00a0Trauma-Focused Cognitive Behavior Therapy<\/a>\u00a0(Akin-Little, Angeleque (Ed); Little, Steven G. (Ed); Bray, Melissa A. (Ed); Kehle, Thomas J. (Ed), (2009). Behavioral interventions in schools: Evidence-based positive strategies, School Psychology (pp. 325-333). Washington, DC, US: American Psychological Association, xi, 350 pp.)<\/p>\n