Category Archives: PTSD

Stepping Stones; Stepping out of PTSD

Trigger Warning – my brand of PTSD came from situations involving sexual assault, and this post may contain loose details about that situation or other sexual topics regarding my recovery. Nothing super graphic though, don’t be gross.

Post traumatic stress disorder seemed to come into my life like a flood. One minute life seemed totally normal, and the next it began to deteriorate rapidly.

It was sort of like, if you could imagine, every time you bought a smoothy someone would walk up and take that smoothy away from you after a couple sips. After a while, you sort of just know to either avoid buying smoothies or, if you do buy one, only expect two sips. This is just the way things are, and because you haven’t known much else there are no real expectations otherwise.

Now imagine someone sits down with you and tells you that we live in a world where you could have (and you deserve) that entire effing smoothy. I mean, more than two sips. And that these people who have been taking this delicious fruity beverage away from you are a-holes who have done something profoundly inappropriate.

Well there’s shock. And anger. And definitely some horror associated with the fact that people can be so awful to one another, and that you’ve let this smoothy-snatching business go on for so long. There is guilt for not knowing things could have been different, and fear that this cycle is something that will never end.

But, maybe you feel a little empowered too. Like maybe now that you know this business about the smoothies you can buy one and enjoy the entire thing. You can break the cycle! So you go out, you buy a smoothy, and after two sips someone walks up, takes it, and walks away.

This time it feels different though, doesn’t it? This time you know you’ve been violated, that the other person is in the wrong, but maybe you just froze and didn’t know what else you could do to stop it. The anger is much bigger, much more difficult to contain. The fear becomes profound, because now you know that people seem cavalier about hurting you and that it can happen anywhere at any time. The shock leaves you frozen, bringing guilt because, somehow, you knew this would happen, didn’t you? Maybe the horror is so overwhelming you decide to pretend the whole thing never happened, just to put it all out of your mind, and ultimately blame yourself. After all, you really just can’t be trusted with a smoothy.

For me there was a series of moments like these that were like seeds being planted. I pushed the memories and my reactions down into the dirt as far as they would go, and once they were there I didn’t feel a need to address them because I thought I won. I thought I put them somewhere that was somehow equivalent to them not-existing, and if they didn’t exist I couldn’t be upset, right?

I admit, it is easy for me to look over this whole process when it is about a deliciously fruity blended beverage or something as seemingly harmless as seeds and connect the dots, but even now, years later, thinking about this process in terms of sexual assault there is a whole host of emotions that come up making it difficult for me to see through the fog that they create.

For several years I did a great job of putting the whole thing out of my mind and ignoring it. Then, after enough time had passed, those seeds that had been planted began to grow.

They broke through the soil and I suddenly began having panic attacks in crowded places. I became physically ill when someone, anyone, would touch me. I couldn’t leave the house without getting into arguments with people, so I didn’t leave the house. I felt powerless and depressed, but also angry and very afraid. Every time I closed my eyes I could sense someone standing next to me waiting for me to be vulnerable, like any moment I was happily unaware or in the shower or asleep.

The most infuriating part of this process for me was not being able to see how one person could get from the situation I was in to something better. My PTSD symptoms (mostly the anxiety and panic) were just as treatment resistant as my bipolar symptoms so I couldn’t rely on any anti-anxiety medications to help with the panic attacks and fear I was having. My doctors suggested deep breathing and reading boring case studies about PTSD, and while the deep breathing only really helped keep me from constantly screaming the reading seemed to trigger my symptoms over and over again.

Having said that, (spoiler alert) I am sitting here today really feeling like I have finally made a big dent in untangling myself from those awful PTSD plants and I found myself wondering just what I did to make it here. I thought that perhaps sharing what helped create a makeshift ladder for me might be useful to others in a similar situation, and while I am not suggesting you go out and do any of the things I am about to share I can honestly say they helped me, and all of these things were done with the consent of my healthcare team (including my therapist and psychiatrist).

For Anxiety and Panic Attacks

Basically I needed to desensitize myself to being around people and sort of re-learn that people (in general) aren’t trying to hurt me. The real trouble was that any time I was in a more crowded place (the bus, downtown, the grocery store) it would just trigger the panic attacks over and over again. Even at house parties of people I knew and loved I felt overwhelmed and would panic, so I entered into the realm of medical marijuana.

I realize this might not be a popular idea, but totally legal here in Washington State. Also, like many of the medications I have tried, it turned out there are some forms of cannabis that actually made my anxiety and panic symptoms worse, so the process of narrowing things down was a little frustrating. Thankfully, as someone with treatment resistant symptoms I have a lot of experience trying treatments that either aren’t effective or have some rough side effects so I already had a system for taking detailed notes on the effects I was experiencing.

I wont lie, I felt pretty weird about this idea at first. Growing up in a time where I was led to believe that the slightest proximity to any and every “drug” out there (D.A.R.E!!) would immediately make me an addict or banish me to hell or make me lose everything I loved made me initially totally recoil from the idea.  The legalization of medical cannabis only dampened this mindset slightly, but after speaking with three different psychiatrists and four separate therapists, all of whom who told me [given the nature of my treatment-resistant symptoms] I should proceed with anything I found that was helping, I felt a little more comfortable. Even so, it took some time for me to feel ok when other people were being judgmental about it but the fact that my doctors had my back (and heck, even my grandmother agreed) made me feel less squeamish about the whole thing.

Once I was able to pinpoint a couple strains that helped alleviate the anxiety and panic I was feeling (without sabotaging something else, like my mood for example) it was a matter of using it strategically (not all the time) to introduce me into settings where I might normally totally freak out, but because the cannabis removed the elements of anxiety and panic I was able to experience triggering situations in what felt like a non-threatening way.

Basically, cannabis allowed me to remember what it was like to be around people and feel safe, or at-ease, and after long enough it became the default setting for my brain again.

For Regaining a Sex Life

This has been very tricky, and while the cannabis was helpful enough to get me to the point of being able to be touched in general (like a back rub or foot massage) I had a big blinking red stop light in my brain around sex for a long time. Not super helpful, considering my PTSD symptoms didn’t actively show up until several years into a committed and safe relationship! Even though it had been years since I was in a place where I was in danger, once those seeds sprouted it didn’t matter.

I am sure it will sound a little funny, but the most helpful thing to removing fear and panic around sex for me was when I had surgery and my doctor told us we weren’t allowed to have sex. That’s right! Having even the possibility of having sex taken off the table made me feel more comfortable because then it wasn’t this awkward thing (or an obligation) I felt compelled to dodge constantly because I felt uncomfortable. Effectively we had to almost start our physical relationship over at square one (I recognize I am really lucky my boyfriend is the most patient person I’ve ever met) and in doing so we re-built the trust that I knew was there, but couldn’t feel because of my anxiety and panic.

For Fear and Paranoia

First I would say going to therapy and spending a lot of time talking about being assertive about boundaries helped me feel a bit more confident, but I was still really afraid that if something happened again I would freeze up and be unable to assert myself.

Something that really helped solidify a confidence in my ability to protect myself was taking a self-defense class with a friend at Fighting Chance Seattle. The staff was really knowledgeable and our male instructor made me feel very much at ease and did not require us to practice defensive moves with him, instead with anyone we felt comfortable with. Being able to connect a physical action to a feeling or desire to protect myself made me believe that if there was ever another situation I knew what to do and would be less likely to freeze in the moment. The class was only one day, but it really helped me feel like I was moving forward.

Another milestone was getting a tattoo that would act as a reminder that the fear I was feeling was coming from me, not from threats around me.

Over the last few years I have tried to keep my apartment feeling like a safe space for me. At first that meant coming home and looking behind every curtain and in every closet to be certain it was safe, but now that I have made some progress with my fear and paranoia I try to talk myself through the fear and visualize every detail of the apartment when it is dark to remind myself it is empty and safe. It is funny to me sometimes to think that my brain wants to imagine all kinds of horrors waiting for me when I close my eyes, but I spend a lot of time actively un-imagining them!


While I can’t sit here and say, “and that’s how I kicked PTSD in the face! It is gone forever!” Things have gotten significantly better.

I still get triggered from time to time, but I’ve got enough tools to keep myself from replanting that same seed over and over again. After taking that self-defense class I felt quite empowered when I was faced with a situation on a city bus, a creepy dude next to me put his hand on my leg.

Initially I started to freeze. I could feel myself starting to shut down as I had in the past, but somehow I managed to turn things around and do the total opposite of the cowering I felt like doing.

“Excuse me?!?” I yelled in his face and then stood abruptly, pushing past him to sit in another seat. He looked over at me and I scowled, shaking my finger at him. Even though my hands were shaking and my heart was racing I turned away to look out the window and my scowl turned into a faint smile.

I was free.

Trigger Warnings – What’s the Point?

It seems that the topic of trigger warnings has recently exploded through the internet and beyond, and I have to say I have been somewhat concerned about a lot of the things I’ve been reading. It seems like there are some big discrepancies about what people think the point of a trigger warning is, so I’m hoping I can shed a little light here.

First, what is a “trigger warning”?

A “trigger warning” is when someone makes a conscientious effort to label content as something that could potentially trigger episodes associated with mental illness and PTSD (post traumatic stress disorder). As far as content on the internet is concerned, this tag is usually provided by the creator of the writing or video associated with it.

Are “trigger warnings” considered censorship?

No. Censorship is the suppression of words, images, or ideas that are “offensive”. In the situations where a “trigger warning” tag is being used, none of the content is being withheld or removed. In fact, the point that none of this content is withheld is part of the reason the “trigger warning” exists. If the content in question was eliminated, there would be no need for a warning. Likewise, this warning does not bar people from reaching, viewing, or sharing the content, therefore nothing is suppressed.

Why would someone use a “trigger warning” tag?

The biggest misconception I’ve been seeing among the current dialogue around “trigger warning” tags is that they are used to help people avoid content which may be “offensive”.

This is not the case. I say that because “trigger warning” tags are not called “offense warnings”. They are called trigger warnings. Here’s the difference:

In a situation where I become offended, I might feel flushed. I might feel disgusted, or annoyed, or angry. I might leave angry comments or write angry emails. I might feel sad, or defensive, or any number of things that any human being might consider a typical reaction to something someone doesn’t agree with on a base level.

Now (and here I am going to employ the *trigger warning – sexual assault* tag simply out of curtosey) I want to give you a brief look at what living with PTSD is like, and what I experience when triggered by something.

In 2007 I was sexually assaulted. I don’t have a very clear memory of what happened, but I do have pretty vivid memories of the days that came after. The injuries I sustained. The hysteria, and screaming at people who came near me on the street. The seemingly constant panic attacks.

Seven years later I have worked hard with several therapists to lessen my PTSD symptoms. Things have gotten quite a bit better, I finally am able to have a sex life again. I can ride on the bus without having a panic attack when people bump into me, but after all that there are still boundaries I have to draw in my daily life. I can’t watch tv or movies with rape scenes (which is getting harder and harder lately as this seems to be becoming more and more common). I generally don’t allow myself to read about rape, frankly just that one little word (especially coming upon it in an unexpected place) is enough to send me spiraling back seven years.

Being triggered (having my PTSD symptoms switched “on”) by images or words associated with sexual assault is far beyond the notion of being “offended”. I find myself being sent back immediately where I mentally re-live the horror of what happened to me over, and over, and over again. It replays in my mind on repeat, but it doesn’t simply replay. It is more like re-living it. 

My throat closes up and I can’t breathe, and I start crying uncontrollably. I freeze, and nobody (not my boyfriend, or friends, or therapist) can say anything to me to bring me out of it. My whole body starts to shake violently in fear and sometimes I faint. My stomach becomes a giant knot and even after the flashbacks subside leaving me shaky and weak, the sense of repulsion is so great I can hardly eat without vomiting.

*end trigger warning* 

This kind of episode is enough to ruin an entire day for me. Having bipolar disorder on top of that means when my PTSD symptoms are triggered, it also often triggers intense depression or mixed episodes, which can leave me suicidal or homicidal and incapacitated for days, weeks, months…

I have to be extremely careful how I spend my time, the people I talk to, the media I can watch, and the things I read. A large part of my life is about avoiding the things that trigger me, and though I am getting closer every day to being able to do all the things I used to do, this is a serious condition that I work with my therapist on constantly to slowly desensitize myself. Can you see how that might be a pitfall? How easy it can be, especially with train-of-thought blogs, to stumble into something I couldn’t see coming? I was surprised to find myself triggered just the other day when watching Downtown Abbey Season 4 and I spent months waiting for that at the library (and that is a show that airs on PBS!). All I’m saying is that a little warning would have been nice!

Realistically, do topics like suicide or self-harm or abuse or sexual assault offend me? Not at all. In fact, I think they are important topics that need to be talked about. However, there are people that might come to harm by reading about these topics, particularly ones in the mental health community who are unstable, trying to take care of themselves, but are attempting to reach out to other bloggers.

I don’t care about the content of tv shows or movies or blogs, and I don’t think anyone who supports the idea of “trigger warnings” wants to stifle the stories or ideas people have. I know there are a lot of people who enjoy or consider particularly triggering content to be educational, so we need to keep writing about the difficult situations in our lives. That is not the issue here.

The mental health blogging community faces different challenges than those of, say, food bloggers, or fitness bloggers, or travel bloggers. Our content can be sensitive, but our readers are often also sensitive… not because they are easily offended, but because they are people living with symptoms of mental illness they often have little or no control over. How long do you think these people will keep reading if they’re being triggered by content presented to them?

While each person out there has the choice of whether or not to read something, they need to be able to make a choice that is right for them. That’s the end game when it comes to mental health, right? Doing what is best for each of us individually? I simply believe making that choice becomes much easier (and safer) when there is some kind of indication that the content might not be suitable for everyone.

Maybe that doesn’t mean using the words “trigger warning”. Maybe that means being conscientious about the title of our blogs reflecting the content, or suggesting the content is sensitive, or any number of things. I’m not here to suggest we all adhere to one set of rules, but does it seem that far fetched to respect our readers and want to help them enjoy the work we’ve enjoyed creating?

Again, I’m not here to stifle the the notion of creativity of free speech, just to show a little respect and care for my readers who, like me, may have lived through something traumatic. I consider “trigger warning” tags to be a common curtosey, a way to let my more sensitive viewers avoid debilitating episodes that have an extremely negative impact on their lives. If a choice I make can help others make good choices for themselves, it feels like a no-brainer to me.

Tattoos and Closure

In many parts of America I think tattoos are written off as the hallmark of degenerates. I think what our culture is slowly realizing (on the tails of American youth) that tattoos are no longer symbols limited to criminals, gang members, and salty dogs, but are swiftly being acknowledged as a disciplined art form that has been spreading (especially through the Pacific Northwest) like wildfire.

Today many different people have and are getting tattoos, and the reasons people get them are practically as widespread as the artwork itself. Some people consider their tattoos to be living works of art with no connection to any specific motive beyond a sense of their own enjoyment of a color, a shape, or an artist. Others collect tattoos to represent things that are important in their lives, like their children. It isn’t uncommon for people to get tattoos as a milestone representing a celebration like graduating, moving to a new place, or starting a business.

While I don’t want to detract from these (and other) reasons people have for getting tattoo work done, I want to specifically address another big reason people seek out the experience of getting a tattoo; closure.

While many people get tattoos as a symbol for a milestone event in their lives, it is very common for these events to have something to do with loss. A memorial piece for the loss of a loved one (like a parent or pet), a cover-up piece to detract from scars associated with physical loss (like a difficult surgery or self-harm), or a piece to symbolize the end of something difficult (like a relationship) are all ways people seek closure through the art of the tattooing.

I find that many, especially those seeking a tattoo to move toward closure, are infatuated with the ritualistic method of tattooing as well. I really believe that most people in the process of seeking closure experience some degree of anxiety about it, which is somewhat amplified when that person is about to be tattooed. As the artists works, there is physical pain that might (as some might suggest with self harm) be like a physical manifestation of the pain the grief of loss has been causing internally. When the piece is finished the pain subsides and is replaced with something beautiful, something permanent that can act as a visual reminder of our loss, replacing that constant need to obsess over it mentally.


After somewhat inadvertently escaping an abusive relationship in 2006 I didn’t realize how much I’d been effected by it until a couple years later. Though I’d moved on and lived in a different place and was in a new relationship, I was in a constant state of terror that my ex would reappear and set fire to everything I’d built.

This fear was not entirely far fetched. It had been common for him to track people down and show up without warning, and though I thought I had made it clear to him never to come near me again, I had the slow churning of the anxious bipolar mind working against me as well.

When I would have periods of psychosis, I was the most afraid. Afraid in general, but mostly afraid of him. My paranoia would take over my life and I would be afraid to open the curtains or unlock the door. After changing my phone number and moving again (for the 4th time since I’d seen him last) I still didn’t feel safe. I still didn’t feel free.

By last year (six years after the relationship ended) I still felt as anxious and terrified as ever. I was afraid I would bump into him in the street (despite a rumor that he lived in another state). I was afraid that I would come home one day and he would be in my apartment. I was afraid that he would do something irrational… and that’s when I took a look in the mirror.

If anyone was being irrational, it was me. I was in a constant state of being engulfed by fear, fear of something that wasn’t very likely going to happen at that point, if it had at all. I had obsessed and worried so much that I felt swamped, completely unable to tell what signs to consider threats and what was harmless.

In a manic epiphany (I tend to have one every few years) I concluded that I should get a tattoo. The tattoo would be a moth, because my ex was terribly afraid of moths. This permanent symbol would act as a talisman, and perhaps not directly repelling him, if I associated myself with something he considered repellant, I hoped I would feel empowered. A reminder that I am safe now.

Frankly, I wasn’t sure if the idea would work. Surely, getting a tattoo would work (I already had two at the time) but I didn’t know if I could ease my mind this way, particularly a very anxious, obsessing, bipolar mind.

When the mania wore off I still felt inspired, and within a few weeks I met up with a local artist (a great one, I might add) who tattooed me.

(I also wanted to note that you wont find any images of my tattoos on this post because I don’t post images of my tattoos on the internet. I prefer they remain singular works of art, not copied by anyone else.)

I don’t think the change was immediate, but I am sitting here almost a year later and haven’t had any problems with anxiety or paranoia about my ex-boyfriend in months. Of course, that isn’t to say that I haven’t had any anxiety or paranoia about other things, but the fear I had before (particularly about him breaking into my apartment) seems to be quelled.

Going through with getting something as simple as a tattoo has greatly improved the amount of closure I have felt about a traumatic time in my life and lessened my fear about my past, and scaling back that fear has meant specifically (for me);

  • Less frequent apartment lock checking (especially when I was getting up in the middle of the night several times to check locks)
  • Being able to keep the window open when I am at home
  • Being able to be home alone without leaving every light on
  • Feeling comfortable leaving the apartment more frequently
  • Less concern that he will jump out at me on the street, I am able to walk much more relaxed
  • I no longer feel the need to keep moving around or changing my phone number

I realize the idea of using tattooing as a way to help combat anxiety or fear is something that people may be skeptical about, and that is why I wanted to share my experience about it. There are many people out there who, like me, see tattooing as a form of therapy.

After all, there have been moments in my regular therapy sessions where my therapist has asked me to close my eyes and imagine wearing an outfit that makes me feel confident, strong, and relaxed. She said that any time I can close my eyes and imagine I’m wearing it.

All I’ve done is taken this idea one step further. I thought of something I can wear that makes me feel confident, strong, and relaxed… and I’ve permanently adhered it to my body.

Now I never have to close my eyes and imagine, I can just look down and remember who I am.

Asking For Help

I’ve been seeing an alarming number of blog posts in which people discredit the notion of asking for help, or claim that asking for help is for the weak.

I find this claim wildly disturbing. Not only has this idea been deterring people across the globe for seeking help for mental health treatment for ages, but it says something that I believe is entirely false.

The truth is that asking for help draws on many traits that are incredibly far from weakness, such as:


Stepping forward and making your needs known, even just asking a question takes courage. Since when was courage ever synonymous with weakness?

Trick question, it never has been! Courage requires:


Something which is the very opposite of weakness!

It is one thing to have courage, but to use it one must have the strength to move forward and take action.


Have you ever heard the phrase, “two heads are better than one?” Asking for help is essentially the intelligent act of asking for two heads to take on a problem instead of just one. Double the heads means double the chances of finding a solution.

Asking for help can be difficult, but overcoming fear shows a display of courage, strength, and intelligence. These traits are not traits of weakness, but traits that most human beings would hope to portray in their lifetime.

I wanted to take a second to also note that asking for help can feel much easier when faced with many options of people to speak with. A parent, friend, or doctor might seem like an obvious choice, but teachers, co-workers, HR department representatives, local crisis phone lines, even sending an email to a blogger (like me) is an option.

If you don’t get the response you are hoping for when asking for help the first time, consider it a practice run! There are other people you can talk to, so don’t give up!

Journalist Comes Out About Having Mental Illness

I want to share an article that I found interesting, it is a post written by Mark Joyella, a journalist and former television reporter who has just recently come out about having a mental illness to help fight the stigma that surrounds it.

His article, Screw Stigma. I’m Coming Out takes us on a journey through his fear of being identified as a mental health consumer to a place where he feels comfortable sharing his OCD diagnosis.

For someone in the public eye, I found this article to be extremely thoughtful and well written, as well as reflective. I think his journey can be related to anyone who has questioned their own diagnosis or felt self conscious about the idea of having a mental illness, not just for folks who have an OCD diagnosis.

In any case, I suggest checking it out… and for Mark Joyella, a big high five – thank you for being brave enough to come forward about your experiences!

The Global Assessment of Functioning (GAF) Scale

Every once in a while I am faced with paperwork concerning my mental health. This has happened with insurance companies, state programs I have applied for, and even the medical records I have requested and snooped through (hey, I should be allowed to know what they’re saying about me, right?). Upon looking at this paperwork, I am generally surprised by what I find -not due to the content (though sometimes I am) but because of the paperwork itself. The way the questions are phrased and answered, the way sections are broken up, entire ranking scales I knew nothing about… obviously there is a system that I have been completely unaware of. I mean, heck, I’m no doctor, I’ve never been trained on what all of this means, and if I didn’t go back and read the paperwork attached to my diagnosis I would never have even known such scales existed.

I thought I would take a little time today to talk about one scale which I have seen several times in various situations, but never really knew much about until recently. You know me, I am all kinds of interested in different ways to quantify my bipolar experience, so I found this scale particularly interesting.

It is called the Global Assessment of Functioning (GAF) Scale. I guess Global suggests it is used throughout the world, and it came to my attention because I noticed this scale popping up on several of the items I have rifled through in the last five years.

So what is the Global Assessment of Functioning Scale?

The Washington Institute On-Line Training and Assessment contracted by the Washington State Mental Health Division calls the GAF scale:

A 100-point tool rating overall psychological, social and occupational functioning of people over 18 years of age and older. It excludes physical and environmental impairment.

Which means this ranking scale is a tool used to rate functioning (not symptoms) in three areas (psychological, social, and occupational).

Since the GAF scale is used to rate functioning (and not symptoms) your score could potentially be constantly changing (that is, if you’ve got bipolar disorder, for example, and have been having symptoms intense enough to change your level of functioning). Generally, the closer you are to 100, the better you are functioning. The scale is also used to quantify disabled-ness, as the closer you are to zero, the more disabled you are considered.

The GAF scale is broken down like this:

Superior functioning in a wide rage of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms.
Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range or activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.
If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning
Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships.
Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning.
Serious symptoms OR any serious impairment in social, occupational, or school functioning.
Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.
Behavior is considered influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas.
Some danger or hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication.
Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death.

Your doctor or clinician might be asked to rate you with this scale in situations of requests by your insurance, if you are going through an intake at a hospital, if you are applying for state or federal disability programs, and the like.

I recently had an insurance agency ask my psychiatrist to give the highest GAF score he would attribute to me for the last year, and that was how my curiosity became piqued by this scale. I had also seen this in passing on medical records from when I was hospitalized. They gave a GAF score for when I entered the hospital, as well as what my score was when I left. Obviously at that point they want to see some kind of improvement on your part in the scale.

The GAF scale is found in the Diagnostic and Statistical Manual – IV TR (or just DSM as many of us lovingly refer to it) in the section on “multi-axial assessments”. You can also find the whole scale online by just googling it, or by following the link here for the Washington Institute On-Line Training and Assessment.

I wondered for a bit if this rating scale is generally supported globally, and I did find an article in the British Journal of Psychiatry about a study done to test the validity of the GAF scale in 1995 (which you can find here). They concluded;

GAF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill.

There are other versions of the GAF scale that have been modified, but apparently don’t stack up quite as well as this original scale.

In conclusion, this was really just something that I find interesting personally, but I also think it is important to understand things like medical records and paperwork that has been filled out by your doctor. I don’t think knowing about what tools our doctors are using is important because we should interfere with their work, but because understanding how our doctors operate can help us maintain a better relationship and get the best care possible.


Hey folks,

So NAMI (the National Alliance on Mental Illness) is hosting a series of walks across the country. The Seattle area walk is happening Saturday, October 27th at Marina Park in Kirkland (for people in the area who are interested in signing up, you can find more details at this website), and I’m planning on attending.

The goal of the walk is to raise both funds and awareness in regard to mental illness. NAMI uses funds for anything from hosting peer-to-peer support sessions, general weekly support groups, family-oriented classes for those who have someone in their lives living with mental illness, as well as provide all kinds of support for folks who may not otherwise be able to receive it. They are a non-prophet organization ran entirely by unpaid volunteers.

The awareness factor is what I am most interested in, and I’m hoping that by spreading the word, others will learn a bit more about mental illness and will help take down the general stigma that surrounds it.

There are a lot of people out there who are experiencing debilitating symptoms and are either afraid to seek treatment, can’t afford to seek treatment, or both. In my experience, NAMI has been an excellent resource for people in the Seattle area to learn more & get help.

You can bet this is the only time I’ll do this, but if you are able to give anything to help support those with mental illness, I’d encourage you to consider it. For more info or my fundraising site, go here!