There are barriers to recovery from posttraumatic stress disorder (PTSD). Mental illness recovery often begins as an uphill battle. It doesn't help that aside from difficult symptoms, those of us living with one or more mental illness also have to combat stigma and wide-spread misinformation--all while navigating a mental healthcare system that often favors the wealthy. Recovery from PTSD is saddled with some very specific barriers. In fact, treatment resistance is actually a symptom of PTSD. If you or a loved one are struggling to recover from trauma, please hold back from judgement. There are reasons for treatment-resistant PTSD behaviors; you or your loved one are not at fault.

Learning how to care for someone with posttraumatic stress disorder (PTSD) can be hard. As someone who has served as both a caretaker of someone with PTSD and a person in need of care, I intimately understand the difficulties interlaced in the care of people with trauma histories. For example, it can be hard for us to express joy and gratitude, even when we feel it. People with PTSD can be prone to anger, which may make us lash out verbally or even physically (though studies have shown that PTSD does not usually make people more violent than the general population). PTSD can be treatment resistant, meaning we feel so damaged, hopeless, or otherwise unworthy that we give up on getting better, or refuse to try in the first place. People with PTSD are sometimes drawn toward self-harming behaviors like cutting ourselves or misusing drugs. It is indescribably painful to sit and hold the hand of someone you care for when that someone doesn't appear to care about herself. But PTSD recovery relies on community support. Learning how to care for someone with PTSD means learning to keep holding our hands, even if we can't find the words to tell you how much it means to us.

Understanding how stress from positive change adds to our stress load improves our self-care and helps us stay on the path to posttraumatic stress disorder (PTSD) recovery. While the word "stress" applies to life-altering situations like traumatic or stressful events as often as it pertains to a long to-do list, it is not typically associated with times when things are good. However, positive change and stress do exist together and it helps people with PTSD to recognize them when they occur.

We can't get away from having toxic people in our life sometimes. In a perfect world, we would never encounter someone unhealthy for us. The people with whom we hold company would all be healthy influences. Unfortunately, as those of us with posttraumatic stress disorder (PTSD) likely already know, we do not live in a perfect world. Although we can choose our friends, and we can migrate toward or away from certain co-workers, acquaintances, and even family members, we cannot always prevent having some toxic people in our life.

Sleep deprivation is a common complaint among people who experience posttraumatic stress disorder (PTSD). Research shows that at least 50% of individuals with PTSD have experienced recurring nightmares, and the majority of people with PTSD report either difficulty falling asleep (sleep onset insomnia), or trouble staying asleep long enough to feel rested (maintenance insomnia). Even though sleep difficulties often accompany PTSD, their importance might be underrepresented. Knowing how to recognize the symptoms of sleep deprivation and how to manage them are useful tools in treating the symptoms of PTSD.

There are several approaches to healing from posttraumatic stress disorder (PTSD), and they may include finding comfort and support from faith communities. Yet, some doctrines do not foster self-care and recovery. If you have a faith community or consider yourself a member of an organized religion, you may develop beliefs that can stand in the way of your healing from PTSD. Here are some observations on faith systems and their impact on PTSD recovery.

Seasonal holidays involve many inherent rituals, but have you considered creating your own personal rituals to protect you from holiday stress and anxiety? I had the opportunity to discuss rituals--both helpful and harmful ones--with psychologist Stanton Peele while researching an article about addiction for Vice.1 He describes the ways in which some rituals actually protect people from developing addictions--such as Jewish customs of drinking wine only during certain occasions. He finds that Jews who associate wine in that religious context often find it odd to think of alcohol as a "party drug." This conversation made me think of the routine rituals we encounter during the holidays. Can trauma survivors intentionally create personal rituals as a means of coping with some of the extra stress associated with holidays?

Setting goals for posttraumatic stress disorder (PTSD) recovery can be difficult, in part because PTSD impacts every aspect of daily living, every day. When seeking help for recovery, it is understandable to want to feel better as quickly as possible in order to put the worst behind you and move on. Sometimes it can be difficult to notice what progress is being made when you are still experiencing the symptoms of PTSD daily. This is where understanding your PTSD diagnosis as well as any coexisting conditions and setting goals for PTSD recovery can help you feel successful.

To avoid the stigma around posttraumatic stress disorder (PTSD), many people keep their PTSD symptoms secret. How others perceive people with PTSD creates the stigma. Yet, there is another form of derision at play here --that of self-stigma. Identifying, understanding and correcting self-stigma can significantly impact us and the stigma around PTSD as well.

In the course of my recovery, there came a time when I wanted my abusers to suffer. Most people who have been, or are being abused, don't seek help. Statistics on abuse show that as many as 60 percent of perpetrators are never prosecuted. In my case, my abusers were never called to account for their actions. When I began to talk about my abuse and work through all that had occurred, I came to a point where I was angry and resentful. My nightmares of abuse shifted to ugly visions of ways in which I could cause as much suffering to them as possible without killing them. I had to work to reconcile these intense emotions where I wanted to make my abusers suffer to continue healing.