By Miles Kaufman, Fall 2020.
When people think of post-traumatic stress disorder (PTSD), they most often think of the “shell shocked” veterans of World War I. While traumatic combat experiences do contribute to a number of PTSD diagnoses, other causes of this disorder are often overlooked.
After a trauma, a number of post traumatic stress (PTS) symptoms are considered typical, and in some cases these symptoms develop into PTSD. The clinical definition of PTSD requires that one has lived through a traumatic incident and has PTS symptoms that last for over a month [1]. The patient must have at least one re-experiencing symptom, one avoidance symptom, two arousal/reactivity symptoms, and two cognition/mood symptoms [1]. PTSD can present differently in children and teens, sometimes taking the form of acting disruptive, destructive, or disrespectful. Young children often stop talking, wet the bed, become particularly clingy, or reenact the event through play [1].
While these symptoms are difficult to cope with, some level of post traumatic stress is expected after experiencing trauma, but the trauma response does not always result in the development of post traumatic stress disorder. The likelihood of developing PTSD depends on a number of factors, including a history of childhood trauma, lack of social support, injury, and added stress after the traumatic incident [1].The difference between the existence of post traumatic stress symptoms and PTSD is duration. Once symptoms persist for more than a month, then the trauma response is labeled a clinical disorder.
PTSD is far more pervasive in our communities than one might expect. In fact, 7-8% of people will develop PTSD at some point in their lives [1]. Perhaps the prevalence of PTSD implies that this may not be a maladaptive response at all, but rather one of our brain’s natural coping mechanisms. Even so, the symptoms can disrupt daily life and cause serious distress.
Many aspects of the brain’s trauma response may have been evolutionarily advantageous, and may have thus been selected for. For example, avoiding places or feelings associated with the specific trauma can protect people from further danger and harm. Re-experiencing the trauma may act to ensure that the danger is not forgotten, further encouraging avoidance of the trauma. The reactivity symptoms may have promoted staying alert to ensure a quick reaction should another dangerous situation arise. It is important to note that PTSD is not a modern phenomenon. There is written evidence from Ancient Mesopotamia of soldiers experiencing PTSD post-combat [2]. Our response to the post-industrialized traumas of car accidents are no different, but these modern day traumas are depicted every night on the six o’clock news. This constant exposure to second hand trauma via the media causes us to witness not only our own traumas but that of our family and friends — increasing in frequency at which we experience trauma. Perhaps the prevalence of PTSD is a symptom of that.
Most cases of PTSD, however, are not caused by large disasters. Interpersonal trauma causes more cases of PTSD than both war and natural disasters [3]. This may be because the threat of interpersonal violence lasts much longer after the initial incident than other natural threats like a storm or volcanic eruption. The PTS response may turn into PTSD more often in these incidences to provide a protection against interpersonal violence that is long lasting.
If that is the case, then it makes sense that victims of abuse and sexual violence have incredibly high rates of PTSD. Given that women more frequently experience sexual violence and domestic abuse, it also makes sense that they are twice as likely to develop PTSD than men despite reporting 33% fewer traumatic incidents [4]. Sexual trauma is far more likely to lead to PTSD than combat trauma, and since one in six women are sexually assaulted [4], we see different PTSD rates between men and women. In addition, the shame and guilt that survivors often experience regarding their sexual assault may prevent them from seeking help. Since social support is a major mitigating factor, this stigma is likely raising rates of PTSD among survivors of sexual violence. While it is still up for debate as to why sexual assault and interpersonal violence are more likely to trigger PTSD, it is thought that the invasive nature of the violence women are more likely to experience may put women at high risk of developing PTSD [5]. Another theory is that the feeling of helplessness is heightened during these types of traumas and that helplessness during a trauma dramatically increases one’s risk of developing PTSD. Lastly, it is also possible that since sexual assault and relationship abuse often occur repeatedly, therefore our stress response is more easily activated [6].
In addition to understanding why women experience higher rates of PTSD, we also need to make the women suffering from this disorder feel seen and heard. No one with PTSD should experience it alone. As a society we need to broaden our preconceived notions of PTSD and its causes, and recognize that a sizable proportion of the population currently lives with it. While veterans certainly suffer high rates of PTSD, and that should not be ignored, survivors of interpersonal violence need to be included in our mainstream definition of a PTSD survivor. We need to better understand how sexual trauma and abuse affect behavior. We also need more research understanding how post traumatic stress develops to PTSD. We as a society may prefer to see PTSD as a disorder that affects survivors of war, but many women are suffering from PTSD unnoticed. Until we can acknowledge and address the symptoms that women and other survivors of sexual trauma face, we will be unable to support these survivors properly.
[1] National Institute of Health. “Post Traumatic Stress Disorder.” United States Government. Last modified May, 2019. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
[2] Becker, R. A. “Ancient Mesopotamian Texts Show PTSD May Be as Old as Combat Itself.” Ancient Worlds. January 26, 2015 https://www.pbs.org/wgbh/nova/article/ptsd-may-old-combat/
[3] Zoladz, Phillip R., Diamond, David M.. “Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature.” Neuroscience & Biobehavioral Reviews. vol 37, 5 (June 2013): 860-895. https://doi.org/10.1016/j.neubiorev.2013.03.024
[4] Greenberg, Melanie. “Why Women Have Higher Rates of PTSD Than Men”Psychology Today, September 25, 2018. https://www.psychologytoday.com/us/blog/the-mindful-self-express/201809/why-women-have-higher-rates-ptsd-men
[5] Iverson, Katherine M., McLaughlin, Katie A., Gerber, Meghan R., et al. “Exposure to Interpersonal Violence and Its Associations With Psychiatric Morbidity in a U.S. National Sample: A Gender Comparison.” Psychol Violence. vol. 3,3 (July 2013): 273-287. https://doi.org/10.1037/a0030956
[6] Mauritz, Maria W., Goossens, Peter J., Draijer, Nel, & van Achterberg, Theo. “Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness.” European journal of psychotraumatology, vol. 4, (April, 2013). https://doi.org/10.3402/ejpt.v4i0.19985
[7] Friedman, Matthew J.. “ PTSD History and Overview.” U.S. Department of Veteran Affairs. Last modified October 14, 2019. https://www.ptsd.va.gov/professional/treat/essentials/history_ptsd.asp