PTSD- Not Just Veterans

Post Traumatic Stress Disorder
 
When we hear the term Post Traumatic Stress Disorder, or PTSD, many of us automatically think of this as a condition experienced by military personnel, or veterans, resulting from combat or other service-related trauma. This perception is certainly not unwarranted as many of these individuals do suffer from PTSD, and awareness of the disorder increased during and after the Afghanistan and Iran operations.  While PTSD was recognized as a formal diagnosis in 1980, the recognition and awareness has continued to evolve, and in 2013 PTSD was recognized as a Trauma- and Stressor-Related Disorder in the DSM V. 
We now realize that anyone can experience PTSD, at any age, and the disorder occurs after experiencing a traumatic event. This includes childhood abuse, domestic abuse, and relationship violence.
 
PTSD and Abuse/Violence
 
It is estimated that approximately 6 out of 100 people will experience PTSD in their lifetimes. It is also proven that women will develop the disorder more frequently than men. Statistics indicate that 10% women will experience PTSD compared to 4% of men. This significant difference is linked to the type of trauma women are subjected to, which have a higher risk for PTSD. This trauma could include domestic violence, sexual assault, physical assault, or emotional abuse.
Health professionals are now recognizing the strong link between emotional abuse, domestic abuse, and PTSD.  The goals of emotional abusive behaviors are to control, scare, and manipulate. Domestic violence includes intimate partner violence  (IVP), and can include:

• Stalking
• Sexual violence
• Physical violence
• Threats of abuse
• Psychological abuse

Emotional abuse and domestic violence are repeated and long-lasting trauma which results in PTSD, or in some cases Complex Post Traumatic Stress Disorder (CPTSD).  
 
PTSD and Complex Post Traumatic Stress Disorder
 
Symptoms of PTSD can develop within three months of the traumatic event, or later, and can be classified into re-experiencing, avoidance, arousal and reactivity, or cognition and mood symptoms. Some examples of these include.

• Re-experiencing
  • Flashbacks
  • Recurrent memories or dreams
  • Distressing thoughts
• Avoidance
  • Avoiding places, events, or objects that are reminders of the trauma
  • Avoiding thoughts or feelings related to trauma
• Arousal and Reactivity
  • Startling easy
  • Tense feelings
  • Difficulty in concentration
  • Irritability or angry outbursts
• Cognition and Mood
  • Having trouble remembering traumatic event
  • Having negative thoughts
  • Having negative emotions, fear, anger, guilt, or shame
  • No interest in activities
  • Social isolation

 
So how do we distinguish between PTSD and CPTSD? 
As discussed previously CPTSD results from chronic abuse or trauma. Along with the circumstances we discussed previously, this could also include child abuse. Also, along with the symptoms of PTSD, individuals suffering from CPTSD will have additional symptoms. These include:

• Extreme reactivity: Anger and aggressive behavior
• A negative sense of self
• Extreme difficulty developing and keeping meaningful relationships.

Living with PTSD or CPTSD can be life altering for the individual and their loved one.  Therefore, it is important that the symptoms are recognized, and help is pursued.
Coping with PTSD
What help is available for those that experience PTSD? While some medications are used in the treatment of PTSD, other therapies are widely used. These include:

• Trauma-focused Cognitive Behavioral Therapy (TF-CBT)
• Eye movement desensitization and reprocessing (EMDR)
• Dialectical Behavior Therapy (DBT)

While these talk therapies have proven to be very effective, there are healthy coping skills that the person with PTSD can do in conjunction with their treatment. Some of these are:

• Mindfulness
• Self-Monitoring
• Social Support
• Self-Soothing
• Writing and Journaling
• Distraction
• Behavioral Activation (Increasing activity level)

There is no doubt that PTSD is a very complex condition, that if left untreated, can be debilitating. It is encouraging that there is more attention being given to all aspects of the disorder, with ongoing research and development of effective treatments. Resources are also available online to increase awareness and provide education. We should all increase our awareness on PTSD, and most importantly remain empathetic to those that are suffering from this disorder.
                                                                                             Peggy Fossen, DNP, RN, CNE

 
References

BrainLine (2023). All about brain injury and PTSD. https://www.brainline.org/article/dsm-5-criteria-ptsd
 
Bridges to Recovery. https://www.bridgestorecovery.com/post-traumatic-stress-disorder/can-emotional-abuse-cause-ptsd/
Cleveland Clinic (2023). CPTSD (Complex PTSD). https://my.clevelandclinic.org/health/diseases/24881-cptsd-complex-ptsd
NIH (2014). Trauma-Informed Care in Behavioral Health Services. https://www.ncbi.nlm.nih.gov/books/NBK207201/
 
Miao XR, Chen QB, Wei K, Tao KM, Lu ZJ. Posttraumatic stress disorder: from diagnosis to prevention. Mil Med Res. 2018 Sep 28;5(1):32. doi: 10.1186/s40779-018-0179-0. PMID: 30261912; PMCID: PMC6161419.
 
Tull, M. (2020). Dialectical Behavioral Therapy (DBT) for PTSD. VeryWellmind. https://www.verywellmind.com/dbt-for-ptsd-2797652
 
Tull, M. (2021). How PTSD is treated. VeryWellmind. https://www.verywellmind.com/ptsd-treatment-2797659
 
University of South Carolina School of Medicine. Post Traumatic Stress Disorder. https://uscmed.sc.libguides.com/c.php?g=885034&p=6359964
 
US Department of Veteran Affairs. PTSD: National Center for PTSD. https://www.ptsd.va.gov/understand/types/violence_ipv.asp
 
Vernor, D. (2019). PTSD is more likely in women than men. NAMI. https://www.nami.org/Blogs/NAMI-Blog/October-2019/PTSD-is-More-Likely-in-Women-Than-Men