mental illness – UAB Institute for Human Rights Blog

PTSD is Not Just for Veterans; It’s A Trauma Disorder

by Marie Miguel

Some people believe that PTSD is only a mental health condition that affects those who have come back from war, but this isn’t the case. People who have Post Traumatic Stress Disorder aren’t just veterans. Individuals with PTSD have experienced severe trauma. It’s not only people that come back from combat, but that’s how many of us associate the disorder. PTSD can happen to anybody who experiences trauma such as a sexual assault, a natural disaster, or many things that would prompt someone to have a traumatic reaction, so let’s stop talking about PTSD as though it’s something that only war veterans experience. Anyone who has been through a traumatic experience can develop PTSD. According to the National Alliance on Mental Illness (NAMI), PTSD affects 3.5% of the U.S. adult population. That works out to eight million American people living with the condition. Approximately 37% of people diagnosed with PTSD display serious symptoms. Women have higher rates than men. Later in this article, we’ll discuss the gender divide.

What is Post Traumatic Stress Syndrome?

Post Traumatic Stress Syndrome happens after a person experiences trauma, and it’s something that sticks with a person. Symptoms can include flashbacks, night sweats, insomnia, panic attacks, and isolating from friends and family. We need to understand that people with PTSD aren’t dramatic; they’re traumatized. When you experience trauma first-hand it changes your brain. According to the U.S. National Library of Medicine – National Institutes of Health, Several areas of the brain are involved when a person experiences PTSD. A stress response includes the amygdala, hippocampus, as well as the prefrontal cortex. PTSD and trauma can cause lasting changes in those areas of the brain.

What causes PTSD?

The cause of PTSD is that a person experiences trauma and never adequately deals with the issues because it sticks with them. People think that PTSD is caused by being in combat because combat can be a traumatic experience, especially if you see someone die in front of you. The cause of PTSD is when an individual has difficulty adjusting after a traumatic event; their brain changes and the memory of the traumatic event gets stuck in their brain. These intrusive memories make it difficult for an individual to function. The root cause of PTSD is a traumatic event, but the symptoms are what overwhelm people to the point where it’s diagnosable. People with PTSD often have recurring distressing and upsetting memories of the trauma, and when you continually have upsetting memories and can’t stop them, it makes you want to shut down, which is a problem that many people face when living with PTSD, and it can seriously impact your relationships.

Causes of PTSD

A stressful experience
Trauma
Mental Illness
Predisposition to mental illness or family history of mental illness

Risk factors for PTSD:

Long lasting trauma
Childhood sexual abuse
Other childhood trauma
A job where you’re exposed to trauma such as a military position
If you don’t have a sound support system
Seeing someone get hurt
A history of substance abuse

Types of trauma

When we think of PTSD, we might think of combat, but it’s not just that. Anyone who has experienced trauma is at risk of developing PTSD. Whether you witnessed a violent act or you were physically attacked yourself, you’re at risk for PTSD. In addition to combat, types of trauma that can induce PTSD include but aren’t limited to:

Childhood sexual abuse
Other childhood trauma
Sexual assault or violence
Physical assault
Natural disaster
Being attacked with a weapon

Symptoms of PTSD

Symptoms of PTSD can range from mood symptoms to physical symptoms. These symptoms can include but aren’t limited to nightmares, irritability, being easily startled or frightened, trouble sleeping or concentrating, or even feeling completely emotionally numb. These symptoms occur after a traumatic event and are only some of the possible signs that an individual could experience. Everyone reacts to trauma differently. And it’s understandable that someone may shut down, lash out, or break down crying. These are all responses that could happen.

How intense are your symptoms?

Depending on the person, the intensity and type of PTSD symptoms will differ. If you have suicidal thoughts or ideation, it’s incredibly crucial to reach out to a friend, loved one, or to contact the national suicide prevention hotline (1-800-273-8255 or 1-800-273-TALK in the United States.) It’s essential that you talk to your doctor if you’re experiencing difficulty functioning.

Complications of PTSD

PTSD can impair someone’s function to the point where they’re unable to engage in normal life activities. Someone might develop substance abuse issues, an eating disorder, or other comorbid mental health conditions. PTSD can be debilitating. It can lead people into a state where they can’t work. It can make it so that they’re unable to attend social functions, and it can severely impact a person’s life. If you’re diagnosed with PTSD, you need to have the following symptoms:

One avoidance symptom – Avoidance is where you’ll stay away from things that remind you of the trauma. Avoidance symptoms include avoiding places and situations that remind you of the trauma, and avoiding thinking about upsetting thoughts connected to the event

At least two arousal symptoms– Arousal symptoms of PTSD make a person extremely anxious. Arousal symptoms include:

Getting startled easily
Feeling tense
Having problems sleeping
Angry outbursts

At least two cognition/mood symptoms – Cognitive symptoms of PTSD can rob people of things they once enjoyed. Cognitive symptoms include difficulty remembering the trauma, distorted emotions including guilt, and loss of interest things you once enjoyed

One re-experiencing symptom – Re-experiencing a key marker of PTSD, and it sounds exactly like what it is; re-experiencing. Re-experiencing symptoms include flashbacks or reliving the trauma, nightmares, or scary thoughts.

a lone little boy sitting on a platform — Source: John Smith, Creative Commons

Children vs. Adults With PTSD

Children can have different responses to trauma in comparison to adults. They might wet the bed or have selective mutism, they might start acting out during play time, or they might begin experiencing separation anxiety. According to the National PTSD center, seven or eight out of every 100 people experience PTSD at some point during their life. Not every person who has PTSD has been through a dangerous incident; some people experience it after a loved one has suffered harm.

According to The U.S Department of Veteran Affairs Studies, approximately 15% to 43% of girls and 14% to 43% of boys experience significant trauma. Of the children and teens that experience trauma, 3% to 15% of girls and 1% to 6% of boys go on to develop Post Traumatic Stress Syndrome.

We can see that females seem to develop PTSD more than men do. What is the reason for this? Many women are survivors are sexual assault, try to speak up and aren’t believed. According to the National Sexual Assault Resource Center, one in five women and one in 71 men will be raped at any given point during their lives. Yet, we as a society do not believe survivors as we should. We need to start believing women when they come forward. When we do they can get treated for what happened to them appropriately.

Why do some people get PTSD and others don’t?

You may be wondering why some people develop PTSD while others do not. Part of it has to do with having the risk factors listed above, but there’s nothing wrong with you if you have PTSD and someone else in the same situation did not. There are other disorders that can go along with PTSD. An individual with PTSD can have additional mental health conditions. They may also struggle with suicidal ideation and may attempt to take their life. Here are some mental health conditions that people with PTSD also manage:

Generalized Anxiety Disorder
OCD
Depression
Borderline Personality Disorder
Substance Abuse

How to prevent PTSD

PTSD isn’t necessarily preventable because you can’t control when trauma happens, but you can deal with the trauma after it happens. After experiencing a traumatic event, it’s vital to seek mental health treatment in the form of therapy and, if you need to, a psychiatrist. You can reach out to people in your network and find someone to treat your symptoms. Whether you see someone online or in your local area, PTSD is treatable and even preventable if you address trauma right away. If you develop PTSD, it’s okay, and there’s no need to feel shame. It’s a treatable mental illness, and you’re not alone. Many people live with PTSD, and with support, you will get through this. It starts with getting help from a mental health professional, whether that’s working with someone in your local area or finding the help of an online counselor, like one at BetterHelp, you can find a treatment plan and get the help that you need to health from PTSD. You’re not alone, and remember that millions of Americans live with the condition. By going to therapy, you’re doing something incredibly brave, which is taking charge of your mental health. You will get better, but it’s going to take time. Be patient with yourself. Healing from trauma can be difficult, but it’s worth it.

Marie Miguel has been a writing and research expert for nearly a decade, covering a variety of health-related topics. Currently, she is contributing to the expansion and growth of a free online mental health resource with BetterHelp.com. With an interest and dedication to addressing stigmas associated with mental health, she continues to specifically target subjects related to anxiety and depression.

We Beretta Do Something: Gun Violence, Public Health & Their Discontents

doctor-gun. Source: spacecoastdaily.com, Creative Commons

Continuing the Institute for Human Rights’ blog series on gun violence, this contribution illuminates a public health lens, offering an evidence-based analysis and pragmatic solutions to the U.S. gun violence epidemic.

Following the February mass shooting at Marjory Stoneman Douglas High School (Parkland, FL) that resulted in 17 fatalities, mainstream fervor on U.S. gun violence has, once again, returned. Parkland Students have utilized their recent tragedy as a platform to demand an end to gun violence and mass shootings, stressing why their lives matter. According to Amnesty International, the world’s largest grassroots human rights organization, U.S. gun violence is a human rights crisis. Human rights are protected and enforced by international and national policy, and with the U.S. government marshalling many of these treaties and laws, it is, too, culpable of upholding such rights.

The nation’s leading science-based voice for the public health profession, the American Public Health Association (APHA), claims gun violence is one of the leading causes of premature death in the U.S., killing over 38,000 people and injuring nearly 85,000 annually. Gun violence can not only affect people of all backgrounds but disproportionately impacts young adults, men and racial/ethnic minority groups. Recently, Parkland Students teamed with students in Chicago to address inner-city gun violence, a phenomenon commonly overlooked by the media while addressing its threat on young lives. Though most gun violence is not an agent to mass shootings, the APHA claims, in 2017, there were 346 mass shootings in the U.S., killing 437 as well as injuring 1,802.

Furthermore, the American Medical Association (AMA), who leads innovation for improving the U.S. health care system, labeled gun violence “A Public Health Crisis”. At their 2016 Annual Meeting of House Delegates, the AMA actively lobbied Congress to overturn legislation that averts the Centers for Disease Control and Prevention (CDC) from researching gun violence. The CDC is one of the leading institutions of the Department of Health Human Services (DHHS), working 24/7 to protect Americans from foreign and native health threats, whether they be chronic, acute, curable or preventable, accidental or intentional. Ultimately, the CDC protects U.S. national security and critical science is imperative to addressing health threats.

According to the Union of Concerned Scientists, a 1993 CDC-funded study published by the New England Journal of Medicine found that firearms in the home increased the risk of homicide in the household, as opposed to home protection. This galvanized the National Rifle Association (NRA), a major force in U.S. gun rights and education, to campaign against the CDC and its “anti-gun propaganda”.

In response to this 1993 publication and the NRA’s support, Congress in 1996 passed an appropriations bill known as the Dickey Amendment, named after former Arkansas congressman and NRA member Jay Dickey, which states, “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” Almost two decades and thousands of tragedies later, Dickey renounced these restrictions in 2015 by claiming, “Research could have been continued on gun violence without infringing on the rights of gun owners, in the same fashion that the highway industry continued research without eliminating the automobile.” Despite this humility, the Dickey Amendment persists, curtailing efforts to address gun violence in the U.S.

a picture of a Beretta handgun — Beretta 9000S. Source: James Case, Creative Commons

In the U.S., a common method to circumvent the argument that guns extrapolate acts of violence is to scapegoat people with mental illness. The American Psychiatric Association (APA), the leading voice and conscience of modern psychiatry in the U.S., recently published a book on gun violence and mental health. Specifically, they address the topic of mass shootings and mental illness.

Some popular misperceptions are:

Mass shootings by people with serious mental illness represent the most significant relationship between gun violence and mental illness.
People with serious mental illness should be considered dangerous.
Mass shooting will be effectively prevented with gun laws focusing on people with mental illness.
Gun laws focusing on people with mental illness, or a psychiatric diagnosis, are reasonable, even if they perpetuate current mental illness stigma.

On the other hand, it is evidence-based that:

Mass shootings by people with serious mental illness represent less than 1% of all annual gun-related homicides.
People with serious mental illness contribute to an overall 3% of violent crimes. An even smaller percentage of them are found to involve firearms.
Laws for reducing gun violence that focus on the previously mentioned 3% will be extremely low yield, ineffective, and wasteful of resources.
The myth that mental illness leads to violence is perpetuated by gun restriction laws focusing on people with mental illness, as well as the misunderstanding that gun violence and mental illness are strongly linked.

However, a significant caveat related to mental illness and gun violence is suicide. The American Foundation for Suicide Prevention (AFSP), who funds research and offers education on suicide, claims depression is one of the most treatable psychiatric illnesses yet is seen in over 50% of people who die by suicide. Suicide lays in the shadow of repetitive, media-frenzied mass shootings, while representing nearly two-thirds of gun-related deaths in the U.S. Harvard University T.H. Chan School of Public Health indicate a number of factors that define lethality of suicide methods, including inherent deadliness, ease of use, accessibility, ability to abort mid-attempt and acceptability — all attributable to gun ownership and usage, specifically in the U.S. To strengthen civil discourse on gun-related deaths and injuries, we must uphold a national platform for suicide prevention, too. If you or a loved one is experiencing a suicidal crisis or emotional distress, the National Suicide Prevention Lifeline is 1-800-273-8255 (available 24/7).

Last year, researchers at Johns Hopkins University School of Medicine analyzed data from the Nationwide Emergency Department (ER) sample between 2006-2014 and concluded the U.S. accumulates an annual $2.8 billion in hospitals bills from gunshot wounds, with an average ER cost of $5,254 and approximately $96,000 in follow up care per patient. This study was limited because data was only used for gunshot victims who arrived at the hospital alive; people who did not seek medical treatment or were dead on arrival were not counted. Furthermore, after accounting for lost earnings, rehabilitative treatment, security costs, investigations, funerals, etc., a 2015 Mother Jones report estimated gun violence cost Americans $229 billion annually.

The APHA insists gun violence is not inevitable but preventable, and suggests core public health activities are capable of interrupting the transmission of gun violence. Notable ways to curb gun violence are:

Better Surveillance
- Increased congressional funding of The National Violent Death Reporting System which is currently employed in 40 U.S. states, D.C. and Puerto Rico.
More Research
- Lifting restrictions on federal funding for research on gun violence. There is barely any credible evidence on the effect of right-to-carry laws.
Common-Sense Gun Policies
- Criminal background check on all firearms purchases. This includes gun show and internet purchases.
Expanded Access to Mental Health Services
- Funding for mental health services has declined, so increased financial support for the Substance Abuse and Mental Health Services Administration (SAMHSA) is advised.
Resources for School and Community-Based Prevention
- Intervention and preparedness programming to prevent gun violence and other emergencies in communities, namely schools.
Gun Safety Technology
- Innovation that prevents illegitimate gun access and misuse such as unintentional injuries.

If the above prescriptions are not followed, the tragedies will likely continue. So, it is imperative we support leaders who will encourage gun policy that protects public health and our right to life. Tomorrow, March 24, 2018, people across the world will March For Our Lives, demanding the lives of kids and families, amidst the controversy circling around gun violence, become prioritized.

A march for our lives, your life and mine is exactly what the doctor ordered.