The Emergence of Post-Traumatic Stress Disorder

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Post-traumatic stress disorder, or PTSD, is the response an individual has following the events of an extremely traumatic experience that caused life threatening harm to themselves or someone they are close to. Over the past 40 years, the study of PTSD has progressed and found that there is not a specific answer to what triggers PTSD but, instead, a combination of other factors making it even harder to fully diagnose and come up with an effective treatment plan. However, if misdiagnosed or left unattended, PTSD can cause a maelstrom of problems ranging from everyday anxiety, heightened irritability, and even dissociation. Together, these symptoms left unattended can eventually build up and cause an individual to partake in criminal activity or violence.

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The history of PTSD is somewhat limited but the effects of PTSD have probably been experienced by numerous throughout the many traumatic historical events. The first time PTSD-like symptoms were actually documented was in the nineteenth century during the American Civil War; physician Arthur Meyers started seeing soldiers return with feelings of extreme anxiety which seemed to evoke insomnia, heart palpitations, tremors, and other things leading to him naming the symptoms the term “soldier’s heart”. Jacob Mendez Da Costa was an American physician who furthered the research on soldier’s returning from war and giving it the official term of “Da Costa’s Syndrome”. This new medical syndrome was not given much thought until about 50 years later, after the start of World War I, when Charles Samuel Meyers witnessed similar symptoms of anxiety in the soldiers who had returned home and decided to give it the name “shell shock”; this was again later renamed to “war neurosis” during World War II by psychiatrist Abram Kindler. It was not until the next major war, the Vietnam War, that this disorder would really again be revisited and studied. The psychological damage the war veterans experienced granted a revision of the Diagnostic and Statistical Manual of Mental Disorders to allow the diagnosis of PTSD to be added which gave an explanation of what these war veterans were experiencing.

Before delving into the negatives associated with being diagnosed with PTSD, the requirements for diagnosis must be clear. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) specifically details the requirements to be diagnosed with PTSD. Before the 5th edition of this handbook, PTSD was classified and treated just like an anxiety disorder, but is now classified in a new category of ‘Trauma- and Stressor-Related Disorders’. The first requirement, also known as Criteria A, is that an individual must have “exposure to actual or threatened death, serious injury, or sexual violence” either by directly being involved, witnessing, or knowing someone closely involved that falls in this criterion. The next requirement of this diagnosis is that there must be presence of “intrusion symptoms” such as recurrent flashbacks or nightmares of the situation. These symptoms must last for at least a month after the tragedy and cause significant impairment of normal human behavior, such as social and occupational struggles. Other symptoms include dissociation with others, avoidance of certain stimulants that might be similar, negative mood swings, and anger. Together, these symptoms bring about disabilities one previously would not be susceptible to had they not been involved in a traumatic event. Some of the disabilities associates with PTSD are, as follows: “work-related impairments, somatic complaints, poor quality of life, negative body image, impaired memory and intimacy, increased burden too loved ones, social dysfunction, and suicidal tendency”. The practice of just avoiding the things that are connected with negative feelings instead of dealing with them in a healthy way has been found to possibly contribute to maladaptive behavioral patterns such as increased irritability, anger, and substance abuse. Although some of these really are not considered to be a physical or mental disability, they can cause distress and deficiency to the victim feeling it, ultimately being detrimental to how they live their everyday life.

The idea of having PTSD is most notably associated with veterans and others returning from war. However, studies have found that PTSD is actually found in civilians in higher numbers than in soldiers. Even though the idea of PTSD has been around since before the Vietnam War, it was not until the 1980s that clinicians and psychologist accepted that those surviving traumas suffered from a unique range of reactions that they could not fix with the limited knowledge they had at the time. They realized that to appropriately evaluate someone’s response to trauma and come up with a treatment plan, they would have to dig deeper than it just being caused by a trauma. Some people who have been exposed to trauma don’t experience symptoms until several years later into their old age when their physical and physiological vulnerability increases. They must consider that there could be many etiological roots to an individual’s reaction regarding experiencing a trauma and that even the mere presence of PTSD is more of an exception rather than a rule. Although a group of people all experiences the same traumatic event, it comes down to the individual’s personal history and experience of life that ultimately leads to one being diagnosable for PTSD. When assessing if someone is at a high risk of developing PTSD, clinicians must look at many things such as: personal vulnerability, age at time of the exposure, individual’s social support and relationships, types of stressors in an individual’s life and personal resilience.

Being involved in a traumatic event that causes PTSD does not always involve a death or major catastrophe. There are many ways in which one can start to develop the symptoms associated with PTSD. Mothers who refuse to adequately care for their young children can cause those children to grow up symptoms of PTSD due to being mistreated as a child causing them to have a combination of anxiety and other psychological problems. The combination of these symptoms causes children to be more likely to attempt suicide, abuse drugs and alcohol, run away from home, or even engage in teenage prostitution. Those with a personal or family history of childhood mental trauma, especially women, have been found to be at a higher risk of developing PTSD. Some of the other recognized causes for PTSD include experiencing or witnessing: physical, emotional or sexual abuse; physical or sexual assault; drug addiction; or even natural causes. Studies have found that a spike in gender-based violence is accountable for the reason that more women portray symptoms of PTSD than do men. Tolin and Foa (2006) conducted a meta-analysis of 290 studies and found that women are more susceptible to more severe psychological reactions when confronted with traumatic events. This may be caused by gender-based violence such as: rape, gender/sexual assault, intimate partner violence and stalking; which is far more common amongst women than men. Some studies have even found a link between elderly dementia and the reemergence of PTSD symptoms due to the neurodegeneration inhibiting vivid dissociative flashbacks.

The most common symptoms of PTSD include flashbacks of the traumatic event, avoidance issues, and hyper-arousal. The DSM-V stated that symptoms must at least inhibit an individual until one month after the trauma to ensure that they can actually be considered psychologically deprecating. Kessler, Bromet, & Nelson (1995) found that approximately 60% of individuals who do develop PTSD following a traumatic event see a decline in symptoms with the mere passage of time alone. A 1992 longitudinal study on PTSD in rape victims found that although almost 94% met the diagnostic criterion, only 47% of those same victims met the criteria three months later.

Time might be able to heal some PTSD symptoms, but it is not always that easy. There is some data that suggests that the longitudinal course of PTSD symptoms “develop, progress, and worsen over time”. This is more specifically seen in children and teens who develop PTSD symptoms as they grow older stemming from childhood mental, physical, and emotional trauma or neglect. Many of these children end up in the criminal justice system early in life as direct victims, witnesses, or perpetrators of violence. For many, this also establishes a negative view on the whole criminal justice system for these children, therefore, it is crucial that law enforcement intervene and try to reduce this potentially negative impact. Some research has suggested that individuals who develop PTSD in response to sever sexual trauma had greater and more complex problems than others dealing with these symptoms. Canadian scientists have also found a link between PTSD symptoms and women living with HIV hinting at the development of PTSD brought on by the sexual circumstances in which they acquired the disease.

The effects of PTSD, like many other psychological problems, can be reduced through treatment. The most practiced treatment plan for patients with PTSD is the Trauma-Focused Cognitive-Behavior Therapy. This treatment model involves some degree of prolonged exposure to traumatic memories and the reprocessing of traumatic events to try to cognitively restructure any dysfunctional beliefs about the said trauma. Another similar treatment plan is the Prolonged Exposure Therapy Model. Through the use of this model, patients gradually expose themselves to trauma-related feelings or triggers that have been avoided to eventually decrease the affect they have. Another frequently used but not as popular of a treatment is the Eye Movement Desensitization and Reprocessing Therapy (EMDR) Model. This practice requires the patient to rapidly move both eyes side to side to help desensitize the stress associated with a traumatic memory to ultimately reprocess the memory with a different feeling. Sometimes the eye movement is replaced with hand claps or another form of distracting auditory tone. Although these have been found to be the best therapy models to follow, there is a lack of mental health professionals specifically trained in handling this because of the limited training institution focusing on trauma-focused treatments. All of these treatments have been evidence-based treatments, however, they have really only been tested in upper-class first world countries, therefore, it is unclear how these treatments would work in a multicultural global context. Treatment of PTSD using one of these methods might lead to a reduction in the symptoms but treatment alone will not fix everything. Along with active treatment, individuals experiencing PTSD should engage in positive relationships with others, adopt an optimistic mindset, spirituality and other personal strengths.

Research and further developments are being made on the diagnosis and treatment of PTSD. Over the next couple of years, the diagnosis of PTSD will be broken down into two possible classifications: “complex PTSD” or “core PTSD”. “Core PTSD” would be a classification for those individuals who develop symptoms after a short, one-time event such as a car wreck. “Complex PTSD” would be reserved for those who develop symptoms after a history of long-term abuse or violence and would have deeper, more complex issues. Along with treatment plans mentioned above, group therapy sessions play a vital role in recovery, especially for those who could be diagnosed with “complex PTSD”, because it can help victims process what they have been through, discover they are not alone, see different viewpoints and opinions of the situation, and help reduce the emotional suffering.

As mentioned above, PTSD can cause a multitude of reactions ranging from heightened arousal of negative feelings, substance abuse, or even dissociation. Along with these symptoms, many individuals with PTSD try to self-medicate themselves through the use of alcohol or other substances to help combat the negative feelings but this has been found to make some symptoms worse. The Epidemiological Catchment Area Study showed that almost 8% of individuals who had been diagnosed with PTSD in the 12 months prior reported the use of violence while only about 2% of those without any mental deficit reported violent use. If these reactions happen somewhere law enforcement can intervene, it most likely results in putting these people in to the criminal justice system, if not already there. Once here, it is rather difficult to establish PTSD as a liable criminal defense because generally, those with PTSD have not lost touch with reality and are still able to appreciate wrongfulness. There are four main reasons to try to use PTSD as a legal defense: Sensation seeking, where crime is committed to recreate the adrenaline felt at time of traumatic event; Guilt/Self-Punishment, where crime is committed in effort to seek punishment from PTSD-based guilt; Substance Abuse, where defendant attempts to numb PTSD-based psychic pain; and Dissociative State, where defendant commits a crime while in a dissociative state such as a PTSD flashback.

It might be rather difficult to get out of a crime with a PTSD defense, but it is not impossible and has been achieved. One particular case involved an Iraq War veteran, Jessie Bratcher, and how he was tried with murdering a man in Oregon in 2008 who allegedly raped his wife. This man repeatedly taunted the couple and claimed that the baby she was pregnant with was not Bratcher’s, but his, which ultimately led to Bratcher going to this man’s house and killing him on his lawn. Bratcher had recently returned home from Iraq and had been diagnosed with PTSD by the U.S. Department of Veteran Affairs. Robert Stanulis, a professional forensic psychologist that was used as a defense witness for the case, said Batcher had not received any treatment resulting in flashbacks that were physically affecting him even while he was in jail. He went on to claim that these flashbacks were triggered from the stress around the rape allegation. This case was taken to a jury but even the judge deemed Batcher as unsafe for the community, therefore would be unsafe in a prison setting. Bratcher faced 25 years in prison and was found guilty but insane in 2009 by the Grand County jury. Instead of going to prison, he was sentenced to at least three years in a treatment center up to a life sentence, for as long as he was mentally ill. In 2014, after spending over four years in institutionalized care, the state Psychiatric Review Board decided to release Bratcher after being unable to hold him after finding no evidence of mental disease or defect. This case caught the attention of many nationwide for it was the first time PTSD had successfully mitigated a murder conviction. This case is a good example of someone successfully using PTSD as a criminal defense due to the dissociative state of mind it created.

Post-traumatic stress affects people differently based on one’s personal history of trauma and abuse or other cognitive features. Some people can get over it through times. Others, however, must take necessary steps and treatments to help reduce the negative cognitive behaviors. As mentioned above, there are many different ways in which an individual could develop PTSD but it ultimately comes down to the individual themselves. If left unattended, it can result in a detrimental impact of an individual’s everyday life whether it be personal or occupational.

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