BY VASILIS K. POZIOS, M.D. AND PRAVEEN R. KAMBAM, M.D.

PTSD Hunger Games

Murray Close/Lionsgate

This article was written by the psychiatrists of Broadcast Thought—Dr. Vasilis K. Pozios and Dr. Praveen R. Kambam. Spoilers for The Hunger Games movies follow.

The Hunger Games: Mockingjay—Part 1 opens with a very telling scene. Katniss Everdeen is on the verge of tears and hiding in the bowels of District 13 reciting the most basic facts of her existence: Her name, her age, the fact that she was twice thrown into the Hunger Games arena to fight for her life. It’s a reminder that for all of her resilience and heroism, Katniss is still just a teenage girl who has been in kill-or-be-killed situations far too often.

Psychological trauma is pervasive for Katniss (Jennifer Lawrence). She is haunted by the sheer brutality and life-threatening nature of the Games. In The Hunger Games: Catching Fire, she grapples with processing the emotional scars of her first Games and returning home to her loved ones. Then, in Mockingjay—Part 1, she struggles with her identity as she endures the psychological trauma of her second time in the arena and the knowledge that her friend Peeta Mellark (Josh Hutcherson) has been captured by the Capitol that put them in the Games in the first place.

So, Does Katniss Meet the Criteria to Be Diagnosed with PTSD?
Although it’s become fashionable to use psychiatric terms such as “PTSD” in a colloquial sort of way, post-traumatic stress disorder is actually a strictly defined mental disorder that can be severely debilitating. There are five groups of criteria that must be met in order for the diagnosis of PTSD to be made. So, does Katniss meet those criteria? Is President Coin’s (Juliane Moore) analysis in Mockingjay right— did the Games destroy her? Let’s examine her symptoms.

PTSD Criteria 1: Trauma
To be diagnosed with PTSD, one must of course be exposed to a traumatic event. Even those who flunked Psych 101 know Katniss has been traumatized. But would the specific traumatic things she’s experienced give someone PTSD?

Clinically speaking, traumatic events are defined as those involving the direct experiencing or witnessing of actual death, threatened death, or serious injury. By this definition, Katniss experiences multiple traumatic events—both in the arena and out of it—throughout The Hunger Games films. In fact, by our count, Katniss experiences over two dozen traumatic events throughout The Hunger Games, Catching Fire, and Mockingjay—Part 1.

That’s a lot of trauma.

Katniss’ life is threatened multiple times in the Games—and unlike most combat veterans, Katniss knows the people she kills. She also bears witness to the brutal killing of other Hunger Games tributes—friends and foes alike. She is particularly traumatized by the death of young District 8 tribute—and her friend and ally—Rue (Amandla Stenberg), as well as by Peeta Mellark’s (Josh Hutcherson) many near-death experiences.

And when Katniss isn’t being gassed or electrocuted in the arena, she’s being shot at and choked outside of it—or worse, witnessing floggings, executions, and mass murder.

Traumatic events can also be experienced second-hand if one learns of the violent or accidental deaths of close friends or family. Perhaps the best example of this occurs at the end of Catching Fire, when Katniss hears of the destruction of District 12—and its inhabitants—from Gale Hawthorne (Liam Hemsworth). This sort of trauma happens again, twofold, in Mockingjay when Katniss witnesses, via video feed, Gale risking his life to save Peeta from the Capitol.

PTSD Criteria 2: Intrusion Symptoms Like Nightmares and Flashbacks
Traumatic events can be re-experienced in a number of ways, intruding on normal thoughts. Katniss re-experiences the traumatic events of her time in the arena through recurrent nightmares of the Games. She also experiences at least one dissociative reaction, or flashback, when she sees herself shooting a fellow tribute (Rue’s killer, Marvel) while bow hunting with Gale at the beginning of Catching Fire. In this instant, Katniss believes the trauma of the Hunger Games is actually happening to her all over again.

Exposure to internal and external reminders of traumatic events can result in psychological and physiological reactions. For example, in her second trip into the Games arena in Catching Fire, Katniss is surrounded by a flock of jabberjays in the jungle and is distressed to hear them repeating the voices of her sister Prim (Willow Shields) and Gale. Because of her past trauma, this causes her to briefly believe they have been abducted by President Snow (Donald Sutherland). She falls to her knees overwhelmed by the birds, her breathing labored, and takes a few minutes to recover and reestablish what is real and what isn’t.

We see this time and time again in the Hunger Games films when Katniss experiences a marked variation in her pulse and respiratory rate in response to either traumatic events or the re-experiencing of trauma, often becoming tearful. A similar incident even happens far outside of the arena in Mockingjay when Katniss, retreating to District 13’s bunker during an air-raid by the Capitol, freezes amidst the noise and chaos happening as 13’s residents descend down the stairs to avoid being bombed.

PTSD Criteria 3: Avoidance
After traumatic events, people may be motivated to avoid reminders of the trauma. Even though in the Hunger Games films Katniss refuses to flee from the Games, when faced with being forced back into the arena in Catching Fire, her immediate reaction is to run away with Gale. And at first, Katniss runs from the role of the Mockingjay. Beyond her rebellious streak, Katniss’ initial resistance may indicate avoidance symptoms of PTSD.

PTSD Criteria 4: Negative Thoughts and Mood
Traumatic events can negatively alter thoughts and mood. In Catching Fire, when Gale asks Katniss if she loves him, she replies, “All I can think about every day since the Reaping is how afraid I am&mddash;there is no room for anything else.”

Katniss’ traumatic experiences resulted in a persistent negative emotional state of fear, with inability to experience positive emotions such as feelings of love. In fact, even though she initially begins to emotionally gravitate toward Gale, when she starts to feel unsafe, Katniss becomes estranged from him.

Unless prompted to for survival reasons by Haymitch Abernathy (Woody Harrelson) or Peeta, Katniss does not associate with the other Games’ victors. And hints of self-blame and survivor guilt spill out in Katniss’ eulogy of Rue to the residents of District 11: “I did know Rue. She wasn’t just my ally, she was my friend. I see her in the flowers that grow in the meadow by my house. I hear her in mockingjay song. I see her in my sister Prim. She was too young. Too gentle. And I couldn’t save her. I’m sorry.”

PTSD Criteria 5: Arousal and Reactivity
Individuals with PTSD experience marked alterations in arousal and reactivity associated with their trauma.

As her character develops throughout the films, Katniss becomes increasingly irritable and prone to angry outbursts. She is easily startled, as evidenced by her response to Gale’s approach in the woods, or her exaggerated reaction to Prim’s cat Buttercup jumping through the kitchen window at her home. What’s more, Katniss experiences sleep disturbance when she has difficulty falling asleep in the District 13 bunker.

Diagnosis: PTSD
Given these symptoms—and the fact that they’ve lasted over a year and cause Katniss clinically significant distress—it is our opinion that she suffers from PTSD.

How Katniss Deals with Her PTSD
It’s no surprise that Katniss becomes traumatized—after all, the Hunger Games are the perfect breeding ground for PTSD. Severe, life-threatening, interpersonal violence as well as witnessing atrocities and killing enemies in combat are particular risk factors for the disorder.

Additionally, Katniss may have already been at some risk because of her prior trauma exposure, death of her father, and lower socioeconomic status. And it certainly doesn’t help that she is re-traumatized at every turn.

However, in the face of the perfect storm for PTSD, Katniss endures. We can credit her intelligence, social supports (mother, sister, Gale, etc.), and realization of a greater purpose—becoming the Mockingjay—for our reluctant hero’s relative resilience.

How Katniss’ PTSD Could Be Treated
However, even though Katniss is fairly resilient, she may also benefit from treatment.

In the real world, Selective Serotonin Reuptake Inhibitors (SSRIs) and other medications can alleviate symptoms of PTSD. Cognitive behavioral therapies such as Prolonged Exposure and Cognitive Processing Therapy can also be helpful. Typically, treatment with medications and psychotherapy in concert provide the best results.

Finally, peer support groups can help foster a sense of connectedness between those recovering from psychological trauma. For Katniss, the surviving victors—Peeta, Johanna Mason (Jena Malone), Finnick Odair (Sam Claflin)—may fill this role.

But as Haymitch told Katniss, when it comes to the Hunger Games, there are no winners.

Only survivors.

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