16 Jun 2017
June 16, 2017

The Other Reason You Can Get PTSD

Three weeks into her new job — a contract position at a Canadian company — Roslyn, 23, who did not want her last name used, was raped by a coworker. They had been introduced by a close friend, and he’d been driving her home each day after their shift ended at midnight in exchange for gas money. At first, Roslyn said, their sexual activity was consensual. But when she told him she didn’t want to go any further, he assaulted her.

Roslyn reported the attack to her supervisor at work and management called the police. She filed a statement and her coworker was charged with one count of sexual assault. Pending prosecution, the company moved Roslyn to the day shift and sat her at a workstation on a different floor, away from her coworkers. Her attacker stayed on the same shift, at the same workstation.

She began to experience flashbacks to the assault. She’d see her attacker in the halls and start to hyperventilate and feel nauseated. She felt intense rage and hatred. She had trouble sleeping, an irregular appetite, and she grew depressed. “Having such an intense reaction at work was draining, and my work suffered,” she said. “My depression also seeped into my personal life. I’d be easily irritated and preferred being alone.”

She began seeing a counselor through her company’s employee assistance program, who told her she had post-traumatic stress disorder.

Public Attention to PTSD.

PTSD does to brainFLICKR / ALLAN AJIFO – FLIC.KR

For many people, PTSD conjures an association with military personnel who return home “shell-shocked,” as the condition was called long ago because soldiers traumatized by the horrors of war or the effects of a grave injury.

But in the days after Marvel’s Jessica Jones debuted on Netflix, a flurry of articles praised the show’s frank portrayal of a woman dealing with PTSDin the aftermath of a preternaturally abusive relationship. The show “navigates the importance of space for trauma victims and the fiction of privacy,” wrote Patricia Grisafi for Bustle, “[and] also demonstrates exactly how particular places and events can be triggering. Very few TV shows or movies get this experience right.”

The widespread praise for Jessica Jones’ handling of PTSD in a rape survivor may speak to the knee-jerk association of the condition with veterans. Military personnel deserves visibility and support — aspects crucial to overcoming PTSD — but it is equally important to publicly recognize those affected by PTSD who have never seen combat.

Post-traumatic stress disorder can develop after exposure to a trauma, broadly defined as experiencing or witnessing a grave physical harm or the threat of physical harm, Dr. Farris K. Tuma, program chief of the Traumatic Stress Research Program at the National Institutes of Mental Health, told ATTN:. In addition to experiences accrued in combat, the NIMH lists a number of traumas that can trigger PTSD, including mugging, rape, torture, kidnapping, childhood abuse, car accidents, plane crashes, or natural disasters like floods or earthquakes.

The symptoms fall into three clusters, Dr. Tuma said: re-experiencing the trauma, through vivid nightmares or intrusive thoughts and flashbacks while awake; avoidance of reminders of the event and thoughts related to it, including feelings of guilt or anger, often accompanied by behavioral changes like becoming more moody and withdrawn, avoiding social interactions, and developing drinking or substance abuse problems; and hyperarousal, being “jumpy” or experiencing a heightened physiological response to things in the environment well after the traumatic event is over. Most people who experience a trauma will have some of these symptoms in the immediate aftermath of the event, but the small percentage of people whose symptoms intensify or persist for more than a month may receive a diagnosis of PTSD.

In any given year, an estimated 3.5 percent of adults in the U.S. — about five million people — may have symptoms of PTSD, Dr. Tuma says. But depending on the trauma, the rates of PTSD vary. An estimated 13 to 17 percent of returning service members will have symptoms, for example, compared with just 3 to 6 percent of people who experience a major car accident.

For sexual assault survivors, the numbers are staggeringly high: 50 percent or more. Research has identified certain important risk factors. “The severity and the duration of the trauma is an important factor, [as is] how the person responds in the moment, the severity of their acute feelings of helplessness and horror and fear,” Dr. Tuma said. “If they’ve had previous psychiatric problems, anxiety or depression or other conditions; if there’s a history of alcohol abuse and addiction, or childhood abuse, [these] may well have teed somebody up biologically” to develop PTSD.

Lack of support reinforces trauma.

upset-womanBIGSTOCK/VASILCHENKO NIKITA – BIGSTOCKPHOTO.COM

Social support is another important risk factor, Dr. Tuma said. “If somebody has someone that they feel comfortable talking with, if they feel they’re not alone, that seems to make a very big difference.”

When it comes to sexual assault, particularly an assault that occurs on a college campus or in the workplace, lack of support may be institutional rather than social. A woman who has been raped on campus, for example, may have to choose between dropping out or remaining in close proximity to her attacker.

Several months after Roslyn’s coworker was charged with assault, the provincial prosecution dropped the charges. Her company moved her back to to her original floor, seating her across the room from her attacker. “They said they had no legal obligation to accommodate me,” she said. Her doctor and counselor wrote letters protesting the decision, but in the meantime Roslyn was forced to see her attacker every day. She hadn’t told anyone else about the assault, and she felt the best way to protect herself was to withdraw from the office environment entirely, barely speaking to anyone during her eight-hour shifts.

A situation like this could potentially “prolong the traumatic event,” Dr. Tuma said. From a neurobiological perspective, being exposed to their attacker could not only force the survivor to relive the traumatic experience, but also strengthen the association of those traumatic memories with feelings of fear and anger. “It’s one thing to have close friends be supportive, but that might be chipped away at or undone if the larger community you’re in negates [the experience] or denies it,” he said.

Overcoming PTSD.

PTSD “is not a matter of will or weakness,” Dr. Tuma emphasized. “There’s good evidence that the symptoms are rooted in the connections and functions of brain circuitry. People are changed biologically, but not necessarily permanently.”

What’s important to understand is that these traumatic memories are not necessarily fixed forever, Dr. Tuma said. In a person who recovers from a traumatic event without developing PTSD, “they still remember their accident or assault, but with time the memory gets uncoupled from this really strong emotion of fear or horror or guilt.” Researchers call this phenomenon “extinction,” and it’s how psychotherapy for PTSD — prolonged exposure therapy and cognitive processing therapy are the most common — aims to treat the condition. “We want to couple the thoughts of the trauma with [something like], ‘I survived. I’m safe. It’s not happening again,'” Dr. Tuma said. “You’re not getting rid of the old memory, just modifying it.”

Roslyn still sees a counselor, one she was referred to through the hospital where she went for STI screening after the assault. They speak for an hour every week or so, “and I feel comfortable enough to talk about everything.” She also practices hot yoga, which she’d done regularly before the assault. “It helped me stay connected to my body, and the mental benefits have helped me develop a healthier, more positive perspective.” Although she still experiences flashbacks during sex, they’re becoming less frequent.

“The event is part of who I am now, and accepting that instead of trying to deny it or fight it has mitigated the longer-lasting impacts of the trauma. The only thing I can do is make that pain useful in the long run. I’m using my experience to advocate for survivor rights.”

If you know someone who has PTSD, “give them time and space and don’t judge them,” Roslyn said. “Ask them what they need from you and respect it. All you can do is listen to, support, and respect them, and let them heal at their own pace.”

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