Trigger Warning: PTSD, Sexual Abuse, Emotional Abuse
Posted by Riddhi Panchal and Sakshi Jain
Post-traumatic stress disorder, or PTSD as it is usually known, is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape or other violent personal assault. The symptoms include flashbacks, uncontrollable thoughts about the event, severe anxiety and nightmares.
PTSD can have many forms and it be frightening and painful for a person. The memories of the event keep coming back in the form that patients have flashbacks. Patients always feel on edge and even a small trigger can send them back into their shell. People tend towards avoiding people, situations, objects which remind them of their terrifying experience. All this can negatively impact their social, occupational or academic lives. The actions and mechanism behind PTSD is still unknown. Why some people who experience trauma develop PTSD and others do not is still being researched.
PTSD is a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event.
According to DSM- 5, there are eight criteria essential for diagnosis of PTSD. These include: if the person was exposed to death, if the traumatic event is persistently re-experienced, if there is avoidance of trauma-related stimuli after the trauma, presence of negative thoughts and feelings after the trauma, presence of trauma-related arousal or reactivity, symptoms lasting for more than a month, presence of distress and functional impairment and symptoms are not due to medicines, and illness or substance use.
How PTSD manifests itself differs in each individual’s case, but we have and continue to learn about some common and other distinct aspects of how people experience this. Gender is one aspect that can drive this difference. Women are more than twice as likely as likely to develop PTSD than men (10% for women and 4% for men). The reasons for why women may get PTSD include that women are more likely to experience sexual assault, and women are also more likely to blame the trauma on themselves.
A research study in 2009 on Intimate Partner Violence in India and its association with PTSD and Depressive Symptoms showed that 56% of women reported having an history of Intimate Partner Violence and of those 14% exceeded the baseline/cut-off scores for PTSD and 20% exceeded cut-off scores for sub-threshold PTSD. Also 70% of those women reported sexual coercion. Severity of violence and sexual coercion correlated positively with PTSD severity.
Women are more than twice as likely as likely to develop PTSD than men (10% for women and 4% for men).
BW (a pseudonym for someone we spoke with for this piece) mentions: “A few years ago, I was (correctly) diagnosed with PTSD but for the wrong reasons. The minute you tell psychiatrists that you’ve lived through years of sexual abuse, the automatic assumption is that that is the cause of the PTSD. This was just not true in my case. It was three years of living with a physically and verbally violent husband that traumatized me.”
“I think understanding the cause is so important because the triggers are entirely related to what caused them in the first place. Although the abuse itself happened more than a decade ago, I still experience trauma when triggered. I am absolutely terrified of loud or sudden noises which make me palpitate (best case) or give me panic attacks (worst case). The ex-husband had an extremely short temper and a very loud voice. It didn’t help his temper that he was an insecure jerk who tried to control me in any way possible.”
“There were two major ‘incidents’ when he shouted so loudly and physically threatened me that I became paralyzed. The paralysis lasted for a few hours each time because I was literally incapacitated from fright. Although I never experienced this after I left him, I still physically cannot process loud male voices. The terror manifests less physically but more emotionally now. I ‘shut down’ and cannot process anything for a while. I cannot distinguish between men who are loud because they are angry or because they just happen to be yelling. I stay clear of well-built men because I can’t stand even the faintest whiff of aggression; muscles are so not attractive—they’re terrifying to me.”
“It took a while for my current spouse to understand all this, but he is absolutely wonderful when it comes to ensuring I don’t get triggered. He never startles me; he always announces his presence gently so I don’t jump. Unfortunately, not all the men I encounter are this thoughtful. Some of the male relatives are raucous and engage in “pretend yelling” at each other). I try to find ways to shield myself from such situations, but my trauma is about managing/coping and not exactly resolving the problem.”
Also Read: Dating With PTSD: What Is It Like?
There have also been differences uncovered in the brains of females and males with PTSD. According to a research study which was done at Stanford University of Medicine, MRI scans of subjects who were a part of the experimental group showed differences between male and female brain scans.
The differences were found in a region of the insula – a deep fold in the brain thought to be important in a range of processes, including homeostasis and emotion. The particular section of the insula that showed the most pronounced differences is known as the anterior circular sulcus, which integrates emotions and actions. It detects cues from the body and processes empathy and emotions. Usually the insula volume decreases with age. However, the study showed that the volume was shrinking in females faster due to the stress experienced because of the trauma.
Women are more likely to develop PTSD if they do not have a strong support system, if they have experienced life-threatening trauma and/or if they were injured during that particular event.
Another effect on the brain due to PTSD can be seen in the failure of the working of hippocampus during tasks such as memory as per the study. It was seen that women with PTSD have a smaller hippocampal volume when measured with the MRI. However, the changes seen in the brain of males with PTSD is different.
In addition to physiological factors, cultural factors, gender role identification and socialization also plays a major role for the sex differences in PTSD. Women are more likely to develop PTSD if they do not have a strong support system, if they have experienced life-threatening trauma and/or if they were injured during that particular event. Chances of women experiencing PTSD is raised if they experience other events causing stress after that particular incident or trauma.
This matters because it affects how medical practitioners view and treat PTSD, it impacts the research being done and what we are discovering.
Riddhi Panchal works at the MINDS Foundation, which works to eliminate the stigma surrounding mental illness and providing access to cost-effective, high-quality care. See our interview with the founder of MINDS Foundation here.
Featured Image Source: Women.com