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PTSD: War, Abuse, or Accidents?


At one point in Remarque’s All Quiet on the Western Front, the narrator, a German veteran of WWI, describes his visit home on leave: “I look at myself in the glass. It is a strange sight.” He feels agitated and “cannot get on with the people.” A few times, he is startled in the street by “the screaming of the tramcars, which resembles the shriek of a shell coming straight for one.” He reflects that the war has “crushed” him, adding: “I find I do not belong here any more, it is a foreign world….I prefer to be alone.” People “talk too much for me,” he says, and they have “worries, aims, desires, that I cannot comprehend.” His sense of alienation really comes through in the paragraph below:

When I see them here, in their rooms, in their offices, about their occupations, I feel an irresistible attraction in it, I would like to be here too and forget the war; but also it repels me, it is so narrow, how can that fill a man’s life, he ought to smash it to bits; how can they do it, while out at the front the splinters are whining over the shell-holes and the star-shells go up, the wounded are carried back on waterproof sheets and comrades crouch in the trenches.—They are different men here, men I cannot properly understand, whom I envy and despise.¹

The narrator’s anxiety, agitation, and alienation—as illustrated in the fictionalized experiences described above—are commonly understood as important symptoms of a psychological disorder called posttraumatic stress disorder (PTSD), which is associated with exposure to trauma. But are these symptoms the only expression of trauma? And might some people develop PTSD if not exposed to war trauma?

First, let me define trauma. Trauma comes from the Greek word for wound. In psychological research, the word trauma refers more specifically to an “extremely upsetting” event that “at least temporarily overwhelms the individual’s internal resources, and produces lasting psychological symptoms.”²

The DSM-5 definition for PTSD requires, among others, “exposure to actual or threatened death, serious injury, or sexual violence” directly or vicariously; the presence of intrusive symptoms such as memories or dreams related to the traumatic event; “persistent avoidance of stimuli associated with the traumatic event,” feeling detached, numb, and a sense of a “foreshortened future”; negative changes in the event-related mood (e.g. including the inability to feel happiness) and cognition (e.g. distorted view of the causes and effects of the trauma).³ See the full criteria here: https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/

These symptoms need to be present for at least one month and cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning.”³

In the DSM-5, PTSD is diagnosed based on the presence of a minimum number of symptoms (of total possible symptoms) in different categories. Therefore, one may meet the criteria for PTSD in literally thousands of different ways. So the assumption that PTSD is exclusive to combat trauma or is associated with only specific symptoms is wrong. One may be diagnosed with PTSD after a car accident, a natural disaster, and even after suffering emotional or physical abuse at home.

In fact, traumas are quite common. As cited in a literature review on trauma, in one study, 61% of men and 51% of women reported having experienced one or more traumas:

The most common trauma was witnessing someone being badly injured or killed (cited by 35.6 percent of men and 14.5 percent of women). The second most common trauma was being involved in a fire, flood, or other natural disaster (cited by 18.9 percent of men and 15.2 percent of women). The third most common trauma was a life-threatening accident/assault, such as from an automobile accident, a gunshot, or a fall (cited by 25 percent of men and 13.8 percent of women).

Close to 15% of men reported experiencing two traumas, nearly 10% three traumas, and just over 10% reported four or more traumas. Similar but lower percentages were reported for women: 14% of women had experienced two traumas, 5% three, and over 6% reported experiencing four or more traumas.

In short, though stories from people who have survived war trauma (as fictionalized in the novel discussed earlier) can be illustrative, we need to remember this: Trauma can occur anywhere, anytime, and to anybody. And PTSD may be expressed in different ways. If you suspect you have been traumatized, seek help from a mental health professional directly or ask your doctor to refer you to a specialist.

References

1. Remarque, E. M. (1996). All quiet on the Western front (A. W. Ween, Trans.). Ballantine Books. (Original work published 1929).

2. Briere, J., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment, 2nd ed., DSM–5 update. Sage.

3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.

PTSD: War, Abuse, or Accidents?


Arash Emamzadeh

Arash Emamzadeh attended the University of British Columbia in Canada, where he studied genetics and psychology. He has also done graduate work in clinical psychology and neuropsychology in US. Arash maintains a personal psychology blog and a blog for Psychology Today. Arash has a wide range of intellectual and artistic interests; he also maintains a poetry blog.


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APA Reference
Emamzadeh, A. (2020). PTSD: War, Abuse, or Accidents?. Psych Central. Retrieved on August 4, 2020, from https://blogs.psychcentral.com/fearless/2020/07/ptsd-war-abuse-or-accidents/

 

Last updated: 10 Jul 2020
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