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Spring 2009 | Vol 12 No 3

Myth busters

“Get over it!” Combating myths about PTSD

 

Throughout history, people have recognized that the experience of extreme stress can have a profound effect on the mind and body; however, it was not until 1980 that the diagnosis of post-traumatic stress disorder (PTSD) was formalized in the Diagnostic and Statistical Manual of Mental Disorders. Here we debunk some of the common myths about PTSD.

Myth: Everyone who experiences a traumatic event will develop PTSD.

Fact: PTSD is a human response to markedly abnormal situations, and it involves specific chemical changes in the brain that occur in response to experiencing a traumatic event. However, not all people who experience a traumatic event develop PTSD. This myth emerged from early diagnostic conceptualizations of PTSD. According to the DSM-III, “The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone.” In fact, most research suggests that no more than 10 to 20 per cent of trauma survivors experience PTSD symptoms that last beyond one year. A strong support system and resiliency may help trauma survivors; however, even with the best supports, a person may think they are “over” a traumatic event, only to be triggered later and realize they are still emotionally affected by it.

Myth: PTSD is only seen in people with “weak characters” who are unable to cope with difficult situations.

Fact: There is no evidence that PTSD stems from not being “strong enough.” Some risk factors for PTSD include having experienced other traumatic events, having a personal and family history of mental illness and the severity of the trauma.

Myth: All of us have been through frightening experiences and have at least one symptom of PTSD as a result of that experience.

Fact: Although memories of frightening experiences may be similar to symptoms of PTSD (e.g., vivid memories), most people do not have the severity of symptoms or impairment associated with PTSD. The specific brain-based responses seen in PTSD differ from those seen in normal anxiety. Similarly, the experiences of normal anxiety and of PTSD are markedly different.

Myth: Severity of trauma always predicts severity of PTSD.

Fact: By and large, the research literature has not found a relationship between objective trauma severity and extent of psychological distress or severity of PTSD symptoms. Some evidence exists that severity of initial physical injury predicts PTSD in victims of motor vehicle accidents, but this finding has not been consistently replicated. This is likely because the effects of the trauma reflect individual characteristics of the survivor, such as resiliency, and the post-trauma environment, for example, external supports and resources.

Myth: If someone with PTSD tried hard enough, they would be able to move past the traumatic event.

Fact: Perhaps the greatest misconception about PTSD is that the person is unwilling to move past the traumatic experience and enjoys playing the role of victim when they are angry, scared or unforgiving. Current research is exploring the potential role of the amygdala in holding the “emotional memory” hostage until a safe environment presents itself for expression. This process is not within the control of the individual; rather, it is the brain’s way of protecting the individual until it is safe to express the full impact.

This myth is related to the belief that people will have fewer symptoms of trauma if they just “put it out of their mind.” This belief reflects what psychiatrist and trauma expert Judith Herman has called our culture’s history of “episodic amnesia” about trauma. This myth expresses the wish that trauma will not happen by silencing those who have experienced it.

Myth: People who seem calm and functional at the time of the trauma are “handling” it well.

Fact: This myth reflects mainstream cultural norms that reward non-emotionality and see strong emotions as “hysterics” and “overreaction.” People who are traumatized often experience something called peritraumatic dissociation (PD). People with PD appear calm and functional, but are in fact numb and shut down, acting on automatic pilot. When people have PD at the time of a trauma, they are more likely to experience serious post-traumatic problems later. Trauma is terrifying. Experiencing strong emotions during the trauma and afterwards is a reasonable response to the unreasonableness of horror, betrayal or helplessness, not a sign of weakness or “losing it.”

A “good” trauma survivor is someone like Nelson Mandela or Elie Wiesel – transcendent, articulate and highly functional.

Fact: Often, when people have experienced trauma, it has an impact on their identity and how they understand who they are in the world. Most people do not have transcendent experiences as their immediate response to trauma. It is only well down the path of trauma recovery that people can transform terror and helplessness into spiritual growth or social action.

Myth: Early psychological debriefing of trauma symptoms will prevent PTSD.

Fact: Psychological debriefing of trauma survivors is ubiquitous. However, studies suggest that there is no reliable decrease in PTSD symptoms from such debriefing.

Sources: Anxiety and Its Disorders (2nd ed.), edited by D.H. Barlow. New York, Guilford Press, 2002; “Positive change following trauma and adversity: A review.” Journal of Traumatic Stress, 2004; “Progress and controversy in the study of posttraumatic stress disorder.” Annual Review of Psychology, 2003; “Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis.” Psychological Bulletin, 2003; The Complete Guide to Mental Health for Women, by Lauren Slater et al., Beacon Press, 2003