Why PTSD Is a Mental Injury, Not a Mental Illness
New research suggests that PTSD is a normal response to common life events.
Posted Sep 23, 2019
According to the National Institute of Mental Health, 7.7 million adults suffer from Post-Traumatic Stress Disorder (PTSD). Along with a surge of awareness regarding PTSD, there are also many misconceptions. For example, some believe it is only associated with war veterans, events such as 9/11, or natural disasters.
Although this diagnosis has historically been associated with military veterans who undergo multiple deployments, there are many other events that can trigger symptoms of PTSD. For example, prolonged exposure to emotional and psychological abuse (e.g., verbally abusive relationships, alcoholism, or stressful childhoods) are risk factors for developing symptoms. Some of these lingering misconceptions may be due to the fact that development and recognition of the disorder is relatively recent and has really only blossomed in the last three decades.
In 1980, the American Psychiatric Association (APA) formally recognized PTSD as an actual mental health diagnosis. Historically, it had been formally recognized as “shell shock” and was thought only to occur in military war veterans. Further, PTSD had historically been thought of as something that someone “gets over” over time. This may be true for some, but it isn't for others.
Researchers continue to discover risk factors that can cause PTSD symptoms. This includes emerging research on the study of what happens in childhood and how it affects adults in their lifetime (van Der Kolk, 2014). For example, some of my clients may have grown up with “tough love” and were disciplined with physical violence by a family member or a teacher. As adults, they may suffer with trauma-related symptoms but not realize the origin of their suffering.
Many who suffer from PTSD symptoms may have behavioral consequences such as binge eating, or they may self-medicate with alcohol, drugs, gambling, or other compulsive behaviors. Equally as important as identifying PTSD symptoms is understanding that they are a natural response to overwhelming events.
PTSD is a Mental Injury, Not a Mental Illness
Researchers argue that it is important to view PTSD symptoms as a mental injury, versus a mental illness or something pathological (Zimbardo et al., 2012). This is because PTSD symptoms are a natural reaction to a distressing event where one may have felt overwhelmed, afraid, or helpless. Historically, mental illness is pathologized as something that is "wrong" with the person, versus simply a manifestation of how most people would respond.
For example. if a person falls and cuts their leg, that would be an injury. Bleeding could occur, which would be a symptom of the injury; the amount of bleeding would be based on the severity of the wound, previous injuries, etc. Similarly, PTSD symptoms may manifest into problems with concentration, angry outbursts, sleep disturbance, sadness, anxiety, and even nightmares. These are natural responses to overwhelming circumstances, whether they are obviously traumatic to most (war, natural disasters) or less obvious to most people.
Obvious vs. Less Obvious Trauma
Researchers state that forms of trauma can be categorized into obvious and less obvious trauma. Obvious traumas include war, childhood abuse and neglect, sexual assault, rape, and natural disasters such as hurricanes. However, there are also less obvious forms of trauma that include:
- Parental divorce, child abandonment, or betrayal
- Toxic relationships with emotional and psychological violence (name calling, verbal abuse)
- Narcissistic parent(s) or caregivers with mental health issues
- Bullying, cyberbullying
- Witnessing violence in the home
- Alcoholism or addiction during childhood
- Invasive medical procedures; higher risk if performed on children who may have been restrained or had chronic issues.
- Falls and accidents, particularly in children or the elderly
- Natural disasters like hurricanes, fires, or earthquakes
- Being left alone as infants or children
- Automobile accidents or whiplash
A mental health professional can formally diagnose and treat PTSD. However, some people have symptoms but do not meet the full criteria.
It may be irrelevant whether a person meets the full criteria—what matters is if symptoms are causing problems in their life. Symptoms include feelings of irritability, angry outbursts, issues with concentration and sleep, feelings of detachment from others, and nightmares of the event.
There are several treatment recommendations for PTSD, including Eye Movement Desensitization and Reprocessing (EMDR). This is a highly effective treatment used by the U.S. Department of Defense to help veterans with PTSD.
Originally published on www.drtracyhutchinson.com
Levine, P. A. (2010). In an unspoken voice: how the body releases trauma and restores goodness. Berkeley, Calif.: North Atlantic Books.
McLaughlin, K. A., & Lambert, H. K. (2017). Child Trauma Exposure and Psychopathology: Mechanisms of Risk and Resilience. Current opinion in psychology, 14, 29–34. doi:10.1016/j.copsyc.2016.10.004
van der Kolk, B. A. (2005). Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401-408.
van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York, NY, US: Viking.
Zimbardo, P., Sword, R., & Sword, R. (2012). The time cure: Overcoming PTSD with the new psychology of time perspective therapy. San Francisco, CA, US: Jossey-Bass.