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Writer's picturePatrick Carson

Dispelling the Myths about PTSD



When we see Post-Traumatic Stress Disorder (PTSD) depicted in movies and television, it’s often the same picture presented over and over again. People with PTSD are generally depicted as male, military veterans, prone to dissociations and flashbacks, and regularly display violent or unstable behaviours. In addition, PTSD is often depicted as something untreatable, something that’s present for the remainder of the person’s life. One reason these stereotypes are so prevalent is because a lot of them, at first glance, appear to make some sort of intrinsic sense - you can’t erase the past, so why would you be able to erase the effects of the past? If PTSD often relates to violent experiences, why wouldn’t someone be more prone to violence as a result? And if PTSD often results from military service, and the Defence Force is a primarily male field (with women making up around 13% of the Australian Defence Force), then wouldn’t it make sense for men to make up the bulk of those who experience PTSD?


Unfortunately, while these statements make some sort of intrinsic sense if we don’t examine them closely, the truth is more complex, and the cost of these stereotypes can be significant. It can distort our view of the problem, can discourage people from seeking treatment, and can contribute to the stigmatisation of those experiencing PTSD. In this blog, I’ll attempt to call some of our common myths about PTSD into doubt.


Myth #1: PTSD only affects military veterans.


This one is tricky, because much of the early research on PTSD was done in relation to the aftereffects of combat. Prior to PTSD being coined as an official diagnosis by the American Psychiatric Association in 1980, it was often known by such terms as “Shell Shock” or “Combat Neurosis”. While those who have seen combat can absolutely develop PTSD as a result, and while the prevalence of PTSD appears higher for combat veterans, the truth is that anyone who experiences a traumatic event can develop PTSD. The range of events which constitute a trauma is broad, and can include any exposure (either experienced, witnessed, or learnt about) to actual or threatened death, serious injury, or sexual violence. In addition, it is possible to develop post-trauma symptoms even from events not included in this category. Arguably, for instance, repeated bullying or emotional abuse without threat of death, sexual violence, or serious injury may not meet the criteria for a PTSD diagnosis, depending on the method of classification. This does not mean that it cannot produce significant post-trauma symptoms, and it doesn’t not mean that it is not real, distressing, debilitating, or crucially, treatable. Anyone can develop post-trauma symptoms or PTSD, not just combat veterans.





Myth #2: People with PTSD are typically violent.


This myth can be quite harmful, as the stigmatisation of those with PTSD can result in a number of adverse mental health outcomes. The reality is that violent behaviour is not required for a diagnosis of PTSD, nor is it present on typical questionnaires that assess PTSD symptoms. One common cluster of symptoms within PTSD, however, is hypervigilance. People experiencing hypervigilance will often be very alert to potential danger. They may regularly assess their environment for threats, and may appear to be on “high alert”. This can result in them often feeling jumpy, and having a heightened response to being startled. As such, it’s true to say that people with PTSD may perceive threats differently and respond to those threats differently relative to someone without PTSD. However, while our response to threat and our emotional reactions may be impacted by trauma, people with PTSD who engage in interpersonal violence are the minority, not the majority.



Myth #3: People with PTSD are generally men.


This one is easier to dispute. Current studies in PTSD prevalence vary, but generally PTSD is estimated to be diagnosed 1.5 to 2 times more often in women rather than men.



Myth #4: PTSD always looks the same.


PTSD is a complex condition, and there’s a lot of room for variation across presentations. People are required to have symptoms from a number of different clusters, so there are often common elements across presentations, but each cluster has a number of different symptoms contained within them, and two people can have very different experiences while both still meeting the criteria for PTSD.


Myth #5: PTSD cannot be treated.


This myth is potentially one of the most harmful ones, because it can lead to people becoming reluctant to seek treatment. The fact is that there are several evidence-based treatments which are generally effective for treating PTSD. Cognitive Processing Therapy (CPT), Prolonged Exposure (PE), and Trauma-Focussed Cognitive Behavioural Therapy (TF-CBT) are all strongly recommended by the American Psychiatric Association, while other treatments with generally good evidence-bases available as alternatives. My background is primarily with Cognitive Processing Therapy, and in my experience, it’s been both effective and efficient. No treatment will have a 100% success rate for all people, but evidence suggests that it is generally effective at producing significant reductions in PTSD symptoms, as are other frontline PTSD treatments.


If you think you might be experiencing PTSD, it’s important to discuss it with your GP, and to seek a referral to a professional who can provide evidence-based treatment. If you’ve broken your leg, you can never go back in time and un-break that leg. Likewise, if we’ve experienced a trauma, we can never again become people who have not experienced that trauma. We can, however, improve the symptoms, change and deepen our understanding of the past, and become people who no longer have PTSD. The first step is seeking treatment.



References:


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


Watkins, L. E., Sprang, K. R., Rothbaum, B. O. Treating PTSD: A Review of Evidence-Based Psychotherapy Interventions. Frontiers in Behavioral Neuroscience, 12, 258.


American Psychological Association. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults.


Asmundson, G. J. G., Thorisdottir, A. S., Roden-Foreman, J. W., Baird, S. O., Witcraft, S. M., Stein, A. T., Smits, J. A. J., & Powers, M. B. (2019). A meta-analytic review of cognitive processing therapy for adults with posttraumatic stress disorder. Cognitive behaviour therapy, 48(1), 1–14.


Mittal, D., Drummond, K. L., Blevins, D., Curran, G., Corrigan, P., & Sullivan, G. (2013). Stigma associated with PTSD: perceptions of treatment seeking combat veterans.

Psychiatric rehabilitation journal, 36(2), 86–92.


Olff M. (2017). Sex and gender differences in post-traumatic stress disorder: an update. European Journal of Psychotraumatology, 8(sup4)


Hu, J., Feng, B., Zhu, Y., Wang, W., & Zheng, J. X. X. (2017). Gender Differences in PTSD: Susceptibility and Resilience. In (Ed.), Gender Differences in Different Contexts.

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