Can one get PTSD via Twitter?

Please note: I do not know Melody Hensley, and I have never had any interaction with her. As far as credentials go for my understanding of PTSD, here they are: I’m a licensed clinical psychologist and psychology professor who specializes in the assessment and treatment of anxiety disorders, and have published extensively on them, including several papers and a book. Check out my personal website at www.caleblack.com for more information (including reprints of the articles and chapters and slides from my course on anxiety disorders).

I don’t really keep up much with drama and goings-on in the skeptoatheist online world. I’ve got friends who do, though, and they pointed me to a recent post with the in no way linkbaitesque title of:

Woman claims she has PTSD from Twitter and Cyberstalking



Twitter gave me PTSD’: Woman claims mean comments and ‘cyberstalking’ gave her an illness usually suffered by WAR VETERANS

I was asked by this friend, basically, “Can one get post traumatic stress disorder from Twitter?”

In a word: Yes.

But, before I show you why, let’s learn a bit more about PTSD, first. PTSD has long been considered an anxiety disorder (until the latest edition of the DSM anyway, but that’s a whole other can of worms). As I write in the introduction to the above linked book:

Anxiety is a common and essential process of daily life. It is highly important, evolutionary speaking, as people typically experience anxiety when faced with environmental threats such as encountering a lion (not so common a concern in modern society for most people), scarcity of food or other resources, or acceptance among one’s peers and society at large. This anxiety orients the individual toward anticipating dangers, motivates the person to act in order to avoid events that might cause bodily harm or psychological distress, and prepares the body and mind for taking some sort of action (Zeidner & Matthews, 2011)….When intense worry or fear begins to disrupt one’s daily functioning, however, it can be detrimental to one’s health.

So, anxiety is generally good, until it goes awry. This can cause enormous amounts of problems for the person with this maladaptive anxiety.

Meta-analyses have shown that the most damaging anxiety disorders to overall quality of life are social phobia and post-traumatic stress disorder (PTSD), but that all are associated with high rates of QoL and functional impairment, especially in the areas of mental health and social functioning (Olatunji, Cisler, & Tolin, 2007).

Although some would argue, PTSD does not seem to be a new phenomenon, with accounts dating back fairly far in written history. It also appears to be as well validated a diagnosis as most other mental disorders (which are, in and of themselves ,social constructions, as are medical disorders, but this does not mean they are “made up” or not real. I’ve written a whole series of posts on how we define psychopathology, so I’m not going into detail here). Specifically, persons with a diagnosis of PTSD display three broad groups of symptoms:

1. Re-experiencing symptoms Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating

Bad dreams

Frightening thoughts. Re-experiencing symptoms may cause problems in a person’s everyday routine. They can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing. 2. Avoidance symptoms Staying away from places, events, or objects that are reminders of the experience

Feeling emotionally numb

Feeling strong guilt, depression, or worry

Losing interest in activities that were enjoyable in the past

Having trouble remembering the dangerous event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. 3. Hyperarousal symptoms Being easily startled

Feeling tense or “on edge”

Having difficulty sleeping, and/or having angry outbursts. Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating. It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months.

There has been an enormous amount of research on who has PTSD, or the epidemiology of it.

The majority of people experience some sort of traumatic event at least once during their lifetime, with 25% of people experiencing multiple traumas. Rates are slightly higher for men (61%) than for women (51%), although types of trauma vary dramatically between genders. Women, for example, are much more likely to experience sexual assault or rape (9%) than males (1%), but men are much more likely to be involved in a serious accident (25% vs. 14%). Thankfully, though, the prevalence rate for PTSD is much lower than these numbers, as the vast majority of those involved in traumatic experiences do not develop it. Lifetime prevalence rate for the general U.S. population is 6.8%, with 12-month rates of only 3.6%. Not all groups are equally at risk of developing PTSD, however. In high- or at-risk individuals (e.g., combat veterans, disaster victims, or criminal violence), prevalence rates ranging from 3% to 58% have been found. In countries with high rates of civil war and internal strife, shockingly high rates of PTSD have been found. In one study, over 37% of Algerians in the late 1990s met criteria for a PTSD diagnosis, compared to 6.8% of Americans. Interestingly, the type of disaster a person experiences greatly impacts the chance of developing PTSD. For example, while only 4-5% of those who live through a natural disaster develop PTSD, studies have found that 30% or more of people involved in man-made disasters (shootings, bombings, and so on) develop PTSD. In recent U.S. combat veterans, studies have found that lifetime prevalence is about 39% in males, above the rate of 30% seen in veterans of the Vietnam War. When compared to other types of traumas that males experience, being in combat results in higher lifetime PTSD prevalence, a greater likelihood of delayed onset, and a greater likelihood of unresolved symptoms. Several studies examining PTSD in military females have found similar rates, even without the front-line combat experience. These studies have been criticized, though, due to some methodological difficulties.

Although I didn’t specifically address it in my book, rates of PTSD diagnoses are at 50% or more for victims of sexual assault, which actually put them at a higher rate than even military veterans. Anyway, we can see that a majority of people who experience traumatic events will not develop PTSD (just as we know most people exposed to major losses in life will not develop major depression). But what could cause someone to be more likely to develop it in the face of a traumatic event?

Alone among all the disorders listed in the DSM, PTSD has a specific etiological event – experiencing a trauma. While it is highly adaptive to have a strong fight-or-flight response during a trauma and when your life is threatened, these reactions should decrease once the trauma has passed. In persons with PTSD, however, they do not. As such, PTSD can be seen essentially as a failure to adapt to differing situations. Why people’s reactions fail to return back to normal after can be influenced by a number of factors. Prior to the event, a number of factors will greatly increase risk. These include being female, of a minority race, having a lower level of education, and having a lower income level. Also, a history of previous psychiatric problems and childhood trauma make it more likely that one will develop problematic symptoms. In addition to the type of trauma experienced, certain factors about the trauma can increase risk, such as greater perceived threat or danger and helplessness, as well as the unpredictability and uncontrollability of traumatic event. Post-trauma, lack of social support, overall amount of life stress, coping mechanisms used, and type of attributions made for the disaster can all increase risk.

As well as these, there has been increasing interest in the role that epigenetic gene expression can have in the development of PTSD (and other psychopathology). Interestingly, there’s also good research showing that it’s not so much the type of trauma experienced that makes you more likely to experience PTSS (PTSD symptoms), but that it’s a) your interpretation of the events (i.e., how threatening and dangerous you feel the situation was, regardless of “objective” danger) and b) your attributions after the event (i.e., the reasons you come up with for why the trauma occurred). In addition to the type of trauma resulting in very different chances of developing PTSD, it turns out that being female also greatly increases your risk.

Women are significantly more likely to develop PTSD after a traumatic experience than men, even when predominantly female victim traumas, such as sexual crimes, are taken into account, with lifetime prevalence rates well over double that for men (9.6% vs. 3.6%). The genders also show differential patterns of response to traumas. For example, only 1% of males threatened with a weapon will develop PTSD, but over 30% of females in similar situations will. Females also show higher rates after physical and sexual assaults.

TL;DR – PTSD occurs more often in females, as well as for a host of pre-, peri-, and post-trauma variables, with around 6-7% of the U.S. population qualifying for the disorder at some point in their lives, not just war veterans (although they have very high rates).

So, now that you know a bit more about PTSD than you did before (hopefully, anyway. If not, you may need to do some rereading), let’s return to the question at hand: can one “get” PTSD from Twitter?

Bullying has long been known to have a severe impact on mental health, particularly if the bullying is repeated and prolonged. While research has traditionally focused on youth (as briefly reviewed here), more recent work has examined it’s impact on adults. as well, particularly in the workplace. Research focusing specifically on cyberbullying has found very similar results to “traditional” bullying, in terms of increased risk of depression, suicide, and anxiety. In youth, around a third of bullying victims display quite high rates of PTSD symptoms and rates are perhaps even higher in adults who are bullied.

So, given what we know about PTSD, and given what we know about the effects of bullying (cyber and otherwise) on mental health, I think it’s relatively safe to say that “Yes, you can ‘get’ PTSD from Twitter.” One needs to be careful, though, to be specific about this: it’s the bullying and harassment that could lead to PTSD or PTSD symptoms (as well as depression, increased suicidality, and so on), not anything inherent to Twitter itself. Twitter and other forms of social media are just a new tool to use to bully and harass others, but the underlying mechanisms and the results are the same as if these interactions were face to face.

Now, on to your comments, which will hopefully not be as abhorrent as those on the Daily Mail article.