“PTSD?! But I’m not a Veteran!” and other Misconceptions

This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course during Spring 2014. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders, with one of those focusing on evidence-based treatments for those disorders and the other focused on a particular myth or misunderstanding about mental illness.

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“PTSD?! But I’m not a Veteran!” and other Misconceptions by Rosa Kesner

One of the few positive aspects of our decade-long wars in the Middle East is the rise in awareness about Post-Traumatic Stress Disorder (PTSD). With thousands upon thousands of young veterans returning with PTSD, the public is now aware of the obstacles that present themselves to individuals who have experienced a traumatic event. The downside of this awareness is that certain myths surrounding this disorder are enhanced, deepened, and created. One of these myths is that only veterans are affected with PTSD.

The facts show that approximately 9% of the population will develop PTSD due to a specific traumatic event experienced during their lifetime. Veterans are not even the leading group in the area of who will develop PTSD. Women, who are statistically more likely to endure domestic violence, rape, and physical beatings, will develop PTSD more often than the rest of the population. The historic under-reporting of sexual assault compounds the effectiveness of properly diagnosing women with PTSD.

Statistically, 27% – 31% of women have experienced a sexual assault in their lifetime, with 13 – 17% of women experiencing a completed rape. A recent study conducted on college campuses across the country found that 20% of the women on campus had reported being raped. Within the first nine months of a sexual assault, 94% of victims will develop PTSD, and one in three of these victims will have long-term PTSD symptoms. This rate of PTSD in victims of sexual assault is even greater than the reported 15% – 30% rate among returning veterans, illustrating the importance of treatment for sexual assault victims. This reflects a greater importance when considering that only 36% of rapes and 26% of sexual assaults are reported nationwide. Considering the midrange of this number of unreported victims pushing the total number of victims to the 1.5 million, the prevalence of un-diagnosed, untreated PTSD takes on a new level of importance.

Victims of natural disasters, such as tornadoes, hurricanes, and earthquakes, are also likely to develop PTSD in the aftermath of these destructive events. The trauma endured by the survivors of such events is just as real and these survivors of natural disasters are as likely to produce PTSD, as the trauma experienced by veterans of a war zone. In a survey of 815 survivors of hurricane Katrina one year after the disaster, 26% of respondents within the New Orleans metro area and 21% of respondents outside the metro area reported PTSD symptoms. The survivors of Katrina experienced not only the personal devastation but the trauma of aftermath of the hurricane, in which death, destruction, and the lack of food, fresh water, and basic necessities left lasting effects and long-term PTSD rates greater than that of returning veterans of the wars in the Middle East.

The widespread outbreak of tornadoes across Alabama in 2011 has produced its own psychological devastation in the number of victims suffering from PTSD. A recent study of 1398 cases of the affected people in Alabama reflected a 22.1% rate of PTSD. These numbers reflect consistent results in the prevalence of PTSD symptoms among the survivors of natural disasters. The survivors of the Moore, Oklahoma tornado of 2013 should expect symptoms of PTSD to manifest within the same 17% to 25% range as other natural disasters, except that there may be some variation due to the age range of many of the elementary age children directly affected by the disaster.

This variance due to the age of the victim is highlighted by a wide study of 12 different mass shooting incidents, ranging from the 1984 McDonald’s Massacre in San Ysidro, California, where 22 customers were killed and 15 were injured to the Virginia Tech shooting in 2007 where the shooter killed 32 and injured 25 before killing himself. The study made some predictable conclusions, but showed a wider variance in the percentage of victims with long-term PTSD symptoms of 10% to 36%. Much of this variance has to do with the age of the victims since these shootings cover adult as well as school age children. This is reflected specifically in the study of the Evanston Elementary school shooting in 1988, in which a woman killed one child and injured five others in front of their classmates. In this specific incident, the prevalence of PTSD in adults was 19% but 27% in children. As a whole the reporting of PTSD in survivors of mass shootings fell into the severe range when compared to other disasters.

The highest rates to date were found in the direct-line survivors of the 1995 Oklahoma City bombing. In the study, 187 respondents who were all within the direct path of the OKC explosion were assessed. The respondents were interviewed at the 6-month post-event mark and again at the 17-month post-event mark. In the case of the bombing survivors, all the cases manifested in long-term, chronic PTSD (89% un-remittance), specifically with very high scores in the avoidance and numbing symptom group, confirming the immediacy as well as the persistence of symptoms in survivors of this terrorist attack. Since a specific study of the direct-line victims/survivors of the 9/11 tragedy has yet to be done, this study is important in the prevalence of PTSD symptoms and the chronic nature of these symptoms in direct-line victims/survivors. Current research of PTSD percentage in the survivors of 9/11 runs closely to the rate of other natural disasters and veterans of the middle-east wars, which is 22% in retired firefighters who responded to the devastation of the attacks. This difference in the rate of PTSD could be attributed to the difference in the rate of a first-responder and that of actual direct-line survivors. In the case of 9/11 there were very few actual direct-line survivors, so the majority of studies represent first-responders. The respondents in the OKC bombing study were actual survivors in the line of the explosion.

The empirical studies of victims of sexual assault/rape, hurricanes, tornadoes, mass-shootings, and terrorist attacks show conclusively that PTSD is not exclusive to veterans. The ten years of war in the Middle East has contributed to the rise in awareness of PTSD, but it has also given rise to a common myth that could be detrimental to the actual treatment of this disorder. This myth is that only veterans suffer from the effects of PTSD, this may dissuade victims of the above-mentioned traumas from seeking treatment for their symptoms. The evidence agrees on one important factor: the importance of effective and evidence-based treatment for those who are victims/survivors.