Post Traumatic Stress Disorder

Trauma, PTSD, and Relationship Violence

Separate from PTSD, a connection has been found between the experience of certain traumatic events and relationship violence. In particular, studies have found that men and women who have experienced physical abuse, sexual abuse, or emotional neglect in childhood may be more likely to be abusive in intimate relationships as compared to people without a history of childhood trauma.

In addition, people with PTSD have also been found to be more likely to be aggressive and engage in intimate partner abuse than people without a PTSD diagnosis. The connection between PTSD and violence has been found for both men and women with PTSD.

How Are They Related?

Several studies have been conducted in an attempt to better understand what may lead people with a history of trauma or PTSD to engage in aggressive and violent behaviors. In studies of U.S. veterans, it has found that depression played a role in aggression among people with PTSD. People who have both depression and PTSD may experience more feelings of anger and, therefore, may have greater difficulties controlling it.

In line with this, a couple of studies have found that violent and aggressive behavior, especially among men, may be used as a way of attempting to manage unpleasant feelings. Aggressive behavior may be a way of releasing tension associated with other unpleasant emotions stemming from a traumatic event, such as shame, guilt, or anxiety. While aggressive and hostile behavior may temporarily reduce tension, it, of course, is ineffective in the long-run -- both in regard to relationships and dealing with unpleasant emotions.

Despite these findings, it is important to note that just because a person has experienced a traumatic event or has PTSD does not mean that they will exhibit violent behavior. There are many factors that contribute to aggressive behavior and much more research is needed to identify the specific risk factors for aggressive behavior among people exposed to traumatic events or who have PTSD.

What Can Be Done?

Mental health professionals have long recognized that trauma and PTSD increase risk for aggression. Therefore, many treatments for PTSD also incorporate anger management skills. Learning more effective ways of coping with stress is a major part of reducing aggressive tendencies, such as deep breathing and identifying the short- and long-term negative and positive consequences of different behaviors.

[ PSTD and Domestic Violence from pstd.about.com © 2012. Thank you for making this information available ]

[ The following article paraphrased from The National Center for PSTD © 2007. Thank you for making this information available ]

All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD.

Most people who go through a traumatic event have some symptoms at the beginning. Yet only some will develop PTSD. It isn't clear why some people develop PTSD and others don't. How likely you are to get PTSD depends on many things:

• How intense the trauma was or how long it lasted
• If you lost someone you were close to or were hurt
• How close you were to the event
• How strong your reaction was
• How much you felt in control of events
• How much help and support you got after the event
• How many times the trauma was repeated

Many people who develop PTSD get better at some time. But about 1 out of 3 people with PTSD may continue to have some symptoms. Even if you continue to have symptoms, treatment can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships.

People who suffer from PTSD exhibit a variety of symptoms. These can include a deep sense of helplessness, problems at home or work, abnormal fear, feelings of devastation, flashbacks from the event, a feeling of numbness, aversion to social contact, or avoidance of situations that might trigger memories of the event. Some physical responses may include depression, anxiety, sleep disturbances, panic attacks, irritability, anger outbursts, difficulty with concentration or memory, feelings of vulnerability, fear of normal every-day activities, or feeling overwhelmed by the smallest of tasks.

Symptoms of PTSD can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day.

PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you probably have PTSD.

There are four types of PTSD symptoms:

1. Reliving the event (also called re-experiencing symptoms)

Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares. You even may feel like you're going through the event again. This is called a flashback. Sometimes there is a trigger - a sound or sight that causes you to relive the event. Triggers might include:

• Hearing a car backfire, which can bring back memories of gunfire and war for a combat Veteran.
• Seeing a car accident, which can remind a crash survivor of his or her own accident.
• Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped.
• Witnessing abusive acts
• Hearing couples or people fighting or arguing

2. Avoiding situations that remind you of the event

You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event. For example:

• A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes.
• A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants.
• Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.

3. Feeling numb

• You may find it hard to express your feelings. This is another way to avoid memories.
• You may not have positive or loving feelings toward other people and may stay away from relationships.
• You may not be interested in activities you used to enjoy.
• You may not be able to remember parts of the traumatic event or not be able to talk about them.

4. Feeling keyed up (also called hyperarousal)

You may be jittery, or always alert and on the lookout for danger. This is known as hyperarousal. It can cause you to:

• Suddenly become angry or irritable
• Have a hard time sleeping
• Have trouble concentrating
• Fear for your safety and always feel on guard
• Be very startled when something surprises you

People with PTSD may also have other problems. These include:

• Drinking or drug problems
• Feelings of hopelessness, shame, or despair
• Employment problems
• Relationships problems including divorce and violence
• Physical symptoms

Children can have PTSD too. They may have the symptoms described above or other symptoms depending on how old they are. As children get older, their symptoms are more like those of adults. Here are some examples of PTSD symptoms in children:

• Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom.
• Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event.

When you have PTSD, dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But treatment can help you get better. There are good treatments available for PTSD

• Cognitive behavioral therapy (CBT) appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy.
• A similar kind of therapy called EMDR, or eye movement desensitization and reprocessing, is also used for PTSD.
• Medications can be effective too. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), "The essential feature of Post Traumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor" (p. 463).

The following specific diagnostic criteria are reproduced verbatim (except for codings and page references) from the DSM-IV TR (where 'IV TR' indicates fourth edition, text revision), pages 467-468. Also see the separate page on the closely-related Acute Stress Disorder.

A. The person has been exposed to a traumatic event in which both of the following were present:

• the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others
• the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

• recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
• recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
• acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
• intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event
• physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

• efforts to avoid thoughts, feelings, or conversations associated with the trauma
• efforts to avoid activities, places, or people that arouse recollections of the trauma
• inability to recall an important aspect of the trauma
• markedly diminished interest or participation in significant activities
• feeling of detachment or estrangement from others
• restricted range of affect (e.g., unable to have love feelings)
• sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

• difficulty falling or staying asleep
• irritability or outbursts of anger
• difficulty concentrating
• hypervigilance
• exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Historically, PTSD has been associated with military personnel and their reactions to traumatic experiences involving combat and warfare situations. More recently, PTSD has been linked to traumatic situations encountered by everyday individuals. The trauma can be triggered by large-scale ordeals, like terrorism attacks or devastating natural disasters, or highly personal events like a single-car accident, losing a job or business, divorce, failing to achieve a goal, loss of a loved one, seeing or hearing of a death, personal injury, childhood trauma or any other life-altering experience.

PTSD can occur when living with repeated abusive behavior, whether they be physical, mental, sexual or emotional. Living with long-term repeated, or cyclic, abuse undoubtedly results in some form of post traumatic stress disorder.

If left untreated, PTSD symptoms can become worse. Some documented cases include addiction to drugs or alcohol; chronic pain, hypertension or physical maladies; self injury; overwhelming fear of death; compulsiveness; personality changes; and self destructive incidents, to name a few.

The good news is that PTSD is treatable. Unfortunately, many health care providers are not always able to link the symptoms with the diagnosis. By making people aware of PTSD, including individuals whose loved ones have experienced a traumatic situation, is one of the best ways to assist in accurate diagnosis and that can lead to treatment, and, eventually, healing, growth and recovery.

• The National Center for PSTD
• The PSTD Association
• PTSD and Domestic Violence

[ This article paraphrased from The National Center for PSTD © 2007. Thank you for making this information available ]