Post Traumatic Stress Disorder (PTSD)

Content Warning(s): References to traumatic events.

For Mental Health Awareness Month, we're highlighting certain conditions that may impact the convention community. This article covers Post-Traumatic Stress Disorder (PTSD).

Please note: although I have a psychology degree, I am not a clinician and this is provided for informational purposes.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) lists these criteria for a PTSD diagnosis:

• Exposure to actual or threatened death, serious injury, or sexual violence, by experiencing it directly, witnessing it, or learning that it occurred to someone.
• Presence of recurrent distressing memories or dreams, dissociative reactions/flashbacks, intense psychological distress, and/or marked physiological reactions when exposed to stimuli associated with the traumatic event.
• Persistent avoidance of associated stimuli.
• Negative alterations in cognition & mood, such as amnesia, persistent & exaggerated negative beliefs about themselves, persistent negative emotional state, markedly diminished interest or participation in significant activities, feeling of detachment or estrangement from others, and/or persistent inability to experience positive emotions.
• Marked alterations in arousal & activity, such as irritable behavior, angry outbursts, reckless/self-destructive behavior, hypervigilance, exaggerated startle response, difficulty concentrating, and/or sleep disturbance.
• Duration of the disturbance is more than 1 month.
• Disturbance causes distress or impairment in social, occupational, or other areas of functioning.

The clinician may specify if it has dissociative symptoms - feelings of being detached from one's mind or body, as if moving through a dream or seeing one's self as if one were an outside observer; or feeling as if the world itself is unreal.

The most common traumatic events that come to mind when we think of PTSD are exposure to combat, threatened or actual physical violence, and threatened or actual sexual assault. However, it may also manifest after a severe car accident, living through a natural disaster, or having a child go through a life-threatening medical catastrophe. Trauma, as Jennifer Cross defines it in Writing Ourselves Whole, is an experience "that causes damage to bodily or psychological or spiritual integrity, one we're not able to immediately integrate or process, that overwhelms, and then transforms, our understanding of ourselves and our reality," one that "confounds understanding, and which leaves a person feeling silenced, and/or unwitnessed/unheard/shut down when they attempted to speak about [it]."

This condition is more than the cursory treatment it tends to get in fictional media. They show the veteran jumping at the sound of a helicopter, or the assault survivor screaming if someone touches their arm in a spot that triggers a bad memory. While distress upon reexperiencing trauma is a common feature of the condition, a person with PTSD may also be quick-tempered and become aggressive with little or no provocation. Their emotional regulation is skewed or nearly non-existent. They may seem forgetful or irresponsible, zoning out and oversleeping, failing to remember to perform important tasks or engaging in reckless behavior such as drinking and driving or drug abuse. They may seem numb, detached, and generally uninterested in things their friends enjoy, constantly turning down invitations to hang out.

These features often help reinforce negative self-perceptions that those with PTSD frequently have. If they alienate their loved ones, it validates that notion that they really are a horrible person, who deserved all the bad things that happened to them. It makes them feel like they'll always be alone and unable to have a normal life. The people in their lives may not understand what they're going through, tell them to stop being so "clingy" or "demanding," or telling them they just need to "get over it." They may even lose their jobs and end up homeless.

Prevalence & Population

Projected lifetime risk of developing PTSD in the United States is a little under 9%; it's lower in most other countries. Rates of PTSD are highest among combat veterans and survivors of rape. In addition, higher rates of PTSD have been found in people of color (with the exception of Asian Americans) as compared to non-Latino white Americans.

Cause

In the case of PTSD, unlike many other mental health conditions, the cause is fairly obvious - the traumatic event the individual experienced. People with mental illness in the family or a prior history of depression and anxiety, as well as those who have already suffered trauma before, may be more susceptible to developing it.

Treatment

PTSD is treatable, and it's important to note that it's not something the individual can just "snap out of" or "get over" if they try hard enough. Often individuals need help from therapy and medication to recover from the condition.

Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) can help with emotional regulation. Medications that help with anxiety or sleep disturbances may also be prescribed.

There are many theraputic practices that may be used to help PSTD clients, including cognitive behavioral therapy (CBT), exposure therapy, acceptance and commitment therapy (ACT), and eye movement desensitization and reprocessing (EMDR) therapy. For an example of what EMDR looks like, you can view this video here. In a clinical setting, video such as this would be accompanied by instructions from the therapist.

Impact on the Cosplay Community

Conventions pose one of the biggest stressors to those in the cosplay community who have PTSD. If any of their triggers include loud noises or unexpected physical contact, the potential for distress is everywhere. While it's unreasonable to demand that conventions be as quiet as a library, one thing you can do is limit unnecessary noises. Organizing groups to run through the halls screaming or using vuvuzelas, air horns, or kazoos might seem like a funny idea; but aside from those of us who are prone to headaches, activities like these might cause anxiety spikes in those who are still recovering from traumas.

When it comes to physical contact, this is simple - ask before you touch anyone. Whether you're posing in a group or a photographer who needs the cosplayer to move their arm, don't touch someone unless you know they're okay with it. If you accidentally bump into someone and their response seems disproportiate to the situation, try to be understanding. Maybe they're a jerk, but it's also possible you hit a sore spot - either a physical or mental one. If they seem to be in extreme distress, offer to get a friend or con staff to help them.

What should you do if you personally know someone with PTSD?

First, remember that you can't cure them. You can be the most supportive, wonderful person in the world, but recovery involves treatment and self-work.

Be patient. Do research. Respect their wishes if they say they can't do something because it might be triggering. Respect their boundaries; accept it if they decline to talk about what's going on with them. Alternatively, if they want to discuss their trauma, understand that they're trusting you with something important. Be willing to listen unless doing so would trigger or cause harm to you. Don't tell them to "stop living in the past" or that they just need to "get over it." If they're having a flashback or have been otherwise triggered, you may be able to help them ground themselves by guiding them through the 5-4-3-2-1 method detailed here.

Most importantly, believe them.

Resources

Sites:
American Psychiatric Association's page on PTSD
Center for the Study of Traumatic Stress
National Center for PTSD through the United States Department of Veterans Affairs

Books:
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma
The Complex PTSD Workbook
Emotion Efficacy Therapy: A Brief, Exposure-Based Treatment for Emotion Regulation Integrating ACT and DBT
Overcoming Trauma and PTSD: A Workbook Integrating Skills from ACT, DBT, and CBT
The PTSD Workbook
Writing Ourselves Whole: Using the Power of Your Own Creativity to Recover and Heal from Sexual Trauma

Thank you for reading; our next topic in this series will be on Narcissistic Personality Disorder.

-Fractali

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