Victims Affected by Abuse - Post-Traumatic Stress Disorder

• Watch the video on Post-Traumatic Stress Disorder (PTSD)

Read about  the process by which  victims of physical, emotional, psychological and sexual abuse, especially repeated abuse, develop PTSD.

How Victims Are Affected by Abuse: Post-Traumatic Stress Disorder (PTSD)

(I use "she" throughout this article but it applies to male victims as well)

Contrary to popular misconceptions, Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (or Reaction) are not typical responses to prolonged abuse. They are the outcomes of sudden exposure to severe or extreme stressors (stressful events). Yet, some victims whose life or body have been directly and unequivocally threatened by an abuser react by developing these syndromes. PTSD is, therefore, typically associated with the aftermath of physical and sexual abuse in both children and adults.

This is why another mental health diagnosis, C-PTSD (Complex PTSD) has been proposed by Dr. Judith Herman of Harvard

University to account for the impact of extended periods of trauma and abuse. It is described here: How Victims are Affected by Abuse

One's (or someone else's) looming death, violation, personal injury, or powerful pain are sufficient to provoke the behaviors, cognitions, and emotions that together are known as PTSD. Even learning about such mishaps may be enough to trigger massive anxiety responses.

The first phase of PTSD involves incapacitating and overwhelming fear. The victim feels like she has been thrust into a nightmare or a horror movie. She is rendered helpless by her own terror. She keeps re-living the experience through recurrent and intrusive visual and auditory hallucinations ("flashbacks") or dreams. In some flashbacks, the victim completely lapses into a dissociative state and physically re-enacts the event while being thoroughly oblivious to her whereabouts.

In an attempt to suppress this constant playback and the attendant exaggerated startle response (jumpiness), the victim tries to avoid all stimuli associated, however indirectly, with the traumatic event. Many develop full-scale phobias (agoraphobia, claustrophobia, fear of heights, aversion to specific animals, objects, modes of transportation, neighbourhoods, buildings, occupations, weather, and so on).

Most PTSD victims are especially vulnerable on the anniversaries of their abuse. They try to avoid thoughts, feelings, conversations, activities, situations, or people who remind them of the traumatic occurrence ("triggers").

This constant hypervigilance and arousal, sleep disorders (mainly insomnia), the irritability ("short fuse"), and the inability to concentrate and complete even relatively simple tasks erode the victim's resilience. Utterly fatigued, most patients manifest protracted periods of numbness, automatism, and, in radical cases, near-catatonic posture. Response times to verbal cues increase dramatically. Awareness of the environment decreases, sometimes dangerously so. The victims are described by their nearest and dearest as "zombies", "machines", or "automata".

The victims appear to be sleepwalking, depressed, dysphoric, anhedonic (not interested in anything and find pleasure in nothing). They report feeling detached, emotionally absent, estranged, and alienated. Many victims say that their "life is over" and expect to have no career, family, or otherwise meaningful future.

The victim's family and friends complain that she is no longer capable of showing intimacy, tenderness, compassion, empathy, and of having sex (due to her post-traumatic "frigidity"). Many victims become paranoid, impulsive, reckless, and self-destructive. Others somatise their mental problems and complain of numerous physical ailments. They all feel guilty, shameful, humiliated, desperate, hopeless, and hostile.

PTSD need not appear immediately after the harrowing experience. It can - and often is - delayed by days or even months. It lasts more than one month (usually much longer). Sufferers of PTSD report subjective distress (the manifestations of PTSD are ego-dystonic). Their functioning in various settings - job performance, grades at school, sociability - deteriorates markedly.

The DSM-IV-TR (Diagnostic and Statistical Manual) criteria for diagnosing PTSD are far too restrictive. PTSD seems to also develop in the wake of verbal and emotional abuse and in the aftermath of drawn out traumatic situations (such a nasty divorce). Hopefully, the text will be adapted to reflect this sad reality.

We tackle recovery and healing from trauma and abuse in our next article.

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