Louisville Medicine Volume 66, Issue 3 | Page 23

VIOLENCE
TRAUMATIC Stress
Eric Lydon, MD
Edvard Munch, Aften på Karl Johan, 1892.
© Munch-museet / Munch-Ellingsen gruppen / BONO
“I
have never been in the Army or seen
combat, how can I have PTSD?” I
have had patients ask me this ques-
tion on numerous occasions after
discussing their diagnosis at the
conclusion of an initial interview. There is a
perception among people that Post Traumatic
Stress Disorder (PTSD) is a diagnosis reserved
only for those who have lived through the
terrors of war, but that is not at all the case. The trauma could be any
event in which the individual witnessed death, or was threatened
with death, severe injury, or violence in a whole host of ways. In
my practice, the most common trauma that results in a diagnosis
of PTSD is sexual abuse and molestation.
The stress of living through such horrific events, or the fear of
experiencing bodily injury or harm after such an exposure will
increase ongoing anxiety. This can lead to a wide range of very
unpleasant symptoms. The act does not always have to be experi-
enced or witnessed by the individual for them to have symptoms
of anxiety, depression, PTSD or another psychiatric disorder. The
repeated stories of violence or knowing someone who suffered
from a horrific event awakens our senses to the possibility of the
same thing happening to us. Even going to a concert or ballgame
where we are subjected to searches of handbags, our pockets, and
having to pass through metal detectors make us all too aware that
there is the possibility of some pending act that raises our arousal
and puts us on edge.
Violence has become part of everyday life. The TV brings horrific
images of school shootings, murders, and threats in the form of racist
marches in our cities. We watch families being forcibly separated and
victims being gunned down by police, on a far too frequent basis
these days. These images of violence can have a profound effect on
the psyche of our citizens. After a recent school shooting, a news
report featured a middle school child who expressed that she knew
this was going to happen at her school one day. When people begin
to fear daily that their very lives are in jeopardy, increased anxiety,
depression, insecurity and panic can ensue.
The effects of the trauma are profound and long-lasting. Treat-
ment, for those who seek it, is usually very lengthy and requires a
combination of medication and therapy. The therapy work can be
extremely difficult because people get uncomfortable discussing
their symptoms and reliving the experiences. Diagnostically, the
criteria of PTSD include avoiding things or places that remind
the victim of the trauma. Flashbacks are a common and troubling
occurrence for victims of trauma, and therapy may trigger these
flashbacks or bring to mind memories of events that are wished
(continued on page 22)
AUGUST 2018
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