Neglected, Post Traumatic Stress Disorder Can Be Caused After Rape and Pregnancy

Nancy Méndez-Booth was diagnosed with PTSD (post-traumatic stress disorder) after giving birth to a stillborn baby in the winter of 2008. An hour after she rushed to the hospital, in labor and elated, a doctor told her that the baby she’d spent years planning didn’t have a heartbeat.

When he returned home, Méndez-Booth said he felt as if he had “arrived from Mars”; she got lost in her own building. She vacillated between numbness, vivid paranoia – she feared the police would arrest her for her son’s death – and outbursts of rage. Her kitchen cabinets came loose as she slammed the doors nonstop, looking for a way to release some of her anger.

“I just thought to myself: who in their right mind experiences four different and incredibly intense mental states in the space of 15 minutes?” said Méndez-Booth, a writer and educator based in New Jersey, in the United States. She couldn’t differentiate between past and present. She kept returning mentally to the delivery table. She thought she was having a psychotic break, but later found out she was experiencing post-traumatic stress disorder, or PTSD.

Méndez-Booth considers himself lucky to have received a diagnosis. According to experts, it is very common for this disorder to go unnoticed. Widespread misconceptions about who develops PTSD and confusion about its complex set of symptoms can prevent people with the disorder from seeking treatment, or even realizing they have it.

“We’re talking about the millions” of people who suffer from PTSD without being diagnosed, said Bessel van der Kolk, author of the seminal book on the subject “The Body Keeps the Marks” and a leading expert in the field of trauma care.

PTSD entered the US Diagnostic and Statistical Manual of Mental Disorders in 1980 as an official diagnosis in response to symptoms exhibited by Vietnam War veterans, and today, people in combat still report high rates of the disorder. According to the US Department of Veterans Affairs, between 11% and 20% of service members who served in Operations Freedom for Iraq and Enduring Freedom have PTSD in any given year. As Russia continues its war against Ukraine and more citizens enter combat, researchers expect cases of PTSD to emerge in the coming years.

But civilians are also affected by PTSD. The trauma most likely to cause the disorder is rape, with combat trauma a “close second,” said Dr. Shaili Jain, a PTSD specialist at Stanford University and author of “The Unspeakable Mind” [A mente indizível]. That’s why she, along with Dr. Van der Kolk and other experts say it’s vital that more people understand what PTSD really is.

Why PTSD Might Not Be Treated

Paula Schnurr, executive director of the US National Center for PTSD, said that about 70% of adults in the country experience at least one traumatic event, which the CDC defines as a traumatic event. experience “marked by a sense of horror, helplessness, serious injury, and threat of serious injury or death”. But only 6% of the population will develop PTSD at some point in their lives, according to the Department of Veterans Affairs, most of whom are women.

Scientists are still trying to identify the biological and social factors behind these discrepancies – how generational trauma works, the idea that some elements of PTSD can be passed down genetically, and what “complex” trauma caused by repeated traumatic events does. with the psyche, for example.

“When we created this diagnosis of PTSD, we said it came from an extraordinary event beyond the reach of human experience,” said Dr. Van der Kolk, referring to the scientists and researchers who treat the disorder. “We were completely out of whack for thinking that this trauma is exceptional.”

Vanessa Haye, 34, from East Midlands, England, developed PTSD following an ectopic pregnancy in 2019. She rushed to the hospital for surgery at nine weeks pregnant, and a doctor told her she might not survive. Three weeks into a painful recovery, she had to decide what to do with her pregnancy remains: cremation or burial. Afterwards, she began to experience debilitating memories. Haye woke up just before 3:00 every night, agitated by nightmares, wondering what the baby would be like.

Invasive thoughts hijacked her brain: she would go for a walk with her son and imagine a car hitting them both. When her husband didn’t answer the phone, she thought he was dead. Everything felt like a risk. The stress was so intense that her period stopped. After six months, Haye went to see a doctor, who told her that PTSD is common after ectopic pregnancy. Still, she felt disconnected from the diagnosis, shocked that it could apply to her. It took months to start seeing a therapist regularly and finding a way to deal with her symptoms.

Recognizing the symptoms

Studies show that early intervention is critical to managing and potentially preventing PTSD. But it can take up to two years or more for people who have symptoms to receive a diagnosis, said Dr. Jain. Those who do not undergo treatment within the first two years have a much lower chance of recovery.

“Hearing that I had PTSD, it felt like I didn’t deserve it because I didn’t go to war,” said Natalia Chung, 30, who was diagnosed with the disorder in 2016 after ending an abusive relationship.

Many people like Chung begin PTSD therapy only after years of struggling with the disorder, struggling to cope with symptoms that, with earlier treatment, might not have developed.

Part of the reason people delay treatment is that “avoidance is the hallmark of PTSD,” said Vaile Wright, senior director of health innovation at the American Psychological Association. The disorder causes people to ignore memories of trauma — they make their lives smaller and smaller to block out any evidence of what happened.

For Michelle DiMuria, 39, rain splashes on the window can trigger an episode. She was raining on the day she was raped in 2015, and the weather pulls her brain back into the fray. She can’t stop imagining her attacker’s face. Since DiMuria was diagnosed with PTSD in the fall of 2017, she has struggled to avoid the facts of everyday life that remind her of: the scent, certain songs her abuser liked. Her spine broke during the attack, and she tries to avoid looking in the mirror at the scars from the surgery smeared across her skin.

DiMuria, who founded a mental health advocacy organization called the Bee Daring Foundation, wears a braided bracelet when in public. She’s told friends that if she starts messing with the fabric, she’s probably dissociating. She’s set up coping mechanisms for the bad days — peanut M&M’s, Marvel movies, a coloring app. She watches football and yells at the screen, trying to find a way out of the bouts of aggression that sometimes come with PTSD.

Emotional fluctuation is typical in people with the disorder, said Dr. Wright. “They feel like they’re going crazy,” she said. “They don’t usually identify this as PTSD until, ideally, a well-trained therapist says it’s actually a normal reaction to an abnormal event.”

However, few therapists have such training, said Yuval Neria, director of the PTSD Research and Treatment Program at the New York State Psychiatric Institute. And the disorder is especially difficult to treat because it’s often linked to other mental health issues: drug addiction, depression, anxiety. Unless clinicians are specifically trained to ask about trauma, they may struggle to identify PTSD as the root of a patient’s problem.

“We need to identify people faster, get them to treatment faster, before it becomes this horrible problem,” said Dr. Jain. “Because the reality is that this is a manageable and treatable condition.”

While experts still don’t know everything about the disorder, the language of PTSD has become a mainstay of modern conversation. “Trigger” is a buzzword and a meme; “trauma” is trending on social media.

“The Body Guards the Marks” has been on the paperback bestseller list for nearly 180 straight weeks and has gained a fervent following. (“I’m very unsure about the impact it’s having,” Dr. Van der Kolk said when asked about the book’s popularity, saying he saw no concrete action taken because of his work — no new congressional hearings focused on PTSD and no general change in medical school curricula.)

Some experts say this diffusion has diluted the meaning of PTSD. The disorder stems from severe trauma, said John Tully, an associate clinical professor in forensic psychiatry at the University of Nottingham in England. “We’re talking death or near-death risk,” he said. The term loses its meaning when people apply it too broadly, he explained — and PTSD means more than struggling with the consequences of an upsetting event.

“When it gets to the point where office stress causes PTSD, people writing nasty things about you on Twitter causing PTSD, that’s when doctors are skeptical,” he said.

looking for help

PTSD does not always have a linear trajectory, and there is no clear mark of recovery. For Haye, working closely with a therapist helped her recognize and respond to her symptoms. She’s finding her way to sleep through the night.

Traditional talk therapy is not the only treatment option, however. Prolonged exposure — a cognitive intervention that involves patients describing a traumatic event in precise detail — has been shown to alleviate PTSD symptoms in nine to 12 sessions. And emerging experimental treatments, from virtual reality therapy to controlled doses of MDMA, have shown positive results.

Digital tools can also be helpful in managing the disorder, said Dr. Jain. An app called the Department of Veterans Affairs PTSD Coach, for example, provides information about the disorder as well as grounding exercises to help people deal with symptoms.

Cognitive processing therapy, medications, and a therapeutic technique called eye movement desensitization and reprocessing (EMDR) are also highly effective in treating the disorder, said Dr. Schnurr. EMDR sessions helped Méndez-Booth deal with panic attacks. She still experiences paranoia, but episodes of it have become less frequent over the years. She lives a more complete and functional life now than she thought possible when she first showed symptoms.

“I know it’s still there,” she said. “It’s part of my fabric. But it’s not all about me.”

Translated by Luiz Roberto M. Gonçalves