You Can Get PTSD Without Experiencing Violent Trauma
Feelings of guilt and shame are common when those diagnosed think their incidents aren’t “serious” enough.
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Five years ago, I developed PTSD after a freak accident in which my jawbone popped out of its socket while I was yawning, leaving me unable to talk, swallow, or close my mouth. ER doctors were able to reset the bone, and the ordeal lasted no more than an hour. I knew deep down that it wasn’t a big deal in the grand scheme of things, and yet, in the months that followed, I developed a panic disorder that consumed my life.
Until then, I’d never experienced a panic attack, and at first I didn’t understand what was happening: All I could think, as I stood in a crowded train station with my heart pounding out of my chest, was that my life as I knew it was over and that I was going to die. It was difficult for me to accept that something as everyday—and frankly ridiculous—as dislocating my jaw could result in Post Traumatic Stress Disorder (PTSD), and for a long time, I felt too embarrassed to admit how much the incident affected me.
But as it turns out, this reaction is not uncommon. Feelings of guilt and shame frequently go hand-in-hand with a PTSD diagnosis, says psychologist Elena Touroni, director of the Chelsea Psychology Clinic in London. Touroni says this reaction is especially common for someone whose life was previously stable—it doesn't seem “bad enough” to warrant PTSD. “But what you experience is individual to you," she says. "If you're having symptoms, then clearly that event was significant enough [to cause them]."
Eleanor Healy was ten meters under water in Koh Tao, Thailand, when her incident happened: As part of her scuba diving course, she was to remove and replace her eye mask in one swift movement. “But stupidly, when I removed my mask," Healy says, "I inhaled half the ocean through my nose and began to choke." Unable to breathe or see, Healy instinctively began to swim towards the surface. But resurfacing too quickly is dangerous, so Healy’s instructor grabbed hold of her to slow her ascent. “I was trying to push him off me, and I can still remember the force of him pulling me back down deeper,” she says. With her lungs full of water, Healy was drowning. “I completely accepted that I was going to die,” she says.
The ordeal only lasted a minute, and Healy even dove back into the ocean the next day. But a week later, she had a panic attack that lasted two hours. Healy continued to have up to a dozen panic attacks daily until she returned to the UK, and was unable to leave the house for a month before her doctor diagnosed her with PTSD.
While PTSD is usually associated with soldiers returning from war, the vast majority of people who experience it have never been anywhere near a combat zone. Seven to eight percent of the US population, in fact, will experience PTSD at some point, and around 8 million US adults live with the disorder. While it’s true that exposure to armed conflict significantly increases your odds of developing PTSD, so do a range of other factors—such as being in a car accident, having a difficult birth, experiencing sexual assault or domestic violence, witnessing a murder, or being abused or neglected as a child.
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The primary association that PTSD has with soldiers, however, means that a lot of people who develop the condition in more everyday settings don’t realize what’s happening to them. Even fictionalized depictions of PTSD often involve vivid flashbacks of armed conflict, which can make people who have milder symptoms feel guilt or shame about the "validity" of their experience. “At first, I thought a lot about whether I was just being a massive wimp,” Healy says. “I was being way too hard on myself.” But as her symptoms left her unable to live a normal life, Healy accepted her diagnosis. Now, she says, it’s a relief to put a name to what happened to her.
Not everyone who experiences trauma gets PTSD, of course. It’s not clear yet why PTSD occurs, but researchers have posited that it may depend on a person’s temperament and predispositions, Touroni says. Generally, there are two sets of conditions that can leave one vulnerable: “If you're already anxious and fearful and have a general feeling of not being safe," Touroni says, "a [traumatic incident] is likely to reinforce your pre-existing vulnerabilities.”
But surprisingly, the opposite association can also hold true: “If a person's experience has been that the world is a very safe place," Touroni says, "when something traumatic occurs there’s a massive loss of safety. There's a sense that the world is not the same place, and that everything you knew to be true no longer is.” The realization that what you thought was a safe world was actually a naive illusion can be a shock to the system, which could explain why people develop PTSD from seeing someone else get attacked, for instance, or from hearing descriptions of how a loved one has been abused.
“Any kind of experience that threatens our physical or mental wellbeing can lead to PTSD," says Janina Scarlet, a San Diego-based clinical psychologist who specializes in treating people with PTSD. Scarlet was born in the Ukraine, and developed PTSD herself after falling severely ill with radiation exposure after the Chernobyl nuclear accident.
In order to be formally diagnosed, she explains, the symptoms must last for longer than a month and be severe enough to significantly interfere with a person’s life. Common symptoms include nightmares, flashbacks, and hypervigilance. “People can become irritable, anxious, or numb," she says. "They may avoid talking about what happened and be keen to avoid reminders, as they can become triggered if exposed to things that remind them [of the trauma].” While Healy is doing better since the incident in Thailand, she still struggles with going underground on trains or in tunnels, and can’t go near the ocean.
Eve Menezes Cunningham, an author based in the UK, developed PTSD after a house fire. “I got out safely, but I had to move out for several months as they rebuilt. Everything stank of fire—there had been an electrical fault so there was a plastic smell too," she says. For a long time, flashing lights or any strong, unidentifiable smells would trigger an episode.
In these instances, the symptoms align with the specific trauma. But with what’s called complex PTSD—where trauma is repeated over longer periods of time—that’s not always the case. “It's common for people who have experienced emotional abuse by a family member or significant other to experience PTSD,” Scarlet says. This, Scarlet adds, can lead to people being angry or hypervigilant in relationships. "They may believe that the people they love will reject them. It can lead to people getting triggered and getting into significant verbal altercations with their partners, and not know why," she says.
The incidents that lead to PTSD aren’t always physical in nature, either—they can be tied to emotional triggers as well. For Joshua Anderson*, it’s taken a long time to accept that what happened to him in a previous marriage was emotional abuse. “After seeing my therapist for four years, and pressing her on what the hell is wrong with me, she finally used an analogy about soldiers,” he says, with a wry laugh. Only in recent months, however, has Anderson been comfortable using the word ‘abuse’ to describe what happened to him. "She was the one who decided if I was good or bad. If I did something that displeased her, it could wipe the score down to zero in an instant," he says. "She held my children and my life hostage. But my ex-wife didn’t hit me, didn’t slash my car tires, didn’t put rat poison in my cereal. I had legs, I had cash, and I could have left.”
Intimidation and threats, criticism, undermining, and being controlled are all common forms of emotional abuse. As Anderson struggles with emotional numbness and physical fatigue, he now accepts that he has PTSD. Arguments can still trigger flashbacks, but things are slowly getting better: “For years," he says, "there simply wasn’t room for me to have emotions.”
People with PTSD may have lingering symptoms for the rest of their lives—no matter the severity of the triggering event. While I knew that being in a combat zone, for instance, would have been far worse than my hour of difficulty dealing with a dislocated jaw, my central nervous system had no such clarity—it was simply responding to the worst thing that's ever happened to me.
It’s been five years since I developed PTSD, and while I no longer meet the diagnosis criteria, I still experience the occasional nightmare. Trauma can permanently alter your psyche, and it can take a lot of work to get back to a place where—although you now understand that bad and unpredictable things can always happen—you can also intuitively understand when you're in a relatively safe position, Touroni says.
Most people who are exposed to trauma eventually recover on their own, just as I did; the anxiety, nausea, and emotional and physical disassociation that I experienced slowly faded over the nine months that followed. For those who seek help, treatments for PTSD are also effective: Cognitive Processing Therapy is the gold standard in the US and UK. Roughly 75 to 80 percent of those who seek help will recover, Scarlet says. “Finding meaning in the trauma, or a way to reconnect with loved ones or a meaningful activity can help people recover naturally."
*Name changed for legal reasons
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