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Special Populations and PTSD

By Dr. Karl Benzio MD

Page Overview

Behavioral health disorders, like Post Traumatic Stress Disorder (PTSD), affect individuals from young to old, male and female, rich and poor, every race, faith, ethnic group, and country, as well as any special demographic group you can think of. We all experience some very hurtful, even traumatic experiences, which can lead to a full-blown PTSD response if they aren’t processed quickly and accurately as we’ve described in earlier pages of this PTSD.

But certain populations are at greater risk simply because their line of work, present life circumstances, or past experiences expose them to extreme hurtful or traumatic situations or repetitive exposure to harmful events. Included in these high-risk groups are military and veterans, emergency first responders, healthcare clinicians and therapists, clergy, sexual abuse victims, those working in the sex industry, victims of violent crimes, victims of severe natural disasters, those in war-torn areas or with abusive tyrannical governments, and parents of an aborted child. Not everyone in these groups develops PTSD, but they have a higher probability of struggling with PTSD than the general population.

ACTIVE MILITARY AND VETERANS

Individuals serving in the military are involved with violent and stressful situations every day. While trained to handle many dangerous scenarios, experiencing life and death situations and witnessing grotesque violence can have lasting damaging effects. Even veterans who are retired for many years, can continue to suffer from PTSD symptoms. It is important to help those in the military process the dangers they witness as soon as possible, in order to reduce the risk of developing PTSD.

Post Combat and Deployment Stress Contribute to Substance Abuse

It is normal for someone who has been through combat to struggle with post combat stress when they return home. Responses to this stress include startling easily (especially with loud noises), trouble relaxing or sleeping, hypervigilance, nightmares, flashbacks, and irritability. The person might have trouble getting back to things they once enjoyed, such as family time, work, sports, and hobbies. When it becomes disruptive to their everyday life and is prolonged, it can become classified as PTSD. See Page 1 of our guide to learn about the criteria for diagnosing PTSD.

Not only will someone struggling with PTSD have trouble jumping back into everyday life, but they often find the need to self-medicate their anxiety, anger, or edginess which worsens their situation. Some turn to drugs and alcohol to escape their worries and temporarily relieve their minds. According to the U.S. Department of Veterans Affairs, more than two out of every ten veterans with PTSD also have a substance use disorder, and nearly one out of every three veterans seeking treatment for a substance use disorder also has PTSD. Getting help early for PTSD is so important to avoid the complications of dealing with and trying to simultaneously treat two very disruptive and complex disorders.

Female Veterans and PTSD

Female members of the military also struggle with PTSD. Among women veterans of the conflicts in Iraq and Afghanistan, almost 1 out of 5 (or 20%) have been diagnosed with PTSD, and about 27 of every 100 female Vietnam veterans (or 27%) suffered from PTSD sometime during their postwar lives (U.S. Department of Veterans Affairs).

On top of dealing with the life and death dangers of war, many females in the military are victims of the unfortunate aspect of sexual assault, abuse, or humiliation in a male dominated environment. Military sexual trauma (MST) refers to experiences of sexual assault or repeated, threatening sexual harassment that a veteran experienced during his or her military service. National data from the VA show that about 1 in 4 women and 1 in 100 men have experienced MST. This is a type of trauma that if left untreated, can also lead to PTSD.

Suicide Among Veterans

If the stress a veteran experiences is not addressed or processed correctly, it can lead to PTSD, substance abuse, depression, and suicide. As the individual sinks deeper and deeper into their condition, if they don’t get the right kind of help, they feel hopeless and lost. The suicide rate is high among veterans with PTSD according to the U.S. Department of Veterans Affairs:

  • In 2012 over 5,000 suicides in the United States alone occurred as a result of combat-based PTSD.
  • PTSD related suicide is the 10th leading cause of death in the United States.

FIRST RESPONDERS

First responders are another group of individuals whose professions put them at risk for PTSD as they are the first to respond to or witness extreme, dangerous, violent, and deadly situations in our society. These include 911 operators, paramedics, firefighters, and law enforcement personnel such as policemen, sheriffs, and FBI or CIA agents.

Statistics of PTSD among First Responders

There is very little hard data on the rates of PTSD among first responders. According to the magazine of the National Fire Protection Association, empirical data on the problem remains scarce, but there are suggestions that behavioral health problems among emergency responders may be widespread; studies have found that as many as 37 percent of firefighters may exhibit symptoms of PTSD.

According to the Centers for Disease Control (CDC), the class of occupations which include first responders have higher rates of suicide than many other occupation classes. Of the 12,312 total suicides included in the report, 745 were among the classes that include first responders. While this data is not specific to just first responders, it does suggest these occupations carry with them a risk for PTSD, mental illness, addictions, and suicide.

Issues that can Cause PTSD in First Responders

First responders regularly witness or experience many extreme and dangerous situations which can lead to PTSD such the aftermath of a horrific automobile accident, having to pull someone out of a burning building, being shot at, physically attacked or threatened, having people die in their arms, or even having to harm or kill another person. But, each person is different and is affected differently by these situations. There are many more situations that are less acutely dangerous but can also cause PTSD as the incidents accumulate over the person’s career. It all depends on the person, the stress and stress management skills in their life, and how they process the events in their minds. To learn more about how PTSD begins and progresses, see page 2 of our guide. 

HEALTHCARE CLINICIANS

Another professional who see acute injury and deals with death and dying people regularly are those serving in healthcare: physicians, nurses, phlebotomists, respiratory therapists, and other healthcare professionals. They witness first hand the damaging effects of accidents and diseases and the suffering inflicted on the individual and their loved ones. Not only do they see acute situations, but they also see the traumatic effects of illness over time, often leading to significant disability and death. The daily exposure and accumulation of these incidents makes it difficult to regularly process each one fully, so their risk for PTSD, battle fatigue, and burnout are dramatically increased.

THERAPISTS AND CLERGY

Some professions might not witness death, violence, or be the acute responders or healthcare workers, but they are regular vicarious witnesses. This means they are hearing about traumatic events from the victim or perpetrator, as they intimately work with victims to identify, heal, and overcome these traumatic experiences. The professions most often fitting this description are psychiatrists, therapists, others in the behavioral health field, and clergy. They are vicariously exposed to so much trauma as they are always talking to people and hearing about everyone’s traumatic and hurtful experiences, especially as they are the primary psychological and spiritual treaters of those with PTSD.

GROUPS AT HIGHER RISK OF BEING A TRAUMA VICTIM OR PERPETRATOR

Sadly, we live in a stressed out, chaotic, destructive and fallen world. As we see in the news, hurtful and destructive acts are perpetrated every day on many people. But certain categories of people are at a much higher risk of PTSD than the general population because of their greater chance of having experienced abuse or violence as either a victim, perpetrator, or both.

These populations with definite traumatic experiences are sexual abuse victims, victims of violent crimes, and the mother and father of an aborted child. Sexual and physical abuse, as well as an abortion have lasting ripples that need to be processed quickly and well or PTSD risk is dramatically increased.

Populations exposed to difficult or extreme circumstances with a much higher occurrence of traumatic events and being a perpetrator and/or victim would be the following:

  • Workers in the sex industry – those in the pornography industry and those in the adult entertainment, strip club industries (sex slaves would be included in the sexual abuse victims above)
  • Living in a war-torn or under a tyrannical regime where psychological abuse and intimidation is frequent, but physical and sexual trauma is also common
  • Prison – many of those incarcerated have been both a perpetrator and a victim of sexual or physical trauma/abuse. Sadly, instead of treatment, most prisons have a high frequency of physical, psychological, and sexual trauma, so those needing the most help are witnessing, perpetrating, or being the victim of more trauma thus worsening the PTSD they already have, or increasing the likelihood of developing PTSD
  • Natural Disasters – the sudden and devastating effects of natural disasters contribute to the traumatizing aspects to the survivors. Many of the support systems a person would use are now gone making it more difficult for the victim to properly process the natural disaster. 

PERCEIVED BARRIERS TO TREATMENT

Several barriers keep these different groups from accessing the treatment they need for PTSD:

Denial. Most people struggling with PTSD will usually deny there is a problem, especially in the beginning, hoping it will go away. They often think, if you don’t acknowledge it, it will go away, or doesn’t even exist. Only those who have been educated about the issue or have seen someone close to them go through it will actually be on the lookout for symptoms of PTSD and get help right away.

Stigma on the job. Military, first responders, healthcare workers, therapists, and clergy are public servants who are not looking for praise or glory, but they don’t want to be viewed as weak either. Some who are struggling with symptoms of PTSD feel like they would be letting their colleagues down if they admitted they had a problem and needed help.

Fear of job loss. Some believe they will lose their job if they admit weakness. Most of these fears are unfounded when the person accesses good help to process the traumas or treat the PTSD. But where job loss could occur is when the individual doesn’t access treatment and their symptoms, and thus, their functioning continues to deteriorate and endangers their colleagues or those they are charged to serve.

Stigma from the community. Some of these professionals are afraid that if the community finds out, they will be looked down upon. They are used to being the helpers, the rescuers, the ones everyone else turns to for help, not the ones seeking help.

I chose it. Many feel because they willingly put themselves in a position to be around trauma or death, be it military, first responder, healthcare, clergy, or even sex industry, that they need to put up with what they chose and not “complain” about the consequences. This mentality also invades the thinking of those who chose abortion and other perpetrators of violence and abuse.

I am the perpetrator, I don’t deserve help. Perpetrators of violence, abuse, death, and parents of abortion often think they are unworthy of help or that PTSD is part of the punishment they deserve for the acts they committed.

Being overwhelmed. With symptoms of PTSD and the ongoing stressors of their job, disaster, war-torn country, prison, etc, the victim is psychologically or logistically overwhelmed, so trying to think through the need for treatment, find the right treatment, go regularly, and implement the skills they are learning is beyond the scope for many by the time they realize they really need help in beating their PTSD.

Effectiveness of treatment. When many pursue treatment, they usually expect a quick turnaround and don’t stay with treatment long enough. They tell others treatment simply doesn’t work, so many think why would I want to put my reputation and job on the line for something that won’t even help.

Cost. As with anyone facing a mental health or substance use disorder, the time and financial cost of treatment is not small and is usually a concern or another stressor. Individuals with these concerns don’t know treatment isn’t as expensive as they think, but more importantly, how costly and harmful untreated PTSD can really be as it can cause the loss of a job, marriage, health, and family if allowed to progress.

Access to treatment. Finally, most people just don’t know where to turn for help. They might not have access to an effective program near them, or might not know how to find the right program, or even just who to call first.

TREATMENT ESSENTIALS

The most significant way to help any of these groups avoid PTSD and all the resulting complications we’ve talked about in past pages of this guide,  is to provide them with therapy as soon after the trauma as possible. Talk therapy provides a safe environment in which the individual can process the thoughts so they can store accurate information from the event and not store misinformation or erroneous predictions. They can also express their raw and vulnerable feelings instead of stuffing them and learn healthy ways to express and discharge these difficult feelings instead of stuffing them. Read more detailed information about talk therapy in past treatment page 3.

Medications for PTSD, sleep, nightmares, anxiety, impulsivity, and distorted thinking can also provide relief from debilitating symptoms while the individual works with their therapist in a treatment program. Read more specifics about helpful medications in past treatment on page 3. Most importantly, accessing God’s love, forgiveness, peace, hope, and strength, while implementing the Bible’s guidance to handling trials and tribulations, pain and suffering, is the foundation lasting treatment and healing for PTSD needs to be built on. These are the main components and the best way to prevent PTSD from developing or progressing.

Visit our page discussing God’s impact in treating PTSD on pages 4 and 5.

GETTING HELP NOW

If an individual already is showing signs of PTSD, they need help right away so the illness doesn’t worsen and more damage occurs. Psychotherapy and counseling, life skills development, medications, and spiritual care are all used to help the individual learn how to work through their past experiences so that they don’t continue to haunt them in the future.

For all the reasons listed above, many individuals put off getting help and instead live in denial that they have a problem or a belief that they are destined to live this way. But as the individual continues to wait, the issue just builds and gets worse, making it more disruptive and harder to treat.

If you or a loved one is struggling with PTSD or PTSD with substance use disorder, get help today. Call our Helpline at 844-Life-Change (844-543-3242) and we will find you the right place to stop the PTSD progression and start the psychospiritual healing process God wants to bless you with.