Artillery Row

You probably don’t have PTSD

The danger of self-diagnosis

One of the hottest acronyms doing the rounds at the moment is PTSD. Once usually associated with the horrors of war, post-traumatic stress disorder has been thrust into the limelight by the past year’s seismic events and the mental health-related problems they have sowed. Not only are more people now talking about PTSD, but some are also self-diagnosing.

The risk of exposure to trauma has been a part of the human condition since we evolved as a species

It’s understandable in many ways. The likes of quarantines, curfews, lost jobs, ruined businesses and destroyed relationships can produce numerous negative psychological impacts, including PTSD-like symptoms, depression and insomnia. But overdiagnosis of PTSD risks various psychological pitfalls.

“For people who do not meet the threshold for PTSD, it can be a heavy, burdensome label to take on,” says Lucy Foulkes, a university lecturer in psychology and author of Losing Our Minds: What Mental Illness Really Is and What It Isn’t that explores the state of the UK’s mental health. “It might help to provide meaning and gain access to help, but it can also be frightening and disempowering, making an already distressing situation worse.”

Foulkes sums up how “diagnostic labels are double-edged swords, and they come with a price, especially if you don’t actually meet criteria for a disorder.”

Last September, the Archbishop of Canterbury pronounced that the Great British Public were suffering “national PTSD” after years of accumulative shocks and worries about Brexit, whether the United Kingdom stays intact, the economy, the environment and the arrival of a global pandemic. 

That is quite a tally, and coming on the back of a profound event like Brexit with all its implications, arguably Brits and their emotional well-being were more vulnerable, compared to the collective psyches of other countries, to a contagion so shape-shifting as Covid-19.

The trend of merging various forms of trauma with PTSD has some psychologists cautioning how there are plenty of events described as “traumatic” in everyday language nowadays that while tough and unpleasant don’t qualify as PTSD. Burgeoning rates of PTSD diagnosis are resulting from “broadened disease definitions,” according to a recent article in the British Medical Journal (BMJ). 

“Post-traumatic stress disorder is a serious and uncommon condition resulting from severe trauma, but it has unhelpfully become an umbrella term incorporating other disorders and normal reactions to stress,” explain psychiatric and mental health specialists John Tully and Dinesh Bhugra in the BMJ article. “The conflation of stress with trauma — and of trauma with stress — has become rife.”

The risk of exposure to trauma has been a part of the human condition since we evolved as a species, notes the US Department of Veterans Affairs’ National Center for PTSD:

“Attacks by saber tooth tigers or twenty-first century terrorists have probably produced similar psychological sequelae in the survivors of such violence. Shakespeare’s Henry IV appears to meet many, if not all, of the diagnostic criteria for [PTSD], as have other heroes and heroines throughout the world’s literature.”

The crucial point is the concept of trauma and how it does not automatically lead to PTSD; events such as getting divorced, losing a job, even losing a loved one typically don’t qualify. This rare psychological disorder typically results from extremely traumatic events, such as military combat or torture, and usually happening in high-stakes environments. This context of exposure to a traumatic event combined with a lengthy set of symptoms — such as withdrawal and avoidance, hyper vigilance and arousal, flashbacks and nightmares — is what places PTSD in a different realm to the usual stresses and anxieties that we have to contend with as frail and very mortal humans.

In clinical terms PTSD emerged in the wake of the Vietnam War and its thousands of traumatized and broken veterans in the US. In 1980 it was referred to in the Diagnostic and Statistical Manual of Mental Disorders “as a clinical diagnosis arising after exposure to terrifying, usually life-threatening events, such as combat, rape, or confinement to a concentration camp,” the BMJ article notes. 

Subsequently, the article explains, the threshold for diagnosis has lowered and since 1987 the manual has allowed for indirect experience of trauma. The result: “diagnosis of PTSD has continued to burgeon throughout Western society.”

Before Covid-19 arrived, mental health was already gaining more attention.

“But campaigns to raise awareness of mental health have left us with a tendency to overmedicalize our emotions,” Foulkes says.

As noted in a previous Critic article, increasingly it does seem that we are being told by some expert or commentator from some organization that we must have some form of trauma based on our experiences. “If everyone has PTSD, including people with transient, mild symptoms, then the term loses value for the people who are seriously unwell,” Foulkes says. 

Misdiagnosing a person with PTSD also risks a person not getting the right or most appropriate treatment, as well as resources going to the wrong person and therefore depriving those who do have the condition of treatment. It also risks breeding skepticism about PTSD, and in turn underdiagnosis of PTSD.  

A more accurate appreciation of PTSD and where it is or isn’t likely to occur is especially needed in relation to NHS staff now beginning to shake themselves off as things calm down following, for many, the most intense period of their careers. Many NHS staff have been in high-octane situations during spikes in Covid-19 infections, involving life or death choices, which could exact a psychological toll in the form of PTSD or moral injury.

“There is a lot of interest in potential trauma in health workers, in terms of what they have witnessed, and I think this is an entirely reasonable concern,” Foulkes says. “It’s early days in terms of understanding the psychological impact of Covid-19 on healthcare workers, and how long term it might be.”

There are many types of workers alongside NHS staff who are more at risk from the likes of PTSD and moral injury

In the civilian realm, there are many types of workers alongside NHS staff who are more at risk from the likes of PTSD and moral injury, a risk exacerbated by the pandemic but one that is often there at any time simply through the nature of their jobs. The likes of police, paramedics, social workers dealing with abused children may be exposed to trauma directly or indirectly and the accumulation of this over years can eventually become too much: precipitating PTSD.  

The challenge of reaching those in need is compounded by how people with PTSD and moral injury often find it hard to seek help, and even if they do, a specialist might not recognise the symptoms. 

Missing a diagnosis of PTSD must not be underestimated. The authors of the BMJ article estimate adults with PTSD are over six times more likely to attempt suicide than the general population; young people with PTSD are estimated to be ten times more likely to commit suicide than their peers. 

This, combined with events since the first lockdown began last year, drives the need for correctly discerning what is and isn’t acute trauma, and what sort of trauma goes beyond the usual levels of stress that are an inevitable part of existence and therefore warrant more attention. A life may depend on it. 

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