The Many Forms, Faces And Causes Of PTSD

Post-traumatic stress disorder is often associated with combat, but trauma comes in many forms.

About 7 or 8 percent of people experience PTSD at some point in their lives, according to the Department of Veterans Affairs. The rate is higher for women than for men: about 10 percent compared with 4 percent. Experiencing sexual assault or child sexual abuse, or living through accidents, disaster or witnessing death can all be contributing factors, in addition to time in combat with the military.

NPR's Weekend Edition wanted to hear from those people who have struggled with PTSD, but not because of the reasons we often hear about.

Michael Coleman says he faced stress on a daily basis as a social worker in North Carolina. He worked for the government investigating foster care in the state for 13 years.

"When you knock on someone's door, they're not happy to see you," he tells NPR's Lulu Garcia-Navarro.

"There's physical abuse or sexual abuse," he says. "There's pretty severe neglect in cases."

He's shown up to houses with kids bleeding; he's interviewed kids with bruises at school. He had to visit "known drug houses," where his knees would start shaking before he even got out of his car.

Coleman didn't notice any symptoms of PTSD until after he quit that job to become a vocational counselor.

If someone asked him about his old job, he'd get emotional, he says, even at the bar with friends. "When you're crying into your beer, you're like, 'Why is this happening?' "

His new supervisor suggested seeing an employee assistance counselor after he would get emotional at work and have to go home early some days.

The idea of having PTSD didn't even cross his mind.

"My father is a Vietnam vet. My mother is a refugee. I have been around military veterans all my life and never would associate their PTSD the way I would with me," he says.

"I've never been through things like that, so once again it just never occurred to me."

The counselor asked if he'd worked with people who experienced domestic violence: yes. Did he work with people who were sexually and physically abused? Yes. Did they experience PTSD? Yes.

" 'Well, they weren't veterans,' " Coleman remembers the counselor telling him. "Then she kind of turned it around on me, she goes, 'Then why not you?' That just hit me really heavy."

He says he's doing better now — "I'm comfortable where I'm at."

Some of the symptoms Coleman talked about matched the "classic symptoms" of PTSD, Sandro Galea of the Boston University School of Public Health says.

Re-experiencing traumatic events; feeling both jumpy and withdrawn at the same time; avoiding reminders of his "time around the traumatic event."

Galea says having "post-traumatic" as part of the condition's name can be a little misleading.

"We know now that the lifetime experience before the trauma, the nature of the trauma itself, and what happens to you after the trauma — even though unrelated to trauma — all matter for whether you are going to get PTSD," he explains.

Unrelated stress afterward can have an effect on the symptoms, he says.

It's possible for most people to recover from PTSD with treatment — both cognitive behavioral therapy (talking) and medications have been shown to be effective.

But fewer than a third of people who could benefit from help actually get it, Galea says.

If you don't know where to turn, he says a good first step is reaching out to a primary care doctor, who can connect you with the right mental health professional.

The goal of treatment, he says, is "helping the person suffering these symptoms [to] recognize the physiological stimuli, adapt to them, and move on with what the person would like to do."

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