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PTSD in the City: Coping in Silence (Psychology Today)

Posted on November 15 2018

According to the National Center for PTSD or Posttraumatic Stress Disorder, in the U.S. population, 6 out of every 10 men (or 60 %) and 5 out of every 10 women (or 50 %) will experience at least one traumatic event in their lifetime. Of the various forms of trauma, men are more likely to experience physical attack (with or without a weapon), accidents, combat, or witness death or injury. On the other hand, women are more likely to experience interpersonal violence such as sexual assault. These traumatic events could lead to the development of PTSD in 10% of those women and 4 % of those men. However, recent studies have found increased rates in the lifetime prevalence of PTSD in residents living in low income and urban inner-city neighborhoods (see Beckett, 2014). In an effort to engage in early intervention to treat symptoms of PTSD, we must consider including PTSD screenings in primary care setting visits in these communities to detect exposure to traumatic events.

How is PTSD Diagnosed?

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (American Psychiatric Association, 2013) defines the core aspects of PTSD as:

A.    Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: directly experiencing the traumatic event, witnessing the event as it occurred to others, or learning that the traumatic event(s) occurred to a close family member or close friend.

B.     Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the trauma has occurred: experiencing recurrent, involuntary distressing memories, dreams, or flashbacks of the traumatic event; experiencing psychological or physiological distress at exposure to cues that symbolize or resemble an aspect of the traumatic event(s).

C.     Persistent avoidance of stimuli associated with the traumatic event(s) after the traumatic event has occurred.

D.    Negative alterations in cognitions and mood associated with the trauma such as not remembering aspects of the trauma or frequent negative emotional states (e.g., fear, anger, or guilt).

How Does PTSD Impact Communities?

With inner-city communities being disturbingly labeled with monikers such as Chiraq (Chicago), Little Mexico (Kirkwood, Atlanta), or Chopper City (New Orleans) because of their gun violence, drug distribution, and use of assault rifles, we have to look at the impact that living in these communities have on its residents. According to Beckett (2014), a survey conducted by Dr. Kerry Ressler at Grady Memorial – an inner-city public hospital in Atlanta – found that out of the approximately 8,000 patients surveyed, over two-thirds endorsed that they had been victims of a violent assault. Furthermore, 50% of the patients surveyed reported personally knowing someone that had been murdered. In another study conducted by Gillespie et al. (2009) at the same hospital, findings yielded increased rates of traumatic events exposure. As a result, the study reported increased rates of PTSD and other mental illness. In general, findings suggest that about 65% to 87% of participants experienced exposure to traumatic events and 33 to 60 percent of those individuals developed PTSD.

Other studies have revealed that in comparison to people who haven’t experienced trauma, people who experience incidents of childhood or adult trauma participate in increased acts of violence.  When encountered with dangerous situations, the brain is hardwired to release neurotransmitters that signal the release of hormones that cause the body to react in a “fight or flight” manner. People diagnosed with PTSD stay at this heightened alertness for increased periods of time, which does not allow the brain or body to return to a state of homeostasis or feeling of being relaxed. This extended state of hypervigilance also distorts a persons’ ability to distinguish safe situations from dangerous ones.

PTSD is associated with increased healthcare utilization, medical morbidity, and substance use. Although living in communities of lower socioeconomic status is considered a risk factor for developing PTSD, the subjective experience of the event is still relative to the individual. Leaving one to assume that individuals living in these communities may be extremely resilient individuals, the violence has become so commonplace that an emotional numbness exists, or there’s an exorbitant amount of undiagnosed PTSD in these communities. Understanding the number of traumatic events experienced by civilians that live in low income and urban communities offers valuable insights into the importance of this pandemic. If we don’t address the traumatic symptomatology experienced by residents of these communities we are only exacerbating the violence that takes place within them. This could easily lead to generational psychological impairments within the family systems of members in those communities. Preventative efforts need to provide screenings for PTSD in public health facilities (e.g., primary care doctors’ offices) to lower future rates of PTSD from exposure to traumatic events. By increasing early identification it could lead to increased access to treatment to prevent additional negative outcomes.