Young adults with Post Traumatic Stress Disorder (PTSD)

The term Post Traumatic Stress Disorder (PTSD) obviously highlights a connection of this disorder to trauma, in fact, for many years it was connected to combat trauma. Its history was largely related to war zones and the disorder was often seen as the unfortunate prize soldiers had to pay for surviving in battles fought in their patriotic service to the state.

It was most understood through studies on the veterans of the Vietnam War and by 1980, the American Psychiatric Association coined the term Post Traumatic Stress Disorder as a mental diagnosis of ex-servicemen. Only tangentially was it connected to civilians who are victims of extreme trauma such as terrorist attacks or major natural disasters.

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Table of Contents

• Understanding Post Traumatic Stress Disorder
  • Definition, Symptoms, and Diagnosis of Post Traumatic Stress Disorder
  • Triggers of Post Traumatic Stress Disorder
  • Long term outcomes for young adults with ptsd if not well managed include : 
• The Internet and Post Traumatic Stress Disorder
  • Some other factors that could contribute to this heightened vulnerability include
• Perpetuating factors
• Recommendations
• Conclusion
  • References

Understanding Post Traumatic Stress Disorder

Revolutionary studies considering the mental health outcomes of victims of other traumatic exposures such as rape, child abuse, etc. have helped to widen the scope of Post Traumatic Stress Disorder¹.

From the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (DSM-V), the latest diagnostic manual published by the American Psychiatrist Association in 2013 for psychiatric disorders, the following is generally known of Post Traumatic Stress Disorder²  :

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Definition, Symptoms, and Diagnosis of Post Traumatic Stress Disorder

Post traumatic stress disorder is a mental health illness developed by some persons following exposure to extremely stressful or traumatic events especially those of an interpersonal and intentional nature.

Persons who suffer from this disorder may experience  any combination of these clusters of symptoms:

• Re-experiencing the traumatic event as vivid nightmares, flashbacks, or intrusive thoughts that often precipitate distressful anxiety attacks often leading to an irrational desire to avoid reminders connected to the traumatic event.
• Recurring negative thoughts and feelings such as survivors’ guilt or impressions of worthlessness or self-blame and may further reinforce the avoidance and estrangement behavior.
• A persistent autonomic hypersensitivity and psychological arousal leading to sleep disturbance, poor concentration, elevated blood pressures, irritability, and aggression, etc.

There is often a significant decline in the standard of living as the symptoms interfere with and impair normal physical and social functioning. A good number of patients could come down with other mental health disorders or resort to substance and alcohol abuse as coping mechanisms.

Diagnosis of this disorder is typically made when such symptoms persist beyond one month of trauma, in the absence of substance abuse or other possible causes. These symptoms must also have been absent prior to the initiating trauma. Further details of the disorder could be found in the DSM V or in the World Health Organization’s International Classification of Diseases, 10th edition (ICD-10), diagnostic manuals where detailed clinical criteria are provided to guide clinicians in making a diagnosis of this condition.

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Triggers of Post Traumatic Stress Disorder

Some defined traumatic triggers in young adults with Post traumatic stress disorder include:

• Direct exposure to actual or threatened death. 
• Serious injury or sexual violation.
• Witnessing a loved one experience such trauma also triggers this condition in susceptible persons.
• Some professionals in fields that deal with crime and disasters such as the police force, fire service, etc. are also at risk.

Exposure to violence on the media is however not included in the risk factors ². Certain biological factors such as a lower volume of the hippocampus, a dysfunction of the Hypothalamic-Pituitary Axis in response to stress, and certainly not well understood hereditary factors have also been implicated as risk factors ³.

Among those experiencing certain levels of stress, it is noted that social factors such as poor economic and educational background, dysfunctional homes, and prior emotional deprivation contribute to the development of PTSD in the sufferers.

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Long term outcomes for young adults with ptsd if not well managed include :

• Increased risk of developing other mental health disorders such as depression. 
• Substance abuse disorders and bipolar disorders. 
• Decreased quality of life. 
• Increased predisposition to intentional acts of violence and increased cases of suicide attempts 2.
• A groundbreaking study on the relationship between Post traumatic stress disorder and completed suicide carried out in Denmark has established that a significantly high rate of completed suicides was found in young adults with PTSD and higher still in those with depression as a comorbid condition ⁴.

While it appears that large scale wars and deployment of soldiers has greatly reduced in recent times a concomitant drop in the incidence and prevalence of certain trauma associated mental health disorders such as Post traumatic stress disorder has not been noted.

Exposure to combat has now been overtaken by sexual abuse as the leading risk factor for Post traumatic stress disorder while childhood neglect and other forms of physical abuse account for high rates seen in several studies ⁵ .

The risk factors for young adults with Post traumatic stress disorder are multiplying and bullying has emerged in a number of studies to be heavily linked to the development of PTSD ⁶.  While the link between traditional bullying and PTSD is still controversial, it appears that online bullying is not even considered at all by many psychiatrists.

The fact however that many young persons who do not have any identifiable major traumatic exposure come down with this condition calls for a search for unidentified triggers in this age category and effects of harassment online should be given a thorough evaluation.

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The Internet and Post Traumatic Stress Disorder

With the emergence of the internet as the dominant mode of social interaction, there are many who have reported that they have been victims of abuse on some online platforms and have had their lives significantly impacted by such abuse. Just as many changes have been seen in a number of societal structures due to the proliferation of internet use, there may be a modification to the traditional societal perception of trauma. It is left for us to try to understand just how much online abuse could contribute to the growing rate of young adults with Post traumatic stress disorder.

The internet was born during the intense arms race of the late twentieth century between the United States of America and the then Union of Soviet Socialist Republics (USSR),  which would embrace different sectors of technological development as each sought to gain superior control of the various fields of modern warfare⁷ .

It was initially intended to be a technology that could interconnect the US Department of Defence’s main computers via a diffused and dispersed global network but gradually its capacity to facilitate links between researchers who could share their specialized resources became the priority ⁷. In the 1990s, a number of factors most important of which was the creation of the world wide web by  European Organization for Nuclear Research’s(CERN) scientist Timothy Berners Lee sparked the widespread use of the internet thus transforming the face of communication.

By the early 2000s, many businesses had online platforms to facilitate relationships with customers and for advertisement. Over the years more parts of the world got connected and companies like Amazon, Facebook, Google, Instagram, etc. rose to become giants, amassing billions of users on their platforms. By 2017 about half of the world’s population, amounting to over 3.5 billion people were on the internet ⁸.

Similarly, users of social media platforms grew exponentially. Currently, Facebook has about 2.3 billion users on its platform, about 1.9 billion people are on YouTube, 1.3 billion on WhatsApp while Instagram and WeChat each boasts of about 1 billion users 8. A huge proportion of those on these platforms is young persons. A survey carried out in Organization for Economic Cooperation and Development (OECD) countries (an organization of about 34 countries that support the free market) in 2014 showed that an average of 90% of young persons aged 16-24years were engaged in social networking online ⁸.

With its capacity to reach many people, these platforms have transformed the face of modern life. Huge chunks of the budget for the advertisement of many companies are invested on these platforms and influencers on these platforms have become highly sought after as ambassadors of different brands.

Many communities for individuals with similar interests have also arisen on various platforms and individual status is measured by the number of followers one has and the influence on their opinion. For many young persons, getting likes on posts, plenty of retweets, and increased views and followers have become new ways of social recognition or acceptance and the reverse is taken as an indicator of social ostracism.

This new approach to creating self-worth or value has tremendous consequences. It means that rather than looking at objective standards of value, one would have to depend on what the online majority view as valuable. Many times this does not correspond to reality and can generate a lot of friction in relationships with others in real environments. This world view of value also means that people become much more vulnerable to ego attacks that may be considered harmless by the older generations.

A lot of instances have been seen where people who are attacked online go on to suffer serious and some even see no reason to continue living. Unfortunately, a lot of groups and individuals with malicious intent have capitalized on these potentials to carry out their hideous agenda making these platforms a new theatre of war. Among these are people who in a bid to win popularity or to establish authority in certain communities resort to measures like bullying or mudslinging, targeted at their rivals.

In fact, cyberbullying is one of the fastest-growing internet phenomena albeit a negative one. It has been defined clearly by the American National Crime Prevention Council as the process of using the internet, cell phones, or other devices to send or post texts or images intended to hurt or embarrass another person and has acquired a host of euphemisms like dragging, trolling, savage response, sexting, etc.

A number of studies have reported high rates of cyberbullying. A 2018 study by Pew Research Centre found that about 59% of teenagers had experienced some form of online bullying ⁹; another by Florida Atlantic University involving about 20,000 middle and high school students reported that over 70% were victims of online bullying ¹⁰.

According to i-SAFE foundation’s bullying statistics, over half of adolescents and teenagers have been bullied online and the same number have engaged in cyberbullying; over 25% of young people have been bullied repeatedly through their cell phones or the internet ¹¹. The effect on the victims is made worse than that of traditional bullying by the wide audience the bully has access to online, enabling him for instance to spread false rumors or explicit contents of the victim to much more people.

It is also much more difficult to avoid such perpetrators because they have easy access to information about their victims and can readily invade their private spaces. These attacks also have the potential to go on for longer periods without any check than would traditional bullying.

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Some other factors that could contribute to this heightened vulnerability include

• The victims like many young persons are emotionally unprepared to deal with complex socio-anthropological issues such as rejection, loss of reputation, loneliness, etc. that could result from the perpetrator’s actions.
• A lot of young persons suppose a certain need to be constantly online so as to be up to date with happenings. This also means that they are constantly exposed to possible violations. In many places measures like deleting a social media account to protect oneself from bullies are considered as grave as suicide and would only be a last resort.
• The victims are often reluctant to report cases of abuse to others for fear of being misunderstood or for fear of worse reprisal attacks if any action is taken.
• Lack of significant punitive action against the perpetrators may discourage the victims and others from reporting further abuses
• On platforms where people can connect from different parts of the world, the perpetrators may be unreachable or anonymous.

Over time, victims of repeated cyberbullying have been seen to gradually internalize these stressors and manifest symptoms of mental health imbalance. Some come down with depression and anxiety disorders and have an increased chance of substance abuse 12. Some manifestations such as withdrawal from family and friends, avoidance of school or activities formerly enjoyed, changes in sleep and appetite, noticeable changes in mood or behavior especially after using a computer or phone 6, etc. are strongly suggestive of Post traumatic stress disorder.  

Some unable to cope, proceed to attempt suicide. In 2016, suicide was a leading cause of death among young people aged 15-29 years, second only to road traffic accidents ¹³ . It may be possible that quite a good number of these were indeed victims of this new theatre of war.

Perpetuating factors

There is a growing concern globally that many social media platforms are unable to screen users from toxic content.  Recently Disney had to order the closure of unauthorized fan-operated clones of its online game Club Penguin after BBC discovered that users were exposed to intimidating and abusive explicit messages  14.

The difficulty in verifying the contents of posts or preventing false rumors from spreading are also contributory. In fact, has been a growth in the tolerance of certain victimizing contents on a number of platforms.

For instance, there has been a surge in the spread of revenge pornography on different sites with little action from the managers of the platforms except when pressure is mounted on them by users. More subtle but nonetheless important is the growth in negative and violent criticisms of opposing opinions on a number of platforms thereby creating fear for meaningful discussions.

Many people have reported receiving millions of hateful comments and losing followers for sharing posts that are considered unpopular views. A few other perpetuating factors include:

• Lack of legislation: Until the mid-2000s no country had any proper cyberbullying law. By 2019 only about 16 countries had any laws related to cyberbullying and in many places cyberbullying is considered a mild infraction deserving only mild punishments.

• Bad coping strategies: Some persons resort to other addictive reliefs such as substance abuse, pornography, or becoming themselves perpetrators of cyberbullying as ways to deal with bullying. These measures would only worsen the negative impact on mental health.

•  Environmental conditions: low socioeconomic status and poor educational background have been noted to worsen the outcome of victims of abuse. This could be due to the reinforced feeling of helplessness and worthlessness. In some other places family situations such as separated homes, lack of adequate parental attention and emotional deprivation contribute to worse outcomes in victims.

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Recommendations

A commendable amount of effort has been put in various places in recent years to help a lot of people deal with mental health disorders. The majority of successes are attributed to increased awareness of such disorders and an early search for help from appropriate channels. This approach would also go a long way in helping people to realize the impact of cyberbullying on the mental health of young persons and the conditions it could predispose them to.

A few other general suggestions that could be of benefit include:

•  Invest time in other ways of increasing self-worth: this could be learning other skills, get involved in social welfare services, etc.

• Participate in offline engagements with friends and family. For example, form a book or a hiking club with friends and spend quality time on rewarding hobbies.

• Pay attention to subtle changes in suggestive of pressure from cyberbullies. Many times victims develop unusual behaviors and could be better helped if they are noticed by those who live or spend time with them.

• Talk to family and friends about the challenges faced: people are encouraged to talk about the pressures faced by friends or trusted family members. Sometimes these other persons could offer valuable advice or take measures to check such abuses. In many cases, these discussions form part of the healing process.

• Efforts could be made to encourage the different levels of government to make better legislation that would protect victims and punish offenders.

• Finally, a modification of the criteria for the diagnosis of Post traumatic stress disorder that accommodates online harassment as traumatic exposure could aid clinicians in identifying this condition early in such victims and instituting therapy.

Conclusion

In the year 2014, the Popular (name of the director) movie, American Sniper generated widespread sympathy for the US military veterans who never recovered from the exposure to the Iraq war.

Amongst many other effects, this awareness resulted in a greater effort by various charity organizations to foster ways to help the reintegration of veterans into civilian life and consolidated ongoing efforts to help them manage their mental health challenges.

The suicide of the popular female Japanese wrestler and Netflix star Hana Kimura following months of online harassment by fans nearly sparked such a movement before it was overtaken by many other events. Such a movement may be required to help many young persons who have become veterans of the new internet warfare and who may have been left to suffer in silence for a long time.

Increased awareness by both clinicians, family members, and friends could lower the percentage of those who would cross the point of remedy.

References

1. “Post-Traumatic Stress Disorder.” Wikipedia, Wikimedia Foundation, 7 Jun. 2020, https://en.wikipedia.org/wiki/post_traumatic_stress_disorderTSD
2. Diagnostic and Statistical Manual of Mental Disorders: DSM-V. Arlington, VA: American Psychiatric Association, 2013. Print
3. Kaitlin A. Chivers-Wilson “post-traumatic stress disorder in sexual assault victims” McGill J Med. 2006 Jul; 9(2): 111-118. PMCID: PMC2323517. PMID: 18523613
4. Gradus, Jaimie L et al. “Posttraumatic Stress Disorder and Completed Suicide.” American Journal of Epidemiology 171.6 (2010): 721–727. Web.
5. “Post-traumatic stress disorder: the management of PTSD in adults and children in Primary and Secondary Care”. Leicester (UK): Gaskell; 2005. (NICE Clinical Guidelines, No 26.) 2, Post-traumatic stress disorder [Internet] https://www.ncbi.nlm.nih.gov/books/NBK56506/#_NBK56506_pubdet_
6. Nicole Arzt. “Victim of Long-term bullying or harassment and PTSD” published online at americanaddictioncentres.org. retrieved from https://americanaddictioncentres.org/trauma-stressor-related-disorders/effects-being-bullied-harassed
7. Cohen-Almagor, Raphael. “Internet History.” International Journal of Technoethics Vol. 2 (2011): 45–64. Web.
8. Max Roser, Hannah Ritchie and Esteban Ortiz-Ospina (2015) – “Internet”. Published online at Ourworldindata.org. Retrieved from: ‘https://ourworldindata.org/internet’. [Online Resource]
9. Monica Anderson. A Majority of teens have experienced some form of cyberbullying published online at pewresearch.org. retrieved from ‘https://www.pewresearch.org/internet/2018/09/27/a-majority-of-teens-have-experienced-some-form-of-cyberbullying/ [online resource]
10.  Florida Atlantic University. “Nationwide teen bullying and cyberbullying study reveal significant issues impacting youth.” ScienceDaily. ScienceDaily, 21 Feb 2017. https://www.sciencedaily.com/releases/2017/02/170221102036. Accessed on 15 June 2020.
11. Cyberbullying statistics published online at bullyingstatistics.org. Retrieved from ‘https://bullyingstatistics.org/content/cyberbulling-statistics.html’. [Online Resource] Accessed on 15 June 2020.
12.  Isaac Alexis. Cyberbullying and substance abuse published online at addictioncampuses.com Retrieved from https://www.addictioncampuses.com/addiction-resources/cyberbullying-substance-abuse/ on 15 June 2020
13. World Health Organization 9. (2016). Mental health. retrieved from https://www.who.int/mental_health/prevention/suicide/suicideprevent/en/
14.  Joe Tidey. Disney forces explicit club Penguin clones offline. BBC News, 15 May 2020 https://www.bbc.com/news/amp/technology-52677039. Accessed on 18 June 2020.
15.  Hana Kimura: Netflix star and Japanese wrestler dies at 22. BBC News, 23 May 2020. https://www.bbc.com/news/amp/world-asia-52782235. Accessed on 18 June 2020.