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Post Traumatic Stress Disorder and Community Violence

Source: The National Center for PTSD website at:

 http://www.dartmouth.edu/dms/ptsd

Community violence can take many forms: riots, sniper attacks, gang wars and drive-by shootings, and workplace assault. On a larger scale, terrorist attacks, torture, bombings, war, ethnic cleansing, and widespread sexual, physical and emotional abuse can affect entire populations.

• Natural disasters can be traumatic, but community violence has several unique features that can have a lingering and traumatic impact. Sometimes in natural disasters people have time to prepare themselves, but community violence usually happens without warning and comes as a sudden and terrifying shock.
• Natural disasters can force people to leave their homes and friends, but community violence can permanently destroy entire neighborhoods and end friendships -- or make the neighborhood or the relationships too unsafe to trust and continue.
• Natural disasters are uncontrollable and unpreventable, but community violence is the product of people's actions. Even though most survivors of community violence are innocent victims, they may feel guilty, responsible, self-blaming, ashamed, powerless, or inadequate because they wish they could have prevented the violence even though it was beyond their control.
• The damage caused by natural disasters is accidental. Community violence involves terrible harm done on purpose, which can lead survivors to feel an extreme sense of betrayal and distrust toward other people. 

Being victimized by violence leads some individuals to react with violence, but there is no evidence as yet that survivors of community violence who have PTSD are more prone to perpetrating community violence than survivors who do not have PTSD. While PTSD does not cause violence, PTSD symptoms can lead survivors of community violence to have difficulty managing violent feelings or impulses. For example, people with PTSD due to witnessing or being directly exposed to community violence may experience:

• Disturbing memories and feelings of reliving the violence.
• Flashbacks or nightmares, in which they unintentionally act violently in order to protect themselves.
• Feeling indifferent to their own or other people's suffiring because they feel emotionally numb and cut off from others.
• Increased arousal, startle responses, and hypervigilance (feeling extremely on-guard or in danger).
• Feelings of betrayal and anger from being exposed to violence in what should be their "safe haven."

Most people exposed to community violence, with or without TSD, do not act violently. The stereotype of the violence survivor being out of control and hell-bent on revenge or "payback" is a myth that rarely occurs in real life. Severe day-to-day stressors that are demoralizing, but not life-threatening, appear to play a greater role -- both in causing community violence in general and in leading individuals to act violently -- than PTSD or even traumatic violence itself. Research suggests that violence is somewhat more likely in those communities whose people live in highly stressful circumstances such as the following:

• High unemployment rates
• High rates of illegal drug use
• High rates of school drop-outs
• Chaotic, disorganized, or physically and emotionally abusive families or classrooms
• Periods of extremely hot weather

Perhaps the greatest danger of violence associated with PTSD occurs when community violence spills over onto the family and home, especially in intimate relationships. No studies yet have determined whether there is a link between community violence and domestic violence, but this is a sts and clinicians take very seriously, because of a growing awareness that domestic violence is more common and more devastating than previously realized. Survivors of community violence struggle with many vital personal issues:

• How to build trust again (issues of power, empowerment and victimization)
• Seeking meaning in life apart from revenge or hopelessness
• Regaining trust versus being trapped in feelings of guilt, shame, powerlessness, and doubt
• Finding realistic ways to protect themselves, their loved ones, and their homes and community from danger.
• Healing traumatic losses and putting memories of violence to rest without trying to avoid or erase them
• Commitment or recommitment to life (choosing life versus giving up or seeking escape through suicide)

Rapid, timely, and sensitive care for the community as well as for affected individuals and families is the key to preventing PTSD in the wake of violence (and of reducing violence itself). Mental health professionals with expertise in community violence can contribute in several ways: 

• Helping community leaders to join together to develop violence prevention and victim assistance programs.
• Helping religious, educational, and health care leaders and organizations to set up relief centers and shelters.
• Providing direct psychological services near the site of violence. These might include debriefing survivors, supervising a 24-hour crisis hotline, and identifying survivors or bereaved family members who are at high risk for developing PTSD (and helping them to get connected with appropriate continuing treatment, to either prevent or recover from PTSD).
• Providing education, debriefing, and referrals for affected children at their schools, often working with teachers.
• Providing organizational consultation to government, business, and healthcare programs affected by the violence.

This article and others like it can be found on The Alational Center for PTSD website at http://www.dartmouth.edu/dms/ptsd The National Center is a program of the U.S. Department of Veterans Affairs and carries out a broad range of activities in research, training, and public information.