PTSD in Men

As we walk into National PTSD Awareness Month and Men’s Mental Health Month. let’s see how post-traumatic stress disorder presents itself in men. Gender differences exist in the prevalence, symptomatic expression, and risk factors of PTSD. Both men and mental health professionals encounter challenges and barriers when diagnosing PTSD in men.

Post-Traumatic Stress Disorder: An Overview

When any individual is exposed to any traumatic events and long after the subset of the event continues to experience fear reactions then their symptoms can probably be meeting the DSM V diagnosis criteria for PTSD.

Read More: PTSD: Symptoms, Diagnosis and Treatment

DSM V Criteria For PTSD

1. The traumatic events should be at least one of the following

• Serious injury
• Sexual violence
• Actual or threatened death

2. The traumatic events don’t have to be directly experienced. Beyond the direct exposure of them, they can also be

• Witness the event as it occurs (e.g. watching someone being shot and dying)
• Event occurring to a close friend or family. In this case, it should be violent or an accident.
• Exposure to the grave details of an event (e.g. collecting bodily remains as a first responder). This exposure, however, shouldn’t be through media like movies or television.

3. To make an effective diagnosis, categorize the symptoms of PTSD into four groups.

A. Intrusion: repetitive experiencing of the trauma even, eg. through nightmares

• Flashbacks
• Scary dreams
• Distressing dreams
• Unwanted stressful memories
• Strong distress from reminders
• Physical reactions to reminders
• Trauma reenactment in play in children

B. Avoidance of any reminders of the trauma through thoughts, feelings, places, etc.

• Avoiding distressing memories or thoughts
• Avoiding external reminders (people, places, activities)

C. Negative changes in mood and cognition and mood

• Lack of interest in activities
• Persistent negative emotions
• Feeling detached from others
• Inability to feel positive emotions
• Distorted blame about the trauma
• Inability to remember parts of the trauma
• Negative beliefs about oneself or the world

D. Arousal and reactivity like being Hypervigilant or being aggressive.

• Hypervigilance
• Sleep disturbances
• Concentration problems
• Exaggerated startle response
• Reckless or self-destructive behaviour
• Irritable behaviour and angry outbursts

4. Symptoms should persist for at least a month

5. A significant hampering in daily functioning should occur from the presence of symptoms.

6. Symptoms should not be related to any Medication, substance use or other illness.

Acute Stress Disorder vs PTSD

The minimum criteria for being diagnosed with PTSD in DSM V is that symptoms should be present for at least a month. But what happens when the onset has begun with severity before a month? Then for a month to make a diagnosis after learning about the severity wouldn’t be the wisest of things.

If the same symptoms of PTSD diagnosis criteria present themselves immediately after the exposure to a traumatic event and persist for at least two days then clinicians make a diagnosis for Acute Stress Disorder and after a month of experiencing the symptoms it is re-diagnosed as PTSD.

Gender Differences in Post-Traumatic Stress Symptoms

Studies have shown that women usually report inability to concentrate well and distress from the reminders whereas men report nightmares which are higher in numbers, going emotionally numb, and hypervigilance.

Men exposed to combat may exhibit symptoms such as hypervigilance, nightmares, and aggression, while women may experience symptoms related to sexual trauma or interpersonal violence in addition to combat-related symptoms.

Men might display more overt signs of hyperarousal, such as aggression or anger outbursts, while women might internalize these symptoms or experience heightened emotional reactivity.

Prevalence of PTSD in Men

There have been numerous studies done researching the prevalence of PTSD in men.

• An intriguing trend of their female counterparts having a higher prevalence than them across various dimensions has been found. Approximately 5% of men will experience PTSD at least once throughout their lives, in comparison to about 10.4% of women.
• The differences in trauma-related cognitions, emotional reactivity, and coping strategies can be suggested as the reason for this variance.
• It has also been found various professions like veteran combats and first responders like firefighters are at higher risk.

How Men may develop PTSD: Causes and Risk Factors

The factors that might make men vulnerable to the diagnosis of PTSD are categorized into three groups

1. Pre-traumatic risk factors

Genetic, personality and cognitive factors, previous trauma history, and previous psychiatric disease all determine predisposition to PTSD.

• People with intellectual disability have 10% instances of PTSD as compared to people with high cognitive capacity which helps In coping with trauma.
• Factors like low psychological resilience, high harm avoidance behaviours, difficulties in regulating negative emotions, and specific cognitive schemas along with neurotic, avoidant personalities increase PTSD risk.
• High heritability rates have been reported in the genetic factors associated with PTSD. Genetic variants in glucocorticoid receptor and binding proteins associated with PTSD risk. Trauma exposure may cause epigenetic changes, predisposing to psychiatric disorders like PTSD.

2. Trauma-related risk factors

Trauma-related risk factors for PTSD development include the severity and type of trauma experienced.

• Perceived fear of death or threat to life during the traumatic event independently heightens the risk of developing PTSD.
• Factors such as sexual assault, domestic violence, participation in Studies conflicts, political violence, and natural disasters elevate PTSD risk.
• Direct exposure to trauma, physical injury, or loss of loved ones increases the likelihood of PTSD, with direct exposure being more impactful than indirect exposure.

3. Post-traumatic risk factors

• Inadequate social support increases PTSD vulnerability
• Negative social reactions exacerbate PTSD risk more than positive support
• A survey done for PTSD showed a correlation with pain from grave physical injury.
• PTSD risk is increased with higher physical disability, loss of daily functioning, and mild traumatic brain injury

Read More: How PTSD Impacts the Survivors of a Crime?

Barriers to seeking help

Studies have shown that women are more likely to report symptoms of distress and seek professional clinical help for both psychological and physical distress as compared to men. But why do these differences arise? There are several studies done in diving into the nature of men’s Inability to seek help openly.

• Normality: Traits such as emotional stoicism, independence, and to theirs are often valued in men, making it difficult for them to admit vulnerability or seek assistance. This can lead to untreated PTSD and other mental health issues, as men might avoid therapy or other forms of support that they perceive as conflicting with these masculine ideals.
• Internalization of traditional masculine norms: Ever Since the traditional view of masculine problems emphasized the virtues of self-reliance and emotional control being ideal for men. Seeking professional help translates into being dependent on someone else and not being in control of their emotional state which can be seen as a sign of failing the norm.
• Normativity of the Problem: If men perceive their problems as common or normal among their peers, they are more likely to seek help. For instance, a man is more likely to seek help for an issue he sees many other men facing, such as common health problems, but less likely for issues he perceives as uncommon, like mental health struggles
• Peer Group Influences: The attitudes of men within a man’s social network significantly impact his help-seeking behaviour. If a man’s peer group views seeking help as a weakness, he is less likely to seek help. Conversely, supportive environments can normalize help-seeking behaviour and make it more acceptable
• Societal and cultural stigmas: Stigmas associated with mental health issues, particularly the perception that seeking help is a sign of weakness or failure like the traditional internalized masculine norms that discourage men from seeking mental health help.

Read More: Understanding the Psychological Impact of Trigger Warnings

Challenges in Diagnosing PTSD in Men

The internalization of masculinity along with societal and cultural stigmas does not only refrain men from seeking help but can also induce biases from the therapist’s side. Eg the aggressive expression of distress is a common symptom of PTSD in men but this can be dismissed as typical male behaviour. Another example can be due to the stoic virtue of masculinity a therapist may assume a man to be less expressive which might create a judgemental, less vulnerable environment for male clients.

How to encourage men to seek help and adhere to Treatment

1. As a close one: Family, friends and immediate social institutions play a crucial role in providing men with a non-judgemental space for expressing themselves. Emotional backing is needed to encourage men to seek help and adhere to treatment plans. Family members and friends can also help by being attentive to symptoms and changes in behaviour.
2. As a Therapist: Therapists should adjust their communication styles to better engage male clients. Eg, Men might be more responsive to action-oriented or solution-focused therapy rather than approaches that emphasize emotional expression. Therapists should also self-reflect and seek, identify and address any biases that might affect their practice to ensure that they provide equitable and effective care to all clients, regardless of gender.

Read More: The Role of Chatbots in Mental Health Services: How Does It Impact People?

The very nuance of having a Men’s Mental Health Month reflects on the severity of making the expression and helpful mental health resources more readily available for men and being society as a whole provide the men of our society with a safe, non-judgmental space to combat their distress and flourish healthier and happier.