Today’s How I See DV perspective comes from Barbara Van Dahlen, named by TIME magazine as one of the 100 most influential people in the world. Dr. Van Dahlen is the founder and president of Give an Hour. A licensed clinical psychologist who has been practicing in the Washington, D.C., area for over 20 years, she received her Ph.D. in clinical psychology from the University of Maryland in 1991. We’re excited to have her share her voice during our DVAM campaign.
Please help us understand what post traumatic stress is and how it differs from post traumatic stress disorder?
When a human being is traumatized, whether it’s due to combat, physical violence, natural disaster or something else, there are certain reactions that we expect people to have. Many of those are the symptoms that are now captured in the diagnosis of posttraumatic stress.
So if I’m in a car accident, we would expect that for quite some time I might be more jumpy, hyper-vigilant when pulling out of my driveway, I might have flashbacks of what happened, I might have bad dreams, I might get depressed… so all of these reactions are what we expect for the situation that I’m in following my accident. It only becomes a disorder if it doesn’t get resolved, if I don’t heal, if I don’t receive the support I need to address all of my understandable reactions and symptoms associated with this trauma.
What are some misconceptions around post-traumatic stress in the military and domestic violence?
Most people assume that PTS looks the same for everyone – many think of the Rambo version of PTS. That’s not the typical reaction at all. People who have experienced trauma, whether its due to combat or another event, can experience trauma differently from other folks who may have experienced the exact same event.
You might have two people who were in the same firefight — one person might become withdrawn and depressed, the other might become very anxious, agitated. A third person in the same fight might show no indication of stress – no interference with their functioning. People assume that PTS looks similar and in fact, the manifestation of PTS really varies. In addition it exists on a continuum. What it looks like today is not what it necessarily looked like six months ago and not what it will look like in six months.
Another misconception is that most soldiers/service members come home with PTS. That is not true either. Depending on the studies you look at — 18%, 20%, high is 35% depending on what we are assessing or measuring. Not everyone comes back with PTS.
Even if someone has PTS that doesn’t mean that they’re an ineffective partner, parent, employee, student. Many people function with the aftermath of trauma. There are some people with severe and possibly disabling PTS – but that’s not the case all of the time.
Also, domestic violence is not a symptom of PTS. That’s really important. PTS, especially when it’s very severe, might, in some people, make them more likely to be violent towards a partner if they’re already agitated and aggressive, if they’re not sleeping or if there’s substance abuse. PTS can be one unfortunate risk factor that may make violence more likely.
It depends on who the person is with PTS. We all carry around our predispositions, our tendencies, our personalities, our view of the world. And that will be compounded or affected by PTS. If someone was already a fairly controlling person, or tended to be hot-tempered but wasn’t ever violent before… if they become distressed and aggressive as a result of trauma, they may be more likely to engage in domestic violence.
Returning servicemen and women may experience PTS and exhibit violent behaviors when they didn’t before they left for duty. What do couples in this situation need to know?
PTS for both the person experiencing it and their partner can be very unnerving and scary because the person who has PTS may not know when a trigger may elicit a reaction, anxiety or aggression. So both partners need to come to understand what PTS is going to look like in themselves or their loved one. It doesn’t mean that the person cant be a good partner. It’s like being diagnosed with diabetes — if you don’t recognize what that means, if you don’t take it seriously, you can get yourself in serious trouble.
If the spouse/ partner reacts angrily to the PTS, because they’re hurt and miss the person they love and they’re angry that the person is having trouble sleeping, doesn’t seem to be the same, etc., it’s like throwing gasoline on the fire. The partner’s reaction can exacerbate a difficult and potentially volatile situation. It’s the same for the person experiencing PTS. I’ve heard soliders say that they learned to be aware of what triggered them and their reactions. They can also learn how to be more careful with their spouses – learn to be understanding of the feeling their spouses may have that are in reaction to the PTS. Couples can learn together – to decrease the risk of violence. But they have to work on it.
It’s important to take PTS seriously because under the wrong combination of circumstances, that can really lead to a very dangerous and very upsetting situation … especially if you add alcohol to one or both of the partners. A fight or anger that would normally dissipate with them going off to their own corners, may turn into something far more violent than it ever would have before.
And just because we can understand how/why the violence occurred, that doesn’t mean that we can – or ever should – tolerate it.
What are some behaviors that a person who experienced trauma might exhibit?
There are many ways a person might show that they are processing trauma, especially if they are a victim of domestic violence. Their self-esteem may deteriorate. You can see that both in what they say – they say negative comments about themselves, negative perceptions of themselves – and also how they take care of themselves or don’t. Their self-care will start to be affected, falter, fail. They’re not dressing the way they used to, with care. They’re not working out, they’re not eating healthy. Or maybe there’s substance abuse. So anything that is a self-care clue that somebody is suffering, we can often see those in people we care about and notice them.
We all go through ups and downs in our lives, but if you see people who don’t seem like themselves for extended periods of time, several days or weeks, it may be a reaction to trauma.
What are some myths around mental health and domestic violence?
One myth about mental health is that someone with mental illness is having mental illness makes you more likely to be violent. In fact, having a mental illness makes you more likely to be the victim of violence.
People with severe mental health issues, maybe schizophrenia or bipolar disorder, are more likely to be the victim of domestic violence because they are often less able to take care of themselves, they are more vulnerable, their thinking is not always as clear.
In addition, mental health issues place a person at risk in other ways. Someone who is severely depressed may be less likely to step out of or seek help to get out of a domestic abuse situation. They may get more entrenched, and feel like “I’m worthless” because low self-esteem is part of the depression, so they see abuse as confirmation of how they feel. Or if someone has severe depression and is prone to being abusive, they might be more likely to become violent because of their mental health issue.
Those conditions — depression, anxiety, eating disorders, substance abuse — they don’t create domestic violence, or victims. They’re just risk factors on both sides .
About Our Contributor
Concerned about the mental health implications of the wars in Iraq and Afghanistan, Dr. Van Dahlen founded Give an Hour in 2005 to enlist mental health professionals to provide free services to U.S. troops, veterans, their loved ones, and their communities. Currently, the network has nearly 7,000 providers, who have collectively given over $9.4 million worth of services.
Dr. Van Dahlen, a featured speaker at the October 2012 TEDxMidAtlantic “Be Fearless” event, has joined numerous panels, conferences, and hearings on issues facing veterans and has participated in discussions at the Pentagon, Veterans Administration, White House, and Congress. She has become a notable expert on the psychological impact of war on troops and families and a thought leader in mobilizing civilian constituencies in support of active duty service members, veterans, and their families. Working with other nonprofit leaders, Dr. Van Dahlen developed the Community Blueprint Network, a national initiative and online tool to assist communities in more effectively and strategically supporting veterans and military families.
Dr. Van Dahlen and Give an Hour have received numerous awards, including selection as one of the five winners of the White House’s Joining Forces Community Challenge, sponsored by First Lady Michelle Obama and Dr. Jill Biden.