Running head: avoidant behaviors with ptsd 1

PTSD and Common Avoidant Coping Behaviors

Tyler Cassity
Salt Lake Community College

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PTSD and Common Avoidant Coping Behaviors
Posttraumatic stress disorder (PTSD) is a psychiatric condition that develops in people
who have seen or lived through dangerous, extremely fearful, or potentially life threatening
events (Schacter, Gilbert, Wegner & Nock, 2014). Symptoms include: recurrent unwanted
thoughts or images of the trauma, flashbacks of the trauma, nightmares, intense irritability and
anger, hypervigilance, and an exaggerated startle (Anxiety and Depression Association of
America, 2016). On top of the symptoms of the disorder, individuals suffering from PTSD also
are more likely to experience family problems, job instability, legal difficulties, additional health
problems, and avoiding all things that call the traumatic event to mind (Jordan et al.; Smith,
Schnurr, & Rosenheck, 2005). This Paper will examine who is affected by PTSD, and common
avoidant coping skills that are harmful to the individuals.
Who is Affected by PTSD
In 2015 The U.S. Department of Veterans Affairs estimated that at some time over the
course of their lives, about 7% of Americans may suffer from PTSD. They estimate that 8
million adults have PTSD during any given year, 10% of all women, and 4% of all men. The
numbers are even higher however for U.S. service men and women returning from current
Military deployments, with estimates as high as 14-16% (Hoge et al., 2004; Tanielian & Jaycox,
2008). There are many factors associated with PTSD, and what causes it. These risk factors can
be divided into three categories: pre-trauma individual factors, characteristics of the trauma
itself, and post-trauma factors (Keane, Marshall, & Taft, 2006).
Pre-trauma factors include: the age of the individual at the time of the trauma,
intelligence level, socioeconomic status, history of prior traumas, and military rank if enlisted.
The biggest impacting characteristics of the trauma include: the severity of the trauma exposure,

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perceived threat of life or injury, and exposure to death, killing, or abusive violence (King et al.,
1998; Schnurr et al., 2004; Gahm et al., 2007). The last category is the post-trauma factors,
which can largely affect how the person copes with their experiences. These factors include; lack
of social support, a negative homecoming experience, and continual exposure to additional life
stressors (Brewin et al, 2000; Johnson et al., 1997; Koenen et al., 2003). Studies have shown that
majority of the individuals exposed to trauma do not develop clinical PTSD, suggesting that
these and other factors of an individuals behavior, strongly influence the onset and course of this
disorder (Marx & Sloan, 2009).
But its not only the individuals coping with PTSD that suffer from the symptoms; family
members and friends are also directly affected by the disorder. When victims of PTSD fail to find
healthy ways to cope with the symptoms, they can begin to engage in harmful behavior, either to
themselves or those in their social circles (U.S. Department of Veteran Affairs, 2015). Next we
will take a look at some of these harmful coping behaviors, commonly used by victims of PTSD.
Common Avoidant Strategies
When individuals who have survived these traumatic events, try to work through them
without help, they may struggle to completely overcome the experiences because of internal
conflicts. These conflicts stem from the inability to incorporate the traumatic experience into
their existing belief system, which may ultimately lead to the form of trauma-related guilt and
shame (Resick, 2001). Trauma-related guilt comes from negative evaluations of specific actions
or behaviors, whereas trauma-related shame is the negative evaluation of the self (Tangney &
Dearing, 2004). Many individuals may begin to view themselves as defective because of their
inability to manage and overcome these symptoms of the traumatic stress on their own, and may
further fuel feelings of shame (Ehlers & Clark, 2000). These feelings of guilt and shame along

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with the other constant symptoms of PTSD often push people to avoidant, dissociated, and
disengaged behaviors.
Substance abuse is one of the most common coping behaviors of avoidance with
individuals suffering from PTSD. One common explanation for this is the self-medication
hypothesis, which states that these individuals attempt to dampen, avoid, numb, or escape from
distressing traumatic memories through the use of these substances (Brady, Back, & Coffey,
2004). Approximately 52% of men, and 28% of women who met diagnostic criteria for PTSD
also met criteria for either alcohol abuse or alcohol dependence in their lifetimes (Kessler et al.,
1995). When these substances are used to cope with PTSD symptoms and feelings of guilt, they
often intensify both the symptoms themselves, as well as intensifying the feelings of shame and
guilt (Potter-Efron, 1989). These increased negative feelings, along with more intense symptoms
from the disorder, build a stronger need to numb through the increased use of alcohol and other
substances.
Anger or increased aggressive behavior is another psychological adjustment problem that
can be viewed as dissociating. Studies conducted among veterans not seeking treatment for
PTSD, found that 40% of veterans report getting angry with someone and kicking, smashing, or
punching something at least once in the past month (Elbogen et al., 2010; Sayer et al,. 2010;
Thomjas et al., 2010). This increased aggression, combined with the abuse of substances, directly
affects the victim as well as their familys physical and emotional health. These feelings of anger
and aggression usually stem from a feeling of lack of control of ones self. For example,
flashbacks may catch the individual off-guard, happening at any time. This may lead the
individual to believe that they are not in control of all elements in their psychological experience,
and that there is a part of them functioning independently and unpredictably (Gadi et al., 2013).

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Emotional disengagement is when an individual shuts themselves, and their feelings, away from
other people. In the case of PTSD, the individual will also continually criticize, and blame
themselves for what happened. Isolating oneself, and increased feelings of guilt, shame, feelings
of loss of control or defectiveness can all attribute to victims becoming majorly depressed. It is
estimated that depression is 3 to 5 times more likely to occur with PTSD victims than those
without (Kessler et al,. 1995). Major depression is characterized by a persistent low mood, low
self-esteem, loss of interest in normally enjoyable activities, and persistent suicidal ideation
(Barlow et al., 2005). A study conducted with individuals suffering from chronic PTSD were
assessed for suicidal ideation, plans and attempts since the initial trauma. The study found that
that 54% of the participants reported some aspect of suicidality, 8.5% reported suicide plans, and
9.6% having attempted suicide since the initial trauma (Tarrier 2004).
All of the above mentioned methods of avoidant behaviors can push the victim into a
downward spiral, further advancing the symptoms of PTSD itself. These actions also push away
the individuals social support that would help further isolation, and increase the likelihood of
developing depression, and abusing of substances.
Conclusion
In conclusion, PTSD is a potentially disabling mental disorder that has powerful affects
over the victims life. When experiencing extreme guilt from their trauma, individuals can either
approach or avoid their experiences (Kubany & Watson 2003). Those who approach their
experiences and work through them, tend to notice reductions in their shame and guilt. However,
those individuals who engage in avoidance behaviors, tend to notice an increase in traumarelated guilt and shame. Attempting to avoid thinking about the traumatic experience of guilt and
shame is common among most trauma survivors. Trying to actively work through a traumatic

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experience is frequently associated with intense emotional pain, and as a result, individuals often
use avoidant coping strategies (Harman & Lee, 2010). These commonly used ways to avoid the
experiences can greatly impact their lives, and the lives of their loved ones in negative ways.
The U.S. Department of Veterans Affairs also claims that working through the traumatic
experiences is the best strategy one can take. Actively seeking out help from social circles, and
medical professionals, can shorten the duration of the disease, and bring victims a more
favorable outcome. Raising awareness of these harmful behaviors can be the most important
thing that we can do. Individuals suffering from PTSD who have isolated themselves are the
ones who need the most help, and due to their avoidant behaviors, they are the least likely to get
it.

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References
Gates, M. A., Holowka, D. W., Vasterling, J. J., Keane, T. M., Marx, B. P., & Rosen, R. C.
(2012). Posttraumatic stress disorder in veterans and military personnel: Epidemiology,
screening, and case recognition. Psychological Services, 9(4), 361-382.

Held, P., Owens, G. P., & Anderson, S. E. (2015). The interrelationships among trauma-related
guilt and shame, disengagement coping, and PTSD in a sample of treatment-seeking substance
users. Traumatology, 21(4), 285-292.

Gonzalez, O. I., Novaco, R. W., Reger, M. A., & Gahm, G. A. (2016). Anger intensification with
combat-related PTSD and depression comorbidity. Psychological Trauma: Theory, Research,
Practice, and Policy, 8(1), 9-16.

Zerach, G., Greene, T., Ginzburg, K., & Solomon, Z. (2014). The relations between
posttraumatic stress disorder and persistent dissociation among ex-prisoners of war: A
longitudinal study. Psychological Trauma: Theory, Research, Practice, and Policy, 6(2), 99-108.

PTSD: National Center for PTSD. Retrieved April 11, 2016, from
http://www.ptsd.va.gov/public/index.asp

Tarrier, N. Suicide risk in civilian PTSD patients--predictors of suicidal ideation, planning and
attempts. Retrieved August, 2004, from http://www.ncbi.nlm.nih.gov/pubmed/15300376

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Serani, D., Psy. D. (2012, April 25). PTSD and Depression. Retrieved April 13, 2016, from
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Schacter, D. L., Gilbert, D. T, Wegner, D. M., & Nock, M. K. (2014). Psychology. 3rd Ed. New
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Symptoms of PTSD. Updated April, 2016, from http://www.adaa.org/understandinganxiety/posttraumatic-stress-disorder-ptsd/symptoms