What It’s Like to Live With PTSD After Escaping Domestic Violence

Original Post: Self | By Zahra Barnes | April 19, 2018

Sometimes all it takes is a whiff of familiar cologne to make Sophia*, 25, remember the feel of her abuser’s fingers around her neck. Sometimes the rib he broke will start to ache, or she’ll feel the spots where he bruised her. She escaped an abusive relationship in the winter of 2015 but relives what happened through post-traumatic stress disorder (PTSD)—a mental health condition that can occur after various kinds of trauma—which she was diagnosed with that June.

Right after she escaped her abuser, Sophia was “petrified” to be alone. A friend stayed with her in her apartment, and Sophia literally followed her from room to room. “I wasn’t able to take care of myself,” Sophia tells SELF. “She would have to remind me to eat and help me go grocery shopping. The best way to describe it is that I was a zombie.” Scared that her abuser would find her, Sophia was often too afraid to leave the house. If she heard even the slightest noise, her heart rate would skyrocket, a stress rash would creep across her cheeks, neck, and chest, and she would start to shake. “I was a wreck,” she says.

Almost three years later, Sophia has made incredible strides in her healing process. But like many survivors, she says she has sometimes struggled with everyday things that remind her of what she went through. A seasonal component makes it especially hard.

On a winter night in early 2015, Sophia’s boyfriend raped her. The next night, he continued the abuse. He strangled her until she blacked out. He videotaped her trying to defend herself with a champagne bottle, saying he’d show the world how abusive she was. He called her a “retard,” a “cunt,” a “stupid bitch.” Every time she tried to get up from where he’d shoved her to the ground, he pushed her right back down. She managed to get away, grab her dog, and run to a friend’s house.

Sophia pressed charges, and her abuser was jailed for what he did to her. She graduated from college later that year, moved home to Maine, got a job as a case manager in social work, and now pours her extracurricular efforts into domestic violence awareness. But the memories persist. “The weather is the biggest trigger for me, and I still have a hard time opening up to others. That winter was the snowiest I can remember, and watching snow fall brings it all rushing back,” she says. “The cooling of the air from summer to fall is also a trigger, especially here in Maine. It’s that feeling of walking outside, having all these bruises on my body, and then the cold air hits me.”

Graphic showing mountains and red snow

When someone experiences domestic violence, like Sophia did, she can develop post-traumatic stress disorder as a result.

PTSD affects 7.7 million Americans over 18 in a given year. According to the National Institute of Mental Health, it can affect anyone who has experienced a shocking, scary, or dangerous event, which includes women who have been through violence or another trauma.

Women are particularly susceptible to PTSD, which is sparked by “exposure to an event that involved or held the threat of death, violence, or serious injury,” according to the Mayo Clinic. According to the National Center on PTSD, due to women’s higher likelihood of experiencing trauma, including domestic violence, they have a 10 percent chance of developing the condition, while men’s odds stand at 4 percent.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists the criteria for a clinical PTSD diagnosis. Still, Carole Warshaw, M.D., director of the National Center on Domestic Violence, Trauma, and Mental Health, tells SELF that the way trauma manifests in individuals is very personal. The symptoms, she explains, are often complex or layered, and can include flashbacks, emotional distress, physical reactions to upsetting memories, forgetting key parts of the traumatic event, emotional numbness, trouble focusing, and more.

Although survivors of domestic violence who develop PTSD can experience it in a variety of ways, “survivors are often people whose sanity, well-being, and mental health were actively being undermined by their partners,” Dr. Warshaw says.

PTSD is different for each person, but like Sophia, many survivors have triggers that evoke memories of the trauma they experienced and lead to intense physical and emotional reactions.

Sometimes triggers persist well after a survivor has left the abusive relationship. After escaping her domestic abuser more than 25 years ago, Kathy Jones, a domestic violence awareness advocate in her late 40s in the greater Boston area, moved to her parents’ house in New Hampshire. “With my former [partner], I could tell by how the gravel crunched in the driveway whether or not I was in for it that night,” she tells SELF. “Crunching gravel in New Hampshire doesn’t mean the same thing, but my body didn’t know the difference. It just hears it and immediately goes into alert.”

She’s right: We’re hardwired to safeguard ourselves from danger, Dr. Warshaw says. “Experiencing a threat activates our neural pathways in our amygdala, hippocampus, and elsewhere that allows us to respond and protect ourselves,” she explains. Stress hormones and other chemicals pump through our body when we experience fear. This physiological fight-or-flight response can linger even after the danger’s gone.

Due to the nature of his job, Kathy’s ex used to come home with a distinctive rancid scent. “He wouldn’t shower, and he would rape me with that stench all over him,” she says. Kathy’s come a long way in her healing process. But to this day, if she ever catches a whiff of that specific odor, a dry heave will rise in her throat.

While triggers can unleash nausea, survivors may have to contend with many other PTSD symptoms, such as reliving the experience through recurring dreams or flashbacks. Three years after leaving an abusive relationship that lasted almost as long, Melanie*, a 26-year-old from the San Francisco Bay area, has constant nightmares. It’s known as “re-experiencing symptoms” of PTSD. “Last night I had a nightmare about him. It’s all very vivid,” she tells SELF.

Graphic showing night sky with red blockage

Many survivors also struggle to mentally reorient themselves after an abuser has tilted their world on its axis.

Gaslighting is an abusive manipulation tactic meant to loosen someone’s grip on reality. “Abusers accomplish this through various methods: lying, sabotage, trickery,” Lynn Fairweather, an abuse survivor and the founder and president of Presage Consulting and Training, a boutique threat assessment and management firm centered around domestic violence, tells SELF.

Lynn, 43, of the Pacific Northwest, recalls when her abuser would leave her dog at the edge of the woods, then come home and tell Lynn he’d killed her pet just to watch her panic. She remembers when she’d call the police because her abuser was threatening suicide—he’d sometimes leave pill bottles lying around or hang nooses from the staircase—and he’d tell the responders she was the one with the problem.

Experiencing something like that even once would be psychologically disorienting. But when compounded, it can destabilize a survivor’s understanding of reality, of whom she can trust, and of everything she knows about herself, creating negative thoughts that are a PTSD hallmark.

“Every day, I have to tell myself I’m capable of making OK choices,” Melanie says. “I think about how much I let get by me with my ex. It makes you question your ability to have strong decision-making skills.”

In turn, many survivors must try to build back what was tamped down during the experience. “People who have [experienced] domestic violence often are conditioned to basically give up on themselves,” Melanie says. “Every day beyond that point is them fighting to get back, to stand on level ground.”

In addition to the more familiar symptoms of PTSD, other effects can be just as harrowing.

A common one is cognitive: Many survivors have trouble concentrating. After leaving her abusive relationship on that winter night in early 2015, Sophia’s ability to focus suffered, which affected everything from schoolwork to her legal case. “I couldn’t just sit down and write things out,” she says. Her professors extended some of her deadlines beyond graduation, and her mother recorded her victim impact statement, then typed it up for her to read aloud in court.

Melanie is still grappling with this symptom. When she was younger, she had laser focus, digesting long movies and books with ease. “It’s still a strength of mine, but since the relationship, more often than not I have just this kind of foggy, hazy feeling in my head. My work productivity suffers, and I am less able to follow conversations that escalate or intensify,” she says. There’s also an emotional component to her daze. “My ability to think rationally in most moments on a day-to-day basis is not really there anymore, and I find it hard to trust my choices or judgement, since it has failed me in the past.”

This is affecting her current relationship with someone she describes as a wonderful person. “I have a really bad mechanism that shoots down a lot of my initial instincts because I worry I’m going to somehow upset someone. In the past, I would get assaulted if I misspoke or said the ‘wrong’ thing,” says Melanie, who has trouble socializing in general, another common PTSD symptom. “I know that the world is not my abuser. It’s a much kinder, more open place. But it’s a paralyzing conflict. I adore people, but I find myself feeling more and more like an outsider, which causes feelings of anxiety and self-consciousness.”

Graphic showing big red dots covering words

Although not an official criterion for diagnosing PTSD, panic attacks can also be a result of domestic violence.

Some survivors find that their PTSD experience includes debilitating panic attacks. Marked by sudden feelings of fear with accompanying physical symptoms such as palpitations and sweating, panic attacks are a classic sign of panic disorder, one of the various conditions under the anxiety-disorder umbrella.

Lynn says she had her first panic attack in the middle of a violent encounter with her abuser. After leaving the relationship, she was constantly on edge, triple-locking her doors at night as her abuser stalked, harassed, and threatened her, she says. Believing he wasn’t going to leave her alone, she decided to move 1,000 miles across the country. Although he continued to try to contact her, he eventually left the country. Once he moved to the other side of the world, Lynn settled into a feeling of relative safety.

Even after 15 years of marriage to a nonabusive partner, the panic attacks persisted, often arising seemingly out of nowhere and sometimes during nonthreatening verbal arguments with her spouse. On other occasions, the root cause is clear. Due to the time she says her ex rushed up from behind and started strangling her, Lynn’s panic might emerge when she hears the patter of feet running up behind her.

Panic can be like prairie dogs, she says, seemingly disappearing from one place, then emerging unexpectedly in another.

These symptoms sound devastating because they are. But people who escape domestic violence can and do heal, often figuring out what works for them along the way.

Some survivors turn to counseling or therapy, of which there are many different kinds. There’s the approach that people usually think of: talking about your struggles. Melanie found a counselor and started discussing her residual anxiety and other negative emotions, along with how to handle them. Having an unbiased yet invested person to talk to helped her move past what she calls “the stigma that comes with wanting to prioritize your mental health.”

“I was so disconnected from friends and family during my relationship with my ex, and I subsequently had spotty relationships afterward, so I didn’t have too much of a safe haven to express what I was feeling,” she says. Although a psychiatrist once prescribed her antianxiety and antidepressant medications, Melanie’s trying to talk to her counselor, busy herself with projects, and see friends and family more before going down that road.

For some survivors, therapy works especially well in conjunction with meditation. Melanie took up the practice after her counselor mentioned how beneficial it can be. “I’ve found meditation to be extremely effective in quieting the noise and guilt and echoes and remnants of doubt this type of experience can put you through,” she says.

There are also psychotherapies rooted in specific healing techniques, such as eye movement desensitization and reprocessing therapy, which uses exposure therapy to help people confront what they fear and guided eye movements to help a survivor change how she reacts to traumatic memories. According to the EMDR Institute, “the treatment was originally designed to alleviate the distress associated with traumatic memories.” It’s helped Lynn make good progress in managing her PTSD. “I’ve learned to control my anxiety better so I haven’t had a panic attack in quite a while,” she says.

Whether they seek therapy or not, some survivors have to do the heavy emotional lifting on their own. One essential part is learning how to deal with the flood of emotions triggers can release. Since her work has lent her a lot of knowledge about domestic violence and PTSD, when panicked moments arise, Sophia’s learned to breathe deeply and tap her feet to help bring herself back to earth.

Kathy takes a similar tactic. She has never tried counseling. She decided it wasn’t for her after a pair of counselors suggested that in response to her ex pouring hot spaghetti sauce on her for making the “wrong” dinner, she needed to make a list of her own sins and seek forgiveness. Instead, she started reading and learned to identify her anxiety symptoms: butterflies crowding her stomach, tingling skin, sweaty palms, the feeling that she needed eyeballs in the back of her head. Like Sophia, she anchors her feet to the floor and breathes deeply, asking herself what set her off, evaluating her environment to reiterate that she is safe.

Graphic showing tree with support

Some survivors find it particularly helpful to use activism as a way to lead current victims of abuse out of the darkness.

“I knew that when God allowed me to survive what I survived, he was calling me to reach others and help pull them out of the muck,” Kathy says. She started volunteering as a domestic violence advocate in 1998. Now she runs DVSur5r, a program that focuses on survivor justice and support, and estimates that she’s helped more than 2,000 people. Her husband is financially supporting their family while she pursues her calling. “I could not have ever dreamed of a more encouraging partner,” she says.

After Kathy’s abuser sexually assaulted her, she turned to her church leaders for help and guidance and felt as if she was only met with blame. In an effort to prevent others from going through the same thing, she also founded SELAH, which aims to teach those who helm faith-based communities how to respond to family violence.

“It was a blessing to help people, but to be honest with you, it was my way of saying screw you to my ex,” Kathy says of first volunteering. “With every person I helped, I was saying, eff you. I’m not worthless, I am useful, I am strong, I am smart, I am capable. That gave me strength.”

Sophia, who is now in the fitness industry as a personal trainer, wants to help others build mental and physical strength. She also wants to spread awareness about healthy relationships and domestic violence. “I think the best thing we can do is be open about our experiences and not stay silent,” she says. “I encourage people to stand up for others,” she continues, “and let them know it’s not OK to be treated this way.”

Although the road to healing can be filled with obstacles, it is indeed possible.

All it takes is a few moments of speaking with a survivor to understand the tremendous strength these women possess. “People think of battered women as unable to think for themselves, unable to do this, not able to do that,” says Kathy. “In reality, they’re the most resourceful, resilient, kind, compassionate people I think I’ve ever come across.”

Dr. Warshaw says happiness after domestic violence isn’t out of reach by any means, but getting there is a different process for everyone. “It takes time and patience—it’s not linear,” she explains. “But there’s no reason people can’t expect to heal.”

*Name has been changed.

If you or someone you know is experiencing domestic abuse, call the National Domestic Violence Hotlineat 800-799-SAFE (7233) or 800-787-3224, or visit the National Resource Center on Domestic Violence. An expert will answer you call and help you figure out what steps you can take.

Teenage Girls and Dating Violence: Why We Should Be Paying Attention

Original post: New York Times | By Maya Salam | May 21, 2019

“This is a public health issue that should be taken seriously.”

— Avanti Adhia, the lead author of a new study about teen dating violence

It’s no secret that intimate partner violence is a leading killer of women in the United States: More than half of homicides of women are at the hands of a romantic partner, according to the Centers for Disease Control and Prevention. Now it appears that this type of violence is also affecting adolescent girls.

A new study found that of nearly 2,200 homicides of young people from 2003 to 2016, some 7 percent — or 150 of those deaths — were at the hands of current or former intimate partners. Girls made up 90 percent of the victims, underscoring the importance of not discounting early dating relationships as casual or pretend.

“While the dynamics of these relationship may be quite different than among adults, this is a public health issue we need to take seriously,” said Avanti Adhia, who led the study, one of the most comprehensive ever on the topic, which was published in the April issue of JAMA Pediatrics.

Dating violence among teenagers has the potential to lead to death, she went on, and girls are at the highest risk.

Breakups or jealousy precipitated more than a quarter of the homicides, researchers found, and a majority of the deaths involved guns (which are also a major factor in the number of adult women killed by their partners). The average age of girls killed was 17, while their partners were, on average, 21.

The fact that teenagers are grappling with intimate partner violence might be surprising, but it’s actually incredibly common.

In 2017 alone, 7 percent of high schoolers said they had experienced sexual violence by a dating partner, and 8 percent reported physical violence, according to C.D.C. “That translates to a huge number of adolescents,” said Adhia, a researcher at the University of Washington School of Medicine.

Include psychological abuse, and these numbers rise significantly. More than 60 percent of adolescents who date (both boys and girls) said they had experienced physical, sexual or psychological abuse from a partner, according to the National Survey on Teen Relationships and Intimate Violence published in 2016.

“These relationships set the stage for future relationships,” Adhia said, adding that this abuse could lead to long-lasting emotional scars like anxiety, depression, substance use, antisocial behavior, eating disorders and suicidal thoughts.

What can be done? Dr. Megan Bair-Merritt, a pediatrician at Boston Medical Center and Boston University School of Medicine who wrote an editorial to accompany the study, says it’s important for adults to foster open and honest conversations about relationships with the children in their lives, even before they start dating.

Children should also know they have “safe adults” (parents, grandparents, teachers, coaches) to rely on during hard times, Bair-Merritt said.

“Safe relationships with adults buffer from stressors,” she said. “The more, the better.”

If you or someone you know needs help, support is available. Visit the The National Teen Dating Abuse, call (866) 331-9474 or text LOVEIS to 22522.

Child sexual abuse victims — mental health support is critical

Original Post: The Hill | BY ASHELY GARLING, OPINION CONTRIBUTOR, 05/22/19

Google “child abuse” on any given day and you will find reports from across the nation. This year, there were reports of Baptist church leadersabusing children, some as young as 3 and the Pope’s acknowledgment of nuns being abused by church leaders. In both cases, investigations found the majority of the crimes had been long standing and some even continued for decades, but little is said about support for the victims. 

This silence is dangerous; without access to health care, belief from loved ones and support from the community, it can lead to serious mental health consequences.

Over 24 million individuals experiencing a mental health illness are going untreated primarily due to poor access and the results of that lack can be catastrophic. Included in that number are more than 5 million survivors of child sexual abuse. Many survivors cope with their trauma by using drugs and alcohol and even suicide.

Child abuse victims are three to four times more likely to suffer from post-traumatic stress (PTSD), depression and even resort to self-medicating with dangerous drugs, according to RAINN, Rape, Abuse & Incest National Network. They suffer in silence without access to help and support while their perpetrators continue to live normal lives.

As a 12-year-old victim of sexual abuse, I needed more than just access; I also needed the belief and support of my community, my friends and my family. I knew that what was happening to me was wrong, but I never told anyone at the authorities. That was one of the only regrets of my life. I know that I am not alone in my silence.

According to the National Sexual Violence Resource Center, one in six boys and one in four girls are sexually abused in the United States before the age of 18. This statistic rises to one in three women that become victims of sexual violence within their lifetime. As in my case, the majority of these crimes go unreported, with only 12 percent of child sexual abusebeing reported to authorities.

One of the primary reasons that victims do not speak out is that they fear that others will not believe them. Until this article, I have only told my story to close friends and family. My abuser was a police officer, the stepfather living in my home, the person I was supposed to be able to trust. If I had a place to go, a resource, or a person to tell outside of my family and friends I may have gotten the help I needed sooner.

Instead, I experienced post-traumatic stress (PTSD) and flashbacks for many years, especially when trying to form relationships with the opposite sex. These flashbacks could strike at any time and without warning, in the shower or in a movie theater and they were starting to push me to the edge.

The shame, guilt, fear and loss of confidence felt by a survivor are often too much to bear alone. In college, I could no longer take the anguish of PTSD and I sought help from a crisis center named Hope Harbor in Bowling Green, Ky. If it weren’t for the dedication, support and belief I received from my late counselor, Pam Campbell, I would not have become the successful woman, pharmacist and mother I am today. It took me years of intensive, twice weekly, one-on-one therapy sessions to stop being a victim, develop self-acceptance and bloom into the survivor and heroine of my own story. 

Unfortunately, many men and women are not as lucky as I was to have access to such a wonderful resource. RAINN also reports that 70 percent of rape or sexual assault victims, suffer from significant psychological distress. This figure dwarfs that of victims of other violent crimes. Victims of sexual assault are also three times more likely to use marijuana, 6 times more likely to use cocaine and 10 times more likely to use other major drugs.

Survivors of sexual violence are at a higher risk for anxiety, PTSD, depression, eating disorders, dissociative and personality disorders. The link between these mental health responses to sexual violence and substance abuse is so prevalent that The National Violence Against Women Prevention Research Center reports survivors are 26 times more likely to abuse drugs. This is not the primary reason for the substance abuse crisis in America, but there is an undeniable correlation.

Sexual abuse survivors need access to mental health resources and — equally as important — belief. If we, as family, friends, health-care providers and American citizens, would support, believe and love those who say they have been victimized, we may start to see a decrease in national crises like substance abuse in addition to addressing sexual violence. Survivors need easy access to sexual violence reporting sources, recovery centers, counseling and mental health resources. But first they need to find the courage to break their silence by having a society that says “I believe.” 

Ashely Garling PharmD is a clinical assistant professor at the University of Texas at Austin College of Pharmacy and a UT Austin Public Voices fellow of The OpEd Project.