Running head: CRIS 607: PTSD AND COMBAT RELATED TRAUMA 1
CRIS 607: PTSD and Combat Related Trauma
Student’s Name
Institutional Affiliation
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 2
CRIS 607: PTSD and Combat Related Trauma
PTSD within Domestic Violence Victims
Introduction
Post-Traumatic Stress Disorder (PTSD) is a disease of invasive re-experiencing
emotional freezing and hyper-arousal signs that occur in some people in the outcome of a
traumatic incident (Smith & Holmes, 2018). A traumatic experience is the act of witnessing or
experiencing an event that involve threat to physical integrity or life that results in feelings of
helplessness, fear, or horror. Intimate Partner Violence (IPV) takes place more often. Domestic
violence has been found among people experiencing traumatic events or with PTSD (Smith &
Holmes, 2018). There is a close connection between the occurrence of some traumatic events and
domestic violence. Particularly, women are considered to experience emotional, physical or
sexual abuse during their romantic relationships (Smith & Holmes, 2018) Therefore, the link
between violence and PTSD has been evident in partners suffering from the disorder.
Signs and Symptoms of PTSD in Domestic Violence Victims
PTSD develops after a frightening, stressful, distressing event, or after a long
traumatic experience. Although not everybody suffering from trauma develops PTSD,
strong people do not show PTSD as a sign of weakness (Palmary, 2016). There are various
categories of signs associated with PTSD, which include avoiding the causes of trauma,
such as people, thoughts, places, or other activities connected to the event. Also, a person
can be hyper-aroused sometimes with feeling of sudden anger or irritation, having
difficulties in sleep or a lacking concentration and being easily startled. Also, a person can
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 3
relieve an event through persistent nightmares or intrusive images that occur randomly.
Typical reliving an event result in great emotional and physical reactions, which include heart
palpitations, chills and panic after being faced with memories of the event. When untreated,
PTSD can cause other major symptoms, such as severe depression, loneliness as well as anger
management issues (Palmary, 2016).
Biblical Worldview about PTSD and Domestic Violence
The bible considers every form of violence an offence against God and humanity. In the
scriptures, violence is connected with the evil and predestined as “detestable to the Lord”
(Proverbs 3 and 10, Psalm 11 Cited in Driggs, 2018). Particularly, the bible condemns agression
against females. In the law of Jews, rape was considered equal to killing (Deut 22:26), because it
was forcing a woman physically or psychologically into sex. The Bible has a lot of stories of the
terrible sexual abuse of women. Rape is seen as an “outrage” (nebalah), which is a term that
occurs 13 times within the Old Testament and is kept for great actions of defiance against the
Lord and humans, including the cases of rapes of Tamar and Dinah, and the Bethlehem woman.
In particular, the Psalms show aggression in a way that resonates the way survivors of assaults
define their abuser:
"His mouth is filled with cursing and deceit and oppression; under his tongue are
mischief and iniquity" (Psalm 10 Cited in Driggs, 2018).
God helps the abused and oppressed (Psalm 56). The bible express God’s wish for a
remarkable change of society for people troubled, marginalized, or unfairly treated (Proverbs
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 4
14:31; Luke 4:18-21; Mark 3:4-5; Matthew 9:13). Jesus does not play by the rules of power and
violence (Matthew 26:52, Isaiah 42:3, Mark 10:41-45).
PTSD as a Consequence of Intimate Partner Violence
The United States (US) national estimates show that 20 persons are physically abused by
a close partner in 60 seconds (Tull, 2020). This adds up to more than 10 million people annually
(Tull, 2020). PTSD victims have been considered to have a high likelihood of aggression and
involved in violence compared to those without PTSDs. Some researchers have tried to
understand why people with a history of PTSD or trauma engage in violent and aggressive
behaviors (Iverson, Dardis & Pogoda, 2017; Palmary, 2016). They have considered depression to
play a key role in violence among individuals with PTSD. Individuals with both PTSD and
depression may have more anger and may face greater challenges when trying to manage it
(Iverson, Dardis & Pogoda, 2017; Palmary, 2016).
Despite the findings, it is imperative to understand that the fact that some individuals
have PTSD or have undergone through a traumatic event does not imply that they will show be
violent. There are other factors contributing to violent behavior and more studies have
established the factors for aggression among individuals with PTSD or likely to face traumatic
situations. People should not rule out their potential loving partner because they have undergone
through a traumatic event. It is important to find out whether they have sought assistance for the
trauma they suffered or for their PTSD diagnosis. IPV can threaten the lives of some women, but
they mostly cause immune disorders, injuries, gastrointestinal problems and difficulty in
sleeping.
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 5
Apart from depression, other psychological health complications related with IPV can
include psychological distress and low self-esteem (Iverson, Dardis & Pogoda, 2017). For
women, not only those who experiencing IPV, PTSD is normally connected with other
psychological health issues. The pervasiveness of PTSD among beaten wives is high, and
Iverson, Dardis and Pogoda (2017) find a major relationship between PTSD and IPV. Most of
the forms of IPV experienced, which include sexual, physical, or emotional abuse increases the
number of the PTSD symptoms for a woman. Psychologically and physically assaulted women
display increased rates of PTSD, anxiety signs, depression signs, and suicidal opinions compared
to non-abused women (Iverson, Dardis & Pogoda, 2017).
Interventions for IPV
When looking at domestic violence victims, females are mostly affected. According to de
Lucena et al. (2016), 85 percent of the victims of IPV are women. They suffer more harsh
physical injuries after domestic violence compared to men. Additionally, there is inadequate
research about mental health outcomes for battered men. Also, there is inadequate information
about the psychological health consequences of same-sex partner violence (de Lucena et al.,
2016). However, interventions aimed at improving safety behaviors among IPV victims are
effective in the reduction of the frequency of assault experienced by some women (Ogbe et al.,
2020). Ogbe and colleagues looked at various interventions to boost abused pregnant women's
empowerment sense by teaching them safety behaviors. The authors targeted such kind of
population because it is more risky for abused pregnant women to commit suicide, abuse
substance and have complications during pregnancy. Within the intervention, women met
personally with a therapist to establish a safety plan. They were directed to secure copies of vital
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 6
documents as well as additional keys, find a code with friends and family, hide additional
clothes, and find out activities of the attacker that showed a high danger. There was an effective
intervention in reducing the cases of abuse but they did not assess the women's PTSD status.
At family medicine appointments or primary care, physician intervention has been
considered effective in the reduction of exposure to abuse of some women (Miller & McCaw,
2019). The researchers demonstrated that after physicians asked a screening question about
whether women were being abused, the women had several benefits. Doctors were more able to
record the abuse, which is useful if women chose to get a restrictive order or take the legal
action. The women were likely to act and improve their safety after they had revealed the abuse
to their doctors. Also, the doctors were able to refer them and help them to improve their
protection or move away from their abusive relationship (Miller & McCaw, 2019). Also,
screenings and referrals can occur at the emergency room. However, whether screenings at the
emergency room are effective in the reduction of abuse is not empirically determined. Chisholm,
Bullock & Ferguson II (2017) pointed out that it may be helpful for emergency medicine and
primary care physicians to screen every female patient for IPV. However, it is recommended that
women who screened positive for IPV should be screened for PTSD.
Finally, another intervention focus on the reduction of IPV is couples therapy. Karakurt
et al. (2016) pointed out that more than half of the couples seeking couple therapy has shown
husband physical violence. Although treatment involving the partners may be contentious, it is
evident that this form of intervention is effective in the reduction of IPV because they are
considered gender-specific therapies. In fact, a research performed by Karakurt and collegues
specifically assessed the impact of a PTSD diagnosis on the outcomes of treatment in female
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 7
victims of IPV. The study participants were couples concerned in a group therapy program that
aimed at reducing spousal assault. Generally, the women showed a major reduction in fear of
their partners, depressive symptomatology, as well as reports of the psychological and physical
abuse of their partners. Also, the women reported rise in marital satisfaction. There were no
major differences on any of the outcome measures between women with and without PTSD.
PTSD Treatment
Although the above interventions do not characteristically target or assess for PTSD, the
addition of psychotherapeutic and pharmacological treatments that target the signs of PTSD may
help in the reduction of distress and functional injury in IPV victims with PTSD experience.
Empirically supported pharmacological treatments from randomized trials for their efficiency in
reducing the signs of PTSD include monoamine oxidase inhibitors, tricyclic antidepressants, as
well as selective serotonin reuptake inhibitors (Lorman, 2018). Looking at the reported general
efficacy and side-effect profiles, there is the emergence of SSRIs as the main treatment for
PTSD. Although there is an empirical evidence for the use of pharmacological methods to
manage the signs of PTSD, pharmacology alone cannot manage the disorder or address certain
indicator clusters, such as avoidance (Lorman, 2018).
During a review psychotherapy literature, Nasset et al. (2020) pointed out that that the
combination of cognitive and behavioral therapies has the strongest empirical support for
efficiency with the signs of PTSD. Additionally, such kind of approaches may be the most
effective to address the avoidance symptom cluster of PTSD. This may be important in the
management of IPV victims. McLean and Foa (2017) found avoidance symptoms as the best
predictors to treat dropouts in female victims of IPV. Cognitive-behavioral therapies for PTSD
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 8
include education about the nature of PTSD, stress inoculation, exposure and prevention to
memories of the shocking event, and challenging cognitions that may be the patients’ stuck
points (Nasset et al., 2020). An alternative of cognitive-behavioral therapy purposely intended to
treat PTSD after sexual abuse is cognitive processing therapy. It uses the above therapeutic
methods organized around safety issues, trust, control, power, intimacy and esteem (Nasset et al.,
2020).
Finally, psychological health experts have long recognized PTSD and trauma to increase
the risk of aggression. Therefore, most of the PTSD treatments incorporate the anger
management skills. Learning better ways to cope with PTSD, which can include deep breath and
identification of both short-term and long-term positive and negative results of behaviors, is a
critical part of reducing violence tendencies. Additionally, learning healthy ways to cope with
anger is an effective way to not only reduce the chance of aggression but also to help PTSD
victims to approach situations that cause anger effectively. If a person is a victim of domestic
violence, it is important for them to take immediate steps.
Conclusion
The link between violence and PTSD has been evident in partners suffering from the
disorder. By looking at the high rates of frequency of PTSD in the female victims of IPV and the
access to empirically supported psychotherapeutic and pharmacological interventions for PTSD,
it is surprising that none of them directly target the signs of the disorder. As stated above, the
mismatch between signs and methods of treatment may be a challenge for IPV victims. In fact, it
is clear that female victims of IPV with PTSD are more affected than those without PTSD.
Ignoring these severe symptoms in intervention efforts brings significant harm in the majority of
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 9
the victims. PTSD may act as a barrier for women to follow up on doctors’ referrals or to engage
in structured interventions to reduce violence. It may also act as a mediator of treatment
outcome, with women more affected by the disease and having a less likelihood to benefit from
the intervention. If PTSD were identified in high-risk individuals, the disorder could be treated
easily, thereby making it more likely that such women would gain from the above interventions.
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 10
References
Chisholm, C. A., Bullock, L., & Ferguson II, J. E. J. (2017). Intimate partner violence and
pregnancy: screening and intervention. American journal of obstetrics and
gynecology, 217(2), 145-149.
de Lucena, K. D. T., Deininger, L. D. S. C., Coelho, H. F. C., Monteiro, A. C. C., de Toledo
Vianna, R. P., & do Nascimento, J. A. (2016). Analysis of the cycle of domestic violence
against women. Journal of Human Growth and Development, 26(2), 139-146.
Driggs, D. (2018). Spiritually Oriented Cognitive Processing Therapy for Spiritual Struggle in
Christian Sexual Assault Survivors with Posttraumatic Stress Disorder.
Iverson, K. M., Dardis, C. M., & Pogoda, T. K. (2017). Traumatic brain injury and PTSD
symptoms as a consequence of intimate partner violence. Comprehensive psychiatry, 74,
80-87.
Karakurt, G., Whiting, K., Van Esch, C., Bolen, S. D., & Calabrese, J. R. (2016). Couples
therapy for intimate partner violence: A systematic review and meta‐analysis. Journal of
marital and family therapy, 42(4), 567-583.
Lorman, W. J. (2018). Pharmacology Update: The Selective Serotonin Reuptake
Inhibitors. Journal of Addictions Nursing, 29(4), 260-261.
CRIS 607: PTSD AND COMBAT RELATED TRAUMA 11
McLean, C. P., & Foa, E. B. (2017). Emotions and emotion regulation in posttraumatic stress
disorder. Current opinion in psychology, 14, 72-77.
Miller, E., & McCaw, B. (2019). Intimate partner violence. New England Journal of
Medicine, 380(9), 850-857.
Nesset, M. B., Lara-Cabrera, M. L., Bjørngaard, J. H., Whittington, R., & Palmstierna, T. (2020).
Cognitive behavioural group therapy versus mindfulness-based stress reduction group
therapy for intimate partner violence: a randomized controlled trial. BMC psychiatry, 20, 1-
11.
Ogbe, E., Harmon, S., Van den Bergh, R., & Degomme, O. (2020). A systematic review of
intimate partner violence interventions focused on improving social support and/mental
health outcomes of survivors. PLoS one, 15(6), e0235177.
Palmary, I. (2016). Post‐Traumatic Stress Disorder. The Wiley Blackwell Encyclopedia of
Gender and Sexuality Studies, 1-2.
Smith, T. J., & Holmes, C. M. (2018). Assessment and Treatment of Brain Injury in Women
Impacted by Intimate Partner Violence and Post-Traumatic Stress Disorder. Professional
Counselor, 8(1).
Tull, M. (2020). Is PTSD a Cause of Domestic Violence in Relationships? Retrieved 1 October
2020, from https://www.verywellmind.com/ptsd-and-domestic-violence-2797405
