Big Little Lies is a best-selling-book-turned-hit-HBO-drama that begins as a murder-mystery and binds five women together over – you guessed it – one big lie. It has all the makings of an instant cult classic.

But that’s not all.

Actresses who play the “Monterey Five” on the TV show ‘Big Little Lies.’ Photo credit: Shutterstock.com

The series also skillfully tackles a mental health condition that affects roughly 8 million adults each year: post-traumatic stress disorder, also known as, PTSD – an anxiety disorder caused by very stressful, frightening or distressing events.

While many people associate post-traumatic stress disorder with men, war and combat – and rightfully so, an estimated 11-20% of veterans of the Iraq and Afghanistan wars and up to 30% of Vietnam War veterans have experienced PTSD – women are two times more likely to develop the disorder than men.

“The general public often thinks of a combat veteran when they hear PTSD,” said HCA Healthcare psychiatrist Robin Bershader, DO. “Although there are many, many combat veterans struggling with PTSD, and it deserves our attention, a greater proportion of PTSD patients are actually women because of the risk of sexual assault.”

Dr. Bershader, who treats patients at HealthONE’s The Medical Center of Aurora, adds that sexual assault is the most common trauma in women with PTSD.

According to the National Center on PTSD, due to women’s higher likelihood of experiencing trauma, including domestic violence, they have a 10% chance of developing the condition, while men’s odds stand at 4%.

**SPOILER ALERT**

Two of the “Monterey Five” – the main characters on Big Little Lies – exhibit symptoms of PTSD after surviving rape and domestic violence, respectively. The characters’ symptoms included reliving those events through nightmares, flashbacks, or intrusive thoughts or images at unwanted moments, which the National Health Service explains are classic signs of PTSD.

Dr. Bershader notes that PTSD is typically diagnosed after a person experiences symptoms for at least one month following the traumatic event.

Robin Bershader, DO, is a psychiatrist at The Medical Center of Aurora’s Behavioral Health & Wellness Center.

While Big Little Lies may serve as a backdrop for spotlighting domestic violence and, to some extent PTSD, the important mental health issue is still too often stigmatized and misunderstood.

Dr. Bershader enlightens us on PTSD, challenging us to rise above the stigma, shame and self-blame associated with traumatic sexual and violent events.

How common is PTSD in women?

An estimated 5 out of every 10 women will experience at least one traumatic event in their lifetime. These traumatic events could lead to PTSD in 10% of those women. Also, women usually have PTSD symptoms longer than men (on average, 4 years versus 1 year) before diagnosis and treatment.

The transgender community is another population that is susceptible to PTSD due to an alarming rate of sexual violence and trauma.  The 2015 U.S. Transgender Survey found that 47% of transgender people are sexually assaulted at some point in their lifetime.

What are the signs and symptoms of PTSD?

We see a heightened startle response, alterations in mood, irritability, but also more isolation. That’s what we typically see more of in women – becoming more isolated, more guarded, less engaged and social, as well as anxious and avoiding any kind of situation that might trigger memories of the trauma.

We also see thematic complaints in women with PTSD, such as avoidance of sexual intimacy and gynecological care, given the close correlation with sexual assault.

Why might women experience PTSD at higher rates than men?

Women are an unrecognized, high-risk population for PTSD. This is largely in part due to the higher exposure to sexual trauma, including rape and assault, adverse experiences in childhood (i.e. neglect or abuse), birth trauma and loss, and societal expectations of women’s roles. In other words, women may be more likely to blame themselves for trauma experiences than men.

What are the dangers of not associating PTSD in women?

It’s dangerous to ignore domestic violence, sexual assault, early childhood trauma, and other types of trauma that largely affect women because often without specifically asking about these things, it goes undisclosed, which can exacerbate PTSD and actually trigger one of the developments of the disorder. People with PTSD can have suicidal thoughts and behaviors and tend to suffer in silence. So, without asking, often individuals are suffering alone and we are ignoring a very important issue.

Tips to prevent PTSD?

Preventative measures for women who have experienced trauma include:

  • engagement in social support groups
  • keeping in contact with existing social networks
  • disclosing the trauma and encouraging people not to keep it inside
  • identifying as a survivor rather than a victim
  • using humor and other mature defense mechanisms to work through the trauma
  • finding meaning in the trauma
  • helping others heal, and
  • believing the trauma can be coped with and overcome.

Treatment for PTSD?

We can look at two different avenues to treat the disorder. There is the psychotherapeutic approach with therapies specifically focused on trauma like cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) therapy – an interactive technique used to relieve psychological stress. Supportive and group therapies are v effective as well.

From a medication standpoint, we largely treat post-traumatic stress disorder symptoms (depression, anxiety) with anti-depressants. And for nightmares, a very common feature of PTSD, a medication called Prazosin is the recommended first-line of treatment.

Sometimes the symptoms are severe enough that people relive the trauma or are unable to function in their daily lives. For those instances, physicians may recommend an atypical antipsychotic.

What other ways might sexual trauma affect women?

Women may avoid routine women’s health services after sexual trauma. So, we must encourage and help them understand that their gynecological health and well-being is important to maintain. Further, women who have experienced trauma should acknowledge that their discomfort around sexuality and intimacy is not unusual, nor is it anything to be ashamed of. It is encouraged for their significant others to keep an open mind about the potential impact trauma may have had on their partners’ intimacy and sexual activity, and to talk about it when appropriate.

How to help someone suffering from PTSD?

First and foremost, if you know someone struggling with post-traumatic stress disorder, continue to provide them support, even if they try to push everyone away. It’s a challenging balance to be encouraging and supportive, but not intrusive; however, providing that face-to-face time is so effective. Also, it’s important to let that individual reestablish trust in their lives, so being a good listener and letting them talk through their trauma, even if they need to do it several times, can help.

Individuals can help their loved ones anticipate things that might be triggering or upsetting, so when those triggers surface in day-to-day life, the physiological and psychological response will not be as surprising.

The National Alliance on Mental Illness can be a great resource for friends and family struggling with PTSD. The National Suicide Prevention Lifeline (1-800-273-8255) offers 24/7 support if there is a concern about a loved one’s safety.

June is National PTSD Awareness Month, raising awareness for millions of people affected by the disorder and the effective treatment available. People in crisis should call their local emergency number or the National Suicide Prevention Hotline at 1-800-273-TALK (8255).