On Facebook recently, I was tagged to comment on a thread in which someone remarked in passing that "PTSD caused [unnamed relative] to do [inappropriate act]."
Clearly I am highly abridging the text for the person's privacy, but I was tagged in to comment on the idea that PTSD caused the behavior. This is a common tendency in popular culture – from the movie "Rambo" in which PTSD 'caused' the character John Rambo to commit violent acts, to the dangerous medical tendency to consider PTSD as a 'mental disorder' as an excuse to deny fundamental rights. Given that PTSD is of considerable research interest to me, I have adapted my comments to the current blog and installment of The Lab Rats' Guide to the Brain:
PTSD is a disorder with strong physiological basis that result in effects generally revealed through personality. It is characterized by memory disorder (flashbacks or triggered memory with a strong emotional content), generalized anxiety, hypersensitivity to certain audiovisual or sensory stimuli reminiscent of the traumatic stress event, depression (sometimes bipolar), attention deficit, etc. Further, there is an alteration in how brain and body react (physiologically) to future stressful incidents.
We now know that PTSD in particular, and stress in general, result in a change in the normal balance of neurotransmitter and receptor subtypes. There are 7 primary neurotransmitters and about a dozen secondary neurotransmitters, and as many as 15 distinct receptor subtypes for each neurotransmitter - thus the balance of neurotransmitter synthesis and release, as well as the ratios of receptors and their regulation are important to brain function.
It is no more accurate to state that PTSD caused a person to commit rape than it is to say that depression caused a person to suicide or that schizophrenia caused a person to commit murder. Rather, imbalances of mental state alter the "censor" that each of us has regarding actions that are or are not socially acceptable. We all have random thoughts and urges that we (usually) immediately set aside because we know that such urges are inappropriate. However, when the "censor" is affected, the urge is not immediately suppressed.
Virtually everyone has had the urge - when wronged by someone - to take revenge. The schizophrenic, literally being of "split mind." does not apply the social norm and commits some act of violence. We get temporarily depressed and think "What if I weren't here? So-and-so would really regret it then!" The normal person gets a cup of coffee or a cigarette and moves on to other things, but the depressed person acts on the impulse and commits suicide. The PTSD reaction is much more likely to manifest in the realm of anxiety and stress (especially "over-reaction"). A sleeping person rolls over and touches his/her companion, startling them awake and triggering a violent PTSD-related response resulting in an ER visit for broken nose and concussion. A non-sensitized person simply rolls over and goes back to sleep, but for the PTSD sufferer, the "filter" that says "home" & "safe" never really engages, and all sudden events are perceived as possible threats.
Now, it is possible for a person to have more than one disorder, such as anger disorder plus PTSD or schizophrenia plus PTSD. With such combinations we do speak of the disorder 'causing' the behavior, but again, it is not the PTSD, but the underlying condition that 'allows' (not causes) the person to act on impulses that they would ordinarily ignore or suppress. The terms "psychopath" and "sociopath" have fallen out of favor among psychologists and psychiatrists – favoring instead the catch-all term "personality disorder." However, the older term both refer in common to individuals that do not understand or care about social norms – or at least care whether their actions violate those norms.
The choice to commit an act of exhibitionism or violence was not itself caused by the PTSD. Having PTSD may have allowed the person to act on the impulses. Having another type of psychological or personality disorder would certainly compound the problem.
The reason researchers and psych types stress these issues is that it is very important to understand all of the contributing effects (and consequences) of an action. Successful treatment of a mental disorder requires that medical professionals accurately describe which symptoms and actions are due to which disease – that way, as treatment progresses, they know which effects and side effects are appropriate.
On the other hand, a diagnosis of PTSD is often a stigma, often resulting in loss of respect, jobs, family and even certain rights as a citizen. Partly this is because of misdiagnoses, and part due to the tendency to attribute any and all "bad" behavior to PTSD. We owe it to our soldiers and fellows not to abuse the term!