Stigma and Posttraumatic Stress Disorder

 

PTSD and HIV Infection

The availability of antiretroviral drugs for treatment of HIV infection has been associated with a concurrent battle for treatment. Our current healthcare system does not screen
healthcare providers for mental illness. While it is difficult to estimate the number of physicians with primary psychopathy, informal estimates are as high is one in one hundred.  [full text]  The rates of secondary psychopathy appear to be even higher and the lifetime rate of all psychopathologies among healthcare providers has been estimated to be as high as 30%.  [full text] These astronomically high rates of mental illness among healthcare providers has taken its toll on patients with HIV infection, who have historically found it difficult to obtain antiretroviral therapy as well as therapies for complications due to HIV infection.

The epidemic of  posttraumatic stress disorder (PTSD) among people with HIV infection has largely gone unrecognized until recently. Even today, many psychiatrists deny that PTSD is common among AIDS carriers.

As far back as 1998, an Australian study reported that thirty percent of men diagnosed with HIV infection develop PTSD in response to the infection. However, the emergence of
symptoms took several month, with more than one-third of the cases having an onset of greater than six months. PTSD-HIV was significantly associated with a pre-HIV history of PTSD from other causes, and other pre-HIV psychiatric disorders and neuroticism scores, indicating a similarity with findings in studies of PTSD from other causes. [abstract] This early study challenged the prevailing view that PTSD is rare among AIDS carriers.

In the deep southern United States (Louisiana, Mississippi, Alabama, Georgia, South Carolina, and North Carolina) HIV is transmitted primarily by heterosexual intercourse. Pronounced HIV-related stigma may be contributing to the spread of the infection and there is a high burden of mental illness and traumatic events among HIV-infected individuals. Many HIV-positive individuals in this largely rural region distrust the government and face the dual stigma of HIV and mental illness. The psychiatric needs of these individuals often go unaddressed. Half of the study subjects not receiving antiviral therapy had CD4 counts greater than 350. Individuals with CD4 counts below 350 and not
receiving antiviral therapy were more likely to be black. The vast majority (>90%) of these patients reported at least one severe traumatic event (e.g., abuse, parental neglect or death of a spouse) in their lifetime. [full text] Since virtually all HIV-positive individuals have a history of being abused, it is difficult to infer that this abuse is essential for the subsequent development of PSTD-HIV.  However, most AIDS carriers do not develop PSTD.  So, classically defined abuse is not sufficient to cause the disorder.

A 2005 New York, study found stigma to be the greatest predictor of PTSD among women with HIV infection.  [abstract]  The reason why stigma induces PTSD among AIDS carriers remains unclear.  One possibility is that HIV infection is lethal when untreated.  AIDS carriers may view stigma from healthcare providers as a threat to access to care.  This threat, unfortunately, is still very real.

Stigma among bipolar individuals

Bipolar individuals also suffer elevated rates of PTSD [abstract] and cite stigma is a barrier to treatment. [abstract]

Combat related PTSD

Combat veterans with PTSD are at an elevated risk for punishment for misconduct.  [abstract] Though it remains unclear if the punishment is a cause or a consequence of the PTSD.  It may be that stigma may impair recovery from trauma which in turn may increase the level of stigmatization that traumatised combat veterans face.   This may isolate the veteran from the social support which is essential for recovery. 

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