It seems logical that if you have a certain illness or ailment, that you should seek medical attention. However, when a symptom of a disease is distrust, it can be difficult to convince someone that they need help. Additionally, societal factors play a role.
When it comes to PTSD, there are many factors that cause a sufferer to continue to hurt in silence.
1. Fear of Stigma
Admitting you have a mental health issue is a big step. Even if someone does the work in accepting they have a mental health issue, they may fear the consequences: being ostracized at work; losing employment; not being believed or supported by loved ones; being spoken about; and losing the respect of others.
Stigma can prevent people from seeking help and cause them to think they can shoulder the weight of this burden. However, no one should have to suffer alone.
2. Misrepresentation in Media
Most of the time, when we hear about PTSD in the media, it is in relation to soldiers and war. While soldiers and PTSD is a very worthy topic, this skewed representation can omit the fact that PTSD sufferers are more 13x more likely to be civilians, and twice as likely to be women.
If someone suffering from PTSD does not see anyone "like them" in popular media, they may think that they don't have PTSD at all. They may rationalize by thinking things like "well, I wasn't in a war, so there's no way I have PTSD." This can also cause people to downplay their own trauma and think PTSD is something they didn't "earn" the way a soldier did.
3. Women tend to internalize more
Women tend to internalize and self-blame more. This might even be a reason they develop PTSD more often, as there is a tendency to identify with the pain: I deserved this; I am not good; I am doomed; I am inherently bad. Self-blaming can worsen ongoing trauma issues because a person starts to think there is some greater reason something bad happened to them.
There are many fears a woman might have if she admits she has PTSD: She may fear she is no longer desireable if she was sexually assaulted, and she may fear her prospects for a romantic life might diminish if she admits she has a mental health problem. She might make herself feel even worse by thinking she is "damaged" so no one would "want" her.
While this particular issue is not limited to women, there is a role sexism plays in society's views of a woman with a mental health issue, and in sexual assault, that cannot be ignored.
4. The distrustful nature of the illness itself
A symptom of PTSD is hypervigilance. Someone suffering from this symptom finds it difficult to trust, be vulnerable, and even enjoy intimate experiences. Trusting others can trigger the sufferer and if someone does not know how to handle this and becomes defensive, the person with PTSD will only feel validated in their distrust.
It's a tightrope for everyone around them.
With PTSD, people may refuse to seek treatment because they see therapists and doctors as the "bad guys." Even people who show genuine concern can appear to be a "bad" person to a sufferer. This feeling is not necessarily grounded in reality, but nonetheless, it makes it difficult for a person to ask for and receive the care they need.
It's also very difficult for people without PTSD to relate, even if they are genuinely trying to help. When a person with PTSD pushes people away, they may even feel relief, and so they feel rewarded for maintaining a wall.
5. Fear of losing autonomy
Because people with PTSD tend to catastrophize, they may make assumptions about therapy and treatment that fuel their fear. In popular media, there's no shortage of sensational stories where people are medicated, institutionalized, and experimented on. Instead of assuming they will be able to live a better life and manage their symptoms, someone with trauma issues might assume treatment is a "trick" or "trap" to take away their autonomy.
The suspicion might cause someone with PTSD to focus on the negative over the positive—the cost of therapy, the side effects of medication, etc—over the benefits. This will cause them to want to quit before they even begin.
However, it is this exact pattern of thinking that treatment could potentially overcome.
6. Fear of accepting the diagnosis, or reliving what happened to them.
PTSD sounds like a scary problem that might never go away. The feeling that one might have something that is "incurable" is very terrifying. However, more research into PTSD shows it can be managed to the point where the sufferer can resolve their symptoms ang gain more control over their life.
The fear of the diagnosis also triggers the avoidance response. Avoidance is a negative symptom of PTSD—This is exactly what it sounds like: People will avoid topics that cause anxiety.
On the surface, this sounds fine, but avoidance has many negative consequences: Avoiding bills; serious discussions; confrontation; medical conditions; and more.
Deep down, what the PTSD sufferer is trying to avoid is reliving and processing the trauma they experienced. The freshness of the event is always there and is always raw. Of course, no one wants to continuously feel the way they felt during war, sexual assault, abuse, a disaster, an accident, etc. It's understandable to see why someone would want to avoid reliving that moment, but the feelings begin to manifest in situations that are not life-threatening, when it's not appropriate or helpful to be in that state of alertness and fear.
Once again, a symptom of the illness can prevent someone from seeking care.
7. Fear of healing and losing important relationships
This one might be hard to grasp: Wouldn't someone with PTSD want to heal?
Not necessarily. There seems to be a strong genetic component to PTSD, and if one person begins to heal, they might no longer relate to their relatives. They lose the people who understood them, and might have to make new relationships. If you have relatives who are also untreated, they may wonder why you're "changing" and becoming more like "them."
Similarly, we tend to make like-minded friends. When someone begins to change, they may lose their peer group.
It can be hard to make new friends, develop new hobbies, and begin to create a life that is not centered around PTSD symptoms. It can actually mean recreating your entire identity. This can be very scary—If you've become accustomed to revolving your life around these symptoms, it can literally be hard to decide what you want to do with your time.
Treatment does help with these symptoms.
There are many symptoms of PTSD that make it difficult to treat, particularly hypervigilance and avoidance. PTSD sufferers also have to deal with stigma, being called weak, and society's inaccurate portrayal of the disorder. These factors combined create a complicated environment to navigate.
When taken into consideration, we can see why it would be difficult for someone to open up and receive care—and people who suffer from PTSD need compassion, patience, and acceptance to overcome what was an understandable, automatic response to a horrible event.