PTSD Effects on Mass Shooting Survivors

Introduction

Post traumatic stress disorder (PTSD) is common among soldiers returning from active duty overseas, where they encountered combat, shelling, intense encounters with the enemy and so on (Thomas et al., 2010). Symptoms of PTSD can range from anger, hostility, and aggression, to depression and suicidal ideation (Jakupcak et al., 2007). While it is understandable that combat veterans might experience PTSD, what is less frequently appreciated is the fact that survivors of mass shootings can also experience PTSD (Cimolai et al., 2021). This is important because PTSD, if undiagnosed and untreated, can wreak havoc on a persons personal and professional life or on a persons development if the individual is still a child when the traumatic event occurs (Bardeen et al., 2013). Moreover, it is also important because mass shooting events have occurred with more frequency in recent years: there was the Las Vegas shooting in 2017 that killed 60 and injured nearly 1000; the Orlando night club shooting that killed 49 and injured nearly 60; the El Paso Walmart shooting that killed nearly two dozen people and injured just as many; the Virginia Tech shooting of 2007; the Sandy Hook shooting of 2012; the Aurora movie theater shooting of 2012; and dozens of others. Clearly there is a need to understand the impact that PTSD can have on survivors of these shootings. This paper will discuss the PTSD effects on mass shooting survivors and show that survivors should be both screened just as returning soldiers from combat are screened for potential PTSD and taught coping strategiesfor the risk of not treating PTSD among mass shooting survivors is too great for it to be ignored.

What is a Mass Shooting?

A mass shooting event has been defined by the non-profit association Gun Violence Archive as an incident in which four or more people, excluding the perpetrator(s), are shot in one location at roughly the same time (Cimolai et al., 2021, p. 1). Mass shooting events can thus occur anywhere: beaches, schools, theaters, public places like shopping centers, private places such as temples or churches; stadiums, concerts, parks, work places, and so on. In fact, mass shooting events have occurred at all of these venues in recent years. One of the deadliest places where mass shootings have occurred is, unfortunately, the school place setting. As Cimolai et al. (2021) point out, the prevalence of mass shootings at schools is rarebut when a mass shooting does occur at a school it is often very deadly: Four of the top deadliest shooting in the past 21years, where the fatalities were between 13 and 33, were in schools, accounting for a majority of gun violencerelated fatalities: Columbine High School, Littleton CO (1999); Virginia Tech, Blacksburg, VA (2007); Sandy Hook Elementary School, Newtown, CT (2012); and Marjorie Stoneman Douglas High School, Parkland, FL (2018). About 60% of all school shootings occurred in a high school setting (p. 2). School shootings are especially likely to induce PTSD because survivors are not just adults and children who happened to be present at the shooting but also members of the communityfamilies and others who are impacted indirectly by the shooting. One does not need to experience a traumatic event directly to be traumatized by it (Knight, 2013).

Mental Health Consequences of Mass Shootings

Mass shootings are traumatizing events that can have a severe impact on the mental health of survivors (Lowe & Galea, 2017). Just as soldiers or police officers can experience trauma in the line of duty, survivors of mass shootings can be doubly at risk for developing PTSD because they are not trained for such a situation nor are they likely to be expecting it in the course of their everyday lives. Likewise, just as a witness of sexual abuse can be counted as a victim of sexual abuse, a witness of a mass shooting may also be one who experiences PTSD from the event. Thus, when a mass shooting incident occurs and people survive it, returning to a state of normalcy can be quite difficult. North et al. (1997, 2002) have shown that the effects of PTSD can linger for years following a mass shooting event.

One vulnerable population to gun violence is children: as Cimolai et al. (2021) explain, this population needs to be given more careful consideration because overall, the impact of gun violence is not felt just during the incident but has long-term consequences for onlookers, family, and the community. Children often unwittingly experience the trauma with few psychological tools to deal with the event (p. 1). Thus, children should receive special attention when discussing PTSD effects on mass shooting survivorsespecially since young children (age 2 to 9) when exposed to direct or indirect violence have increased rates of PTSD (Cimolai et al., 2021, p. 2). One of the most common symptoms among children who are exposed to gun violence is anxiety sensitivity, which is characterized by an irrational fear that negatively impairs ones ability to socialize, function physically, or have normal cognitive functioning (Cimolai et al., 2021). Children are also more likely to have both internalizing and externalizing issues as an effect of PTSD. They may develop physical illnesses because they are unable to express how they feel; these are known as psychosomatic responses, in which the body is made ill even though there is no physical underlying causethe cause is purely psychological.

But of course children are not the only ones who can be adversely impacted as suvivors of mass shootings. Lowe and Galea (2017) show that mass shootings are associated with a variety of adverse psychological outcomes in survivors and members of affected communities, including the parents of elementary school children who survived a mass shooting at their school (p. 62). However, some demographics have a higher risk of being affected by PTSD than others: for instance, Lowe and Galea (2017) have also found that women with pre-incident psychological symptoms are more likely to have PTSD effects. Additionally, those who are very close to the shooting and are an acquaintance of someone who died in the shooting are more likely to experience PTSD than those who only witnesses from a distance and do not know any of the killed. One final factor that makes a person more susceptible to PTSD after a mass shooting event is the extent to which the individual has access to psychosocial resources, such as social support and emotion regulation exercises (Lowe & Galea, 2017).

Longitudinal studies have been conducted...…and the application and development of grit. Grit and determination can empower a person to overcome trauma (Kearney et al., 2012; Littleton et al., 2011). Keys to developing the necessary ability to overcome trauma are emotion regulation and coping strategies that encourage engagement with and acceptance of emotions, thoughts, memories, and sensory experiences (Lowe & Galea, 2017, p. 79). The aim of this approach is to promote resilience; mindfulness training, coping, and emotion regulation all help one to develop resilience in the face of trauma.

Coping is one of the best strategies that can be implemented when trying to address the fallout of a mass shooting. That is why grief counselors are often called into schools when there is a shooting at a school. But what about at other venues, public or private? Who is there to provide support for survivors or to make sure a support network is available for them?

These are important questions to ask because it is not just a matter of making sure everyone is processing emotions well. It is also a matter of making sure people do not become a risk to themselves or to others. Suicidal ideation can be a real threat among mass shooting survivors. Some of them can feel such strong guilt for not having done something that they are driven to the edge of sanity and take their own life. This could be avoided with the right intervention. But many people do not know that they are in need of a coping strategy; they do not even know that they are traumatized. They are simply caught in a downward trajectory and are unable to stop the negative thoughts and feelings that return at the slightest trigger. Without a program in place to help people like this, the victim count of a mass shooting event may actually be much higher than is officially recognized.

Conclusion

A mass shooting event is any situation in which gun violence impacts more than a handful of people. Such events have become more and more commonplace, unfortunately, in America. There is a need for authorities to be able to provide proper support for mass shooting survivors because of the effects of PTSD that can harm them in many different ways. The US military will screen soldiers returning from combat for PTSD symptoms. The same approach to mass shooting survivors should be adopted. A person who has experienced a mass shooting either directly or indirectly may be at risk of PTSD. Moreover, some demographics are at a higher risk than others, such as women and people who have a pre-history of psychological problems. But all individuals need access to support systems, and need training in coping strategies to ensure they are able to possess resilience in the face of stressors. Crisis response teams should play an integral part in helping after a mass shooting scenario. They should create a registry of all survivors so that they can be followed-up with up to a year after the event to make sure that PTSD is not going untreated. However, for some who are closely affected by the mass shooting, time is of the essence, as some survivors may be suicidal immediately after, due to strong feelings of guilt about what…