The Unfair Stigma of PTSD: Why Survivors Are Diagnosed While Perpetrators Often Go Unchecked

When survivors of trauma exhibit symptoms such as hypervigilance, emotional dysregulation, or flashbacks, they are often diagnosed with Post-Traumatic Stress Disorder (PTSD). This diagnosis, while valid and often necessary for treatment, can sometimes carry an unfair stigma. Survivors are labeled as "disordered" for their understandable reactions to harm, while the individuals responsible for their trauma, the perpetrators, are far less likely to receive scrutiny or diagnoses for their actions. This disparity not only compounds the burden on survivors but also overlooks the significant damage caused by those who perpetuate abuse and trauma.

The Disparity in Diagnoses

Research indicates that PTSD affects approximately 6% of the U.S. population at some point in their lives, disproportionately affecting women and those exposed to prolonged or severe trauma. Meanwhile, perpetrators of trauma, particularly those with traits of Antisocial Personality Disorder (APD), are far less likely to be diagnosed or held accountable through psychological intervention.

APD is a condition characterized by a pervasive disregard for others’ rights, lack of empathy, manipulativeness, and often, criminal or abusive behavior. Studies estimate that only about 1-4% of the population meets the criteria for APD, yet those with the disorder account for a disproportionate amount of harm. Individuals with APD are overrepresented in criminal justice systems and are associated with higher rates of domestic violence, exploitation, and psychological abuse.

The Underdiagnosis and Misdiagnosis of Perpetrators

Despite their significant impact, individuals with APD are often underdiagnosed or misdiagnosed. One contributing factor is the very nature of the disorder, those with APD are skilled at manipulation, which can make them adept at evading detection or masking their behavior in clinical settings. Research suggests that diagnostic biases and a lack of routine psychological assessment for perpetrators further exacerbate this problem.

In contrast, survivors often seek help for their symptoms, making them far more visible to mental health professionals. This results in a skewed focus where survivors are pathologized for their trauma responses while the behaviors of perpetrators go largely unexamined.

The Harm Caused by Perpetrators with APD

The harm caused by individuals with APD is well-documented. Studies have shown that those with APD are significantly more likely to engage in repeated acts of physical, emotional, and psychological abuse. They often leave lasting scars on their victims, not only through direct harm but also by creating environments of fear, instability, and control. This, in turn, perpetuates cycles of trauma and mental health challenges for survivors.

Addressing the Imbalance

To shift this dynamic, a more balanced approach is needed. This includes:

1. Increased Screening for Perpetrators: Clinical interviews exploring empathy, remorse, relationship patterns, and emotional regulation. Refer for forensic evaluation if abuse is criminal in nature

   
   

2. Reducing Stigma for Survivors: Public education campaigns and trauma-informed care practices can help reframe PTSD symptoms as natural responses to trauma, not as inherent flaws or weaknesses. Additionally, more public education on manipulation and abuse tactics can make these tactics less effective.

   
   

3. Empathy-Based Training: Educating professionals across fields, from healthcare to law enforcement, on the nuances of APD and the behaviors of perpetrators can prevent misdiagnoses and promote accountability.

   
   

Conclusion

While it’s essential to continue supporting trauma survivors through compassionate care and treatment, we must also recognize the imbalance in how systems respond to trauma. Too often, survivors are pathologized for their valid emotional reactions, while those who cause harm, especially individuals with traits of antisocial or other personality disorders, evade accountability. Addressing this requires systemic reform across mental health, legal, and societal structures. Survivors deserve not only healing, but also justice in a world that acknowledges the true sources of their pain.

Source:

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• Dutton, D. G., & Kerry, G. (1999). Modus operandi and personality disorders in incarcerated spousal killers. International Journal of Law and Psychiatry, 22(3-4), 287–299.

• Douglas, K. S., & Skeem, J. L. (2005). Violence risk assessment: Getting specific about being dynamic. Psychology, Public Policy, and Law, 11(3), 347–383.

• Herman, J. L. (1992). Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror.

• van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.