A lawsuit against the social network raises an interesting question about violent images and videos: Can you really be traumatized by something that didn't happen to you directly? 

By Amanda MacMillan
September 27, 2018
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When you think about someone suffering from post-traumatic stress disorder (PTSD), you might think of a war veteran, a crime victim, or a natural-disaster survivor. But a lawsuit filed recently against Facebook seeks to highlight another form of the disorder. Selena Scola, a former contract employee for the social networking site, says she developed PTSD after repeatedly viewing violent and distressing videos and photos in her role as a content moderator.

The lawsuit, which was filed in California court last Friday, argues that Facebook needs to do more to protect moderators who are tasked with viewing thousands of images and videos of “rapes, suicides, beheadings, and other killings,” according to the New York Times. Scola worked on behalf of Facebook for nine months, and her lawsuit alleges that she developed PTSD that was set off “when she touches a computer mouse, enters a cold building, watches violence on television, hears loud noises, or is startled.”

Because PTSD is usually discussed in terms of people who have experienced violence or distress themselves, this case made us wonder: Is it really possible to be traumatized, long-term, by something that didn’t happen to you directly? We spoke with experts who diagnose and treat patients with PTSD—and studied the disorder’s official criteria—to find out.

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How is PTSD defined?

PTSD is a disorder that develops in some people who have gone through a traumatic experience, says Sandy Capaldi, PsyD, associate director of Penn Medicine’s Center for the Treatment and Study of Anxiety. “It’s unique in that PTSD is the only kind of psychological disorder where there is this criteria that something needs to have happened previously,” Capaldi says. “With other conditions, like major depressive disorder or panic disorder, there’s no previous life event that has to have occurred.”

But not everyone who experiences trauma develops PTSD. “In order for it to be PTSD, the person has to also meet the other criteria and have certain symptoms,” says Capaldi. For example, they have to have upsetting memories, nightmares, or flashbacks, or they have to have emotional distress or physical reactions when they're reminded of their trauma.

The person also has to experience negative thoughts or feelings, as well as trauma-related arousal and reactivity—such as irritability, aggression, difficulty concentrating or sleeping, or a heightened startle reaction. These symptoms must last for more than one month and must create distress or impairment in a person’s social life, work, or relationships.

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Does that trauma have to happen to you?

The criteria above, and more, are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the go-to diagnostic source for psychiatrists and psychologists. The DSM-5 also includes criteria about what types of traumatic events can pave the way for later episodes of PTSD.

In order for a diagnosis of PTSD to be given, a person must have been exposed to “actual or threatened death, serious injury, or sexual violence.” It doesn’t have to be direct exposure, however; witnessing a trauma or learning that a relative or close friend was exposed to it can also be cause for PTSD, according to the DSM-5.

Indirect exposure to the details of a trauma can also cause PTSD, the criteria states, especially when it’s “in the course of professional duties.” First-responders and medics are listed as examples in the official criteria, but Capaldi says that a content moderator who’s bombarded by violent images every day may also fall into this category.

“Usually, if this type of exposure is through electronic media like TV, movies, or social media, it would not count as a traumatic event,” she says. “But there’s a caveat that if it’s work-related—and you are having to watch really violent or graphic or gory content day after day after day—then yes, it’s absolutely possible that you can develop PTSD symptoms.”

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Not all PTSD is the same

Without having evaluated or treated Scola, the experts we spoke with couldn’t say whether her specific case fits all the criteria for PTSD—and without knowing the details of Facebook’s current training and counseling options for its employees, they can’t weigh in on whether the organization should be doing more. (In a statement to the New York Times, Facebook said it does offer “psychological support and wellness resources.”)

Sherrie Campbell, PhD, a psychotherapist in Orange County, California, and author of Success Equations: A Path to Living an Emotionally Wealthy Life, says it’s important to acknowledge that a job like Scola’s can certainly be distressing. “I have no doubt that she’s been traumatized,” Campbell says.

But she also says that using the term PTSD in these “indirect” situations can make light of the distress that actual victims of violence or trauma face. And it’s unusual for a person to experience long-term PTSD just from viewing images or videos, she adds.

“If we remove that person from their situation, from that specific job, I think that over time those memories and those PTSD symptoms would decrease,” she says. “Whereas people who have been raped or were present at a shooting could have these symptoms for the rest of their lives.”

That being said, people can experience PTSD at different levels of severity. People can respond to trauma in different ways, as well: Some can live through terrifying firsthand experiences and have no lasting psychological damage, while others can be extremely sensitive to seeing or hearing about things happen to someone else. People can also be triggered by photos or news if they’ve experienced a similar trauma in their past.

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How to protect yourself

People who know they are sensitive to certain types of content should keep that in mind when they’re considering a job that might require constant exposure, says Campbell. “I thought about being an FBI profiler, and I was fascinated by the prospect,” she says. “But I knew that if I did that job every day, I wouldn’t let my kids go outside.”

If you are considering taking a job that could expose you to traumatic events, it’s smart to ask your prospective employer about what mental health services are in place—both in terms of training beforehand as well as screening and treatment during and after. But most importantly, says Campbell, you should ask yourself if you’re up to the job.

“If you’re looking at disturbing images every day, you should develop some desensitization over time,” she says. “And if that’s not happening, it’s probably a wise choice to take care of yourself and think, 'This probably isn’t the career for me.'"

For the rest of us—those of us who aren’t looking at these images day in and day out—the occasional violent story on the news or disturbing image on Facebook shouldn’t trigger long-lasting distress. But that doesn’t mean these things can’t haunt us in the short-term, or add to feelings of anxiety or depression we may already be experiencing.

In those cases, says Capaldi, it’s important to regulate our media diets and be mindful of the exposure we’re getting. “You may limit how much time you’re spending on Facebook, or take breaks from watching the news,” she says. “And know that if there’s more stress in your life—because of school or work or family issues—that can make it more difficult to cope with these things you’re seeing in the media.”

Self care is also important if you feel yourself getting overwhelmed with distressing content on social media. “Make sure to get regular exercise, get good sleep, eat well,” Capaldi says. “Those sorts of things can help you feel good about yourself and feel in control of your life, which can be helpful when things seem really stressful elsewhere.”

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