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The Hunger Games: A portrayal of PTSD in teenage fiction | The British Journal of Psychiatry | Cambridge Core

The Hunger Games is a young adult dystopian fiction trilogy written by Suzanne Collins. The books have sold over 65 million copies in the USA alone and have been adapted into a hugely successful film series.

The series follows the story of Katniss Everdeen, a 16-year-old girl living under an oppressive government that forces her to fight to the death against 23 other children in an annual event known as the Hunger Games. Katniss is made to go through the Games twice, during which she experiences numerous life-threatening events, including being chased by a wall of fire, blistered by toxic gas and hunted by packs of mutated animals. During the Games, she is forced to kill other children who are competing against her and suffers the loss of friends, one of whom dies in her arms. All this is amidst a constant battle to procure food and water, and indeed she nearly dies of thirst in one of the Games.

While she manages to escape both Games with her life, she is left suffering significant psychological distress and displays symptoms consistent with post-traumatic stress disorder (PTSD). She suffers from vivid flashbacks persisting for much more than a month after the Games; in one she envisions herself back in the arena, holding the bloodied body of her dying friend. Sleep difficulties and nightmares are also a recurrent problem and she is described as screaming and flailing about in her sleep. Her nightmares often seem to stem from feelings of survivor’s guilt, for example dreaming that she is being buried alive by the loved ones for whose deaths she felt responsible.

She is hypervigilant long after imminent threat has passed, displaying exaggerated reactions to innocuous stimuli; in one case, the smell of roses (a reminder of the Games) causes her to dive behind a curtain in fear of imminent attack. Physical symptoms such as headaches and nausea are also a frequent complaint. She displays avoidance behaviour, including avoiding her friend who participated in the Games with her, as well as aversion to any form of discussion of the Games.

Prior to the Hunger Games, Katniss experiences several predisposing factors for PTSD. The death of her father appears to cause severe depression in her mother. This leaves 11-year-old Katniss as the sole carer of her mother and younger sister. The resultant poverty leads to frequent hunger and Katniss having to hunt illegally to feed the family. By assuming a young carer role, Katniss is forced to mature over-quickly and has little time to socialise, leading to a lack of friends. Her mother’s depression increases Katniss’ genetic risk for PTSD, given common genetic risks for both disorders.

All this is set against a backdrop of an oppressive government. Katniss is constantly looking over her shoulder in fear that her illicit hunting activities will get her and her family executed. This background of constant threat serves as a significant psychological predisposing factor to PTSD.

The Hunger Games provides a powerful portrayal of PTSD, detailing clear symptoms of re-experiencing, hypervigilance and avoidance after life-threatening events, and presenting them in a manner that is accessible to its largely teenage readership. By employing detailed first-person emotional accounts set against a bleak dystopian narrative, it gives young readers the opportunity to explore how significant trauma can leave psychological scars long after the physical ones have healed.

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