Accurate PTSD in a Charlize Theron movie! Who would have thought? Of A manifestation of PTSD, mind you... everyone's PTSD is different than anyone else's, of course. Enjoy! This was created by yours truly and Evie Skordara.

1. MOVIE ANALYSIS BY
TANYA GERITSIDOU AND EVANGELIA SKORDARA
DARK PLACES

2. OUTLINE ꞉
● Introduction
● Brief movie presentation
● Meeting Libby Day
- Libby as a child, her history and background
- Libby as a grown up
- Diagnosis for PTSD and DA
● PTSD Prevalence and Etiology
● PTSD therapeutic interventions, Risk and
protective factors
● Conclusion

3. INTRODUCTION
The movie is adapted from a bestselling mystery
novel written by Gillian Flynn in 2009. In the
artistic constraints of telling a suspense crime
mystery story, the movie has managed to portray
Libby’s psychopathology rather accurately. All
required diagnostic criteria are adequately
presented, both for DA and for PTSD, based on
DSM-5, especially when we take into account
Libby’s own statements regarding her off-screen
behavioral patterns.

4. MOVIE PRESENTATION ꞉
The movie is set in a farming town, Kinnakee, Kansas. Libby
Day is the survivor of a horrid and much- publicised night of
multiple homicides of her two sisters and mother. Libby is
forced to give a rather shaky statement against her brother
Ben as the sole perpetrator, which she also adopts as her
narrative of what happened that night. She grows up living
off capitalizing on what happened and her status as a victim.
Continuous distress prevents her from typical inclusion in
social and occupational life.
3 weeks before Ben’s case’s evidence is destroyed, Libby is
approached by a group of amateur investigators known as
“The Kill Club” who believe Ben is innocent and hire her to
help with their investigation.

5. MOVIE PRESENTATION ꞉
It is through this process, and encouraged or
pushed actively by Lyle, her contact from
the Kill Club, that Libby faces the
challenge of unearthing the painful
memories of the event, face her abusive,
psychologically distorted father and
imprisoned brother and fight her own
demons in order to reach catharsis.

6. Meeting Libby Day

7. Libby Day’s History and Background꞉
 Libby Day, at the time of the murders, was an 8
year old child living in Kinnakee, a rural area in
Kansas, with her mother, her two older sisters and
her brother Ben. Her father left the family when
Libby was only 2 years old and as Libby
mentions, “ I didn’t know him”. He was a farmer
but had no stable occupation, he was engaged in
drug dealing and he was an alcoholic himself. He
owed people money and for this reason, he would
occasionally visit Libby’s family, in order to
claim money. He was abusive to the mother and
rather indifferent or even insulting to his children.

8. Runner Day – The abusive husband

9. Runner Day – Evidence of child maltreatment

10. Runner Day – Evidence of child maltreatment
Note that all abusive incidences (verbal and physical)
were taken place in the presence of children. When a
problem came up (pregnant girlfriend) Runner Day
showed no empathy towards his son, he was insulting
and offered no substantial or usable advice or help.

11. Aunt Diane
 Libby’s family encountered serious financial
difficulties and as it is mentioned in the movie,
the mother was forced to sell her agricultural
machines in order to gain extra income and be
able to pay the farm’s loan. A lot of their
household belongings came from goodwill!
Libby’s aunt was a supportive figure to the family,
who was trying to help, even though she was not
living with them. She used to bring food, candies
and toys to the girls, be supportive and empathetic
to her sister and was really concerned about the
nurturing of her nephews.

12. Patty Krause Day – the mother
 Despite their poverty the mother was trying to take care of
her children and follow some rules. However because of the
severe financial issues she faced and the lack of support
from her husband’s side she was actually failing to show
unconditional love and affection to her children. As Libby
mentions in the movie when she recalls her mother “…that
night she turned to me and told me she loved me, she hardly
ever told us she loved us, that’s why I remember it ”.
 Her inadequacy as a mother was something that Patty Day
recognized and it is repeatedly mentioned throughout the
movie by blaming herself and expressing thoughts of despair
and agony as well as suicidal implications
 The above suggests she may have had undiagnosed
depression or dysthymia.

13. Patty Krause Day – possible depression of the mother

14. Patty Krause Day – possible depression of the mother

15. THE MURDERS
 At the time when the murders took place, Libby was
sleeping at her mother’s bedroom. She was waken up
by the shootings and the screaming of her mother and
sisters. She could hear her brother Ben shouting but
she hadn’t actually seen the murderer. She saw her
mother dead and escaped through an open window.
By the time she was found by the police, she was
confused about what really had happened and she was
actually forced by the police to testify against her own
brother. She was trembling and crying, her testimony
is presented below ꞉
“ I think I saw Ben as I was standing at the door of
my mom’s room he was threatening her with our
shotgun”

16. THE TESTIMONY

17. Highlighting the major issues of Libby’s infancy ꞉
 Single parent family
 Possibly depressed, stressed mother (cause for maltreatment
1)
 Abusive, indifferent father (cause for maltreatment 2)
 Poverty, severe financial problems
 Witness the murder of her mother and older
sisters ( major traumatic event in accord with DSM-5 criteria)
 After the murders, her brother is sent to jail as the
perpetrator of the crime because of her testimony,
she experiences again a different type of loss.
 She is left without any evident psychological care,
no time to grieve, demands for public appearances
and promotion

18. Libby as a grown up
 Libby is now a 33 year old woman with the
memories of her traumatic past haunting her.
 She has no contact with her father or her
imprisoned brother. Her aunt had died as well.
 She lives in a poor neighborhood and has no
stable income and no real job, she is actually
making a living through donations or money that
she gets from giving details about her past.
 She shoplifts.
 She is a heavy smoker, but she drinks
occasionally.

19. Libby as a grown up
 She neglects her physical appearance, she
wears the same clothes every day.
 She has low self-esteem “ I have mean inside
me”.
 She has no friends or boyfriend and makes no
dreams about her future.
 She is rude, offensive and shows zero
tolerance when she is provoked.
 She looses interest very quickly and quits
everything without even trying.

20. Libby as a grown up
 She refuses to have any contact with her
imprisoned brother, and when they eventually
meet, during their first meeting, she cannot
maintain eye contact, she refuses to answer his
questions about her personal life and expresses
distress when he tries to compliment her or be
nice.

21. FIRST MEETING IN PRISON

22. PTSD Diagnosis (DSM-5)
 Direct exposure to traumatic event
 Intrusion symptoms:
 Flashbacks
 Intense distress at cues that symbolize/
resemble traumatic event
 Avoidance:
 Of distressing memories, thoughts and
feelings about the event
 External reminders of the event
 Negative alterations in cognitions and
mood:
 Inability to remember important aspects of
the traumatic event
 Persistent negative expectations and beliefs
about herself and others
 Persistent negative emotional state
 Feelings of detachment or estrangement
from others
 Persistent inability to feel positive emotions
 Alterations to arousal and reactivity:
 Irritable behavior and angry outbursts
 Hypervigilance
 Sleep disturbance
 Duration more than 1 month
 Significant distress and impairment in
social and occupational functioning
 Not attributable to physiological effects of
a substance

23. DADiagnosis (DSM-5)
 Unable to recall
autobiographical memory
related to the traumatic event
 The inability to recall the
memories creates distress
 The memory dysfunction does
not have a physiological cause
 The memory dysfunction is not
DID
 The memory dysfunction is not
a result of substance use or
abuse

24. Presented ‘treatment’& problems
 Libby is given
psychological
debriefing:
 She is helped describe
the events of the trauma
 She is somewhat helped
with the cognitions and
emotions about the
trauma
 Problems with this
method:
 It fails to relieve
psychological distress or
prevent anxiety
disorders
 It can increase the
severity of PTSD
symptoms
 Might hinder the
recovery process

25. Actual Popular Treatment Methods
 Trauma-focused CBT
 Expose patient to
memories or stimuli
associated with the
traumatic event
 Teach / encourage them to
think and cope with them
in more adaptive ways
 Challenge maladaptive
cognitions
 Reconstruct maladaptive
narrative
 EMDR
 Ask patient to generate a
mental image about the
traumatic event
 Follow therapist’s
movements with the eyes
while keeping the image in
mind for 30 seconds
 Talk about current
thoughts and emotions
 Repeat several times
during a single session

26. Conclusion
The film adequately presents the symptoms for PTSD and
DA, including several aspects of comorbidity and etiology
(Libby’s alluded conduct disorder issues, her previous
childhood maltreatment and other risk factors associated with
her low SES).
The presented treatment which is shown to be efficient (i.e. a
minimal level of psychological debriefing) is not only
exaggerated but inappropriate for treatment of PTSD.
Additional exaggeration can be argued to exist in the speed
with which Libby recovers (under three weeks’ time) though
adults have been documented to recover from PTSD by
themselves- though not so when the PTSD’s onset was
during childhood, as is implied to be the case with Libby’s
character.

27. References
Afifi, T. O., McMillan, K. A., Asmundson, G. J. G., Pietrzak, R. H., & Sareen, J. (2011). An examination of the relation between conduct disorder,
childhood and adulthood traumatic events, and posttraumatic stress disorder in a nationally representative sample. Journal of Psychiatric
Research, 45(12), 1564–1572. http://doi.org/10.1016/j.jpsychires.2011.08.005
Brand, B., & Loewenstein, R. (2010). Dissociative disorders: An overview of assessment, phenomonology, and treatment. Psychiatric Times,
(October), 62–69. Retrieved from
http://www.researchgate.net/publication/231337464_Dissociative_Disorders_An_Overview_of_Assessment_Phenomonology_and_Treat
ment/file/79e415068c721ef9b5.pdf
Elbogen, E. B., Johnson, S. C., Newton, V. M., Straits-Troster, K., Vasterling, J. J., Wagner, H. R., & Beckham, J. C. (2012). Criminal Justice
Involvement, Trauma, and Negative Affect in Iraq and Afghanistan War Era Veterans. Journal of Consulting and Clinical Psychology, 80(6),
1097–1102. http://doi.org/10.1037/a0029967
Frewen, P. a, Schmittmann, V. D., Bringmann, L. F., & Borsboom, D. (2013). Perceived causal relations between anxiety, posttraumatic stress
and depression: extension to moderation, mediation, and network analysis. European Journal of Psychotraumatology, 4, 1–14.
http://doi.org/10.3402/ejpt.v4i0.20656
Miller-Graff, L. E., Scrafford, K., & Rice, C. (2015). Conditional and indirect effects of age of first exposure on PTSD symptoms. Child Abuse &
Neglect. http://doi.org/10.1016/j.chiabu.2015.09.003
Nilamadhab, K. (2012). Cognitive behavioral therapy for the treatment of post traumatic stress disorder: a review. Neuropsychiatric Disease and
Treatment. 7, 167-181. http://dx.doi.org/10.2147%2FNDT.S10389
Orth, U., Cahill, S., Foa, E., & Maercker, A. (2008). Anger and Posttraumatic Stress Disorder Symptoms in Crime Victims: A Longitudinal
Analysis. J Consult Clin Psychol, 76(2), 208–218. http://doi.org/10.1037/0022-006X.76.2.208
Roach, C. B. (2013). Shallow affect, no remorse: The shadow of trauma in the inner city. Peace and Conflict, 19(2), 150–163.
http://doi.org/10.1037/a0032530
Street, A. E., Gibson, L. E., & Holohan, D. R. (2005). Impact of childhood traumatic events, trauma-related guilt, and avoidant coping strategies
on PTSD symptoms in female survivors of domestic violence. Journal of Traumatic Stress, 18(3), 245–252. http://doi.org/10.1002/jts.20026
Weis, R. (2014). Introduction to abnormal child and adolescent psychology. Los Angeles, CA: Sage