This was written before Season 2 was animated and doesn’t contain all examples of traumatic events nor all events that meet criteria requirements for PTSD. Also, there’s literally only 1 video below, so I’ll give you music at the offset to listen to since it’s a long read!
In 2016, an anime was released named Re:Zero -Starting Life in Another World-. It featured the main character Natsuki Subaru, a 17-18 year old boy who lived in modern Japan. One day, he’s suddenly whisked away to another world filled with magic, fantasy creatures, and danger aplenty. Unfortunately for him, he doesn’t develop the ability to use magic nor does he become physically stronger [Well, not powerful magic]. He’s simply a regular boy in a supernatural world. This, combined with his tendency to help those in need, is evidently a recipe for disaster. Within two episodes of his transportation, he ends up dying. Normally, the story would end there; however, instead of dying, he is returned to the past with full knowledge of what transpired and the emotions that he went through. Due to this power, throughout the entire show, Subaru suffers from PTSD.
PTSD, or post-traumatic stress disorder, was originally added to the DSM-III in 1980 in the wake of the Vietnam War. Previous editions of the DSM have attempted to address what we view now as PTSD, but ultimately failed. It can be caused by direct experience or witnessing of a traumatic event, the knowledge that family or friends have been harmed, or “[if a person] experiences first-hand repeated or extreme exposure to aversive details of the traumatic event” (APA, 2013). A patient must have gone through one of the aforementioned before a PTSD diagnosis can be made.
Commonly expressed through media are some symptoms of PTSD such as when a patient relives the traumatic event or overreacts to stimulus. Reliving the event is commonly done through nightmares and flashbacks. The other two symptoms less commonly, or less visibly apparent, are “negative changes in beliefs and feelings,” and active avoidance of situations that may remind the patient of the event. For someone to have PTSD though, they must experience all the symptoms mentioned for a one month minimum and it must significantly affect their lives in a negative way. This is because people who are exposed to a traumatic event generally also exhibit symptoms of PTSD; whereas PTSD lasts for decades and, in some cases, a lifetime. For diagnosis, the DSM-5 specifically lists eight criteria necessary labeled from A to H which will be listed later (APA, 2017).
War has always been a breeding ground for soldiers and civilians alike to develop PTSD given its very nature. Research done about US soldiers in the Vietnam War showed 2% to 17% of them suffered from PTSD. Meanwhile, research on US soldiers in the Iraq War showed a higher average percentage of 4% to 17% (Richardson, 2010). That said, war is not the only avenue through which people develop PTSD. Occupations such as EMTs and ambulance personnel are also likely. An average of 11% of the workers have been estimated to suffer from it (Petrie, 2018).
A plethora of theories about PTSD exist, with the most well-supported being those which incorporate both psychological and neurological theories (Green, 2017). Additionally, there are two subtypes of PTSD: Dissociative and Preschool. The former is characterized by standard PTSD symptoms while also suffering from depersonalization or derealization. The latter applies to children under seven years of age and they generally don’t need to exhibit the same number of symptoms as an adult would (ADAA, n.d.).
PTSD is usually treated through cognitive behavioral therapy (CBT). With guidance from a therapist, patients think about the trauma and learn to remove illogical associations caused by overgeneralization and negative thinking. Another method within CBT is repeated exposure to trauma over short periods of time. This allows the patient to readjust to the traumatic event, eventually no longer having to avoid event-related thoughts or locations. Group therapy and medication is also used. Moreover, through CBT, patients restore purpose to their lives (Flannery, 2015).
As mentioned before, there are eight criteria necessary to be diagnosed with PTSD. Criteria A requires one of the following:
- Direct exposure
- Witnessing the trauma
- Learning that a relative or close friend was exposed to a trauma
- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)
Criteria B requires one of the following:
- Unwanted upsetting memories
- Emotional distress after exposure to traumatic reminders
- Physical reactivity after exposure to traumatic reminders
Criteria C also requires one of the following:
- [Avoidance of] trauma-related thoughts or feelings
- [Avoidance of] trauma-related reminders
Criteria D requires two of the following:
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
Criteria E also requires two of the following:
- Irritability or aggression
- Risky or destructive behavior
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
Criteria F requires that “symptoms last for more than 1 month.” Criteria G requires that “symptoms create distress or functional impairment,” and Criteria H requires that “symptoms are not due to medication, substance abuse, or other illness.”
Subaru handily meets criteria A. He has directly experienced his own death on multiple occasions through explosions, stabbings, being literally frozen to death, and more. He has also witnessed the torture and death of loved ones. Criteria B is also met. While he does purposefully draw on his memories so that he won’t die in the current timeline, even afterwards his mind is filled with invasive recollection through flashbacks and nightmares where he sees others’ death unfold again.
Criteria C is met when Subaru meets his assailant from a previous life. He visibly recoils and on one occasion he even hides under his bed sheets out of fear. Criteria D is fulfilled by an opinion he forms about himself. He believes that he is weak, not able to protect those he cares about. Conversely, he drags those around him down and suspects his idiocy plays a role in their death. Gradually, he also shuts away from the world and those around him. Subaru also feels mentally isolated because he is physically unable to tell people about his past lives due to a curse.
Criteria E is met when Subaru urges Emilia, another main character and love interest, to stay in the lord’s house. He shouts at her, worried that she’ll die once again if she leaves. Subaru is also met by sleepless nights where he stares at the ceiling for hours, reacting to every noise he hears. Criteria F is met since this continues throughout the series which takes place over the minimum span of a year. Criteria G is met, evidenced by the fact that he is frequently distressed and is unable to even move or think logically at times, frozen and shaking. Criteria H is met given that he doesn’t take any medicine, drugs, nor does he claim to have suffered from any previous mental illness.
The portrayal of PTSD in Re:Zero is surprisingly realistic. For what it is, an anime targeted towards young adolescent Japanese males, nothing was particularly egregious. Attempts to run away from problems and to shut yourself off from the world are perfectly reasonable. In real life, near-death experiences are reason enough for PTSD. To experience death and suffering repeatedly is no doubt cause for it as well. In fact, it could be argued that the portrayal of symptoms should be more exaggerated given that what Subaru suffered wasn’t realistic in and of itself. Rather, it was much worse than what any person would and could ever go through. After all, Subaru can feasibly experience the traumatic event again unlike in real life.
Note that Subaru does come to use this power of returning to the past purposefully. At times, when faced with a problem that can’t be overcome, he willingly dies so that he can stop it from occurring. This marks it as different from a phobia since he isn’t scared of death per se. He’s scared of repeating the suffering he has witnessed and suffered through already.
Despite this praise of the portrayal of symptoms, there’s a glaring lack of treatment. This isn’t a critique of the material in the truest sense because treatment in a fantasy world where murder is a daily occurrence is unreasonable. There are no therapists for him to go through and, due to the aforementioned curse, the efficacy of treatment would be dubious at best. He never does recover from his PTSD, the fact perhaps adding to the realism.
PTSD is a commonly seen disorder in all types of media. While the US in particular did have a surge of it in its media due to news coverage of the Afghanistan and Iraq wars (Armstrong, 2009), writers around the world have used it as a way to add depth to their stories. Even if the setting is that of a fantasy world, such as in Re:Zero, the portrayal of PTSD establishes the tone as a grounded plot. While the world may be different, the emotional hardship is the same, allowing viewers to empathize with Subaru; PTSD serving as the bridge between reality and fiction. In a way, it also subverts viewer expectations, using a cartoon as a vehicle for a dark narrative.
ADAA. (n.d.) PTSD Symptoms in Children Age Six and Younger. Retrieved from https://adaa.org/living-with-anxiety/children/posttraumatic-stress-disorder-ptsd/symptoms
APA. (n.d.). Cognitive Behavioral Therapy: How CBT Can Help with PTSD. Retrieved from https://www.apa.org/ptsd-guideline/treatments/cognitive-behavioral-therapy
APA (2017). Posttraumatic Stress Disorder. Retrieved from
Armstrong, T., & Olatunji, B. (2009). PTSD in the media: A critical analysis of the portrayal of controversial issues. The Scientific Review of Mental Health Practice: Objective Investigations of Controversial and Unorthodox Claims in Clinical Psychology, Psychiatry, and Social Work, 7(1), 55–60. http://search.ebscohost.com.ez.lib.jjay.cuny.edu/login.aspx?direct=true&db=psyh&AN=2010-06600-005&site=ehost-live.
Flannery, R. B., Jr. (2015). Treating psychological trauma in first responders: A multi-modal paradigm. Psychiatric Quarterly, 86(2), 261–267. https://doi-org.ez.lib.jjay.cuny.edu/10.1007/s11126-014-9329-z
Green, J. D., Black, S. K., Marx, B. P., & Keane, T. M. (2017). Behavioral, cognitive, biological, and neurocognitive conceptualizations of posttraumatic stress disorder. In S. N. Gold (Ed.), APA handbook of trauma psychology: Foundations in knowledge., Vol. 1. (pp. 407–428). American Psychological Association. https://doi-org.ez.lib.jjay.cuny.edu/10.1037/0000019-021
Petrie, K., Milligan-Saville, J., Gayed, A., Deady, M., Phelps, A., Dell, L., Forbes, D., Bryant, R. A., Calvo, R. A., Glozier, N., & Harvey, S. B. (2018). Prevalence of PTSD and common mental disorders amongst ambulance personnel: A systematic review and meta-analysis. Social Psychiatry and Psychiatric Epidemiology: The International Journal for Research in Social and Genetic Epidemiology and Mental Health Services, 53(9), 897–909. https://doi-org.ez.lib.jjay.cuny.edu/10.1007/s00127-018-1539-5
Psychiatry (n.d.). What Is Posttraumatic Stress Disorder? Retrieved from https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd
Richardson, L., Frueh, B., & Acierno, R. (2010). Prevalence Estimates of Combat-Related Post-Traumatic Stress Disorder: Critical Review. Australian and New Zealand Journal of Psychiatry, 44(1), 4-19.
Veterans Affairs. (n.d.). History of PTSD in Veterans: Civil War to DSM-5. Retrieved from https://www.ptsd.va.gov/understand/what/history_ptsd.asp
Veterans Affairs. (n.d.). PTSD and DSM-5: DSM-5 Criteria for PTSD. Retrieved from https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp