Mental Health: Post Traumatic Stress Disorder

In their paper Post Traumatic Stress Disorder – A Northern Uganda Clinical Perspective the authors give the following definition:

Post-Traumatic Stress Disorder (PTSD) is a psychiatric condition, which develops after a person experiences, witnesses, is confronted with or hears about emotionally stressful and painful experiences beyond what a human being can bear. The traumatic event may be life threatening; threatens body integrity and causes considerable fear, horror and a sense of helplessness in the affected individual (APA, 1992). Traumatic events are psychologically wounding to the individual and leave deep scars (Anonymous, 2009; and Tonks, 2007) on trauma victims; they are dehumanising, demoralising and humiliating, and may put an abrupt end to the hopes and plans of an otherwise enterprising individual, as the individual loses the sense of the future (Bardin, 2005) as one of the clinical features of post-traumatic stress disorder.

Another study notes that PTSD

is the most common mental health condition in the aftermath of traumatic stress. PTSD prevalence rates depend on cumulative trauma exposure and converge around 8% in the United States, whereas the disorder occurrence is much higher in post-conflict settings.

Statistics for PTSD for the general population are hard to find. The Victimization and PTSD in Ugandan Youth study of youths aged between 13 and 24 years in the major cities of Kampala, Mbarara, and Jinja found that there was a prevalence rate of 37.7% with PTSD. A further 28.2% of its sample had subclinical signs of PTSD. 

There is a well established link between warfare and PTSD. It is no surprise that in a report on High rates of PTSD and depression found among adults displaced by war in Uganda researchers found that three quarters of respondents, 74.3%, met PTSD criteria. A further 44.5% or almost half the respondents had depression.

Without treatment PTSD can become chronic causing severe impairment in daily functioning. There is a further higher risk of physical illness and suicide. 

The study PTSD – A Northern Uganda Clinical Perspective identified the following common symptoms:

Post-traumatic stress disorder usually presents with vegetative symptoms of depressive and anxiety disorders or alcohol use disorder symptoms. Patients may complain about poor sleep due to dreams involving the dead beckoning them unto death. Direct inquiry about probable history of exposure to a traumatic event is required as dreams about the dead may be a significant sign of depressive disorder, anxiety disorder or PTSD representing intrusive thoughts. Sometimes patients may complain about having many thoughts or thinking too much. Too many thoughts may mean being worried, and signify depressive disorder or an anxiety disorder, particularly in association with frightening dreams in which the dreamer is visited by dead relatives, is chased by enemies/armed men, or is involved in battle.

However too much thoughts may be an idiom for intrusive thoughts seen in post-traumatic stress disorder. Individuals may be described as preferring to be alone, and this description is the equivalent of loss of interest in social contact and pleasurable activities as in  depressive disorder or post-traumatic stress disorder; it is not uncommon for post-traumatic stress disorder and depression to co-exist in the same patient. Such individuals are usually intolerant to conversations that might remind them of their traumatic experiences, and may exhibit considerable levels of irritability and may therefore not wish to participate in conversations with family and friends. Individuals who prefer to be alone following exposure to traumatic events also exhibit episodes of depersonalization with aggressive outbursts. The triad of social isolation, depersonalization and aggressive outbursts is so characteristic of former rebel soldiers in northern Uganda that some communities readily recognize the psychological instability in affected individuals and often arrange a quiet room for the victims to rest before they can rejoin their peers in social activities.

In the study of PTSD – A Northern Uganda Clinical Perspective the outcome for those with PTSD in Uganda was optimistic:

... clinical experience indicates that most individuals with the disorder recover on two to six sessions of counselling. It is possible that the ubiquitous social support available to people in their communities contributes to the apparent good prognosis for victims of traumatic experiences in rural Uganda. Ovuga et al (2008) have reported that former child soldiers in northern Uganda who returned to their homes without passing through government established reception centres had lower mean scores on the Harvard Trauma questionnaire and the Hopkins Symptom Checklist for depression. Ovuga and colleagues attributed their observation on the possibility that the child soldiers who went directly to their communities had committed fewer atrocities, were more readily received and forgiven by their respective communities, and possibly experienced fewer traumatic experiences than their colleagues who returned home through the government reception facilities.

PTSD is a mental health issue that has ramifications for the whole community. Prompt identification of symptoms and treatment are of vital importance. It is not only people from war torn areas that may suffer the effects of PTSD. We should never lose sight of those that have had traumatic experiences in all walks of life.

For further information refer to Facebook - Uganda PTSD Alliance and  Twitter - Uganda PTSD Alliance.