South African Institue For Traumatic Stress
18a Gill street
Johannesburg
Tel: (+27 11) 648 7376 , Mobile: 084-2988-135,
saits@saits.org.za

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What is trauma?
Trauma is an emotional state or reaction (response) of the individual or group to a hazardous event that is outside the range of usual human experience (e.g. natural catastrophes, torture experiences, physical or sexual assault). It is not the event itself. There is no choice in trauma. Different people will respond differently (in varying degrees).

NB! Not all people who experience traumatic events are traumatized.
Developments in the field show that trauma goes beyond the "event". Other factors internal and external influence how one reacts to the event. Out of 100% of people experiencing a trauma event only 10% present with PTSD. One of the most useful explanations of traumatisation is the role of the ratio between protective factors and stressors.

Traumatisation = Protective factors
                                    Stressor factors

According to the above ratio, a person is likely to be traumatised if the stressor factors outweigh the protective factors.

Protective factors: Those factors that protect the clients against being traumatised. They reduce stress and improve coping.

Examples:

• Safety
• Security
• Coping abilities
• Personal Resources
• Family strength and Support
• Social network
• Future possibilities
• Ideological/political/religious consciousness
• Stressor factors: Those factors that may contribute to traumatising a person or make it difficult to deal with the traumatic event.

Examples:

• Poverty, Socio-economic hardships
• Major changes
• Chronic distress
• Prior exposure to trauma
• Illness
• Childhood adversity
• Poor social support

What is the difference between stress, crisis and trauma?
It is important to note that trauma is different from stress. All people experience stress in their everyday lives.

Stress occurs when we feel overwhelmed by the demands in our daily life - the "wear and tear" our bodies experience as we adjust to our environment. A crisis occurs when a person feels overwhelmed, and feels that they can no longer cope with their problems. It involves a change or adjustment e.g. getting married, divorce, death in family. What is Post Traumatic Stress Disorder?

National Centre for PTSD Fact Sheet
What is Posttraumatic Stress Disorder (PTSD)? Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

Anyone who has gone through a life-threatening event can develop PTSD. These events can include:

• Combat or military exposure
• Child sexual or physical abuse
• Terrorist attacks
• Sexual or physical assault
• Serious accidents, such as a car wreck.
• Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake.
• After the event, you may feel scared, confused, and angry. If these feelings don't go away or they get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities.

How does PTSD develop?

All people with PTSD have lived through a traumatic event that caused them to fear for their lives, see horrible things, and feel helpless. Strong emotions caused by the event create changes in the brain that may result in PTSD.

Many people who go through a traumatic event don't get PTSD. It isn't clear why some people develop PTSD and others don't. How likely you are to get PTSD depends on many things. These include:

• How intense the trauma was
• If you lost a loved one or were hurt
• How close you were to the event
• How strong your reaction was
• How much you felt in control of events
• How much help and support you got after the event
• PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. About half (40% to 60%) of people who develop PTSD get better at some time. But about 1 out of 3 people who develop PTSD always will have some symptoms.

What are the symptoms of PTSD?
Symptoms of post-traumatic stress disorder (PTSD) can be terrifying. They may disrupt your life and make it hard to continue with your daily activities. It may be hard just to get through the day. PTSD symptoms usually start soon after the traumatic event, but they may not happen until months or years later. They also may come and go over many years. If the symptoms last longer than 4 weeks, cause you great distress, or interfere with your work or home life, you probably have PTSD. Even if you always have some symptoms, counseling can help you cope. Your symptoms don't have to interfere with your everyday activities, work, and relationships. Most people who go through a traumatic event have some symptoms at the beginning but don't develop PTSD. There are four types of symptoms: re-living symptoms, avoidance symptoms, numbing symptoms, and feeling keyed up.

Reliving the event (also called re-experiencing symptoms):
Bad memories of the traumatic event can come back at any time. You may feel the same fear and horror you did when the event took place. You may feel like you're going through the event again. This is called a flashback.

Sometimes there is a trigger: a sound or sight that causes you to relive the event.

Triggers might include:
Hearing a car backfire, which can bring back memories of gunfire and war for a combat veteran Seeing a car accident, which can remind a crash survivor of his or her own accident Seeing a news report of a sexual assault, which may bring back memories of assault for a woman who was raped.

Avoiding situations that remind you of the event:
You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.

A person who was in an earthquake may avoid watching television shows or movies in which there are earthquakes A person who was robbed at gunpoint while ordering at a hamburger drive-in may avoid fast-food restaurants Some people may keep very busy or avoid seeking help. This keeps them from having to think or talk about the event.

Feeling numb:

• You may find it hard to express your feelings. This is another way to avoid memories.
• You may not have positive or loving feelings toward other people and may stay away from relationships
• You may not be interested in activities you used to enjoy
• You may forget about parts of the traumatic event or not be able to talk about them.

Feeling keyed up (also called arousal or hyper-arousal symptoms):
You always may be alert and on the lookout for danger. This is known as increased emotional arousal. It can cause you to:

• Suddenly become angry or irritable
• Have a hard time sleeping
• Have trouble concentrating
• Fear for your safety and always feel on guard
• Be very startled when someone surprises you
• PTSD in children and teens:
• Children can have PTSD too. They may have the symptoms above or other symptoms depending on how old they are. As children get older their symptoms are more like those of adults.

Young children may become upset if their parents are not close by, have trouble sleeping, or suddenly have trouble with toilet training or going to the bathroom Children who are in the first few years of elementary school (ages 6 to 9) may act out the trauma through play, drawings, or stories. They may complain of physical problems or become more irritable or aggressive. They also may develop fears and anxiety that don't seem to be caused by the traumatic event.

What are other common problems? People with PTSD may also have other problems. These include:

• Drinking or drug problems
• Feelings of hopelessness, shame, or despair
• Employment problems
• Relationships problems including divorce and violence
• Physical symptoms

What treatments are available?
Today, there are good treatments available for PTSD. When you have PTSD dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better. Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.