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Normal (Expected) Reactions to an Abnormal Event

This short pamphlet provides some information about the typical circumstances that might lead to normal
traumatic stress reactions in people of all ages. The typical initial traumatic stress reactions are also described to
assist those who are suffering and to help those in their support system to be more understanding. The person
may experience the traumatic event directly, may witness an event that involves other people, or may learn about
a traumatic event that happened to a family member or close personal friend. The event involves the actual or
perceived threat of serious injury or death to the person or others. In addition, the person who experienced,
witnessed, or learned of the traumatic event, reacts to it with intense fear, helplessness or horror.

Traumatic events can include, but are not limited to, the following:

• human violence (e.g., rape, physical assault, domestic violence, car hijack, armed robbery, kidnapping,
various violent crimes, violence associated with military combat, etc.)
• natural disasters (e.g., floods, earthquakes, tornadoes, or hurricanes)
• accidents involving injury or death (e.g., car accidents, industrial accidents, etc.)
• sudden, unexpected death of a family member or close friend
• diagnosis of a life threatening illness (e.g., cancer, HIV/AIDS, etc.)

Three groups of symptoms/reactions can be seen in people suffering from posttraumatic stress disorder: (1) re-
experiencing symptoms, (2) avoidant and numbing symptoms, and (3) hyperarousal symptoms.

RE-EXPERIENCING SYMPTOMS (or reactions) include ways in which the person persistently re-experiences the
traumatic event. This may include intrusive memories or recurrent dreams of the traumatic event, and acting or
feeling as if the event were recurring (flashbacks). Reminders of the event may lead to intense psychological
discomfort and/or physical stress reactions.

AVOIDANT SYMPTOMS (or reactions) are ways in which the person tries to avoid anything associated with the
traumatic event. Part of these symptoms/reactions may also include a "numbing" effect, where the person's
general response to people and events is deadened. Such symptoms/reactions may include being unable to
remember aspects of the trauma, showing a limited range of emotion, and having a sense of a foreshortened
future (including a constant dread that something bad is going to happen again).


HYPERAROUSAL SYMPTOMS (or reactions) include difficulty falling or staying asleep, irritability or outbursts of
anger, difficulty concentrating, short-term memory difficulties, hypervigilance (being constantly on the watch for
possible danger), and an exaggerated startle response (e.g., jumping when one hears a sudden noise).

When children have traumatic stress symptoms/reactions in these three categories they are sometimes
expressed in different ways. For example, children may re-experience the traumatic event through repetitive play
(e.g., a child who witnessed a robbery may re-enact the robbery again and again using his or her toys). Do not
neglect obtaining help for young children as they can suffer just as much as adolescents or adults. Usually young
children will benefit from counselling techniques like play therapy and/or art therapy.

Traumatic stress symptoms/reactions can begin soon after the trauma, or there may be a delayed onset (that is,
symptoms/reactions beginning 6 months or more after the trauma). It is quite normal to experience the above
kinds of traumatic stress symptoms/reactions for about a month after a traumatic incident. However, if the

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reactions persist then the symptoms are classified as Post Traumatic Stress Disorder (or PTSD). PTSD usually
requires the assistance of medical and mental health professionals to facilitate recovery.

The traumatic stress reactions tends to be more intense and lasts longer when the traumatic event involves
human violence, and the likelihood of developing PTSD increases with the severity, length, and proximity of
exposure to the traumatic event. Family history of PTSD, previous traumatic experiences, and other existing
mental disorders may also play a role in vulnerability to developing PTSD.

PTSD may be a chronic and debilitating disorder. People with PTSD may suffer tremendous distress, and the
disorder may impact negatively on their work, family, and social functioning. Serious depression and substance
abuse are particularly common in people with PTSD. There may also be an increased risk of other anxiety or
psychological disorders. It is important to recognize that people with PTSD often have physical symptoms.
Such people may go to general practitioners with a variety of physical complaints rather than with specific
psychological symptoms.

TREATMENTS: Several antidepressants have been shown useful in the medication treatment of PTSD. These
medicines work even when there is no co-existing depression, and they are of course particularly useful when
such symptoms also exist and require treatment. There is increasing evidence for the value of the selective
serotonin reuptake inhibitors (SSRIs) in PTSD. A number of other classes of medication may also be useful in
some patients (e.g., beta blockers like “Inderal”). Sometimes the brief use of the newer sleeping tablets (which
are less likely to become habit forming) may be necessary for a week or two to assist people who are having
profound sleeping problems. Beware the temptation to “self-medicate” with alcohol, over-the-counter
medicines, illegal drugs, etc. Rather take the responsible route of using safe prescription medications under
your medical doctor’s supervision. Avoiding stimulants like excess caffeine and nicotine and increasing physical
activity (e.g., regular cardio-vascular exercise are also helpful.

The psychotherapy that is most widely accepted as useful for PTSD is cognitive-behavioural psychotherapy
(CBT). CBT is a relatively structured kind of psychotherapy; it involves the use of specific techniques, which are
taught to the patient, there are a limited number of sessions (with "homework exercises" between sessions). An
important aspect of counselling is that the therapeutic environment provides a safe place for people to go and
discuss the traumatic event, their fears and reactions to the event, and their symptoms. This feeling of safety is a
way for people with PTSD to begin to re-establish a sense of trust with others. This is true for individual therapy
(between one person and a therapist) and group therapy (where people who have experienced similar events
come together to discuss their symptoms, learn more about PTSD, and provide support for each other).

A combination of medication and counselling will likely be the most helpful treatment strategy for many
people. Medication may act to decrease symptoms fairly early on, and so help the person to carry out the CBT
techniques. Conversely, the use of CBT may be crucial in helping the person to return to a normal life, and
ultimately perhaps allow them to stop medication without return of symptoms.

HELPFUL INTERNET WEBSITES: www.trauma-pages.com and www.www.sadag.co.za

Adapted from: http://www.sahealthinfo.org/mentalhealth/aboutptsd.htm
© January, 2010

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