Mental Health Chatroom

February 10, 2022

Mental health conditions from psychological trauma

Welcome to this week’s “Mental Health Chat Room”, this is a chat room where we discuss the basics of our mental health in order to understand and have a full grasp of the rudiments of mental health and mental well-being.

This is part of our mental health advocacy activities aimed at promoting our wholesome wellness, prevent mental illness, improve our awareness of mental illness, understand that effective, qualitative and modern (technology based) mental health care services are available to ensure quality living, harmonious interpersonal relationships, peaceful coexistence within our communities and enhancement of our commonwealth.

A recap of our last conversation: we discussed mental illness stigma and discrimination, and its deleterious effects. 

Stigma could be public or self, and it has been reported to be a major determinant of mental health care service uptake. 

It has also been shown that stigma involves discriminatory attitudes that others have about mental illness that can be directed towards mentally ill patients and their relatives as well as mental health care personnel working with persons with mental illness, and mental health institutions. 

Situations where stigma is towards mental illness exists among policy makers, it can lead to lack of equity in the distribution resources for the care of the mentally ill and mental health institutions.

Specific advocacy targeting reduction of stigma and discrimination of the mentally ill, improving awareness of the public on mental health and mental illnesses, improved mental health care services by integrating mental health into all levels of health care delivery will stem down mental health stigma and discrimination. 

Very importantly, addressing mental health stigma and discrimination in Nigeria entails that the Government should implement the National mental health care service delivery policy and pass the Mental Health Bill into law.

Today we are discussing mental health disorders following traumatic experiences, otherwise referred to as “psychological or emotional trauma”. It is also often referred to as occult/invisible wounds, which is different from physical trauma or “open wounds”! 

I will be serialising mental health conditions resulting from psychological trauma over the next weeks for proper and better understanding of the deleterious effects of these common traumatic situations that are encountered in our communities quite often.

It permeates all the strata of our society (social, economic, ethnic, religious, educational etc). I will be illustrating these conditions with stories as usual for the understanding the reader. I will like to illustrate today’s conversation with the stories of Fatimatu, (hypothetical).

Fatimatu is a 24 years old JSS3 housewife who was kidnapped from her home by “bandits” wearing camouflage uniforms.

A villager (her helper) tried to rescue her from her abductors but he was also captured in the process by the bandits. Fatimatu watched helplessly as he was murdered by the bandits! Ransom was finally paid by her parents and extended family for her release after two weeks in captivity. 

She was physically and sexually harassed for days while under captivity. Three weeks after regaining freedom, her family observed that she started manifesting intermittent episodes of feeling confused, inability to focus or remain in one place (restlessness) and wanting to run out of the house. 

Fatimatu was also experiencing nightmares (seeing her abductors in her dreams), having difficulty with sleep and avoidance of uniformed men. Her symptoms have continued to worsen in over five weeks despite prayer sessions and traditional medication. 

She remembers how her helper was killed with sense of guilt and self blame. Lately she has become reclusive (withdrawn) and will not contribute to discussions; most times she appears lost in her thoughts. 

She confided in her mother that sometimes, it appears as if the events of the period she was under captivity are being “replayed like a movie”.  

Her family finally decided to take her to the hospital following on the advice of her aunt who was treated at the hospital for emotional disorder and she recovered fully.

Psychological trauma is fairly common in Nigeria presently, and it is natural to feel afraid during and after a traumatic situation. Fear triggers many split-second changes in the body to help defend against danger or to avoid it. Most people will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. 

Psychological trauma is a condition created when a traumatic event or situation overwhelms the individual’s ability to cope and leaves that person fearing death, annihilation or mutilation. 

The characteristic condition an individual could develop, is known as post-traumatic stress disorder (PTSD). 

It is a condition that is marked by the development of some typical symptoms after exposure to traumatic life threatening condition(s), events or ordeal in which death, severe physical harm or violence occurred or is threatened; experiencing or witnessing one or more traumatic life threatening condition(s) or event(s) such as military combat, natural and unnatural disasters, terrorist incidents, serious accidents, physical or sexual assault, war, and severe road accidents. 

The symptoms of PTSD could vary from one person to and another, but it commonly includes flashbacks, nightmares and severe anxiety, avoidance of situations that remind the person of the traumatic event, agitation, irritability, hostility, hypervigilance, self-destructive behaviour, or social isolation. 

Other symptoms include, emotional detachment or intrusive thought.

More specifically, symptoms described as re-experiencing include flashbacks, reliving the trauma over and over which may be accompanied by physical symptoms like a racing heart or sweating, bad dreams, frightening thoughts. Such re-experiencing symptoms may cause problems in a person’s everyday routine.

The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders (cues) of the event can also trigger re-experiencing symptoms.

Avoidance symptoms include staying away from places, events, or objects that are reminders of the traumatic experience, includes avoiding thoughts or feelings related to the traumatic event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine.

For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. Whereas arousal and reactivity symptoms include being easily startled, feeling tense or “on edge”, having difficulty sleeping or having angry outbursts.

Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to accomplish basic physiological functions such as sleeping, eating, or concentrating.

Children can have extreme reactions to trauma, but some of their symptoms may not be the same as adults. Symptoms sometimes seen in very young children (less than 6 years old) can include wetting the bed after having learned to use the toilet, forgetting how to or being unable to talk, acting out the scary event during playtime or being unusually clingy with a parent or other adult.

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths.

They may also have thoughts of revenge. It is very important for parents and teachers at school to pay more attention to children that have experienced or witnessed significant psychological trauma.

Anyone can develop PTSD at any age, person(s) who have experienced or witnessed physical or sexual assault, abuse, accident, disaster, or other serious events.

PTSD is not considered a rare condition, about 7 out of 100 people in the population have a life time risk of experiencing PTSD at some point in their lives. Women are more likely to develop PTSD than men, and individual constitution and genetic make up may make some people more likely to develop PTSD than others.

It is important to remember that not everyone who lives through a dangerous event develops PTSD, in fact, most people will not develop the disorder. Many factors play a part in whether a person will develop PTSD. Risk factors make a person more likely to develop PTSD while other factors called resilience factors can help reduce the risk of the disorder.

Persons who experience symptoms of PTSD should consult mental health worker, it is a treatable condition. Early intervention will ensure quick resolution of the symptoms and recovery while lack of early and expedient intervention can lead to chronic PTSD or complex PTSD.

The main treatments for people with PTSD are medications, psychotherapy (“talk” therapy) or lifestyle modification (social/spiritual/cultural) or a combination of the three (this has proven to be more effective than any of the intervention alone). It is important to note that everyone is different, and PTSD affects people differently, so a treatment that works for one person may not work for another.

It is also important for anyone with PTSD to be treated by a mental health provider who is experienced with PTSD. Some people with PTSD may need to try different treatments to find what works for their symptoms. It is also advisable that if someone with PTSD is going through an ongoing trauma, such as being in an abusive relationship, both of the problems need to be addressed. PTSD can be complicated by other health challenges such as depression, suicide, substance abuse etc.

In conclusion, most people who have experienced or witnessed traumatic event will have reactions that may include shock, anger, nervousness, fear, and even guilt. These reactions are common, and for most people, they go away over time. For a person with PTSD, however, these feelings continue and even increase, becoming so strong that they keep the person from going about their life as expected.

The goal of PTSD treatment is to reduce the emotional and physical symptoms, to improve daily functioning, and to help the person better manage with the event that triggered the disorder. Treatment for PTSD may involve psychotherapy (a type of counseling), medication, or behavioural modification or a combination of two or more.

I hope we have a fair understanding of PTSD. Next time we will look into other mental health conditions that can complicate PTSD.

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