Understanding the effects of trauma on health
by Lydia Atieno, The New Times

Recently, the case of a girl known as Fabienne Isimbi shocked many after she passed away in her sleep.

The 25-year-old was only a year old during the 1994 Genocide against the Tutsi during which her parents were killed. Isimbi had been battling headaches and at the same time, suffering from trauma caused by the death of her parents.

UNDERSTANDING TRAUMA

It’s easy to confuse post-traumatic stress (PTS) and post-traumatic stress disorder (PTSD). In addition to sharing similar names, there’s considerable overlap in symptoms between the two conditions. Both PTS and PTSD are associated with feeling fearful and/or nervous, avoiding the activity or place associated with the traumatic event, and nightmares. However, there are significant differences in symptom intensity, duration, and treatment.

PTS is a common, normal, and often adaptive response to experiencing a traumatic or stressful event. Common occurrences, like car accidents, can trigger PTS as well as more unusual events like military combat or kidnapping. Almost everyone who experiences a scary situation will show at least a few signs of post-traumatic stress. That’s because our brains are hard-wired to tell our bodies to tense our muscles, breathe faster, and pump more blood when we’re under intense stress.

Anyone who has experienced or witnessed a situation that involves the possibility of death or serious injury, or who learns that a close family member or friend has experienced a traumatic event, can develop post-traumatic stress disorder, although most people don’t. It’s still not completely understood why some people who are exposed to traumatic situations develop PTSD while others don’t.

Dr Simon Kanyandekwe, a psychiatrist-physiotherapist at University Teaching Hospital Kigali (CHUK), says headache is one of the many symptoms of trauma in general.

He says that post-traumatic stress disorder (PTSD) symptoms most times include physical pain.

“Trauma is the psychological condition of a person’s inability to cope with the deeply distressing life experience,” he says.

He says these experiences could be death, violence, sexual assault, bullying, and natural disasters.

In a 2012 Social Psychiatry and Psychiatric Epidemiology study in Rwanda, PTSD was still highly prevalent in the Rwandan population, 18 years after the 1994 Genocide against the Tutsi.

The study indicated that PSTD was strongly associated with depression, with manifestations of psychic trauma.

It also gave categories of people who are at particular risk for persistent PTSD, such as widows, orphans and persons living in extreme poverty.

HOW TO TELL ONE IS SUFFERING FROM PTSD

Kanyandekwe says not every traumatised person develops ongoing chronic or even short-term acute PTSD.

“Not everyone with PTSD has been through a traumatising experience. Some experiences, like the sudden, unexpected death of a loved one, can cause PTSD,” he says.

He notes that the symptoms usually begin early, within three months of the traumatic incident, but sometimes, they begin years later, and that these symptoms must last longer than a month and be severe enough to interfere with relationships or work to be considered PTSD.

“The course of the illness varies, some people recover within six months, while others have symptoms that last much longer. In some people, the condition becomes chronic,” he says.

To be diagnosed with PTSD, he says, one must have at least one re-experiencing symptom, one avoidance symptom, at least two arousal and re-activity symptoms, as well as two cognition and mood symptoms.

For children and teens, Kanyandekwe says the symptoms may differ from adults, and that they can have extreme reactions to trauma.

For instance, for children aged six and below, wetting the bed after having learned to use the toilet, forgetting how to or being unable to talk, acting out the scary incident during playtime, and being unusually clingy, are some of the signs of PTSD.

However, for older children/teens, he says they are more likely to show symptoms similar to those in adults. They may also develop disruptive, disrespectful, or destructive behaviours.

“Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of retribution,” he says.

Emamanuella Mahoro, a psychologist working with the youth in Kigali, says there are things that can be done to reduce the risk of PTSD.

For instance, she says, it includes seeking support from other people, such as friends and family, or finding a support group after a traumatic incident.

She adds that learning how to feel good about one’s own actions in the face of danger, and having a positive coping strategy, or a way of getting through the bad incident and learning from it, are just some of the things that if adopted, can decrease the risk of PTSD.

COMPLICATIONS OF TRAUMA

Mahoro says that in some cases, trauma may be the cause of drug, alcohol and dangerous substance abuse.

She adds that it could also causes physical illnesses such as diabetes, obesity, heart disease, pain and chronic headaches that may also result from stress, distress, depression or panic.

However, Mahoro says that headache is managed by rest and pain relief drugs, but treatment happens while handling trauma related complications.

Sylvester Twizerimana, a psychologist based in Rubavu District, says that everyone can suffer from trauma, but according to WHO World Mental Health survey, about 42.7 per cent of trauma cases were due to sexual violence; and females are at greater risk than males.

He says that this is because females are more psychologically affected, it’s easy for them to manifest trauma signs and symptoms, though both sexes are at risk.

He adds that trauma may cause acute stress disorder, explaining that this is characterised by anxiety symptoms, such as panic, depression, and re-experiencing the traumatic incident, among others.

“This may last for weeks but when the problem takes a month, the person is diagnosed with post-traumatic stress disorder,” he says.

Twizerimana says other symptoms will include avoiding some activities, people or areas, mood swings, as well as increased inability to recall certain details of the incident.

WHAT CAN BE DONE?

Mahoro says only a clinical psychologist or psychiatrist can be used to conduct the assessment using professional tools and techniques to distinguish trauma from other mental disorders.

She adds that people of all ages may be victim, so treatment also varies.

For the youth and adults, she says they can be helped using psychological debriefing.

This, she says, is a counselling interview led by the psychologist to allow individuals to directly confront the incident and share their feelings to structure their memories of the incident.

Another method, Twizerimana says, is cognitive behavioural therapy (CBT); this technique is helpful in allowing the psychotherapist to challenge and change unhelpful thoughts, beliefs, attitudes and behaviours of the traumatised person.

By doing so, he says, it helps with emotion regulation and personal coping strategies.

Kanyandekwe says stress management, such as relaxation and exercise, or music, are some of the methods that can help a person who is traumatised.

He adds that the use of medications such as antidepressants is also another possible option for people suffering from post-traumatic stress disorder.

Also, he says, the main treatment for people with PTSD is medications or psychotherapy, or both.

“Everyone is different, and PTSD affects people differently, so a treatment that works for one person may not work for another. It is important for anyone with PTSD to be treated by a mental health specialist who is experienced with PTSD,” he says.

He adds that some people with PTSD need to try different treatments to find what works for them.

However, he says, if someone with PTSD has ongoing trauma, such as being in an abusive relationship; both problems need to be addressed.

Other ongoing problems can include panic disorder, depression, substance abuse, and suicidal thoughts, Kanyandekwe says.

An expert view

Survivors of the 1994 Genocide against the Tutsi who are HIV positive need to be counselled and guided often because some of them, due to trauma or depression, can deliberately stop taking their medication, which is dangerous to their health.

Dr Boniface Nsekanabo, Medic at AVEGA Clinic