When past and present collide: A concise clinical review of post-traumatic stress disorder (PTSD) within the context of family practice

Abstract

Murdered. Murdering. Attempted murder. Armed robbery. Rape. Sexual harassment. Harassment in the work place. Hijacking. Drive-by shootings. Motor vehicle accidents. Child theft. Human trafficking. Domestic violence. Bullying. Abuse. Loss. Pain. In South Africa, trauma has been described as a regular occurrence and more than 7 out of 10 individuals have been found to have experienced trauma during their lives. The most prevalent traumatic events experienced in this country are cited as trauma through the experiences of close others, life threatening incidents and falling victim to crime or violence.¹ Although most people experience trauma at some stage during the course of their lives, and considering that emotional distress following such an event is natural, individual differences in pre- and post-trauma coping behaviour, described in 1979 by Aaron Antonovsky as salutogenic variance,² result in two broad post-traumatic trajectories: adapting, coping and continuing or befalling psychiatric illness. This diversion between post-trauma clinical progressions gradually changed perceptions that posttraumatic stress disorder (PTSD) is monocausal, resulting only from traumatic experience. Rather, PTSD can be conceptualised as a condition of memory impairment³ that manifests only in psycho-genetically susceptible patients following exposure to severe trauma.⁴ Intrinsically, PTSD only refers to the symptomology arising after an individual has been exposed to a traumatic event. However, as initial trauma is necessary to trigger clinical PTSD and considering that the treatment of patients immediately following exposure to trauma may alter the course of disease progression, the current paper will explore core clinical aspects of both trauma and its long term sequelae.