JAN/FEB 2019
ANSWER
Challenges making a diagnosis
Some of the symptoms of ASD/PTSD are very normal reactions to the way we handle traumatic events
and its seriousness can be overlooked. The symptoms may overlap with other Mood disorders such as
major depressive disorder the symptoms of PTSD can be so distressing and debilitating that they cause
depression to develop. Those with PTSD will show a negative view over the circumstances and have
difficulty with experiencing positive emotions all that can show signs of depression. Victims who suffer
from PTSD are more likely to show higher levels of anxiety and will easily refer to other substances to
cope. The individual will develop a substance abuse disorder that will be more easily be recognized
and receive an intervention for the substance abuse rather than looking at the underlining problem that
might be linked to PTSD. The victim might develop co-morbidities such as panic attacks, phobias and
experience social anxiety and have feelings of guilt in shame leading to isolation. Some individuals
might develop obsessive-compulsive disorder OCD trying to avoid certain triggers or use OCD as a
coping mechanism to control a situation due to them feeling out of control when the traumatic event
occurred. All of these disorders will mask the underlying factor of what caused the irrational behaviour
and will have a poor prognosis outcome if the PTSD is not recognized and treated. There is a link to
complex- PTSD and borderline personality disorder, where the behaviours are a result of childhood
trauma that happened when the personality is shaped. These children that are exposed to trauma for
long periods are more likely to develop depression and substance abuse.
People might not always seek therapy immediately after a traumatic event especially if we look at how
often an individual might experience trauma in south Africa. This has caused the likelihood of other
disorders to develop where the individual will only start to seek treatment once the symptoms are severe
and a challenge in daily life. Unfortunately in South Africa, access to mental health care is limited and
expensive for most people, there is also a shortage of counsellors and social workers in communities to
help vulnerable victims. Lastly, the culture also plays a role in how individuals view therapy and
treatment and is not openly accepted, it is viewed as a weakness and a failure, in some religions in South
Africa it is also frowned upon to see a psychologist and not allowed.
,Post-traumatic stress disorder-PTSD
The new diagnosis states that PTSD has multiple emotions that are outside the anxiety spectrum and
have been redesigned so that treatment outcome is more in line with symptoms.
PTSD should involve an extremely threatening situation that will result in an abnormal fear response
of triggers to the trauma and should happen over some time. PTSD is divided into two categories- Type-
I trauma that happens after one extreme traumatic event that falls in category A of DSM-5.
Complex PTSD (C-PTSD) that happens after Type-II trauma, the event should be reoccurring and or
over an extended period where escape from the trauma was impossible. This usually happens in violent
homes, childhood sexual abuse, domestic violence or part of the sex and drug trade and war victims that
are refugees.
The diagnostic criteria for PTSD are as follows- it is specific to children above 6 years and older.
The symptoms of PTSD should be present for more than one month after the event and have an impact
on the individuals daily life where social interactions, interpersonal relationships and occupation are
under clinically significant strain. The symptoms of the individual should not be due to other explained
medical conditions or where the disturbance can be better explained by any substance use that has
physiological and psychological symptoms similar to PTD.
The diagnosis has 4 categories, where each category should be met by one or more symptoms before a
diagnosis can be made.
Criterion A: explains the stressor or event and should at least meet one of the criteria.
The person had to be exposed to a life-threatening situation or injury or a violation of personal
boundaries such as sexual assault
1. the person could have been directly exposed to the stressor
2. Was a witness to an extreme stressor in person.
3. Indirectly, can be a close relative or friend that was exposed to the trauma it must have been a violent
or accidental near-death experience.
4. Repeated or extreme indirect exposure explicit details of events that can be due to occupational stress
that are witness to violent/ inhumane situations. Such as paramedics, police officers, social workers
working closely with sexual abuse victims. It does not include exposure to violent media that is not
professionally related.
Criterion B: known as Intrusion symptoms- where the victims keep re-experiencing the event
1. involuntary disturbing memories that are repetitive.
2. Night terrors related to the event.
3. Dissociative reactions, where the victim experiences a flashback of the event as if it is happening at
that moment. They might lose touch with reality and relive an event and can even lose consciousness
4. Intense or extended distress after event triggers
5. There is a physiological reaction that can mimic the event response- recurring the fight or flight
response.
Criterion C: avoidance of the triggers that are related to an event
, 1. It can be the avoidance of feelings or thoughts that brings back memories
2. External reminders- avoiding the place or object where the event took place.
Criterion D: a negative change in mood and cognitive functioning after the event and should have at
least two of the following symptoms.
1. memory problems such as dissociative amnesia that is not related to a head injury or alcohol abuse.
The victim is not able to recall important aspects of the traumatic event.
2. Exaggerated negative thoughts and perceptions of themselves and the world.
3. Blaming themselves and others for the event
4. Experiencing constant trauma-related emotions such as fear, anger and shame.
5. showing no interest in important events and activities- avoiding social gatherings or family
6. Have problems connecting to others and feel isolated
7. Having difficulty in experiencing positive emotions, such as joy and happiness or love.
Criterion E: affected arousal and reactivity levels with at least 2 symptoms present
1. Irritable or aggressive behaviour having an angry outburst
2. show reckless, destructive behaviour
3. being hypervigilant
4. over-responsive flight-fight system
5. struggle to concentrate
6. Sleep disturbance.
ANSWER
ANSWER
Challenges making a diagnosis
Some of the symptoms of ASD/PTSD are very normal reactions to the way we handle traumatic events
and its seriousness can be overlooked. The symptoms may overlap with other Mood disorders such as
major depressive disorder the symptoms of PTSD can be so distressing and debilitating that they cause
depression to develop. Those with PTSD will show a negative view over the circumstances and have
difficulty with experiencing positive emotions all that can show signs of depression. Victims who suffer
from PTSD are more likely to show higher levels of anxiety and will easily refer to other substances to
cope. The individual will develop a substance abuse disorder that will be more easily be recognized
and receive an intervention for the substance abuse rather than looking at the underlining problem that
might be linked to PTSD. The victim might develop co-morbidities such as panic attacks, phobias and
experience social anxiety and have feelings of guilt in shame leading to isolation. Some individuals
might develop obsessive-compulsive disorder OCD trying to avoid certain triggers or use OCD as a
coping mechanism to control a situation due to them feeling out of control when the traumatic event
occurred. All of these disorders will mask the underlying factor of what caused the irrational behaviour
and will have a poor prognosis outcome if the PTSD is not recognized and treated. There is a link to
complex- PTSD and borderline personality disorder, where the behaviours are a result of childhood
trauma that happened when the personality is shaped. These children that are exposed to trauma for
long periods are more likely to develop depression and substance abuse.
People might not always seek therapy immediately after a traumatic event especially if we look at how
often an individual might experience trauma in south Africa. This has caused the likelihood of other
disorders to develop where the individual will only start to seek treatment once the symptoms are severe
and a challenge in daily life. Unfortunately in South Africa, access to mental health care is limited and
expensive for most people, there is also a shortage of counsellors and social workers in communities to
help vulnerable victims. Lastly, the culture also plays a role in how individuals view therapy and
treatment and is not openly accepted, it is viewed as a weakness and a failure, in some religions in South
Africa it is also frowned upon to see a psychologist and not allowed.
,Post-traumatic stress disorder-PTSD
The new diagnosis states that PTSD has multiple emotions that are outside the anxiety spectrum and
have been redesigned so that treatment outcome is more in line with symptoms.
PTSD should involve an extremely threatening situation that will result in an abnormal fear response
of triggers to the trauma and should happen over some time. PTSD is divided into two categories- Type-
I trauma that happens after one extreme traumatic event that falls in category A of DSM-5.
Complex PTSD (C-PTSD) that happens after Type-II trauma, the event should be reoccurring and or
over an extended period where escape from the trauma was impossible. This usually happens in violent
homes, childhood sexual abuse, domestic violence or part of the sex and drug trade and war victims that
are refugees.
The diagnostic criteria for PTSD are as follows- it is specific to children above 6 years and older.
The symptoms of PTSD should be present for more than one month after the event and have an impact
on the individuals daily life where social interactions, interpersonal relationships and occupation are
under clinically significant strain. The symptoms of the individual should not be due to other explained
medical conditions or where the disturbance can be better explained by any substance use that has
physiological and psychological symptoms similar to PTD.
The diagnosis has 4 categories, where each category should be met by one or more symptoms before a
diagnosis can be made.
Criterion A: explains the stressor or event and should at least meet one of the criteria.
The person had to be exposed to a life-threatening situation or injury or a violation of personal
boundaries such as sexual assault
1. the person could have been directly exposed to the stressor
2. Was a witness to an extreme stressor in person.
3. Indirectly, can be a close relative or friend that was exposed to the trauma it must have been a violent
or accidental near-death experience.
4. Repeated or extreme indirect exposure explicit details of events that can be due to occupational stress
that are witness to violent/ inhumane situations. Such as paramedics, police officers, social workers
working closely with sexual abuse victims. It does not include exposure to violent media that is not
professionally related.
Criterion B: known as Intrusion symptoms- where the victims keep re-experiencing the event
1. involuntary disturbing memories that are repetitive.
2. Night terrors related to the event.
3. Dissociative reactions, where the victim experiences a flashback of the event as if it is happening at
that moment. They might lose touch with reality and relive an event and can even lose consciousness
4. Intense or extended distress after event triggers
5. There is a physiological reaction that can mimic the event response- recurring the fight or flight
response.
Criterion C: avoidance of the triggers that are related to an event
, 1. It can be the avoidance of feelings or thoughts that brings back memories
2. External reminders- avoiding the place or object where the event took place.
Criterion D: a negative change in mood and cognitive functioning after the event and should have at
least two of the following symptoms.
1. memory problems such as dissociative amnesia that is not related to a head injury or alcohol abuse.
The victim is not able to recall important aspects of the traumatic event.
2. Exaggerated negative thoughts and perceptions of themselves and the world.
3. Blaming themselves and others for the event
4. Experiencing constant trauma-related emotions such as fear, anger and shame.
5. showing no interest in important events and activities- avoiding social gatherings or family
6. Have problems connecting to others and feel isolated
7. Having difficulty in experiencing positive emotions, such as joy and happiness or love.
Criterion E: affected arousal and reactivity levels with at least 2 symptoms present
1. Irritable or aggressive behaviour having an angry outburst
2. show reckless, destructive behaviour
3. being hypervigilant
4. over-responsive flight-fight system
5. struggle to concentrate
6. Sleep disturbance.
ANSWER
