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PART III: THEORY
The following factors may make it more likely that a survivor will develop severe PTSD:
• The experience is severe, such as a disaster or a war. The amount of exposure is relevant. Multiple incidents are more likely to trigger PTSD than a single episode of violence.
• A trauma stretches over time and the survivor lives permanently in danger or fear.
• The victim is a woman or a girl. Women and girls may face extra pressure because they must care for children or because they are more sensitive to relationships.
• The victim is a child. Children generally show more distress after catastrophes than adults. Children also recover with more difficulty if their parents are stressed.
• The survivor is injured, or sees other people killed or hurt; or experienced loss of control and helplessness, or felt extreme panic and fear.
• She receives little or no social support. After a traumatic experience, it is important to ensure that survivors are not left isolated without care, or receive no assistance to help them deal with the aftermath of a catastrophe.
• She has no support group.
• She has to deal with other things in addition to the catastrophe: the loss of loved ones, injury or physical pain, the loss of home or income.
• She suffered from mental problems before the traumatic event occurred. If she had previously experienced domestic violence, for example, this might have depressed her self-esteem or capacity to manage stress.
• Her community is in recovery. This can take some time and tends to deprive survivors of critical personal support.
The same factors are relevant to people who have a close association with survivors of trauma, such as witnesses, relatives and helpers.
Coping skills can be understood as resources that are available and that the person is capable of utilising in challenging situations.
The most important coping skills can be summarised by the acronym BASIC-Ph( Lahad 1993). B Belief and value system. A Affect regulation. S Social support available and capacity to utilise it. I Imagery: symbols, play and art. C Cognition, understanding of the inner and outer world. Ph Physical: breathing, relaxation and building strength.
Concluding comments
Most people show strong reactions to serious and dangerous events when these happen, and their response continues for some time after the event( 1-3 months). We have called these‘ acute stress reactions’. Such reactions diminish over time, within months for many, within years for some, depending on the severity of the event and the resilience of the person. Some people experience delayed trauma reactions. Some may develop persistent disorders, such as chronic stress disorder( chronic PTSD), long term depression, or anxiety disorders. See http:// www. hhri. org / thematic / ptsd. html; and Dickstein, Suvak, Litz, and Adler( 2010).