Islamabad-Historically, only war veterans were said to suffer from Post Traumatic Stress Disorder. Various terms were used to describe this disorder such as battle fatigue, soldier’s heart and shell shock but in the early 80’s, the term ‘PTSD’ was conceived to describe severe mental agony suffered by these veterans. Trauma related mental disorders have been known to occur since the time of the ancient Greeks. Today, it is known to occur in people exposed to prior trauma such as sexual abuse, domestic violence, bullying, warfare and severe accidents etc. Symptoms include persistent hyperarousal, avoidance of associated stimuli, intrusive reexperiencing of the event including recurring nightmares and changes in cognition or mood. These symptoms develop due to dysfunction in two key regions of the brain i.e. Amygdala and the Prefrontal Cortex. Anything that resembles the original trauma e.g. a loud noise, a similar incident in a movie or a TV serial or a person who resembles the abuser (in cases of sexual/physical abuse) can emotionally trigger such a patient. A number of traumatizing events and disasters can have a very negative psychological impact on eye witnesses, especially children and teens. According to a recent survey, around 4% of men and 10% of women will develop PTSD in their life, but those who have been exposed to sexual or physical violence are more likely to develop it.

PTSD and Terrorism

The highest number of PTSD patients can be found in conflict zones due to the prevalence of violence, death, and abuse. Children in such areas tend to suffer from severe anxiety, fear, flashbacks and recurring nightmares which develop into PTSD.  Terrorism and war can have long-term public health consequences, 99% of terrorism occurs in war infested countries like Syria, Afghanistan, Yemen, Iraq and Pakistan, survivors in such places don’t have access to basic facilities let alone mental health facilities and support. It is estimated that around 40% of residents in tribal areas of Pakistan suffer from PTSD; majority of such cases remain unreported, so the real statistics are suspected to be far worse.  Apart from soldiers and residents of conflict zones, prison guards, police officers and rescue workers are also at an immense risk of PTSD.  A study in the ‘American Journal of Industrial Medicine’ stated that PTSD is as common in prison guards as in veterans from Afghanistan and Iraq. In 2014, Pakistan witnessed one of the worst terrorist attacks in world history, which specifically targeted children at the Army Public School in Peshawar, not only did it lead to the death of over a 100 children, but also left a high number of injured survivors who suffered from mental and physical disability.

It caused severe fear, stress and anxiety among school children in the entire country. In a study about PTSD among school children of APS after 6 months of the attack, a high prevalence of PTSD was shown among 10-18 years old students. Among the 205 participants of the study, 154 children were found to be suffering from PTSD.

The war on terror in Pakistan caused an increase in psychological disorders among citizens especially those living near border areas, but unfortunately only 0.42 percent of the national  budget is allocated to mental health in the country, according to the Pakistan Economic Survey 2016-17.

PTSD and Bullying

PTSD is also common among children suffering from severe bullying at school due to the high level of stress that comes with it, such children tend to experience recurring nightmares, anxiety, bedwetting and sleeplessness, among other symptoms .Parents should look out for these symptoms in their children and should consult a doctor immediately in case their child is showing any such signs or symptoms. Since PTSD is an actual injury to the brain, it needs to be taken as seriously as an injury to any other part of the body would be taken, thus medical experts are now describing it as an ‘injury’ instead of a ‘disorder’.

PTSD and Sexual Abuse

According to Sahil’s annual report in 2017, 3445 children were subjected to sexual abuse in Pakistan.  The most common effect of sexual violence is PTSD which can extend to adulthood. Due to a high prevalence of sexual and physical abuse among children, teens and young adults, it is vital for educational institutes to establish a help centre on campus and hire a mental health professional to help students cope with anxiety and other issues stemming from such disorders.  A study by Anxiety and Depression Association of America stated that patients with stronger social support and social networks experienced reduced symptoms of PTSD.

*Ali Khan, a survivor of sexual assault and a patient of PTSD said, “People who have been sexually assaulted often try to forget the assault and attempt to suppress the painful memory of it. They are afraid to open up, due to the fear of not being believed, this is what I did, after which I was diagnosed with PTSD. As a guy it’s even harder to open up because male victims are labelled as cowards and are often made fun of or are simply told to “man up”, it is important to remember that anyone can be assaulted regardless of gender, and the consequences that are attached with such incidents are far worse for those who cannot even seek help, such people are more likely to self medicate with drugs, alcohol and can end up getting involved in risky activities that could lead to another assault.” 

Some patients suffering from PTSD have been found to be aggressive and abusive partners. Aggression is a way of releasing tension linked with suppressed emotions associated with the traumatic incident or number of incidents which caused their PTSD and this is why most treatments for this disorder incorporate anger management, but it is pertinent to remember that not all patients suffering from PTSD are violent and most can lead a normal life, if they receive proper treatment.  Dr Osama Muslim suggests, “Patients should be encouraged to try and re engage in the world around them. Cognitive behavioural therapy, where the physician uses a stepwise approach to help eliminate feared perceptions, is widely practiced first in line, around the globe. Medication is often second in line, in the management of PTSD.”  The recent case of sexual assault allegations against an American Supreme Court nominee Brett Kavanaugh is a reminder that assault does not only affects the victim but the entire society, and its effects can last for decades , especially in the shape of PTSD. Nobody deserves to suffer in silence, if you know anyone who suffers from PTSD, please encourage them to seek professional help so they could recover and live a normal life.

 *The name has been changed to protect the individual’s privacy.