Missionary
Medical
Moment
A brief summary of a current topic of medical interest to missionaries.
Topics are updated frequently; if you have a topic or question, let us know!
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MISSIONARY MEDICAL MOMENT
Post Traumatic Stress Disorder
A missionary with 25 years of experience on the field is serving
in a country where there has been a recent increase in terrorism,
with threats of physical violence and kidnapping directed toward
foreigners. She, along with two other missionaries, are attacked
by armed thieves; shots are fired, and one of the three receives
serious but non-threatening wounds. Now, about six weeks after
the event, the missionary is having recurrent memories of having
a gun thrust in her face, is experiencing interrupted sleep, and
is having difficulty concentrating.
In last month's MMM (October 1999) we examined the Acute Stress
Disorder, the cluster of emotional and physical symptoms which
can normally occur after someone experiences or witnesses an
extraordinary traumatic event. As was discussed, the symptoms
associated with the Acute Stress Disorder subside within several
weeks. If symptoms persist for more than one month, then the
diagnosis of Post Traumatic Stress Disorder (PTSD) is likely.
When the symptoms have persisted for less than three months, it
is called acute PTSD; when symptoms persist for three months or
longer, chronic PTSD is diagnosed. While symptoms usually develop
within hours or days of the traumatic experience, in some cases
there is a delayed onset, with more than six months elapsing
between the traumatic event and the onset of symptoms.
The diagnosis of PTSD requires that a person be exposed to a
traumatic event where they either experienced or witnessed an
event which involved actual or threatened death or serious
injury, and as a result, the person's response includes intense
fear, helplessness, or horror. In addition, three more clusters
of symptoms are often seen:
- frequent, persistent, and unwanted re-experiencing of the
traumatic event. This may include uncomfortable recollections
and images of the event, recurrent dreams, a sense that the event
is about to recur, and intense physical and emotional discomfort
when exposed to places or other situations similar to the
traumatic event.
- avoidance of topics associated with the traumatic event,
including avoiding places or people that might serve as
reminders. The person may find that they experience a general
blunting of feelings and interests in activities that would have
previously been enjoyable. Often, the person finds it difficult
to remember certain details of the event.
- symptoms of what is known as "increased arousal": irritability,
difficulty concentrating, sleep disturbances, and an increased
response to sudden sounds and unexpected stimuli.
PTSD can occur at any age; as many as 14% of all people may
experience PTSD during their lifetime. Individuals who live in
areas of significant social and political disruption, criminal
violence, and natural disasters are at higher risk. How
dangerous, how long, and how close the threat was to a person all
directly affect the intensity and duration of symptoms. In about
one-half of cases of PTSD, recovery of symptoms occurs within
three months, but some people have persistent symptoms for years
after exposure to the original trauma.
A best treatment of PTSD is prevention by early intervention; if
the person who has been exposed to a traumatic event is allowed
an opportunity to talk about what they have seen and what they
are feeling, and is given information about what are the normally
expected reactions to such an event (such as were described in
MMM October - Acute Stress Reaction), then the likelihood of
development of PTSD is greatly reduced. If the syndrome of PTSD
has already developed, improvement is still afforded by an
opportunity to talk about the event in a safe environment,
particularly if the information can be shared with others who
have experienced similar trauma. The use of antidepressant
medication may decrease the symptoms of duration of PTSD. More
intense and specialized counseling and therapy may be necessary
for persistent symptoms.
Even under what may appear to be life threatening or horrifying
circumstances, there can be the knowledge that for the believer
in Jesus Christ, all circumstances ".are in the hands of God."
(Oswald Chambers). As Paul, who had undergone beatings, threats
of death, and imprisonment, was able to write to the church at
Philippi, ".be anxious for nothing.and the peace of God, which
surpasses all comprehension, shall guard your hearts and minds
in Christ Jesus."
(Phil 4:6,7)
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