Some thoughts that could be helpful. This is from a 'thing' I wrote last year - might address your issue in a roundabout way:
2.2 Aetiology
Barlow and Durand (2012) state that PTSD is one disorder for which we know the cause at least in terms of the precipitating event; someone personally experiences a trauma and develops a disorder. However, whether a person develops PTSD or not is a complex issue involving biological, psychological, and social factors. As with other disorders, we bring our generalized biological and psychological vulnerabilities with us; the greater the vulnerability, the more likely we are to develop PTSD. (Barlow & Durand, 2012) A family history of anxiety suggests a generalised biological vulnerability for PTSD. Intelligence, personality and other characteristics, some of them partially heritable, may predispose people to the experience of trauma by making it likely that they will be in risky situations where trauma is likely to occur. There seems to be a generalised psychological vulnerability described in the context of other disorders based on early experiences described in the context of other disorders based on early experiences with unpredictable or uncontrollable events. At high levels of trauma, these vulnerabilities do not matter as much, because the majority (67%) of prisoners of war studied by Foy et al., cited in Burke (2012), developed PTSD. However, at low levels of stress and trauma, vulnerabilities matter a great deal in determining whether the disorder will develop.
Family instability is one factor that may instil a sense that the world is a potentially dangerous place so it is not surprising that individuals from unstable families are at increased risk for developing PTSD if they experience trauma. Social factors play a major role in the development of PTSD. The results from a number of studies are consistent in showing that a strong and supportive group of people around the victim decreases the chances of developing PTSD after trauma. The broader and deeper the network of social support, the less chance of developing PTSD, as it affects our biological and psychological responses to stress. A number of studies show that support from loved ones reduces cortisol secretion and hypothalamic-pituitary-adrenocortical (HPA) axis activity (Barlow & Durand, 2012).
Heather Pollett (n.d.) objects to this type of view, saying that one of the issues facing victims of violence is that mental health treatment is currently based on the traditional bio-medical model. This model focuses mainly on biological and genetic factors of mental illness and does not adequately take into the account the social determinants of mental health such as poverty, housing and stigma. Nor does the bio-medical model fully consider the extent to which past experiences of violence influence the onset of mental illness in adulthood. All of these factors disproportionately affect women because of gender inequality.
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3. The epidemiology of PTSD in South Africa
Epidemiology examines epidemic (excess) and endemic (always present) diseases; it is based on the observation that most diseases do not occur randomly, but are related to environmental and personal characteristics that vary by place, time, and subgroup of the population. Edwards (2005b) states that in South Africa there is a high rate of the kinds of traumatic events that cause PTSD, such as criminal and political violence, motor vehicle accidents and industrial accidents. As a result, PTSD is a significant public health problem. Edwards fails to take into account endemic South Africa problems, such as domestic violence, poverty and substance abuse.
According to Grinage (2003), the epidemiology of PTSD is directly linked to the epidemiology of trauma. The likelihood of developing PTSD varies with severity, duration, and proximity of the experienced trauma. Approximately 25 - 30 % of victims of traumatic events develop symptoms of PTSD; however, response to trauma varies with the severity and the subjective experience associated with the trauma. In men, exposure to military combat and witnessing someone being badly injured or killed are the types of trauma most commonly associated with a diagnosis of PTSD. The most common traumatic events associated with PTSD in women are rape and sexual molestation. Grinage fails to factor in the importance of adverse conditions during childhood, which create the conditions for complex trauma.
The full extent (epidemiology) of the problem is not known. Stein et al. (2008) say that there is a lack of epidemiological data on psychiatric disorders in South Africa. According to their research, a household survey conducted between 2002 and 2004, the most prevalent lifetime DSM-IV disorders were alcohol abuse, major depression and agoraphobia, while the most prevalent class of disorder was estimated to be anxiety disorders, substance abuse disorders and mood disorders. Mood and anxiety disorders were significantly associated with female gender, whereas substance use orders were significantly associated with male gender. Lifetime prevalence estimates varied significantly with age interview for several disorders, including panic disorder, generalised anxiety disorder and drug dependence.
Considering the fact that these figures are based on research done using a lay-administered diagnostic interview that generated diagnoses according to the criteria of the ICD-10 and DSM-IV criteria, the prevalent disorders could point in the direction of undiagnosed PTSD in the participants. This assumption is corroborated by figures in Table 1 (Grinage, 2003), which shows the comorbidities for PTSD:
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Comorbidity Men (%) Women (%)
Major depressive disorder 47.9 48.5
Alcohol abuse or dependence 51.9 27.9
Drug abuse or dependence 34.5 26.9
Simple phobias 31.4 29.0
Social phobia 27.6 28.4
Dysthymia 21.4 23.3
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Table 1: Comorbidities in Patients with Post-traumatic Stress Disorder
The public health consequences of these figures are not known. Comorbidities of PTSD and exacerbate not only PTSD symptoms, but could also complicate both the diagnosis and treatment. The emotional and behavioural problems associated with PTSD can have serious consequences for work and relationships. In severe cases, individuals may not be able to maintain their occupations. The disorder takes a severe toll on relationships especially with intimates and in the family (Edwards, 2005a). According to Stein et al., (2010) there is a particularly strong association between sexual and interpersonal violence and suicide ideation and/or attempt.
The epidemiological evidence shows that traumatising associated with PTSD is a common occurrence in South Africa (Edwards, 2005a). There is incontrovertible evidence that traumatic stress syndromes are very real, and that large numbers of South African adults and children are affected on a chronic basis, only a small percentage of whom receive any form of counselling or professional help. They show that the sequelae of traumatising events constitute a significant public health problem in South Africa, and that attention needs to be paid to providing clinical services to those affected.
