Posttraumatic stress disorder
Posttraumatic stress disorder (PTSD) can develop when a person witnesses or experiences a traumatic event (APA, 2017b). Having such experiences does not necessarily lead to developing PTSD; it is important to note that the most common outcome for individuals who have experienced trauma is recovery.
There is some level of subjectivity to the experience of trauma since what may be traumatic for some people may not be for others. The perceived stressfulness of an event is an important determinant of the psychological outcome for survivors of traumatic events.
The symptoms of PTSD include:
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Repeated reliving of the traumatic event(s) through intrusive memories, flashbacks or nightmares.
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Persistent avoidance of stimuli associated with the traumatic event(s).
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Symptoms of autonomic hyperarousal such as irritability and an accentuated startle response.
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Negative alterations in mood or cognitions.
The migration process and risks for PTSD
Migration-related traumas are likely a common experience for both refugees and many other immigrant populations (Perreira & Ornelas, 2013).
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Demographic & socio-cultural background
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Stage of Migration
Pre-migration: Poverty, previous travel, parent-child separation
Migration: Age at migration, family presence, entry without authorization
Post-migration: Family support, social support, neighbourhood safety, discrimination, acculturation
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Trauma exposure
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Symptoms of posttraumatic stress
The highest risk of PTSD in refugees is associated with the post migration experience in Canada. Inadequate support and ongoing stressors after the trauma(s) account for the main differences in rates of PTSD in this population. Refugees who have experienced torture or severe violence generally have higher rates of trauma-related disorders (Porter & Haslam, 2005; Hansson et al., 2010; Kirmayer et al., 2011a; Close et al., 2016).
Not all refugees who have experienced potentially traumatic events will develop PTSD, as is true of immigrants (Perreira & Ornelas, 2013). In most cases, approximately 80% experience natural recovery in the months and years after the trauma. Many individuals experiencing traumatic events will experience normal distress that is proportionate to the event, with no mental disorder (Rousseau et al., 2011).
Video: Trauma and Resilience
with Dr. Meb Rashid (Medical Director, The Crossroads Clinic, Women's College Hospital)
It's interesting. When we look at the rates of PTSD in refugee populations, you'll find that the rates really vary in the literature from very low numbers to very high numbers, which tells us that there's probably a problem with the methodology. And we can certainly see why when we look at those studies. Some use questionnaires, some are interview-based, some are cross-sectional, some will follow people for a long period of time. I think for me the important message is that, although the vast majority of people we see in our clinic are refugees and have suffered from immense trauma, not all of them are broken from that trauma. So we see a number of people who have lived through things that for many of us would be horrific but it's really quite, for me, inspiring to see how many of them arrive here and are really eager to put their lives back together. They're not suffering from those symptoms that really define things like posttraumatic stress disorder or depression. Now that's not to say they wouldn't have been affected by their trauma. The way they view the world, the way they look at relationships might be affected by what they've experienced, but it doesn't necessarily mean they're broken from it. So there was one very interesting study in the Journal of the American Medical Association that came out in the late 90s and it was after Rwanda and although we can look at the methodology and analyze that, I think what's most instructive for me was that they found rates of PTSD to be 25%, which are incredibly high in a population-based cohort. But given what people endured in a place like Rwanda where, you know, it's really in many ways a testimony of the worst things human beings can do to other human beings, 75% of people didn't have PTSD. And I think that's really an important message for those of us working with these populations to recognize that although everyone might be affected by their trauma, not everyone will be broken from it. And the vast majority of people will have actually processed it and be able to move on.