PTSD is a type of anxiety disorder. Anxiety is a type of unease, worry or fear which can range from mild to severe. Uncontrollable worry which causes distress in everyday functioning could lead to anxiety disorder. PTSD may occur in people who have gone through very stressful, distressing, frightening or traumatic events.

Cause

These may include natural disaster (such as earthquake), accident (like car accident or fall), war, pandemic, physical or sexual assault as well as threats of injuries and death. PTSD can develop in people immediately after they go through a traumatic experience or it may develop weeks, months or even years later. PTSD can occur at any age and to any individual who have gone through traumatic events. Secondary PTSD is known to occur in caregivers or family members who attend to someone who has experienced a traumatic event. People with PTSD feel frightened and distress even when they are not in danger.

Symptoms

The symptoms of PTSD can be classified into four categories. These include:

1. Intrusion:
   Intrusion symptoms include distressing memories, distressing dreams/ nightmares, flashbacks, emotional distress (like being nervous or feeling upset) and physiological reactivity such as sweating, dizziness, increase in heart rate when the person is exposed to the reminders of those specific event.
   
   
   
2. Avoidance:
   Avoidance symptoms include avoidance of thoughts and feelings, avoidance of activity and avoidance of memory. They may avoid people, places, activities or situations that remind them of those specific events which might have adverse impact on the long run.
   
   
3. Alterations in cognition and mood:
   Alterations in cognition and mood symptoms include decreased interest in activities, detachment from people (feeling isolated), restricted affect (such as unable to feel emotions or feeling numb), foreshortened future (not able to see future or finding it meaningless to make long term plans, a void of happiness or satisfaction) and guilt (exaggerated self-blame, shame).
   
   
4. Alterations in arousal and reactivity:
   Alteration in arousal and reactivity symptoms include irritability or aggression (anger outbursts) self-destructive or reckless behavior, hyper vigilance (watchful of one’s surrounding in a suspecting way), being easily startled (being on-edge) or difficulty in concentration or falling sleep.
   
   
   

In case of children, the symptoms can also include:

• Wetting bed even after going through the toilet training
• Acting out the traumatic event in play time
• Being unable to speak
• Being unusually clingy to the caregiver
• Acting out or showing disruptive or destructive behaviors
• Having physical problems such as headaches
• Feeling guilty for not preventing such event or injuries
• Being angry or resentful
  
  
  
  Risk factors
  Some factors that increase risk for PTSD include:

• Surviving a traumatic event and traumas
• Childhood trauma and abuse
• Extreme fear and helplessness
• Getting second hand experience of traumatic event through family members
• Seeing accidents or death of another person
• Living in a war zone
• Lack of social support after such events
• Piling up of distressing event, one after another
• A history of mental illness or difficulty
  
  
  Diagnosis
  To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:

• At least one re-experiencing (intrusion) symptom
• At least one avoidance symptom
• At least two arousal and reactivity symptoms
• At least two cognition and mood symptoms
  
  
  Treatment / therapy
  The main treatment for people with PTSD includes medication and psychotherapy.

1. Medication: include antidepressants, anticonvulsants, antipsychotics and such.
   
   
2. Psychotherapies: include but not limited to Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing therapy (EMDR).
   
   a) Cognitive Behavioral Therapy (CBT)
   Cognitive behavioral therapy is a type of psychotherapy treatment which involves talk therapy that focuses on identifying and changing destructive or disturbing thought patterns.
   

• Cognitive processing therapy: It helps the individual learn how to modify and confront painful negative emotions which may include guilt and beliefs such as “I have failed”.
• Stress inoculation therapy: It helps to teach coping skills to manage stress and anxiety related to PTSD symptoms by training in deep muscle relaxation, thought stopping, breathing exercise and assertiveness skills.
• Prolonged exposure therapy: It teaches the individual to gradually approach trauma-related memories, feelings and situations. It involves progressive exposures to symptoms or triggers in a controlled therapeutic way to learn to gain control of fear and learn to cope.
• Group therapy: It helps people share their traumatic experiences and reactions in a comfortable and therapeutic way.
  
  
  b) Eye movement desensitization and reprocessing therapy (EMDR):
  It is a phased, structured therapy that focuses on treating trauma and other symptoms by focusing directly on memories. It encourages the traumatized person to briefly focus on the traumatic memory while simultaneously experiencing bilateral stimulation (typically eye movements, tapping on shoulders, knees). This helps the reduction of sleep-thoughts, emotions, and body sensations associated with traumatic memories.
  

Some factors that may promote recovery after trauma include:

• Finding support group or reaching out to family and friends after a traumatic event
• Having a positive coping strategy
• Practicing relaxation techniques
• Pursuing outdoor activities
• Being resourceful and learning to get through the bad events
• Learning to identify and deal with guilt, shame, fear and other emotions
• Being able to act and respond effectively despite feeling fear
• Following proper sleep, diet and exercise habits
  
  
  In Nepali culture, there doesn’t seem to have a construct that parallels PTSD. In addition, there seems to be a preconception that PTSD doesn’t exist in Nepal since it is highly comorbid with other common illnesses such as depression and general anxiety disorder. 
  
  Nepal has faced two major calamities within a decade with earthquake and covid-19 pandemic. Nepalese who hadn’t yet recovered from earthquake related trauma have to go through additional burden of covid-19 pandemic.
  
  A 2019 study found that 24% of victims (558) of earthquake had PTSD even after four years. However, despite the high prevalence of PTSD, it has been found that diagnosing trauma related disorders is not common in Nepal. There are various types of traumatic events that have impacted people living in Nepal. A few of them are natural disaster (earthquake, landslide, flood, fire), war (Nepalese civil war 1996-2006), physical and sexual assault, life threatening accidents and many more. Although Nepalese population seems to have gone through one ordeal after another, they are known to have high resilience towards adversity.  However, there are still many challenges facing mental health in Nepal as PTSD.
  
  
  
  

Reference

Koirala, R., Søegaard, E., Ojha, S. P., Hauff, E., & Thapa, S. B. (2020). Trauma related psychiatric disorders and their correlates in a clinical sample: A cross-sectional study in trauma affected patients visiting a psychiatric clinic in Nepal. PloS one, 15(6), e0234203. https://doi.org/10.1371/journal.pone.0234203

NIMH » Post-Traumatic Stress Disorder. (n.d.). National Institute of Mental Health (NIMH); www.nimh.nih.gov. Retrieved on June 21, 2022, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd#part_2237

Post-traumatic stress disorder library. (n.d.). NeuRA Library; library.neura.edu.au. Retrieved on June 21, 2022, from https://library.neura.edu.au/category/ptsd-library/

Torres, F. (2020). Post traumatic Stress Disorder. American Psychiatric Association. Retrieved on June 22, 2022, from https://psychiatry.org/patients-families/ptsd/what-is-ptsd#section_6