In general, human beings have a remarkable capacity to adapt to extreme stress from the environment. The majority of survivors of potentially traumatic events experience a brief period of disequilibrium, but do not develop lasting difficulties. However, a substantial minority go on to experience severe and ongoing symptoms that cause much distress and substantially restrict their ability to function in the world. When trauma responses reach this level, they may be classified as a psychiatric disorder. Posttraumatic Stress Disorder (PTSD) is the most widely publicised trauma-related psychiatric disorder and it will therefore be a major focus of this chapter, but there are several others that are also commonly associated with traumatic events. In addition, researchers have recently attempted to describe the psychological and psychiatric effects of prolonged abuse at the hands of another person, and the ways in which these differ from the effects of single traumas. Despite significant advances in our understanding of trauma-related syndromes, in this chapter we will also see that relatively little is known about the effects of exposure to continuous community violence, a context that many South Africans currently live in. Finally, this chapter will review existing South African research on the psychiatric impact of trauma exposure in South Africa, and consider some of the gaps in our local knowledge that require further attention.

Posttraumatic Stress Disorder

Normal trauma reactions versus PTSD

After a traumatic event, most people will experience some degree of distress as they try to adapt to what has happened. Common reactions include feelings of anxiety and mild depression, having distressing thoughts and memories of the traumatic event, difficulty sleeping, and feeling hyper-alert to any signs of danger. In order to manage these symptoms, many trauma survivors may wish to avoid talking about what happened, may withdraw from contact with other people, and may feel emotionally numb when they think about the trauma. These reactions can last for a few days, weeks or even months after the traumatic event and then gradually fade, without severely impacting on the survivor's ability to continue with their normal daily functioning.