PTSD

What it is

After a life-threatening or deeply violating event, almost everyone reacts: shock, fear, poor sleep, intrusive images. For most people these reactions fade over days and weeks. Post-traumatic stress disorder is when they do not fade; the alarm stays switched on for more than a month and starts running the person's life.

PTSD has four clusters of symptoms. Re-experiencing: unwanted memories, nightmares, flashbacks in which the event feels like it is happening again. Avoidance: staying away from places, people, conversations and even thoughts connected to the event. Negative changes in mood and thinking: guilt, shame, numbness, believing the world is entirely dangerous or oneself permanently damaged. And arousal: being jumpy, irritable, unable to sleep, scanning every room for danger.

PTSD is not weakness, and it is not a failure to move on. It is the brain's survival system stuck in the moment that threatened survival.

What it can feel like

A matatu backfires and the body reacts before thought: heart pounding, drenched in sweat. Sleep becomes a battlefield of nightmares. The route past the accident scene gets quietly abandoned. Loved ones say “you have changed”; the person feels permanently on duty, exhausted by their own vigilance. Many cope by drinking or withdrawing, which deepens the trap.

In our region the sources are familiar: road crashes, violent crime, post-election violence, conflict and displacement, gender-based violence, fires and floods. Survivors often carry symptoms silently for years because the event itself feels unspeakable.

How common is it

Most people experience at least one serious traumatic event in their lifetime, yet only a minority develop PTSD; global surveys put lifetime PTSD at roughly 4-6% of adults, with much higher rates after certain traumas, particularly sexual violence and war. Risk rises with the severity and repetition of trauma and falls with strong social support, which is one of the most protective factors known.

What causes it

Not everyone who lives through trauma develops PTSD, and it is not possible to predict with certainty who will. Several things raise the risk: how severe and how repeated the trauma was, trauma involving deliberate human cruelty such as assault or sexual violence, earlier traumatic experiences, and having little support afterwards.

Strong social support is one of the most powerful protective factors known, along with the chance to feel safe again after the event. PTSD is the survival system staying switched on, not a sign of weakness or a failure to cope.

How it is diagnosed

A clinician assesses the trauma history and the four symptom clusters, present for more than one month and causing real impairment. Within the first month, severe reactions are assessed as acute stress disorder instead (see that guide). Good assessment is paced and consent-based; nobody should be pushed to narrate their worst moment before they are ready.

How it is treated

The strongest evidence supports trauma-focused psychological therapies: trauma-focused CBT, prolonged exposure, cognitive processing therapy, and EMDR (eye movement desensitisation and reprocessing). These treatments help the brain file the memory as past rather than present, at a pace the survivor controls. They are recommended first-line by NICE and WHO.

Where therapy is unavailable or symptoms are severe, SSRIs have moderate evidence and are a reasonable option. Benzodiazepines do not treat PTSD and can entrench it; they are not recommended. Sleep, exercise, reconnecting with safe people, and limiting alcohol all support recovery. WHO's mhGAP programme equips general health workers to deliver first-line trauma care in ordinary clinics, which matters greatly in settings without psychiatrists.

PTSD in the African context

Across our region the causes of trauma are common: road crashes, violent crime, post-election violence, conflict and displacement, gender-based violence, fires, and floods. Yet trauma is often carried in silence, because the event can feel unspeakable, because survivors fear blame, particularly after sexual violence, and because there are few specialist services. Some distress is understood only in spiritual terms, which can delay care.

Effective help does not always need a psychiatrist. The World Health Organization's mhGAP programme trains general health workers to deliver first-line trauma care in ordinary clinics, and safe, believing community and family support is itself part of recovery.

Managing it day to day

Alongside trauma-focused therapy, these steps support recovery.

• Keep some structure to your days, with regular sleep, meals, and gentle activity, since trauma disturbs all of these.
• Reconnect slowly with safe people rather than withdrawing, since support protects recovery.
• Use grounding skills, such as naming what you can see and feel right now, when memories intrude.
• Reduce alcohol and other substances, which numb briefly but deepen PTSD over time.
• Approach avoided places and reminders gradually and with support, rather than all at once, and be patient with yourself.

Helping someone

If someone you love has PTSD, your steadiness helps.

• Be patient, and avoid pushing them to talk about the trauma before they are ready.
• Learn their triggers, and try not to take startle reactions, irritability, or withdrawal personally. They are symptoms, not rejection.
• Encourage trauma-focused professional help, and offer to help them find it or go with them. Our find a therapist page can help.
• Help them feel safe in the present, with calm, predictability, and reliable presence.
• Take any mention of self-harm seriously, and help them reach urgent support. Look after yourself too.

Peer and family support groups bring together people facing similar situations.