Clinical presentation

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Trauma refers to an experience in which a person is exposed to, witnesses, or is confronted with a situation in which they perceive that their own, or someone else’s, safety is at risk [24]. Trauma may be a one-off event or it may have occurred over a period of time. Examples of traumatic events include (but are by no means limited to) combat exposure, being in a place of war, experiencing a natural disaster (e.g., fire, flood), actual or threatened physical or sexual assault, being in a life-threatening accident, being kidnapped, taken hostage, or threatened with a weapon, or witnessing any of these events.

Reactions following exposure to a traumatic event are varied, and can include anxiety or fear-based symptoms, aggression or anger-based symptoms, or dissociative symptoms. Although behavioural disturbances following a traumatic event are to be expected, for some people, the reaction to the event can result in prolonged and significant distress, as well as impaired social and occupational functioning [698]. Symptoms may be especially long-lasting when the trauma is interpersonal and intentional (e.g., torture, sexual violence), and if the trauma occurred in childhood [805]. Following exposure to a traumatic event, an individual may experience symptoms of PTSD (described in Chapter A4) such as:

  • Recurrent ‘re-experiencing’ of the traumatic event, through unwanted and intrusive memories, recurrent dreams or nightmares, or ‘flashbacks’.
  • Persistent avoidance of memories, thoughts, feelings or external reminders of the event (such as people, places or activities).
  • Persistent negative mood, and feeling a distorted sense of blame of self or others, or feeling detached from others, and less interested in activities.
  • Persistent symptoms of increased physiological arousal, including hypervigilance towards distressing cues, sleep difficulties, exaggerated startle response, increased anger and concentration difficulties.