The Foreign Service Journal, January 2008

These events could be serious accidents, such as a car wreck; natural disasters, such as earthquakes, fires, floods, hurricanes or tornadoes; sexual or physical assaults, including child sexual or physical abuse; combat or military exposure; or terrorist attacks. The Foreign Service lifestyle has always posed some degree of risk for certain of these traumas. Some employ- ees and families in the past reported being traumatized by evacuations from embassies under siege. Today we have larger numbers of unaccompanied tours, including some in the zones associated with the war on terror. Most trauma survivors experience stress reactions. People may typically describe feeling relief to be alive, followed by fear and/or anger. They also often find they are unable to stop thinking about what happened. Many will exhibit excess nervous arousal, sometimes to the point of agitation. Such stress reactions are natur- al responses to the extreme physiological changes induced by a life-threatening event and have nothing to do with personal weakness. Understanding what is happening when you or some- one you know reacts to a traumatic event will help you be less fearful and better able to cope. The symptoms of these stress reactions may last for several days or even a few weeks, but for most people, they will slowly diminish over time. If these symptoms worsen or don’t resolve after a month, then PTSD may be developing. Some may find the symptoms of this disorder merely annoying; but for others, they can be terrifying. They may disrupt life and interfere with daily activities. Although symptoms usual- ly start soon after the traumatic event, they may not occur until months or years later, and in some cases they come and go over many years. Who Gets PTSD? It is far from rare to experience a traumatic event. In the U.S. general population, about 60 percent of men and 50 percent of women do so at least once in their lives. Women are more likely to experience sexual assault and child sexual abuse, while men are more likely to experi- ence accidents, physical assault or combat, or to witness death or injury. Anyone who has gone through a life-threatening event could develop PTSD due to strong biological responses that create changes in brain chemistry and function. However, most people who go through a traumatic event do not develop full PTSD, despite the early stress reac- tion. Approximately 8 percent of men and 20 percent of women do so. Women are more likely than men to devel- op the disorder after all types of traumatic events except sexual assault or abuse (when men are sexually assaulted, they are just as likely as women to develop PTSD). While we cannot predict with certainty who will devel- op PTSD after a trauma, researchers have discovered some personal factors that are more commonly associat- ed with those who do develop the condition. You are more likely to develop PTSD if you are female; suffer from another mental health problem; had an earlier life- threatening event or trauma, including being abused as a child; lack adequate support from family and friends; or drink a lot of alcohol. There are also factors that involve the person’s relation to the event itself that are seen more commonly in those who develop PTSD, such as: how intense the trauma was and how close you were to the event; if you were hurt or lost a loved one; how strong your reaction was; and how much you felt in control of events. How Is the Condition Evaluated? While it may be tempting to identify PTSD for your- self or someone you know, the diagnosis should be made by a mental health professional. This will usually involve a formal evaluation by a psychiatrist, psychologist or clin- ical social worker who is specifically trained to assess psy- chological problems. It can be difficult to know whether distress is a normal reaction or a symptom of something more serious. Even experts may require the results of a detailed evaluation to answer this question. Several studies have pointed out that many victims of trauma do not believe that they need help and will not seek out services, despite reporting significant emotional distress. Several potential reasons for this are: • Some feel that they are better off than others more affected and therefore “should not be so upset.” • Others may not seek help because of pride, or out of fear that the distress indicates weakness of some sort. • Many individuals are more apt to seek informal sup- port from family and friends, which may not be sufficient to prevent long-term distress. F O C U S J A N U A R Y 2 0 0 8 / F O R E I G N S E R V I C E J O U R N A L 29 Dr. Raymond M. De Castro, a Foreign Service psychia- trist since 1998, is director of mental health services with- in the State Department’s Bureau of Medical Services.