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Implications of PTSD for individuals, families and communities alike, is a complex
concept that is increasingly difficult to understand, particularly in an age that allows
for live images of violence that are being beamed on TV screens around the world
every day. Many news bulletins depict the brutality of violence and effects it has on its
victims, but it seems that these representations merely skim the surface.South Africa
is no exception with its culture of violence. In view of this statement,
1.1 Critically discuss the difficulties experienced by clinicians in diagnosing PTSD
within the South African context. [25]
Influential factors of diagnosis & assessment
1) Limited resources
These aforementioned studies suggest that South African children, as a whole, are exposed
to high levels of trauma and that a significant proportion develop PTSD. Owing to limited
resources, administration of diagnostic clinical interviews to all youth is not feasible. Self-
report scales, even though they do not replace clinical interviews, may be useful in
identifying those youth in the community who are most at risk. This may help to facilitate
more targeted and efficient treatments. In order to develop preventative and ameliorative
strategies for dealing with trauma, reliable and valid measurements of posttraumatic
stress responses are needed. Although several instruments for assessing childhood
disorders and symptoms have been developed over the past two decades [13], most have
originated in the United States [14]. PTSD assessment instruments need preferably to be
standardized in local samples to improve detection of the disorder. In South Africa,
increasingly limited resources such as few school psychologists and large classrooms
make it difficult to accurately identify traumatized children. Nevertheless, identification of
children at risk for PTSD post-trauma may lead to the more efficient use of resources that
are currently available.
Participants may have felt more comfortable in admitting to traumatic experiences on a self-
report scale which may be perceived as less intrusive
2) Multi-cultural context
When individuals from cultures not exposed to Western medical labelling are interviewed
about their experiences of and responses to traumatising events, they do not typically
provide an account of PTSD symptoms. This is because there is considerable cultural
variation in the ‘idioms of distress’ that govern the expression of emotional states,
depending on the overall context of cultural conditioning. For example, in talking about
traumatic events, rural Zulus focus on explanations in terms of a disruption between the
natural and supernatural domains of life.
The cultural expectations which shape the way individuals describe their problems
and symptoms to health professionals may result in their failing to disclose important
information. The result can be that health professionals fail to offer effective interventions
even though they are available.
Dilemma created by the injunction to be sensitive to cultural understanding and
explanations. A girl was brought to the clinic by her mother and there was evidence of
ongoing sexual abuse by a neighbour or family member. However, the father had consulted
a traditional healer whose focus was on why this misfortune had been visited on the family,
rather than on the emotional distress of the child. The father preferred to follow the healer
, in looking for supernatural causes of the misfortune and would not allow the girl to return
for psychological treatment. In such a case there is a strong probability that attributions in
terms of traditional beliefs in witchcraft would serve to perpetuate distress rather than
relieve it.
3) Comorbidity and differential diagnoses
(a) PTSD shares so many symptoms with other disorders, such as MDD and GAD, that
it is difficult to demonstrate that PTSD is unique; (b) PTSD develops more frequently among
people more vulnerable to deleterious effects of a traumatic stressor, making it difficult to
distinguish predisposing risk factors from subsequent reactions to a life-threatening
trauma; (c) PTSD, particularly untreated PTSD, may give rise, over time, to other
disorders, thus complicating differential diagnoses because it is hard to separate original
PTSD symptoms from subsequent problems and (d) PTSD often exists with other
disorders.
Clinicians distinguish PTSD by the situation-specific nature of its symptom-complex
(i.e., by linking current symptoms with past traumatic events) and by symptoms of
avoidance with regard to present reminders of past traumatic events.
4) Other
Low rates of professional help-seeking for mental health issues
Cultural and individual differences for the type and amount of post-traumatic growth reported
by subjects from different cultures.
Western values dominating psychological knowledge introduce severe limitations when
doing cross-cultural research. In SA, it has been confirmed that, in order to me most
effective, practitioners need to respond to abnormal behaviour in patients by using
assessment and treatment frameworks that acknowledge both Western and indigenous
constructions of meaning.
In multicultural settings such as SA, clinicians need to be aware of cultural and ethnic
contributions to psychological problems when treating diverse patient populations, and to
know the degree to which a patient identifies with their culture of origin.
Misconception that black people may be less vulnerable to trauma in relation to other ethnic
groups, due to stronger social support networks and processes such as indigenous rituals, is
not supported by experience.
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