MODULE 7: PSYCHOSOCIAL ISSUES AND OTHER MISCELLANEOUS TOPICS IN OCCUPATIONAL AND ENVIRONMENTAL HEALTH - SECTION 5: WORK AND STRESS: 4: Post Traumatic Stress Disorder

4: POST TRAUMATIC STRESS DISORDER

A special form of work related stress is the condition known as post traumatic stress disorder, a psychological condition which occurs as a result of exposure to an extreme and unexpected occurrence not in keeping with one’s usual work practice, such as the witnessing of a colleague being crushed by machinery in the workplace. This condition is a difficult one to diagnose and is best done jointly by a psychologist and psychiatrist. The Diagnostic and Statistical Manual of Mental Disorders (DSM) version 4 stipulates the criteria necessary for the diagnosis of this condition. The Compensation Commissioner under the Compensation for Occupational Injuries and Diseases Act has recently published the process by which workers in South Africa will receive compensation for this condition.

The Diagnostic Criteria of DSM IV:

A. The person has been exposed to a traumatic event in which both of the following were present:

1. The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.
2. The person’s response involved intense fear, helplessness or horror.

B. The traumatic event is persistently re-experienced in one (or more) of the following ways:

1. Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions.
2. Recurrent distressing dreams of the event.
3. Acting or feeling as if the traumatic event were recurring.
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

1. Efforts to avoid thoughts, feelings or conversations associated with the trauma.
2. Efforts to avoid activities, places or people that arouse recollections of the trauma.
3. Inability to recall an important aspect of the trauma.
4. Markedly diminished interest or participation in significant activities.
5. Feeling of detachment or estrangement from others.
6. Restricted range of affect (for example, unable to have loving feelings).
7. Sense of a foreshortened future (for example, does not expect to have a career, marriage, children or a normal life span).

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

1. Difficulty falling or staying asleep.
2. Irritability or outbursts of anger.
3. Difficulty concentrating.
4. Hypervigilance.
5. Exaggerated startle response.

E. Duration of the disturbance (symptoms in criteria B, C and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

Specify if:
     Acute: if duration of symptoms is less than 3 months.
     Chronic: if duration of symptoms is 3 months or more.

Specify if:
     With Delayed Onset: if onset of symptoms is at least 6 months after the stressor.

Circular Instruction on Post Traumatic Stress Disorder:

Read the Compensation Commissioner’s Circular Instruction.

Have a look at the Case Study.