Woodlands residents experience and PTSD

Kelvin Teo

The Singapore Democratic Party (SDP) was reportedly on the ground at Woodlands Block 686, organising a void-deck meeting with more than 20 residents. One interesting development was that Dr Ang Yong Guan, an SDP candidate at the Holland-Bukit Timah GRC and a consultant psychiatrist in private practice conducted a psychological survey with the residents and concluded that a number of them suffered from post-traumatic stress disorder (PTSD).

PTSD is a severe anxiety disorder that occurs after exposure to a traumatic event, resulting in psychological trauma. According to the SDP, symptoms described by the residents included “migraine, frustration, insomnia, nightmares, pressure, insecurity, tiredness, stomach discomfort, paranoia.” There was also evidence of avoidance behaviour displayed by the residents, avoiding the place connected with the traumatic event, i.e. the lift where the blood stains was found, according to SDP.

PTSD is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the DSM IV-Text revision (DSM IV-TR) and has six diagnostic criteria that must be satisfied in order to be diagnosed with PTSD. For the first criterion to be satisfied, the person has to be exposed to a traumatic event and exposure has two elements – one, the person must experience an event that involved actual death, serious injury or threat to physical integrity of self or others. Two, the person’s reaction to the event involved fear, helplessness or horror. Although the murder of the maid was not likely to be observed, the fact that her body was found in the water tank, which tainted the water supply and drank by the residents may have resulted in the risk of injury to health since the water supply is no longer considered clean. Residents who drank the water and found out that it came from a water tank harbouring the corpse could possibly be considered to be exposed to an injurious event, and their reaction to the event could be fear and horror.

For the second criterion to be satisfied, the residents have to re-experience and re-live their traumatic experience. This includes recurrent recollections of the event, nightmares and experience of psychological distress when exposed to objects and elements involved in that traumatic event. The resident could feel psychological distress whenever he sees a lift, water tank or a tap of running water. And exposure to objects or cues related to the event results could have resulted in a “fight” or “flight” bodily response, what the layman recognises as an adrenaline-fueled experience where his heart and breath rate increases, and he starts sweating.

The third criterion requires the patient to display avoidance behaviour, and this includes efforts to avoid thoughts, conversations, activities (such as using a water tap or lift for example) and places connected with the traumatic event. Avoidance behaviour encompasses diminished interest and withdrawal from significant activities, feeling of detachment and estrangement from others, and sense of a pessimistic future such as not expecting to have children or family.

The fourth criterion is the symptoms of increased arousal as experienced by the patient. This includes two or more of the following: 1) Difficulty falling or staying asleep 2) Irritability or outbursts of anger 3) Difficulty concentrating 4) Hyper-vigilance, e.g. continuing to glance behind the back for any signs of threat 5) Exaggerated startle response, getting jumpy when startled and gets startled easily.

The fifth criterion is that the rest of the other criteria must be experienced for a duration of more than one month. If they satisfy the rest of the criteria for less than one month, then the patient is suffering from this condition known as acute stress reaction. Acute stress reaction may either resolve itself or progress to PTSD if the duration is more than one month.

The sixth criterion is a clinically significant inability to function, for instance in the one’s social and occupational life.

- Diagnostic criteria from MedScape

Patients nowadays tend to be net-savvy, and there are a series of online questionnaires that when answered properly and honestly will indicate the likelihood of PTSD and can be easily accessed. The Trauma Screening Questionnaire is a validated screening tool for PTSD and comprises 10 questions answered in a Yes/No fashion. The questions cover the signs of PTSD. A score of higher than 5 indicates the likelihood of PTSD. The questionnaire has a scoring function indicating likelihood of PTSD.

Link to the questionnaire is http://www.psymed.info/default.aspx?m=Test&id=66&l=3

The Trauma Screening Questionnaire is a more simplified version of the “PTSD symptom scale. Self-reported version”, which is more detailed, in which the patient has to input the frequency in which he experiences the symptoms in terms of the number of times per week. The “PTSD symptom scale. Self-reported version” includes questions on avoidance behaviour, which is not found in the Trauma Screening Questionnaire. And like the Trauma Screening Questionnaire, patient’s responses are scored indicating likelihood of PTSD.

Link to the questionnaire is at: http://www.psymed.info/psymed/default.aspx?m=Test&id=48&l=3

However, it must also be realised that it takes more than a questionnaire or survey to arrive at a diagnosis of PTSD. Such must be made in the clinic, and an appointment involves the recording of the patient’s history, including past psychiatric history and his personal history which includes elements on his early life, schooling, employment history and relationships. Such an appointment would most probably involve a physical examination too.

As for the Woodlands residents of Block 686, if they are displaying symptoms of PTSD listed among the six criteria, and those last for more than a month, they should seek medical attention immediately. If they experience the symptoms for less than a month, it is likely that they are suffering from acute stress reaction. They should also seek treatment for this condition as prompt treatment can prevent their progress to PTSD.

Photo courtesy of Lower Columbia College, Flickr Commons