Physical abuse at the hands of an intimate partner is the most common form of violence experienced by South African women and, together with rape, is a leading cause of post-traumatic stress disorder (PTSD) for women, with far-reaching impact on virtually all aspects of their lives. With 16 Days of Activism for No Violence against Women and Children, running until 10 December, the South African Society of Psychiatrists (SASOP) has highlighted the long-term effects of the trauma of gender-based and domestic violence on survivors’ mental health and ability to function.
South African women who suffer PTSD as a result of rape and/or physical assault by their partners often never fully recover. The nightmares, flashbacks, sleep difficulties, outbursts of anger, difficulty concentrating and emotional numbness that characterise PTSD can have a crippling effect on the sufferer’s social functioning, their work and family life, education and physical health, as well as having costs in terms of lost income and medical care, even long after a woman has escaped an abusive situation.
Twice as many women as men will experience PTSD during their lifetimes, even though men have greater exposure to traumatic events. PTSD sufferers are 80% more likely than those without PTSD to develop other mental disorders such as depression, anxiety or substance abuse, and PTSD is also associated with physical illnesses such as heart disease, diabetes, stomach ulcers and hypertension.
Without treatment, the symptoms of PTSD can continue for years, especially where victims have continued exposure to the traumatic situation, such as having to live with the perpetrator, going through a drawn-out court case or developing other health issues.
Almost 75% of South Africans have experienced at least one traumatic event in their lifetimes, with violence by an intimate partner one of the most frequent (24.3%), at a similar level to the likelihood of being the victim of any crime in general. This has serious costs and consequences for victims, families and the economy, highlighting the urgency of comprehensive, society-wide action and implementing the emergency action plan on gender-based violence announced by President Cyril Ramaphosa in October.
PTSD does not necessarily always follow trauma – it can be described as “failure to recover from the acute (initial) response to a traumatic event”, affecting between 1% and 9% of the general population, and up to 14% of women. The symptoms of PTSD include re-experiencing the trauma through intrusive and distressing memories, dreams or flashbacks; a sense of hyper-vigilance, outbursts of anger or irritability, sleep difficulties, and physical responses to reminders of the trauma.
PTSD also led to avoidance and emotional numbness – efforts to avoid reminders of the trauma in thoughts, conversations, people or places; feelings of detachment from people and difficulty in interpersonal relationships. The disorder is diagnosed when symptoms last for more than a month, and while it can arise immediately after the traumatic event, it is considered to have delayed expression if the full diagnostic criteria are not met until at least six months after the event. PTSD has symptoms of intense psychological and physical distress and, importantly, it affects the individual’s ability to function – to work or study, to maintain social and family relationships, or to continue with hobbies or things that were previously enjoyable in life,” she said.
Treatment would depend on the severity of the PTSD and would follow a bio-psycho-social approach of psychotherapy and medication such as antidepressants. The risk of developing PTSD as a result of gender-based or domestic violence is real, and has long-term impacts on the lives of those who survive this trauma and attempt to live ‘normal lives’ after an abusive relationship.
Strategies to address gender-based violence in South Africa must take into account the need for public mental health support for survivors.
Professor Ugasvaree Subramaney is the academic head of the Department of Psychiatry at Wits University.