Table 6.

Proposed ICD-11 Clinical Descriptions and Diagnostic Guidelines for Post-Traumatic Stress Disorder (PTSD): culture-related features and developmental presentations

Culture-related features

Culturally sanctioned and recognized expressions or idioms of distress, explanatory beliefs, and cultural syndromes may be a prominent part of the trauma response. They may influence PTSD symptomatology and comorbidity particularly through somatization as well as other emotional, cognitive and behavioural expressions of distress. For example, cultural idioms of distress following exposure to trauma may manifest through somatic symptoms, like ohkumlang (tiredness) and bodily pain among tortured Bhutanese refugees; symptoms like possession states in Guinea Bissau, Mozambique, Uganda, and Bhutanese refugees; susto (fright) among Latino populations; kit chraen (thinking too much) and sramay (flashbacks of past traumas in the form of dreams and imagery that spill over into waking life) in Cambodia. These cultural idioms are not equivalent to PTSD, but influence its presentation and interpretation.

Developmental presentations

PTSD can occur at all ages, but the response can differ depending on the age and developmental stage of the individual. In younger children, responses may include disorganization, agitation, temper tantrums, clinging, excessive crying, social withdrawal, separation anxiety, distrust; trauma-specific reenactments, such as in repetitive play or drawings; night terrors or frightening dreams without clear content; sense of foreshortened future; and impulsivity. Self-injurious or risky behaviours are more frequent in adolescence. Prevalence estimates of PTSD are relatively low in older persons, and low compared to other anxiety disorders in older populations. In general there is a decline in PTSD symptom severity over the life course, although findings on the overall course of PTSD across the lifespan remain inconclusive.