Fact Sheet Fact Sheet

Post Traumatic Stress Disorder and Acute Stress

Some migrants may experience PTSD, or psychological and social stress. This fact sheet reviews the symptoms and management.

Last updated

on 15.03.2018

  1. PTSD is a treatable disorder and often self-limiting
  2. Many responses to stress are normal
  3. Strengthening community and family support is very important

Some migrants may be affected by post-traumatic stress disorder (PTSD), which develops following a stressful event or situation of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Rates of PTSD are higher in refugees than in migrants who are not forcibly displaced, but are still relatively low.

PTSD and Psychological and Social Distress

Psychological and social distress among refugees manifests in a wide range of problems including:

  • emotional: sadness, grief, fear, frustration, anxiety, anger and despair
  • cognitive: loss of control, helplessness, worry, ruminations, boredom, and hopelessness
  • physical: fatigue, problems, sleeping, loss of appetite, medically unexplained, physical complaints
  • behavioural and social problems: withdrawal, aggression, interpersonal difficulties, bed wetting, substance use, sleep disturbance in children

The symptoms of PTSD are extreme and encompass more than just remembering the event or dreams, but a combination of disabling recall, dreams and memories. PTSD sufferers may not present for treatment for months or years after the onset of symptoms despite the considerable distress experienced.

PTSD may present with a range of symptoms including:

  • re-experiencing
  • avoidance
  • hyper-arousal
  • depression
  • emotional numbing
  • drug or alcohol misuse
  • anger
  • unexplained physical symptoms.

It is important to use specific clinical tools to make a diagnosis rather than over-diagnose PTSD:

  • Its symptoms should be disabling and present after 4 weeks after the event.
  • It is self-limiting and resolves by itself
  • It is unhelpful to excessively dwell on PTSD rather than positive coping.
  • PTSD is a treatable disorder even when problems present many years after the traumatic event. There may, however, be more severe cases where there is need for a specialised treatment.

    Protecting and supporting mental health

    The World Health Organization (WHO) has produced a guidance note (attached below) with advice on protecting and supporting the mental health and psychosocial wellbeing of refugees, asylum seekers and migrants in Europe. It explains the challenges to mental health and psychosocial wellbeing faced by refugees and migrants and describes common mental health and psychosocial responses they may experience. These experiences and responses can vary widely, and change over time. For example:

    • They may feel elated on first arrival, or be affected by multiple losses and grieving for people and places left behind.
    • They may feel overwhelmed, distressed and anxious, or numb and detached.
    • Some may have reactions which impair their ability to care for themselves and their family, or make them more vulnerable to danger.

    It is important to recognise that many stress responses are natural ways in which body and mind react to stressors and should not be considered abnormal.

    In responding to psychological and social distress among migrants:

    • First acknowledge that stress is a normal response in adults and children.
    • It is very important to strengthen family and community support for the patient to help them integrate and cope with stress factors.

    Stress response can be managed through a range of stress reduction strategies, including:

    • Psychoeducation
    • sleep hygiene
    • breathing exercises
    • relaxation
    • recreational activities

    Guidance (link below) on the assessment and management of conditions specifically related to stress have been produced by WHO.

    Broadly,