Psychological trauma is one of the most debilitating mental health conditions that affect our capacity to function. A contributing factor to its pervasive nature is poor self assessment. Lack of awareness of the causal event and mood-physiology-behavioral nexus affects health seeking behavior

1. Complex Trauma
and Historical
Injustices
Pre Election Anxiety and
Trauma
United States International
University- Africa
15th July 2017
Arthur Muriuki MBPsS,
Consulting Psychologist,
BPS UK Reg. No. 332372.

2. Outline
Historical
scenarios
Introduction
C-PTSD
Clinical
presentation
Impact in
the life
course
Adolescent/
young
adulthood
and old age
Perinatal
vulnerabilities

3. Introduction
Subsequent
governments
Security forces
(Police and Military)
Shifta war, unlawful killing and
enforced disappearances,
Unlawful detention, torture and
ill treatment, Sexual violence
Economic and social
violations, land and conflict,
economic crimes and grand
corruption
Gender, children, minority
groups, indigenous people
gross violation of human
rights
Ethnic tension,
land and politics
IV volumes of Truth Justice and
Reconciliation Report (TJRC)
Colonial regimes
Perpetrators
Methods and the survivors

4. The human brain
and
Complex Trauma

5. Defn. Psychological
trauma
• Personalized
prolonged
Physiological reaction
to a stressor
Event
Direct
exposure
Learning
about
Witnessing in
person

6. Rattan Caning
 Location: Back, buttocks (back of legs)
 Straight, dragged skipping lesion.
 Location: Back.
 Lesions curve with body, tend
to have depigmented centers
and hyperpigmented margins.
Flogging
Note: These lesions may be
much deeper, extend to the
bone or into viscera.

7. Bastinado, Falanga
[Foot Caning with batons, electric cables.]
 80+% have scars, palpable soft tissue irregularities,
pigmentations.
 Often leads to a chronic disability, polyneuropathic anesthesia
or hyperesthesia from heel pad thinning, thickening of the
plantar fascia.
 Chronicity of the pain and disability strongly correlated with
PTSD-constellation symptoms.
 Torture 2009;19:33-40.
 Torture 2009;19:27-32.
Images: Eur J Rad 2007;63:187-204
and Johannes Wier Foundation.

8. Cords, shackles, wires, binding/tying
• Purpose: to inflict pain, mutilate, or
restrain for other tortures.
• Location: extremities, genitalia.
• Findings: sensory or motor
neuropathies or paresthesias,
ischemic injuries.

9. Avulsion of Digit
Thumb Avulsion by
Suspension
Screw compression of distal finger
Eur J Rad 2007;63:187-204.

10. Ligamentous Stress
 Document disability by exam.
 Document soft tissue injuries by MRI.
Parrot’s Perch
Strappado
Dislocation
Fracture and Callus
Eur J Rad 2007;63:187-204.

11. Gunshot wound to Joint
• Knee, hip, shoulder, ankle are most usually involved.
Eur J Rad 2007;63:187-204.

12. PTSDDSM5
Exposure
Intrusive
Sxs
Avoidance
-ve altered
mood and
cognitions
Altered
arousal
and
reactivity
Duration <1
month
Significant
distress/
impairment
Not due to
substance
or medical
condition
Exposure
Clinical
presentation

13. INTRUSION
SYMPTOMS
Repetitive
play with
expressed
traumatic
themes
Trauma
specific re-
enactment
my occur in
play
Intense/prolong
ed
psychological
distress at
exposure to
external/intern
al cues
resembling
aspects of the
trauma
Frightening
dreams with
unrecognizable
content
Intense/pro
longed
psychologic
al distress
at exposure
to
external/int
ernal cues
resembling
aspects of
the trauma
Recurrent
involuntary
distressing
memories
Recurrent
distressing
dreams
Dissociative
reactions-
flashbacks
on a
continuum-
complete
loss of
awareness
*Presence of one or more sxs beginning after traumatic event*
PTSDDSM5

14. Persistent avoidance of stimuli
memories
thoughts
feelings
Avoidance or
efforts to
avoid
People
Places
Conversations
Objects
Situations
Avoidance or
efforts to
avoid
external
reminders
About or
closely
associat
ed with
trauma
About or
closely
associate
d with
trauma
*One or both sxs beginning after traumatic event*
PTSDDSM5

15. Negative
alterations
in cognitions
and mood
Memory loss
on important
aspect of the
trauma
Exaggerated
personal
beliefs about
others, self
and the world
Cause or
consequence
of trauma
events (Self
blame)
Persistent
Negative
emotions (fear,
horror, anger,
guilt, shame)
Diminished
interest in
participation in
significant
activities
Feelings of
detachment or
estrangement
from others
Persistent
inability to
experience
positive
emotions
PTSDDSM5

16. Angry outbursts Self destructive
behaviour
Exaggerated startle
response
Marked alterations
on arousal and
reactivity associated
with traumatic
events
PTSDDSM5

17. Specify
• Feeling detached from or
observing one’s mental
processes or body like as in
a dream
Depersonalization
• Unreality of surrounding
(distant or distorted)
Derealisation
Dissociativesymptoms
PTSDDSM5

18. In the beginning....
Post natal
adolescent
Young
adulthood
Old age
Trauma impact on the life course
Perinatal

19. Neuron

20. Maternal mental health
and fetal development
Cortisol
Alcohol/drugs
Traumatic brain injury
Diseases
Fetal programing
• Permeability of the
blood brain barrier
(BBB)
Tight junctions
Blood side
Brain side

21. Blood capillaries
and the brain

23. Trauma
Attachment
and
relationships
Physical
health
Emotional
responses
Self concept
Thinking and
learning
Behavior
Dissociation
Adolescent, Young
Adulthood and Old age

24. Interventions
Multidisciplinary
approach
Prevention –professional capacities-professors, community health workers, security groups, informal
groupings,
Identification- vulnerable groups (women and children, youth, political biases)
Evacuation- safe corridors
Treatment – referral systems (health, education, socio economic
Follow-up