Millions of people have left their homes because of war, conflicts and political violence in the past few decades. They seek refuge in neighbouring or Western countries whose language and culture are unfamiliar and sometimes vastly different. These pre-migration experiences can negatively affect individuals in  a new country, on top of the culture shock from the uproot.

Because of its high societal and personal costs, treating post-traumatic stress disorder (PTSD) is important. One group in which PTSD may not be treated adequately is refugees.

What is PTSD?

PTSD is classified as a trauma- and stressor-related disorder. PTSD develops in reaction to physical injury, or severe mental and emotional distress, such as exposure to actual or threatened death, serious injury or sexual violation.

The exposure must result from one or more of the following scenarios, where someone: a) experiences the traumatic event; b) witnesses a traumatic event; c) learns a traumatic event occurred to a close family member or close friend d) experiences first-hand repeated or extreme exposure to details of the traumatic event.

It is not the physiological result of another medical condition, medication, drugs or alcohol.

People with PTSD report a range of problems from insomnia, nightmares, night sweats, flashbacks, overwhelming waves of emotions, anger, anxiousness, feelings of detachment and losing interest in everything they used to enjoy. Some potential physiological problems are weakening of immune system, ulcers, chronic fatigue and obesity. PTSD is associated with secondary mental disorders, such as depression and anxiety.

Refugees and PTSD in Toronto

A 2016 report from Refugee Research found “many of the newly arrived refugees in Toronto have undergone difficult and traumatic pre-migration experiences that constitute salient risks and stressors to their mental health.”

Pre-migration traumas such as rape, sexual assault, torture and death of loved ones are significantly associated with extreme PTSD outcomes and these are made worse by post-migration factors such as financial difficulties and legal insecurity.

Individuals with more severe PTSD are at higher risk for developing problematic drug and alcohol use. Not all refugees develop PTSD, but many of them show symptoms.

Adequate treatment of PTSD in refugees requires proper diagnosis of the condition, yet PTSD may not be accurately identified in refugees. The immigration process on its own can be stressful and traumatic although the DSM-5 and other psychology publications don’t define it as such.

Why is the acculturation process in the new country not considered a traumatic experience and more importantly, should it be? This issue complicates the correct diagnosis of PTSD.

PTSD causes great personal costs to refugees and can lead to catastrophic social and economic consequences for Canada. Because of this, we need to have an open discussion, as a society, as to whether or not the acculturation process by itself can cause PTSD or not.

It is important to offer refugees a fair chance at a life in Canada.

By Aureza (Allan) Jamshidi and Ioana Arbone

Image by Adley Lobo