Post-traumatic stress disorder
Post-traumatic stress disorder (PTSD) was not recognized as a disease until 1980, when the American Psychiatric Association created a new classification of disease. Prior to that time, the condition was variously called shell shock or combat fatigue.
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Post-traumatic stress disorder:)
Post-traumatic stress disorder (PTSD) may develop after a person is exposed to one or more traumatic events, such as major stress, sexual assault, terrorism, or other threats on a person's life. The diagnosis may be given when a group of symptoms, such as disturbing recurring flashbacks, avoidance or numbing of memories of the event, and hyperarousal, continue for more than a month after the occurrence of a traumatic event.
Most people having experienced a traumatizing event will not develop PTSD. People who experience assault-based trauma are more likely to develop PTSD, as opposed to people who experience non-assault based trauma such as witnessing trauma, accidents, and fire events. Children are less likely to experience PTSD after trauma than adults, especially if they are under ten years of age. War veterans are commonly at risk for PTSD.
Child circumcision as a traumatizing event
When an infant boy is to be circumcised, it is the usual practice to immobilize the infant for the painful surgery by securely tying his limbs to a molded plastic board specially made for that purpose called a circumstraint. The infant thus is preventing from fighting or fleeing, which is the trauma-producing situation of inescapable shock, described as a "physical condition in which the organism cannot do anything to affect the inevitable."
The male circumcision operation to amputate the foreskin has been shown to be a traumatic event. Taddio & colleagues (1995)(1997) studied the effect of neonatal circumcision on the behavior of boys after surgery and at the time of vaccination. It was found that circumcised boys had a higher pain response at time of vaccination six months later as compared with intact boys,  showing that the nervous system had been permanently sensitized to heightened pain sensation.
Taddio et al. (1997) concluded:
Although postsurgical central sensitisation (allodynia and hyperalgesia) can extend to sites of the body distal from the wound, suggesting a supraspinal effect, the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.
Boyle & Ramos (2019) studied boys in the Philippine Islands who had undergone medical circumcision and others who had suffered the traditional "tuli" circumcision. Of the boys who had a medical circumcision, 51 percent exhibited symptoms of PTSD. Of the boys who had a tuli circumcision, 69 percent exhibited symptoms of PTSD.
Symptoms and signs of PTSD
Re-experiencing is the most typical symptom of PTSD & C-PTSD. This is when a person involuntarily and vividly relives the traumatic event.
- Flashbacks—reliving the traumatic event, and feeling like it happening right now including physical symptoms such as a racing heart or sweating.
- Reoccurring memories or nightmares related to the event.
- Distressing and intrusive thoughts or images.
- Physical sensations like sweating, trembling, pain or feeling sick.
Thoughts and feelings can trigger these symptoms, as well as words, objects, or situations that are reminders of the event.
Alertness and Reactivity Symptoms
You may be ‘jittery’, or always alert and on the lookout for danger. You might suddenly become angry or irritable.
- Being jumpy and easily startled.
- Feeling tense, on guard, or “on edge” – this is called hypervigilance.
- Having difficulty concentrating on even simple and everyday tasks.
- Having difficulty falling asleep or staying asleep.
- Feeling irritable and having angry or aggressive outbursts.
- Self-destructive or reckless behaviour.
- Aversion or difficulty in tolerating sound.
Trying to avoid being reminded of the traumatic event is another key symptom of PTSD & C-PTSD: avoiding certain people or places that remind you of the trauma, or avoiding talking to anyone about your experience.
- Staying away from places, events, or objects that are reminders of the experience.
- Feeling that you need to keep yourself busy all the time.
- Using alcohol or drugs to avoid memories.
- Feeling emotionally numb or cut off from your feelings.
- Feeling numb or detached from your body.
- Being unable to remember details of the trauma.
Avoidance symptoms may cause people to change their routines.
Feeling and mood symptoms
The way you think about yourself and others may change because of the trauma.
- Trouble remembering key features of the traumatic event.
- Feeling like you can’t trust anyone.
- Distorted thoughts about the trauma that cause feelings of blame and guilt.
- Overwhelming negative emotions, such as fear, sadness, anger, guilt, or shame.
- Loss of interest in previous activities.
- Feeling like nowhere is safe.
- Difficulty feeling positive emotions, such as happiness or satisfaction.
- Psychological issues of male circumcision
- Psychiatrist Discusses the Lasting Trauma of Circumcision
Trauma and children - newborns to two years, Better Health Channel, Victoria Department of Health. Retrieved 14 August 2021.
- Philo, Jolene (12 July 2013).
Post Traumatic Stress Disorder in Babies and Toddlers: What Are the Symptoms?, Special Needs Resources. Retrieved 14 August 2021.
It’s normal for children to exhibit some of these behaviors in the first weeks after a significant trauma occurs. But if the behaviors persist more than 3 months after the initial event, treatment may be needed.
- American Psychiatric Association (1980): Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Retrieved 8 August 2021.
- van der Kolk BA (2014): The Body Keeps the Score. P. 19. ISBN 978-0-14-312774-1. Retrieved 7 August 2021.
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. pp. 271–280. ISBN 978-0-89042-555-8.
- National Collaborating Centre for Mental Health (UK) (2005). "Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care". NICE Clinical Guidelines, No. 26. Gaskell (Royal College of Psychiatrists). Lay summary – Pubmed Health (plain English).
- Zoladz, Phillip (June 2013). "Current status on behavioral and biological markers of PTSD: A search for clarity in a conflicting literature". Neuroscience and Biobehavioral Reviews 37 (5): 860-895. https://dx.doi.org/10.1016%2Fj.neubiorev.2013.03.024
- van der Kolk BA (2014): The Body Keeps the Score. P. 76. ISBN 978-0-14-312774-1. Retrieved 12 August 2021.
- Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995; 345: 291-292. PMC. DOI. Retrieved 15 November 2022.
- Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1 March 1997; 349: 599-603. PMC. DOI. Retrieved 15 November 2022.
- Rhinehart J. Neonatal circumcision reconsidered. Tranactional Analysis Journal. July 1999; 29(3): 215-21. Retrieved 28 November 2020.
- Boyle GJ, Ramos S. Post-traumatic stress disorder (PTSD) among Filipino boys subjected to non-therapeutic ritual or medical surgical procedures: A retrospective cohort study. Annals of Medicine and Surgery. 2019; 42: 19-22. PMID. PMC. DOI. Retrieved 28 November 2020.
PTSD-UK, https://www.ptsduk.org. Retrieved 12 August 2021.
When we feel stressed emotionally, our bodies release hormones called cortisol and adrenaline. This is the body’s automatic way of preparing to respond to a threat, sometimes called the ‘fight, flight or freeze‘ response.