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Post-Traumatic Stress Disorder & Seafaring


Traumatic events are very common in any society and people can be traumatized by any event they perceive as life threatening.    Traumatic events  such as family and social violence, accidents, war, natural disasters  and assaults of any nature can traumatize people diminishing their sense of safety  leaving them  temporarily  and in some cases incapacitated to  cope with the event  ( Schwarz, L., 2016).  Individuals suffering major traumatic events  may  experience acute psychological distress and even more chronic symptomatology that leads to post traumatic stress disorder.  Surviving major disasters may be readily identifiable as traumatic events that may lead to post traumatic stress disorder, but often there are less overt potential  causes that set the stage for   trauma  that includes minor accidents, invasive dental procedures, minor injuries , sudden noises etc. ( Levine, P., 2008) .  


Trauma can potentially affect individuals who may not be directly involved but become a   witness to a traumatic event  such as a serious injury , natural disaster ,war acts,  physical or sexual assault of another person ; or exposed indirectly though learning about a traumatic event that occurred to a close relative or friend.   It is important to bear in mind that, not all individuals who either directly or indirectly experience or witness a traumatic event will eventually develop PTSD. Research  has shown that whether  a potential traumatic event  constitutes trauma depends on the perception of the individual and while many individuals   develop transient stress or have  adverse psychological reactions following exposure to  trauma   such as   acute stress disorder, mild  depression , increased aggression  and decline in psychosocial functioning,  not all develop more chronic disorders such as major depression, PTSD or major dissociative  disorders (Schwarz L., 2016) .


Post- traumatic stress disorder ( PTSD) was first introduced in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III, 1980), following the study of combat veterans  who manifested a range of psychological problems  that included affect dysregulation, somatization, depression , dissociation and other symptoms that impacted their psychosocial and occupational functionality(Van der Kolk, B.A.,  2003). In the United States the lifetime risk for PTSD is 8.7% while the twelve- month prevalence rate is about 3.5 %. Rates of PTSD is higher among veterans, individuals who are at increased risk for traumatic exposure, rape, war and genocide survivors. 



The last few years  the  focus of  trauma research  has expanded in many areas beyond veterans of war or rape victims and  implicating PTSD   to a number of  traumatic events that people    may be exposed over the course of life. Traumatic events may  involve  direct  physical assault  or  attack, robbery, mugging, childhood physical or sexual abuse, sexual violence, sexual trafficking, being kidnapped, taken hostage , being a victim of a terrorist attack, torture,  war prisoner, natural or human made disaster and severe motor vehicle accidents . In addition to being a witness of  violent assaults on  another person, or indirect exposure via learning of traumatic events affecting close relatives or friends. Such events include violent personal assault, suicide , serious accidents or injuries (DSM 5).


Post traumatic stress  disorder has been linked to a series of physical ailments, in a study of  more than 10.000 patients with histories of severe childhood trauma,   an increased risk  for alcoholism , depression,  drug abuse,  increased risk of obesity, and even lung disease, cancer, stroke, diabetes and liver disease was  noted (van Dee Kolk, B.A.).   Military trauma has been linked to cardiac, gastro-intestinal and nervous system diseases leading to increased morbidity and mortality ( Pizzaro, M.A., Silver, R.C.,  and Prause, J., 2006 )   Women have twice the risk for developing   PTSD  due to biological differences and type of traumas experienced ; women’s trauma tends to be interpersonal such as sexual molestation, intimate partner abuse , whereas men are physically assaulted more often   than women ( Kessler, 1995).




When people are exposed to trauma, their safety and security is shattered, and their efforts are focused on survival and protection. Their immediate response may include fear,   numbness, shock confusion and while some respond with action or problem solving  to ensure survival other may dissociate . According to trauma expert Van der Kolk,(2003) dissociation , which is the emotional detachment from the experience , right after exposure to trauma  has been identified as an important predictor in the development of PTSD .


The significance  of trauma in people’s lives   is not new but  the implications of trauma  to the central nervous system and  mental disorders is fairly new,  as  proliferating evidence  in the field of neuroimaging reveals the profound effects of traumatic experiences on memory, emotional regulation, biological stress modulation and interpersonal relations.


During the past two decades advances in the field of neurobiology,  has elucidated the psychophysiological reactions of PTSD which has led to the formulation of both theoretical and treatment models  in understanding  trauma  as a causal factor for mental disorders. According to Mc Lean (1990) the brain serves as a device that detects and analyzes information for maintaining a balance between the internal and external environment  to the organism.  When individuals are exposed to potential traumatic events, profound changes in the brain circuitry occur. Neuroimaging studies in patients with  chronic PTSD show a decrease of hippocampal volume ranging from 8% to 26% (Bremer et.al., 1995),  increased amygdala arousal  associated with  increased emotional and hormonal changes  affecting  cognitive processes such as  appraisal  and categorization of events  and information processing.



People  in  high risk occupations often experience incidents that set the ground for developing PTSD with some studies reporting a prevalence rate of 20% ( Skogstad et.,al. 2013) . While, work  related post-traumatic stress disorder   has been the focus of occupational health  research   practitioners,  limited research has been conducted on the risk of PTSD  among seafarers despite the associated risks of the profession . A 2014 study on British seafarers found that fatal accident rate for seafarers was 21 times of that found in the general workforce. Exposure to negative events such as fire aboard, medical emergencies or accidents, ship groundings, cargo damage, collisions, or  witnessing death as a result of  accident or suicide are quite high in this profession. Piracy and hostage captivity constitute additional  factors  that increase the risk for a potential trauma.   Yet, the shipping industry given the transient nature of the seafaring, has not properly addressed the issue of PTSD despite the risks involved in the profession and the critical implications of PTSD  (Simon Beechinor www.supermar.info)


The limited research  on post-traumatic stress disorder has mostly focused   on victims of piracy, citing  that some 25% of former hostages manifest symptoms of PTSD while  exposure  to traumatic events other than piracy  occurs  more often  than  presumed since seafarers deal with many stressors onboard  (Idnani, C.,  2012).   Post-traumatic stress disorder is a serious condition that negatively impacts the individual’s functioning,  and has profound effects on cognitive processes such as  memory, emotional regulation, biological stress modulation and interpersonal relations.




 Preventive psycho-educational interventions, stress reduction programs  and critical incident interventions can act as protective mechanisms or resources  to  decrease the  risk of developing  post-traumatic stress disorder.



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