According to data from the German Federal Chamber of Psychotherapists, about 40% of the asylum-seekers entering Germany suffer from post-traumatic stress disorder (PTSD). The prevalence of this condition stems from the experience of a huge number of stressful and traumatic events they experienced a.) in their homeland, under the conditions of war, violence, poverty and various kinds of deprivation and b.) during their flight to a safer country, including harassment, stigmatization and persecution.
Commemorating the World Refugees Day on June 20th, that was installed by the United Nations General Assembly in 2001, the Federal Chamber of Psychotherapists released a press statement demanding amends in the treatment of refugees seeking asylum in Germany.
Post-traumatic stress disorder is one of the few mental disorders where the influence of an external life event by definition is a causal (or etiological) factor for developing the disorder. Symptoms include hyperarousal, hyper-vigilance, impaired memories of the traumatic event while at the same time experiencing intrusive memories of certain aspects, to the point of full-blown flashbacks.
Etiological models of PTSD state that the intensified neurobiological stress reaction during the traumatic situation impairs the encoding of episodic memory aspects, which later on leads to an impaired memory recall. As a result, in certain situations affected people aren’t able to distinguish between the memory of the past traumatic event and the perception of a present situation. When triggered, they repeatedly feel caught in the perception of an immediately impending thread, just as it was during their traumatic experience, again and again during their everyday life. This means that even when these people escaped the lifethreatening situations they experienced, the terror of fearing for their life stays in their minds, not just as a memory, but as actually present.
As the research of Neuner and colleagues shows, there is a strong connection between the number of experienced traumatic event types and the development of PTSD symptoms. In a sample of West Nile Refugees, they found that while 23% people reporting three or less traumatic events types developed an PTSD, it was 100% of the people who reported 28 or more traumatic event types showed the symptoms of the disorder. Therefore they conclude: (…) if the cumulative exposure to traumatic events is high enough, these results indicate that anybody will develop chronic PTSD. We conclude that there is no ultimate resilience to traumatic stress (…). In other words: The development of this mental illness for these people does not depend on any individual factors as their growing up or mental state. At some point, experiencing too many of these kind of situations WILL lead to the onset of this illness.
These findings are of high relevance especially in the context of refugees escaping from war zones, as they are most probable to have been exposed to a variety of different types of traumatic events (violence, persecution, witnessing of killed or dying people, assaults, rape, and others).
Sources & further literature:
Gäbel, U., Ruf., M., Schauer, M., Odenwald, M. & Neuner, F. (2006). Prävalenz der Posttraumatischen Belastungsstörung (PTSD) und Möglichkeiten der Ermittlung in der Asylverfahrenspraxis (Prevalence of Posttraumatic Stress Disorder among asylum seekers in Germany and its detection in the application process for asylum). Zeitschrift für Klinische Psychologie und Psychotherapie, 35 (1), 12-20.
Neuner, F., Schauer, M., Karunakara, U., Klaschik, C., Robert, C. & Elbert, T. (2006). Psychological trauma and evidence for enhanced vulnerability for posttraumatic stress disorder through previous trauma among West Nile refugees. BMC Psychiatry, 4 (34), full text availiable online
Spiegel: Gewalt in Flüchtlingsheimen: Traumatisiert und eingepfercht (German article describing the tensions in asylum-seeker camps due to their mental strass and acommodation conditions)
Spiegel: Therapie für traumatisierte Asylbewerber: „Ich kann leider nichts für Sie tun“ (German article dealing with the extremely limited possibilites to treat traumaticed asylum-seekers)
Is the Ugly German Back? Flames of Hate Haunt a Nation (English article on the violence attacks on asylum-seeker camps and shelters.
Refugees and asylum-seekers are an incredibly vulnerable population, escaping from circumstances that not only threatened their physical but also their mental health. This has to be considered in the procedures and treatments they receive when looking for a safe place to stay.