The early pattern of distress that points to long-term problems is poorly known. This means PTSD is often under-diagnosed or missed in a medical or surgical outpatient setting, or crisis relief station. Probable early signals of PTSD are depression; recurring memories or flashbacks of the event; patterns of agitation and anxiety, or disordered arousal, such as difficulty falling or staying asleep, panic attacks, irritability or outbursts of anger or hypervigilance; and the extent of disassociation (a psychological method of coping) during the accident. Also common is that soon after the traumatic event the person starts suffering from "emotional anaesthesia" - decreased ability to have affectionate feelings towards others.
In South Africa in 1993 violence has become an integral part of every day life due to the plethora of political killings, revenge slayings and murder by criminals. A form of continuous traumatic stress has been described.
Humanitarian agencies report many new cases of cancer, multiple sclerosis and diabetes in Bosnia, which were possibly provoked by the trauma of war. Nearly one third of the population are judges to be suffering from post-traumatic stress disorder.