A disaster like the tsunami that struck the coasts of India on December 26 has unfathomable psychological effects on the victims. Most of them, especially children, suffer from post-traumatic stress disorder.

What exactly is PTSD? Ehtasham Khan talked to Dr P S Das, Senior Consultant Psychiatrist of Max Healthcare, to know more about it.

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PTSD is characterised by 1) Re-experiencing of the trauma in the form of dreams and waking thoughts, 2) Emotional numbing to other life experiences and relationships, and 3) Symptoms of autonomic instability, depression and cognitive difficulties (such as poor concentration).

Recently, there have been many discussions in the media about tsunami and PTSD. What probably requires more attention is the catastrophic effect it has had on children, adolescents and the elderly.

As might be expected, the prevalence of PTSD is higher in children than in adults exposed to the same stressor. In certain situations up to 90% of children will develop the disorder. In general, PTSD has been underestimated in children and adolescents.

The very young and the very old have more difficulty coping with traumatic events than the middle-aged. Presumably young children do not yet have the coping mechanisms to deal with such immense physical and emotional trauma.

Likewise, old people are likely to have more rigid coping mechanisms and, hence, will be less able to muster a flexible approach to deal with the effects of the trauma.

Child risk factors include demographic factors, age, sex, socio-economic status, negative life events, social and cultural cognitions and inherent coping strategies.

Parents' responses to traumatic events particularly influence young children who may not completely understand the nature of the trauma. Children also suffer as the result of 'indirect' exposure, that is the un-witnessed death or injury of a loved one, as in situations of tsunami.

Children, like adults, re-experience the traumatic event in the form of distressing intrusive thoughts or memories, flashbacks and dreams.

Children's nightmares may be linked specifically to a trauma theme or may be generalised to other fears. Flashbacks occur in children as well as adolescent and adult victims. 'Traumatic play', a specific form of re-experiencing seen in young children, consists of repetitive acting out of the trauma or trauma-related themes in play.

Older children may incorporate aspects of the trauma into their lives in a process termed re-enactment. Fantasised actions of interventions or revenge are common; adolescents should be considered at increased risk of impulsive acting out.

Related behaviours in child and adolescent victims of trauma include sexual acting out, substance abuse, and delinquency. Children often withdraw and show reduced interest in previously enjoyable activities. Regressive behaviours, such as enuresis or fear of sleeping alone, may occur.

The management of problems of such magnitude is never easy or adequate.

Treatments include medication for anxiety, phobia, depression, and aggression usually in combination with psychotherapy. In some cases reconstruction of traumatic events with associated abreaction and catharsis may be therapeutic, but psychotherapy must be individualised.

Psychotherapeutic interventions include behaviour therapy, cognitive therapy and hypnosis. Many clinicians advocate time limited psychotherapy, minimising the risk of dependence and chronicity.

Two approaches can be taken to treat PTSD. The first is the exposure to the traumatic event through imaging techniques or in-vivo exposure. The exposures can be intense or graded. The second approach is to teach the patient methods of stress management, including relaxation techniques and cognitive approaches to cope with the stress.

However, curing PTSD may not be enough to restore the happiness in the lives of the victims, who have lost loved ones, homes, jobs and have been orphaned, crippled and maimed.