**5.7.7 Coping when angry (Asked only of the older children ages 9 through 17)**

Thirty-four of 51 youngsters (66%) reported using specific strategies when angry and for most the strategies worked. However, 1 teen coped very poorly. He would cry and then he thought of running in front of a car. One child reported that he did not get angry. Fifteen reported doing nothing when angry. For 1 child the coping approaches were unknown. For the young people who used strategies there were several approaches to coping:


Post Traumatic Stress Disorder – A Northern Uganda Clinical Perspective 203

selection procedure it is possible that the results of this study are skewed toward the mental health needs of participants who were willing to participate in the study. We are aware that our results might not apply to the general population of children and adolescents in northern Uganda generally. However we endeavoured to ensure that participant selection was unbiased and that our findings could form a reasonable basis for further research into

The professional management of post-traumatic disorder in northern Uganda has taken advantage of the special social and cultural situation of the communities in the region. In general, the principles of PTSD management follow the general ones of any psychiatric disorder but with particular emphasis on preventing re-traumatisation and aimed to

Most individuals who suffer from PTSD will a) present with symptoms that will not suggest the condition b) come to the health unit late and or c) present to health facilities with physical complications of traumatic experiences. Typically patients will present with multiple somatic and vegetative or psychotic symptoms, behavioural problems (children and adolescents), or symptoms of alcohol or other drug abuse. An adequate assessment of PTSD is made on suspicion of the presence of the condition at all times and progresses through three related stages. Firstly the process and type of assessment is thus influenced by the patient's residential address; circumstances in which the individual lives; and history, timing and type of trauma. There are various types of traumatic events but these can be categorised as either individual (e.g. car-accident, rape, etc) or group (e.g. landslides, floods, war-trauma, volcanic eruptions, plane crashes, rebel attacks, etc). It also depends on the severity of injuries sustained, some of which may be life threatening or at other times minor, e.g. slaps. Secondly assessment aims to determine the nature of traumatic event, and as to when the trauma occurred. PTSD can be acute (including Acute Stress Disorder, PTSD), chronic or delayed. Complex PTSD involves the exposure of the individual to multiple and complex patterns of trauma that are often repeated and or prolonged leading to changes in the victim's personality and general behaviour. Acute PTSD (including acute stress disorder) calls for immediate treatment and sometimes rescue operations e.g. in volcanic eruption, in war or terrorist attacks. Thirdly, assessment aims to determine the need for

Immediate intervention is contemplated during the acute phase or shortly after exposure to a traumatic event. Immediate intervention is provided based on the principles of crisis

a. *Assessing risk factors for post-traumatic stress disorder:* Several risk factors for posttraumatic stress disorder have been documented including criminal assault, political detention and torture, rape, childhood physical abuse (Kaimer et al, 2009); acute posttraumatic stress disorder and the presence of premorbid and comorbid psychopathology (Koren et al, 1999); age at first experience of traumatic experience, severity of traumatic experience and availability of social support after traumatic

the mental health needs of children and adolescents in post-conflict settings.

promote psychosocial functioning within the individual's social milieu.

**7. Management of post-traumatic stress disorder** 

**7.1 Principles of assessment** 

immediate intervention.

**7.2 Immediate treatment** 

intervention.
