**5.2 PTSD due to earthquake occurred in children and teens**

Children and teens can have extreme reactions to the trauma of earthquake, but their symptoms may not be the same as adults as discussion above. In very young children, these symptoms can include:


Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a

Hyperarousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic event. They can make the person feel stressed and angry. These symptoms may make it hard to do daily tasks, such as sleeping, eating, or

The emotional numbing of PTSD may present as a lack of interest in activities that used to be enjoyed (anhedonia), emotional deadness, distancing oneself from people, and/or a sense of a foreshortened future (for example, not being able to think about the future or make future plans, not believing one will live much longer). At least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyperarousal symptoms must be present for at least one month and must cause significant distress or functional impairment in order for the diagnosis of PTSD to be assigned. PTSD is considered of chronic duration if

It's natural to have some of these symptoms after a dangerous earthquake. However, not everyone who lives through an earthquake gets PTSD. In fact, most will not get the disorder. On the contrary, not everyone with PTSD has been through a dangerous earthquake. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, they might be PTSD. Some people with PTSD don't show any

Most practitioners who examine a child or teenager for PTSD will interview both the parent and the child, usually separately, in order to allow each party to speak freely. Interviewing the child in addition to the adults in his or her life is quite important given that while the child or adolescent's parent or guardian may have a unique perspective, there are naturally things the young person may be feeling that the adult is not aware of. Another challenge for diagnosing PTSD in children, particularly in younger children, is that they may express their

Children and teens can have extreme reactions to the trauma of earthquake, but their symptoms may not be the same as adults as discussion above. In very young children, these

bad car accident, a person who usually drives may avoid driving or riding in a car.

Having difficulty sleeping, and/or having angry outbursts.

Feeling emotionally numb

3. Hyperarousal symptoms: Being easily startled Feeling tense or "on edge"

it persists for three months or more.

symptoms for weeks or months.

symptoms differently from adults.

Forgetting how or being unable to talk

symptoms can include:

**5.2 PTSD due to earthquake occurred in children and teens** 

Bedwetting, when they'd learned how to use the toilet before

concentrating.

 Feeling strong feelings of guilt, depression, or worry Losing interest in activities that were enjoyable in the past Having trouble remembering the dangerous event.


Older children and teens usually show symptoms more like those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge. For more information, see the NIMH booklets on helping children cope with violence and disasters (http://www.nimh.nih.gov).

PTSD statistics in children and teens reveal that up to more than 40% have endured at least one traumatic event, resulting in the development of PTSD in up to 15% of girls and 6% of boys. Three to six percent of high school students in the United States, and as many as 30%- 60% of children who have survived specific disasters develop PTSD (http://www.nimh.nih.gov). Up to 100% of children who have seen a parent killed or endured sexual assault or abuse tend to develop PTSD, and more than one-third of youths who are exposed to community violence (for example, a shooting, stabbing, or other assault) will suffer from the disorder.

#### **5.3 Causes of PTSD due to earthquake**

Virtually any trauma, defined as an event that is life-threatening or that severely compromises the physical or emotional well-being of an individual or causes intense fear, may cause PTSD. Such events often include either experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the victim of kidnapping or torture, exposure to war combat or to a natural disaster, exposure to other disaster (for example, plane crash) or terrorist attack, being the victim of rape, mugging, robbery, or assault, enduring physical, sexual, emotional, or other forms of abuse, as well as involvement in civil conflict. Although the diagnosis of PTSD currently requires that the sufferer has a history of experiencing a traumatic event as defined here, people may develop PTSD in reaction to events that may not qualify as traumatic but can be devastating life events like divorce or unemployment.

#### **5.4 Risk factors and protective factors for PTSD due to earthquake**

Issues that tend to put people at higher risk for developing PTSD include increased duration of a traumatic event, higher number of traumatic events endured, higher severity of the trauma experienced, having an emotional condition prior to the event, or having little social support in the form of family or friends. In addition to those risk factors, children and adolescents, females, and people with learning disabilities or violence in the home seem to have a greater risk of developing PTSD after a traumatic event.

While disaster-preparedness training is generally seen as a good idea in terms of improving the immediate physical safety and logistical issues involved with a traumatic event, such training may also provide important preventive factors against developing PTSD. That is as evidenced by the fact that those with more professional-level training and experience (for example, police, firefighters, mental-health professionals, paramedics, and other medical professionals) tend to develop PTSD less often when coping with disaster than those without the benefit of such training or experience.

There are medications that have been found to help prevent the development of PTSD. Some medicines that treat depression, decrease the heart rate, or increase the action of other

Earthquake and Mental Health 223

other sleep problems have been found to be particularly helpful in decreasing the sleep

Medications that are usually used to help PTSD sufferers include serotonergic antidepressants (SSRIs), like fluoxetine, sertraline, and paroxetine, and medicines that help decrease the physical symptoms associated with illness, like prazosin, clonidine, guanfacine, and propranolol. Individuals with PTSD are much less likely to experience a relapse of their illness if antidepressant treatment is continued for at least a year. SSRIs are the first group of medications that have received approval by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD. Treatment guidelines provided by the American Psychiatric Association (Tori DeAngelis,2008) describe these medicines as being particularly helpful for people whose PTSD is the result of trauma that is not combat-related. SSRIs tend to help PTSD sufferers modify information that is taken in from the environment (stimuli) and to decrease fear. Research also shows that this group of medicines tends to decrease anxiety, depression, and panic (http://www.nimh.nih.gov). SSRIs may also help reduce aggression, impulsivity, and suicidal thoughts that can be associated with this disorder (http://www.nimh.nih.gov). For combat-related PTSD, there is more and more evidence that prazosin can be particularly helpful. Although other medications like duloxetine, bupropion, and venlafaxine are sometimes used to treat PTSD, there is little research that

Other less directly effective but nevertheless potentially helpful medications for managing PTSD include mood stabilizers like lamotrigine, tiagabine, divalproex sodium, as well as mood stabilizers that are also antipsychotics, like risperidone, olanzapine, and quetiapine. Antipsychotic medicines seem to be most useful in the treatment of PTSD in those who suffer from agitation, dissociation, hypervigilance, intense suspiciousness (paranoia), or brief breaks in being in touch with reality (brief psychotic reactions). The antipsychotic medications are also being increasingly found to be helpful treatment options for managing

Benzodiazepines (tranquilizers) such as diazepam and alprazolam have unfortunately been associated with a number of problems, including withdrawal symptoms and the risk of overdose, and have not been found to be significantly effective for helping individuals with

Our study, "posttraumatic stress disorder in orphans caused by Tangshan earthquake", investigated the morbidity of posttraumatic stress disorder in orphans caused by Tangshan earthquake. Fifty-seven orphans were surveyed using the criteria of Acute Stress Reaction (ASR) and PTSD in Chinese Classification and Diagnostic Criteria for Mental Disorders, the Second Revised Edition. The Self-rating Anxiety Scale, Symptom Checklist 90 (SCL-90), and Minnesota Multiphasic Personality Inventory were used to assess morbidity related to the Tangshan earthquake between the orphans with PTSD and respondents without-PTSD. Twenty seven (47%) cases were diagnosed as ASR and 13 (23%) cases were diagnosed as PTSD among 57 orphans. The orphans caused by Tangshan earthquake may be in the high

Another study, "Life Style and Psychosomatic Health in Paraplegic Suffers of Tangshan Earthquake", investigated the relationship between life style and psychosomatic health of paraplegic suffers of Tangshan earthquake. Paraplegic suffers of Tangshan earthquake in a rehabilitation community (RC) and in a paraplegic hospital (PH) were tested with self

problems associated with PTSD.

has studied their effectiveness in treating this illness.

PTSD when used in combination with an SSRI.

PTSD [Roxanne Dryden-Edwards,2011].

risk to develop to PTSD.

body chemicals are thought to be effective tools in the prevention of PTSD when given in the days immediately after an individual experiences a traumatic event.

### **5.5 Treatment for PTSD due to earthquake**

Treatments for PTSD usually include psychological and medical interventions. Providing information about the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms of PTSD, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness. Education of PTSD sufferers usually involves teaching individuals about what PTSD is, how many others suffer from the same illness, that it is caused by extraordinary stress rather than weakness, how it is treated, and what to expect in treatment. This education thereby increases the likelihood that inaccurate ideas the person may have about the illness are dispelled, and any shame they may feel about having it is minimized. This may be particularly important in populations like military personnel that may feel particularly stigmatized by the idea of seeing a mental-health professional and therefore avoid doing so.

Teaching people with PTSD practical approaches to coping with what can be very intense and disturbing symptoms has been found to be another useful way to treat the illness. Specifically, helping sufferers learn how to manage their anger and anxiety, improve their communication skills, and use breathing and other relaxation techniques can help individuals with PTSD gain a sense of mastery over their emotional and physical symptoms. The practitioner might also use exposure-based cognitive behavioral therapy by having the person with PTSD recall their traumatic experiences using images or verbal recall while using the coping mechanisms they learned. Individual or group cognitive behavioral psychotherapy can help people with PTSD recognize and adjust traumarelated thoughts and beliefs by educating sufferers about the relationships between thoughts and feelings, exploring common negative thoughts held by traumatized individuals, developing alternative interpretations, and by practicing new ways of looking at things. This treatment also involves practicing learned techniques in real-life situations.

Eye-movement desensitization and reprocessing (EMDR) is a form of cognitive therapy in which the practitioner guides the person with PTSD in talking about the trauma suffered and the negative feelings associated with the events, while focusing on the professional's rapidly moving finger. While some research indicates this treatment may be effective, it is unclear if this is any more effective than cognitive therapy that is done without the use of rapid eye movement.

Families of PTSD individuals, as well as the sufferer, may benefit from family counseling, couple's counseling, parenting classes, and conflict-resolution education. Family members may also be able to provide relevant history about their loved one (for example, about emotions and behaviors, drug abuse, sleeping habits, and socialization) that people with the illness are unable or unwilling to share.

Directly addressing the sleep problems that can be part of PTSD has been found to not only help alleviate those problems but to thereby help decrease the symptoms of PTSD in general. Specifically, rehearsing adaptive ways of coping with nightmares (imagery rehearsal therapy), training in relaxation techniques, positive self-talk, and screening for

body chemicals are thought to be effective tools in the prevention of PTSD when given in

Treatments for PTSD usually include psychological and medical interventions. Providing information about the illness, helping the individual manage the trauma by talking about it directly, teaching the person ways to manage symptoms of PTSD, and exploration and modification of inaccurate ways of thinking about the trauma are the usual techniques used in psychotherapy for this illness. Education of PTSD sufferers usually involves teaching individuals about what PTSD is, how many others suffer from the same illness, that it is caused by extraordinary stress rather than weakness, how it is treated, and what to expect in treatment. This education thereby increases the likelihood that inaccurate ideas the person may have about the illness are dispelled, and any shame they may feel about having it is minimized. This may be particularly important in populations like military personnel that may feel particularly stigmatized by the idea of seeing a mental-health professional and

Teaching people with PTSD practical approaches to coping with what can be very intense and disturbing symptoms has been found to be another useful way to treat the illness. Specifically, helping sufferers learn how to manage their anger and anxiety, improve their communication skills, and use breathing and other relaxation techniques can help individuals with PTSD gain a sense of mastery over their emotional and physical symptoms. The practitioner might also use exposure-based cognitive behavioral therapy by having the person with PTSD recall their traumatic experiences using images or verbal recall while using the coping mechanisms they learned. Individual or group cognitive behavioral psychotherapy can help people with PTSD recognize and adjust traumarelated thoughts and beliefs by educating sufferers about the relationships between thoughts and feelings, exploring common negative thoughts held by traumatized individuals, developing alternative interpretations, and by practicing new ways of looking at things. This treatment also involves practicing learned techniques in real-life

Eye-movement desensitization and reprocessing (EMDR) is a form of cognitive therapy in which the practitioner guides the person with PTSD in talking about the trauma suffered and the negative feelings associated with the events, while focusing on the professional's rapidly moving finger. While some research indicates this treatment may be effective, it is unclear if this is any more effective than cognitive therapy that is done without the use of

Families of PTSD individuals, as well as the sufferer, may benefit from family counseling, couple's counseling, parenting classes, and conflict-resolution education. Family members may also be able to provide relevant history about their loved one (for example, about emotions and behaviors, drug abuse, sleeping habits, and socialization) that people with the

Directly addressing the sleep problems that can be part of PTSD has been found to not only help alleviate those problems but to thereby help decrease the symptoms of PTSD in general. Specifically, rehearsing adaptive ways of coping with nightmares (imagery rehearsal therapy), training in relaxation techniques, positive self-talk, and screening for

the days immediately after an individual experiences a traumatic event.

**5.5 Treatment for PTSD due to earthquake** 

therefore avoid doing so.

situations.

rapid eye movement.

illness are unable or unwilling to share.

other sleep problems have been found to be particularly helpful in decreasing the sleep problems associated with PTSD.

Medications that are usually used to help PTSD sufferers include serotonergic antidepressants (SSRIs), like fluoxetine, sertraline, and paroxetine, and medicines that help decrease the physical symptoms associated with illness, like prazosin, clonidine, guanfacine, and propranolol. Individuals with PTSD are much less likely to experience a relapse of their illness if antidepressant treatment is continued for at least a year. SSRIs are the first group of medications that have received approval by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD. Treatment guidelines provided by the American Psychiatric Association (Tori DeAngelis,2008) describe these medicines as being particularly helpful for people whose PTSD is the result of trauma that is not combat-related. SSRIs tend to help PTSD sufferers modify information that is taken in from the environment (stimuli) and to decrease fear. Research also shows that this group of medicines tends to decrease anxiety, depression, and panic (http://www.nimh.nih.gov). SSRIs may also help reduce aggression, impulsivity, and suicidal thoughts that can be associated with this disorder (http://www.nimh.nih.gov). For combat-related PTSD, there is more and more evidence that prazosin can be particularly helpful. Although other medications like duloxetine, bupropion, and venlafaxine are sometimes used to treat PTSD, there is little research that has studied their effectiveness in treating this illness.

Other less directly effective but nevertheless potentially helpful medications for managing PTSD include mood stabilizers like lamotrigine, tiagabine, divalproex sodium, as well as mood stabilizers that are also antipsychotics, like risperidone, olanzapine, and quetiapine. Antipsychotic medicines seem to be most useful in the treatment of PTSD in those who suffer from agitation, dissociation, hypervigilance, intense suspiciousness (paranoia), or brief breaks in being in touch with reality (brief psychotic reactions). The antipsychotic medications are also being increasingly found to be helpful treatment options for managing PTSD when used in combination with an SSRI.

Benzodiazepines (tranquilizers) such as diazepam and alprazolam have unfortunately been associated with a number of problems, including withdrawal symptoms and the risk of overdose, and have not been found to be significantly effective for helping individuals with PTSD [Roxanne Dryden-Edwards,2011].

Our study, "posttraumatic stress disorder in orphans caused by Tangshan earthquake", investigated the morbidity of posttraumatic stress disorder in orphans caused by Tangshan earthquake. Fifty-seven orphans were surveyed using the criteria of Acute Stress Reaction (ASR) and PTSD in Chinese Classification and Diagnostic Criteria for Mental Disorders, the Second Revised Edition. The Self-rating Anxiety Scale, Symptom Checklist 90 (SCL-90), and Minnesota Multiphasic Personality Inventory were used to assess morbidity related to the Tangshan earthquake between the orphans with PTSD and respondents without-PTSD. Twenty seven (47%) cases were diagnosed as ASR and 13 (23%) cases were diagnosed as PTSD among 57 orphans. The orphans caused by Tangshan earthquake may be in the high risk to develop to PTSD.

Another study, "Life Style and Psychosomatic Health in Paraplegic Suffers of Tangshan Earthquake", investigated the relationship between life style and psychosomatic health of paraplegic suffers of Tangshan earthquake. Paraplegic suffers of Tangshan earthquake in a rehabilitation community (RC) and in a paraplegic hospital (PH) were tested with self

Earthquake and Mental Health 225

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report psychosomatic health questionnaire, SCL-90, CMI (Cornell medical index) and SSRS (social support rating scale). The two groups were similar in physical injuries and mental trauma caused by the earthquake. But those in RC selected a different life style from 8 years before when RC was founded. After 8 years, those in RC had better psychosomatic health, lower SCL-90 score or CMI score. None of them had PTSD, while 6 of those remained in PH had this diagnosis. This study revealed that election of a more mature way of life is helpful to psychosomatic health of paraplegic patients caused by earthquake.
