PTSD and Natural Disasters: Symptoms of Psychological Trauma following Earthquakes
Emotional well-being depends on a nurturing environment that ensures consistent basic material and emotional necessities.
Natural or man-made disasters (such as civil war or genocide) can cause terrible personal loss, injuries and illness, and loss of vital resources.
While the survivors of such tragedies may recover from their physical injuries, the emotional damage may be permanent.
Dr. Pynoos studied the effect on 231 children from three cities at increasing distances from the devastating earthquake that occurred in Armenia in 1988.
Following 18 months of the event, children suffered frequently from “severe post-traumatic stress reaction” correlating with the proximity to the quake epicenter (The British Journal of Psychiatry (1993): 163).
The authors concluded from their research that after catastrophic natural disaster, PTSD in children may reach epidemic proportions, remain high for a long period, and jeopardize the well-being of large segments of the populations in earthquake affected areas.
In an article published in the Journal International Social Work (Vol. 52, 2009), Taghi Doostern showed that following the 2003 earthquake in the Iranian city of Bam, children’s grief and distress was compounded by the following adverse elements:
- Loss of family members, homes and communities
- Lack of access to information regarding the well-being of family members
- Uncertainty about the future
There have been several other longitudinal studies investigating the prevalence of PTSD years after other famous natural disasters:
- A prospective study of firefighters after the 1983 Australian bushfires reported rates of PTSD of 30% after 30 months (MacFarlane. J Nerv Ment Dis, 1988)
- A 14 year follow-up on survivors of the 1972 Buffalo Creek flood showed a 28% prevalence of PTSD (Green. Am J Orthopsychiatry, 1990)
- Duggan and Gunn, reporting on adults exposed to an array of different disasters, found the frequency of PTSD of 39% within the first year of the event and falling to 23% after 26 months (British J Psychiatry (1995): 167)
PTSD appears to persist with equal voracity and frequency in other groups of extremely traumatized individuals.
- Aggravated assault victims:10.5% prevalence after 10 years
- Rape victims: 16.5% prevalence after 17 years
- Vietnam Veterans: 15% prevalence after 20 years
- POWs held by the Japanese: 85% lifetime and 59% current prevalence after 40-50 years
During the war in Bosnia and Herzegovina, a study by Nadezda Savjak showed a 42% risk of PTSD amongst the displaced population in comparison to 26.7% for domiciled persons exposed to similar war traumas.
In this study of the civil war in the Balkans, the death of a loved one or physical injury was significantly magnified amongst those individuals who were displaced (Trappler, B., “Modern Terrorism and Psychological Trauma” published by R. Altschuler and Associates, 2007).
This confirms the findings by other investigators that displacement, which represents an accumulative effect of material, psychological, and social loss, is strongly associated with persistent PTSD symptoms among refugees who survive civil war and genocide (PTSD Among Cambodian Refugees in New Zealand, Cheung, 1994).
Since reports suggest that PTSD is most intense and enduring in victims exposed to extreme violence, Goenjian and colleagues compared two groups of adults:
One group had been exposed to a severe earthquake and the other to extreme violence.
78 non-treatment-seeking Armenians were assessed 1.5 years and again 4.5 years following the 1988 Spitak earthquake in Armenia and the 1988 pogroms against Armenians in Azerbaijan (Am J Psychiatry June 2000: 157).
The rationale behind the study was that in both genocide and natural disasters, individuals experience loss of loved ones, displacement, medical injuries, and material loss.
Beginning in February 1988, pogroms were perpetrated against the Armenians. In Sumgait, the most terrorized city, survivors had witnessed murder, looting, and destruction of property.
In Gumri, the second largest city in Armenia, 50% of the buildings were destroyed and 90% severely damaged.
7% of the population (280,000 people) died.
Following the initial devastating earthquake, survivors were subject to unremitting stress in the form of impoverished and crowded living conditions, and lack of basic necessities such as food, heat, electricity, clothes and medicine.
The distinction between PTSD symptoms among Gumri residents (exposed to extreme earthquake trauma) or Sumgait residents (exposed to severe violence) was not in the severity of symptoms, but in their unique profile attributed to the specific trauma experienced.
The flashbacks and trauma recollections experienced by the earthquake victims were dominated by the vivid visual imagery they had experienced. During the earthquake they had heard screams of trapped individuals, and had witnessed friends, neighbors, or family members burned or trapped under collapsed buildings.
In terms of trauma triggers, those exposed to the earthquake recalled how destroyed buildings, shoddy homes, and absence of family members served as trauma reminders.
For the survivors of pogroms, news reports of violence and war functioned as trauma triggers.
The disturbing outcome of this study was that survivors of extreme trauma, caused either by violence or natural disaster, showed persistence of their PTSD symptoms when revisited three years after the initial study.
Traumatized populations remain vulnerable to persistent PTSD symptoms when they are displaced.
There are several possible explanations for traumatogenic effect of displacement:
- “Empty situations,” posed by the sense of an absence of personal location, deprive the victim of a safe “holding environment” necessary for the recovery process.
- These secondary adversities, caused by displacement, function as a barrier to the effort required in “processing” the trauma of personal loss.
The immediate emphasis of rescue functions following war, terrorism, and natural disasters is to provide survivors with food, shelter, medical treatment, and communication with significant others.
The structural devastation of the earthquake in Haiti may become the most significant long-term post-disaster factor determining psychological well-being.