Caught in the crossfire of terrorism

I received an e-mail regarding an article I wrote on coping with disaster:

Doc, I read your article entitled ‘Coping after a disaster.’ In Mindanao and here in our city of Zamboanga, bombs have exploded many times already. We are not coping after a disaster. We are now coping with surviving each day without any threat, especially our children and students and small vendors. Stress, anxiety, confusion and depression are all here. After a bomb explosion, our town experienced acute stress disorder, trauma, and it led to Post Traumatic Stress Disorder (PTSD). I believe, especially with our students, it will destroy their concentration in their studies. Our town now is free from those series of bomb explosions. But the fear lingers amongst our people.

It is disheartening that many of our countrymen and their children in Mindanao are trapped in a situation that continuously threatens their lives. This picture is multiplied in other parts of the world.

Frequent international trimedia coverage of terrorism may result in the perpetuation of a sense of extreme danger among youngsters with prior traumatic terrorism exposure. Terrorist attacks may be conceived [1] to create an atmosphere of extreme danger and fear in the community; [2] to cause personal harm and destruction of property, and [3] to instill the perception that the state may fail to protect its citizens.

The reactions of children and adolescents to exposure to terrorism may be influenced by the following factors: [1] how their parents and other significant adults cope with the traumatic event and the resulting turmoil, [2] how they understand the situation, [3] how they appraise the persisting danger, [4] how they appraise the possibility of recurrent attacks and [5] how they perceive the relative safety of their family and friends. 

A study of adolescents with PTSD with terrorism experience showed that: [1] prior history of anxiety, [2] recent personal exposure to terrorism and [3] past personal life threatening situations led to the development of symptoms of PTSD. The study also disclosed that adolescents with learning disability who have difficulty in comprehension and in processing such traumatic events were high risks and more vulnerable to develop PTSD. 

The psychological disorders that may be associated with terrorism include acute stress disorder, PTSD, depression, anxiety, separation anxiety disorder, agoraphobia (fear of open places), phobic disorders, bereavement, somatization, irritability, dissociative reactions, sleep disturbances, diminished self-esteem, deterioration in school performance, distress when exposed to traumatic reminders and substance abuse.

There are three components of mechanisms for the recovery from exposure to terrorism namely: perception of safety, reestablishment or maintenance of daily routines and proactive interventions to enhance resilience. The concept of perceived safety is believed to be an essential protective factor and also as a component of recovery for an individual.

The youngsters’ perception of personal resilience is protective against symptoms of PTSD. Proactive interventions focused on enhancing a sense of personal resilience and an ability to cope with stressors in the environment will decrease the risk of psychiatric symptoms after experiencing an act of terrorism. To cope well, they should regain a sense of perceived safety by reestablishing daily routines, do altruistic tasks for family, barangay, school and community. There should also be parental expression on safety.

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Congratulations to the new doctors of UP College of Medicine Batch 2008 and 2008 Postgrad Interns of the Philippine General Hospital; Dr. Madge Elloso of Xavier University and to my nephew, Dr. Amelito Halili Perfecto Jr. of UERM.

Congratulations to the UP College of Medicine Physiology team for winning third place in the 6th Intermedical Physiology Quiz held last Aug. 22 to 23 at the University of Malaysia in Kuala Lumpur namely Percy Balderia, Eugene Odono and Carol Stephanie Tan and to their team coach, Dr. Elizabeth Montemayor.

The 5th Post Graduate Course of UP PGH Dept. of Psychiatry and Behavioral Medicine entitled “BABAE” will be held on Oct. 23 at the PGH Dietary Function Room. Call 525-0803. 

(E-mail me at nina.halilijao@gmail.com)