4. Children's Emotional Response to Disaster

4.2. Psychological Trauma

Historically, humanitarian organizations working on mental health of children in disasters and other humanitarian emergencies often focused on the effects of ‘trauma’ and particular on post-traumatic stress disorder (PTSD). However, more recently, specialists and practitioners agree that it increasingly is essential not to assume that all children in an emergency are traumatized. In the short term most children show some changes in emotions, thoughts, behavior and social relations. The majority of children will regain normal functioning with access to basic services, security and family and community-based support. Only a smaller number of children showing persistent and more severe signs of distress are likely to be suffering from more severe mental disorders, including post-traumatic stress, and require focused clinical attention. In general, it is recommended not to use trauma terminology outside of a clinical context in order to avoid a focus on traumatic stress disorders at the expense of other mental health and psychosocial problems. See Table 1.

Table 1. Appropriate Terminology to Use with Children and Youths in Clinical and Non-Clinical Settings in Conflict and Disaster Situations

Examples of recommended terms
Can be used in place of terms to the right		 Examples of terms that are not recommended
Not recommended outside clinical settings
Distress or stress
Psychological and social effects of emergencies		 Trauma
Reactions to difficult situations
Signs of distress		 Symptoms
Distressed children
Children with normal reactions to the emergency

Severely distressed children
Children with extreme/severe reactions to the emergency		 Traumatized children
Psychosocial well-being or mental health
Structured activities		 Therapy
Terrifying events Traumatic events

Source: Jones (2008)

The most frequent childhood disorders following a disaster are in the areas of anxiety, mood, and behavior.

Although grief is not a mental disorder, it may require or benefit from professional attention, especially if it is prolonged longer than 6 months, unusually severe with an inability to return to normal function or complicated by an emotional disorder such as depression or PTSD. The proposed ICD-11 contains a separate diagnosis for prolonged grief disorder, characterized by persistent and severe yearning for the deceased, and associated with difficulty accepting the death, feelings of loss of a part of oneself, anger about the loss, guilt or blame regarding the death, or difficulty in engaging with new social or other activities due to the loss. To meet diagnostic criteria, the symptoms need to persist beyond 6 months after the death and lead to functional disturbance. Traumatic deaths are of particular concern for precipitating severe grief reactions in disasters.

Five factors that increase the risk of “traumatic grief” are:

  • Sudden, unanticipated deaths.
  • Deaths involving violence, mutilation, and destruction.
  • Deaths that are perceived as random or preventable, or both.
  • Multiple deaths.
  • Deaths witnessed by the survivor that are associated with a significant threat to personal survival or a massive or confrontation with death and mutilation.

The most frequent childhood disorders following a disaster are in the areas of anxiety, mood, and behavior (Box 2). These disorders are reviewed below.

BOX 2. Most common emotional disorders in the childhood population exposed to disaster (ICD-10)

  • Severe stress reaction and adaptive disorders (F43)
  • Acute stress reaction and post-traumatic stress disorder (F43.1)
  • Depressive episode (F32) and recurrent depressive disorder (F33)
  • Separation anxiety disorder of childhood (F 93.0),
  • Phobic anxiety disorder of childhood (F93.1),
  • Social anxiety disorders of childhood (F93.2)
  • Conduct disorder confined to the family context (F91)