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A 28-year-old woman, who had an experience of hyperventilation at age 17 years, was struck by the Indian Ocean Tsunami during her stay in the Indonesian island of Sumatra on 26 December 2004. She and her boyfriend were lashed around, and she was floating on the surface of the water. Only she was rescued, and was flown back home 7 days after the disaster. When she was transported to Juntendo University Hospital, Tokyo, Japan, she was suffering from severe insomnia and nightmares, and experienced strong feelings of fear and anxiety. She often became tearful. She suffered a compound fracture of the right fourth finger. Head computed tomography and electroencephalography showed no abnormalities.

At 10 days after the disaster, she was evaluated using the Acute Stress Disorder Interview prepared based on the 4th edition of the Diagnostic and Statistical Manual (DSM-IV). Although the criteria were not fully satisfied, one symptom of dissociation, three symptoms of re-experiencing, and three symptoms of arousal were observed. Score of other scales were as follows: Impact of Event Scale-Revised (IES-R), 22; Hamilton Depression Scale (HAM-D), 21; Hamilton Anxiety Scale (HAM-A), 13. Although she worried about the fate of her boyfriend, she had strong feelings of relief from meeting her family. An operation on her fracture succeeded. At 25 days after the disaster, score of HAM-D and HAM-A decreased to 9 and 6, respectively. However, she had feelings of guilt and shame that only she had survived. At 40 days after the disaster, IES-R, HAM-D, and HAM-A were 24, 11, and 4, respectively. She began to accept his death, and was discharged. The Rorschach Test suggests that her original personality tendency is to over-adapt. At 60 days after the disaster, the authors performed an evaluation using the Clinician-Administered post traumatic stress disorder (PTSD) Scale, prepared based on the DSM-IV. Although the PTSD criteria were not satisfied, there were two re-experience symptoms, three avoidance symptoms, and three symptoms of increased arousal (a total score of 22). Her survivor’s guilt was improved 6 months after the disaster. Her grief gradually disappeared after her boyfriend’s body was found and his funeral was held 10 months after the disaster.

Despite promoting factors for PTSD, such as female gender, anxious personality tendency, and the presence of survivor’s guilt, she did not develop PTSD from acute stress symptoms. Inhibiting factors for PTSD1 such as strong family bonds, not fully satisfying the Acute Stress Disorder criteria, no persistent symptoms of dissociation, no physical after-effects remained, early intervention of psychiatrist, and immediate transportation to Japan, may have contributed to underdevelopment of PTSD. With regard to time course factors, there was no improvement in scores of IES-R and HAM-D between 25 days and 40 days after the disaster. An explanation can be made that the period 40 days after the disaster was from the rebound period to the disillusionment period, during which the patient faced realistic problems including her boyfriend’s death.

REFERENCES

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  • 1
    Altindag A, Ozen S, Sri A. One-year follow-up study of posttraumatic stress disorder among earthquake survivors in Turkey. Compr. Psychiatry 2005; 46: 328333.