RIYADH, 6 June 2004 — Dr. Khaled Al-Zaid, head of psychiatry in the department of neurosciences at King Faisal Specialist Hospital, said most people who experience trauma — such as the survivors of the Alkhobar attacks — suffer from problems such as anxiety, sleep difficulties and repeated nightmares.

These are all part of a condition known as Post Traumatic Stress Disorder (PTSD). In the aftermath of any tragedy, survivors may also experience feelings of isolation and unreasonable guilt with some experiencing paranoia and panic attacks. Physical symptoms of PTSD include occasional and unexplained chest pain or palpitations and trouble breathing. Although symptoms usually develop within three months of the trauma and last for three months, they could develop years later and last longer in some individuals.

“Few will experience long-term problems,” said Dr. Al-Zaid. How a person responds to trauma depends on many factors, including the intensity of the trauma and how close a person was to the actual event causing the trauma.

In the case of the Alkhobar attacks, some residents only heard shots from a distance while others had face-to-face encounters with one or more of the terrorists or with a murdered victim and would likely have suffered greater emotional distress. A prior history of depression, abuse or trauma may also increase the risk of PTSD.

According to Dr. Al-Zaid, the main symptoms of PTSD include reliving the trauma through memory. These recurring “flashbacks” may interfere with normal activity and lead to a temporary psychosis in which the line between memory and reality becomes indistinct.

Some survivors distance themselves from the physical location of the trauma, he said, and from situations that trigger memories. Others may become hyper vigilant and constantly fear for their safety. According to Dr. Al-Zaid, those who need professional help may be hesitant about seeing a mental health expert because of the stigma sometimes associated with mental illness.

“Talking to someone does not mean a person is ‘mentally ill,’” he said. A professional is especially trained to address the problem, he added, and will be able to provide the necessary care.

PTSD may also influence children. “Children are very resilient but a significant part of their response is related to how parents respond; if the parents are disturbed, the children may be disturbed as well,” said Dr. Al-Zaid.

Some children with PTSD may try to reenact the traumatic event in their play. According to UNICEF, PTSD is a “psychological wound” that hinders a child’s normal development; in children under three, severe trauma can permanently alter brain chemistry.

Dr. Al-Zaid encourages parents to talk to children about the traumatic event but to be cautious in doing so. The best way is to start where the child wants to start and to entertain questions, he added. “Parents have to take into consideration the fact that children have needs as well. Whereas parents can tap into a support system of friends and family, children do not have the resources or the means to find similar support.”

Sometimes it can be difficult to understand the needs of someone suffering from PTSD, which can cause complex emotional responses, such as “survivor guilt.”

Dr. Al-Zaid explained, “If 40 people were taken hostage and three were killed, some of those who escaped might feel guilty. This is not rational but it is normal.” He added that those who would like to comfort survivors should be aware of this sense of guilt. Some survivors may also become emotionally numb, requiring patience on the part of friends and family. “Don’t devalue their experience,” said Dr. Al-Zaid. “You might not be able to say anything specific that can make things better.”

People can offer comfort by non-verbal communication, he said, by simply spending time with loved ones and listening to them talk. It is important to let survivors know that they are not alone and have someone they can trust and turn to for help if needed. “When we see them crying, it makes us uncomfortable and we want to say something to make them stop. Sometimes, however, the best thing is just to sit with them and watch them cry.”