DEFINATION Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered

by a terrifying event either experiencing it or itnessing it! Symptoms may include flashbac"s#
nightmares and severe anxiety# as ell as uncontrollable thoughts about the event!
$any people ho go through traumatic events have difficulty ad%usting and coping for a hile# but
they don't have PTSD ith time and good self-care# they usually get better! &ut if the
symptoms get orse or last for months or even years and interfere ith your functioning# you may
have PTSD!
'etting effective treatment after PTSD symptoms develop can be critical to reduce symptoms and
improve function
MUMBAI WITH PTDS
(t's not only the victims ho are suffering but even those ho atched a lot of the
drama on television# say doctors!
)*+),T,-.nbsp/ The tremors of the terror attac"s in $umbai ere felt across (ndia# ith live
television
coverage of the 01-hour carnage! The terrorists have been van2uished but the imprints that the
horrific scenes
left on people's minds have led to a sharp rise in cases of post-traumatic stress disorder (PTSD)
and
depression# say psychiatrists!
'( got my first case on 3ov 45# hen security forces ere still battling terrorists in $umbai!
Professional ethics
don't allo me to name her so all ( can say is she as having fre2uent panic attac"s and as
emotionally
numb#' city-based psychiatrist Shraboni 6hodhury told (,3S!
'(t's not that any of her relatives or friends ere in $umbai at that time! She had the attac"s %ust
by atching the
blasts and the sight of $umbai's 6hatrapati Shiva%i Terminus after the massacre!
'This is not unusual!!!individual brains have different absorbing capacities! This 74-year-old lady's
brain is
hyperactive and she# "noingly or un"noingly# as fantasising herself as one of the victims#'
said 6hodhury!
The psychiatrist said she has so far received seven cases here patients suffered from the after-
effects of last
ee"'s terror attac"s in $umbai!
',nother of my clients is a nine-year-old girl ho# after atching the terror in $umbai on
television# is suffering
from PTSD! Than"fully# it's not an acute case but the girl is so traumatised that she is unable to
sleep! 8ven if
she manages to sleep ith the help of tran2uillisers# she sha"es and a"es up in the middle of
the night due
to nightmares#' 6hodhury said!
'$y daughter is unable to concentrate on her studies! 8very time any nes about $umbai flashes
on screen#
she starts crying and as"s# '9ill the bad men (terrorists) "ill me if ( don't study and top my class:'
9e have
stopped atching nes channels due to her mental condition#' said the girl's mother!
The child is sloly recovering after rigorous counselling sessions and medication# said
6hodhury!
Psychiatrist (ndra%it Sengupta too has received four patients suffering from PTSD since the 3ov
40 terror stri"es
in $umbai!
', young engineer came to me $onday ith the complaint that he is becoming hypervigilant#
hich is alays
thin"ing a danger may erupt anytime and hence being alert and getting easily startled! ;e had
remained glued
to the television set throughout the terror drama in $umbai! (t is a case of PTSD#' Sengupta told
(,3S!
;oever# not all people psychologically affected by the $umbai attac"s are illing to ta"e
medical help!
8very time 5<-year-old Paritosh 'hosh sees or reads about 40=<<# he gets panic attac"s folloed
by chest
pain# headaches and fits of fainting as the massacre reminds him of >=<< in the ?S# hen he lost
his only son!
'The >=<< massacre "illed my only son @a%arshi ho or"ed in 3e Aor"! ( have still not
recovered from that
shoc" and no this $umbai terror attac" is nothing but a brutal reminder of the incident#' 'hosh
said!
;e feels distressed henever remained of the trauma!>=<4=41<B Post-$umbai- Traum
KASHMIR WITH PTDS
6onflict induced stress is not only ta"ing a toll on mental health in )ashmir but also causing
reproductive problems and disorders in young men and omen!
,lmost every night Aasmeen sees a child running into her open arms in her dreams! &efore she
could embrace the child# some noise a"es her up! Tears fill AasmeenCs eyes! (n her five years of
marriage she has not been able to conceive!
D8very day ( have this feeling of emptiness#E she says!
This period has been a torture for her! ;er behaviour has changed! She has become reactive to
every argument! D( have become an ob%ect of extreme disli"e for my in-las# ho never miss a
chance to remind me hat ( donCt have (a child)#E Aasmeen says!
9a"ing up in the middle of the night# tired and unable to go to sleep again# she struggles ith a
headache! She reaches out for the bottle of sleeping pills! Today ill be %ust another day hen
she pops up a sleeping pill! ;oever# her association ith sleeping pills and anti-depressants has
been long!
The first time she had a sleeping pill as ten years ago# after a bomb ent off very close to her!
Though she escaped unhurt# physically# the shoc" as too much for her! She had fallen
unconscious!
D( ould remain gloomy for days# and ould get flashbac"s of the scene! She as no longer able
to concentrate on her studies# and ould suffer from anxiety! ( ould faint henever# ( had the
recollection of the scene of the blast#E she says!
9hen she finally too" medical consultation# she as diagnosed ith PTSD - Post Traumatic
Stress Disorder! (t as here that her tryst ith anti-depressants started! She responded to the
treatment ell# and soon she as up and FnormalC again! &ut conse2uences remained!
;er menstrual cycle became irregular# and she started suffering from increased hair groth -
medically referred to as ;irsutism! She had to go to the doctor again# ho diagnosed her ith
P6*S-Polycystic ovarian syndrome!
P6*S is a ma%or endocrine disorder in omen of reproductive age! (t is one of the leading causes
of female infertility! Doctors identify stress as one of the main reasons of P6*S prevalence in
)ashmir# ith four to <1 per cent of all omen suffering from it!
, study conducted at S)($S among <<4 young and adolescent female patients# found that 0G-H1
percent had psychiatric disorders# says Dr ,shraf# an ,ssociate Professor of 8ndocrinology at
S)($S! 8ight patients ere found to be suffering from obsessive compulsive disorder (*6D)# five
had post traumatic stress order# and 4H had ma%or depressive disorder!
P6*S is considered to be associated ith a host of endocrine and metabolic disturbances such
as hypertension# impaired glucose tolerance# type-4 diabetes mellitus# coronary artery disease
and even breast cancer!
Serum insulin# insulin resistance and homocysteine levels are significantly higher in omen
suffering from the disorder!
*ne of the most glaring symptoms of the condition is hirsutism - or excessive hair groth and
acne! This has lead many young girls toards s"in treatment centres hich have no come up in
)ashmir! @afia# 74# has already spent around 41#111 rupees for the treatment! D( felt as a social
outcast ith the excessive hair groth on my face! ( had very lo self esteem because of this
problem! So ( ent for the laser treatment#E she says! 8very no and then she has to follo the
treatment ith a laser# Ftouch upC! 8ven though the problem of excessive hair groth has been
solved to some extent# but she has still has abnormally high levels of stress! D( get angry all the
time# and have hardly any patience left#E she says!
@afia too has been a victim to the conflict induced stress! D( cannot forget the day hen some
armed men barged into our house# and started loo"ing for my brother#E she says! (n the
commotion shots had been fired# and one of the bullets had bruised her arm! This happened
around <5 years ago# hen she as %ust a <B-year-old# at the threshold of puberty!
Stress has an impact on the hormone levels! (t disrupts the normal state#E says Dr Sada"at
@ehman# ,ssistant Professor of 6linical Psychology at the (nstitute of $ental ;ealth! DPTSD and
depression are very common to )ashmir# particularly affecting omen#E she says! These to
disorders lead to fear psychosis# hich leads to infertility through psychological as ell as
physiological factors!
The effect of the conflict induced stress is not related %ust to the increase in infertility! , study titled
DPrevalence of PTSD in conflict-hit )ashmirE# in 4110 by $edicines Sans Irontiers ($SI)
revealed high rate of abortions and miscarriages among omen in Jalley is due to the PTSD!
,ccording to the study around 07#111 patients visited the hospital in 4110 of hich <G to 41
percent ere suffering from PTSD! *ne of the observations is that 01 percent of the 07#111
cases ere omen that perhaps explain the high rate of abortions and miscarriages!
@u"aiya had three miscarriages! She developed PTSD hen her brother died in crossfire
beteen militants and security forces! The tragedy sent her into depression!
The $SI study also revealed that patients ho itnessed "illings# explosions and torture shoed
higher level symptoms li"e behavioural and emotional change# social avoidance# improper sleep#
and reduced sexual desire! DSuch patients ill remain upset for longer times even if treated
properly#E notes Dr ;a2ue of $alaysia# one of the co-authors of the study!
D(n many cases the depression becomes most manifest in the reduced sexual desire#E says Dr
Shari" $asoodi# ,dditional Professor of 8ndocrinology at S)($S )ashmir! $ost of the omen
suffering from the mood disorder tend to have high levels of anxiety and sleep disturbance! This
affects sexual performance as ell as ovulation# he says!
&ut more importantly D(n a society li"e )ashmir# it is very hard for people to come to terms ith
accepting that they have a mood disorder! So even though they are not able to bear children due
to the mood disorder they see" medical attention instead of psychiatric help! $ost of the tests
reveal them to be normal but still they "eep coming to the doctor for treatment#E says Dr Shari"! ,
situation ensues here a person is being treated for a problem he does not have# and the actual
problem gets overloo"ed! DThus the patient is being over treated for a problem he does not have#
and under-treated for the real problem#E he adds! This creates more problems for the patient!
Stress and infertility are cause as ell as effect of each other# he further states! So this problem
"eeps on aggravating!
Dr! ,niruddha and Dr! ,n%ali $alpani# $umbai based fertility experts ho operate a ebsite
fertiltycommunity!com have studied the issue in detail! They state that in response to stress# the
hypothalamus produces a hormone called corticotropin releasing factor (6@I) hich activates the
hypothalamic-pituitary-adrenal (;P,) system# causing it to release neurotransmitters (chemical
messengers) called catecholamines# as ell as cortisol# the primary stress hormone!
&iologically# since the hypothalamus regulates both stress responses as ell as the sex
hormones# itCs easy to see ho stress could cause infertility in some omen! 8xcessive stress
may even lead to complete suppression of the menstrual cycle# and this is often seen in female
marathon runners# ho develop DrunnerCs amenorrheaE!
(n less severe cases# it could cause anovulation or irregular menstrual cycles! 9hen activated by
stress# the pituitary gland also produces increased amounts of prolactin# and elevated levels of
prolactin could cause irregular ovulation!
Since the female reproductive tract contains catecholamine receptors# catecholamines produced
in response to stress may potentially affect fertility# for example# by interfering ith the transport of
gametes through the fallopian tube or by altering uterine blood flo! ;oever# more complex
mechanisms may be at play# and researchers still donCt completely understand ho stress
interacts ith the reproductive system# they state!
&ut this problem is not confined to omen only! ,ccording to a survey conducted in 411> by the
)ashmir chapter of ,ction ,id (nternational# 4> per cent of the unemployed males in )ashmir
smo"e in order to relax themselves! Iurther a hopping <4 per cent# hich includes omen# ta"e
sleeping pills to overcome stress! Iour percent of the respondents of the survey ta"e drugs to
reduce mental tension!
(n males the primary effects of the stress manifest as erectile dysfunction# decreased libido# and
decreased sperm count! D*ne third of the total infertility cases in )ashmir are due to male factor#E
says Dr Shari2 adding that among males the biggest problem is semen related! Dr $irchandis on
fertilitycommunity!com further state that one more indication of stress loering sperm count in
males is that testicular biopsies obtained from prisoners aaiting execution# ho ere obviously
under extreme stress# revealed complete spermatogenetic arrest in all cases!
DStress leads to an increase in the reactive oxygen species hich then cause oxidate damage to
sperm as ell as *va#E says a noted andrologist at S)($S! The reactive oxygen species are free
radicals# peroxidases etc hich cause harm to cellular membranes! (n this case the target is
sperm membranes mostly! DThe stress induced oxidative damage of the sperm membrane loers
sperm motility# and may even cause a damage of the paternal D3,#E adds the doctor!
9hat is most unfortunate in these cases is that assisted reproductive techni2ues (,@Ts) do not
or"! D8ven if the sperm is ta"en out of the testes in ,@T# it ill still have the damage#E says the
doctor!
*ne more relation of stress to infertility is through smo"ing and other anti-depressant drugs hich
are proven to be sperm damaging! DSmo"ing leads to lo sperm motility as ell as lo sperm
count#E says the doctor!
&ut more important is the stress induced erectile dysfunction and premature e%aculation# hich is
one of the primary causes of partner dissatisfaction!
The primary cause of stress in males in )ashmir is conflict related! , related factor is
unemployment! , doctor ho did not ish to be named said that a number of male patients in the
young age group ho have suffered some sort of trauma from one party or the other in the to-
decade-long conflict complain of very lo confidence and libido!
DThey come to us %ust before marriage ith the fear that they ould not be able to consummate
their marriages! (n many cases marriages have been bro"en because of the same reason#E he
says! The doctor further states that it is unfortunate that a study on lo libido or lo sexual
esteem has not ta"en place in )ashmir! DThe conditions here are such that such a study ould be
very difficult! &ut an indication to the enormity of this problem is the rush e see in places li"e
&atamalo or +al 6ho" at shops operated by 2uac"s ho sell everything and anything as a sex
tonic!E
The biggest reason for female infertility remains Premature *varian Iailure (P*I) also referred to
as premature ovarian inception! , report carried by (ndia Today states that medical experts are
struc" by the abnormally high rate of P*I-41-G1 per cent-among infertile )ashmiri omen!
,ccording to the report a clinical screening of 4#111 omen ith infertility symptoms at the
@otunda-;ygiea (JI 6linic in Srinagar in the past three years puts the incidence of P*I at 40 per
cent! This is in star" variation ith the nationide P*I rate of <-G per cent among infertile omen
belo B1 years!
Dr Shari" is also of the opinion that ovarian failure is more common to )ashmir# but he adds that
proper studies have not been conducted hich ill lin" it primarily to stress# though stress is a
cause! Some genetic studies on the sub%ect are planned!
(n most cases of ovarian failure# childbirth is not possible even through artificial means! @u"sana#
a government school teacher# is in early forties! She as divorced because of the problem four
years ago!
She had tried every medical treatment available! D( ent to Delhi for treatment but after spending
la"hs of rupees nothing happened#E she says! 8ven though her husband as initially supportive#
he later gave in to the pressure of his parents! D$y husband as the lone son! $y mother-in-la
anted a successor from him! 9hen it became clear to her that ( could not give her one she
could not even stand my sight#E she says! Soon there as no option left! ;e divorced me! Today
she lives ith her brothers# but every day reminds her of the vacuum! D$y mother passed aay a
year after my divorce! $y father had died much earlier!
8ven though ( live in the same house in hich ( as born# it gives me a feeling of being an
outsider#E she says# D(t belongs to my sisters-in-la ho are also mothers!E
@u"sana is comparatively luc"ier! She has a %ob and is Dnot a burden on anyoneE! )ulsoom ho
faced everyday ridicule in her husbandCs place# came to visit her parents one day! , divorce paper
reached her the next day! She has not signed it! (t has been a year since then! ;er husband has
re-married!