LAPORAN TUTORIAL SKENARIO 2 “RELAWAN BENCANA” BLOK 4.2 DISASTER NURSING
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PROGRAM STUDI ILMU KEPERAWATAN FAKULTAS KEDOKTERAN UNIVERSITAS GADJAH MADA 2016
SKENARIO 2
',"awan ,nana P,-,!inta# P,-,!inta# -,ngu-u-k -,ngu-u-kan an 7,nana 7,nana nasiona" nasiona" yang &ika!,nakan &ika!,nakan g,-a 7u-i 9 ska"a !i#t,! &i Da,!a# Anta# P!oinsi ,!anta# %s A&i &itugaskan s,7agai sa"a# satu &a!i iM,&is Da!u!at (MD) yang akan &i7,!angkatkan (deploy (deploy)) k, &a,!a# 7,nana t,!s,7ut agi %s A&i -,nja&i !,"awan 7,nana -,!uakan ,nga"a-an ,!ta-a s,#ingga %s A&i -asi# -as i# 7,"u- -,-a#a-i 7,7,!aa #a" s,,!ti ga-7a!an 7,k,!ja s,7agai !,"awan; ,!an &an tanggungjawa7 s,!ta akunta7i"itas s,o!ang !,"awan; !og!a- ,"ayanan k,s,#atan &i &a,!a# 7,nana; ko"a7o!asi &,ngan !,"awan 7,nana "ainnya STEP 1 M!"#$% K#&# S'(%& ) STEP 2 M!*#+',#! P$&#!-##!
1 Aa saja sya!at sya!at -,nja& -,nja&ii !,"aw !,"awan< an< $ Aa saja saja tangg tanggung ungjaw jawa7 a7 s,o!an s,o!ang g !,"awa !,"awan< n< + .a" aa aa sajaka# sajaka# yang #a!us &isiakan &isiakan s,o!ang s,o!ang !,"awan< !,"awan< agai-ana agai-ana ko"a7o ko"a7o!asi !asi !,"awan !,"awan -,&is -,&is &,ngan &,ngan !,"awan "ainnya< "ainnya< 5 Aa saja !og!a!og!a- "ayanan "ayanan k,s,#atan k,s,#atan a&a &a,!a# 7,nana< 7,nana< 6 agai-ana agai-ana ga-7a!an ga-7a!an ,!an %s A&i s,7agai s,7agai !,"awan !,"awan 7,nana< 7,nana< Aa saja sanksi sanksi k,a&a k,a&a !,"awan yang ti&ak -,"aksan -,"aksanakan akan tanggu tanggungjawa ngjawa7< 7< 8 Aa saja ko-,t,nsi ko-,t,nsi yang #a!us #a!us &i-i"iki &i-i"iki o",# s,o!ang s,o!ang !,"awan !,"awan -,&is< -,&is< 9 Aa yang &i-aksu& &i-aksu& &,ngan &,ngan akunta7i" akunta7i"itas itas s,o!ang s,o!ang !,"awan< !,"awan< 10 *iaaka# yang 7,!w,nang &a"a- ,!,k!utan s,o!ang !,"awan< STEP M!+#/# P$&#!-##!
1 Diku Dikuku ku#k #kan an o",# o",# o!ga o!gani nisas sasi; i; -,- -,-uny unyai ai basic ,ng,ta#uan basic ,ng,ta#uan &an k,t,!a-i"an yang 7,!,!an &a"a- 7,nana; ,!na# -,ngikuti ,"ati#an k,7,nanaan; usia -ini-a" 18 ta#un; 7,!&,&ikasi tinggi; W%4; &aat 7,k,!ja sa-a s,a!a -an&i!i &an ti-; s,#at jas-ani &an !o#ani; 7,7as &a!i -asa"a# #uku- atau s,&ang ti&ak -,nja"ani !os,s #uku-; -a-u 7,!ko-unikasi; -,-,nu#i sya!at o!ganisasi; koing kuat; -a-u -,nguasai ,-,taan; &an -a-u -,ng,"o"a osko $ M,-7a M,-7ant ntu u s,-ak s,-aksisi-a" a" -ung -ungkin kin s,su s,suai ai &,ng &,ngan an ,!a ,!an n -asi -asing ng=-a =-asin sing; g; -,naa -,naati ti ,!atu!an &an !os,&u!; -,nja-in k,a-anan; k,s,"a-atan &i!i s,n&i!i &an o!ang "ain; ,"ao!an atau &oku-,ntasi #a!us j,"as
+ .a!us sia s,a!a jas-ani &an !o#ani; ko-,t,nsi; "ogistik (disaster kit ); -,-astikan k,a-anan &a#u"u; s,!ta a"at ko-unikasi Ko"a7o!asi &ija"ankan s,suai sist,- ko-an&o; -,-7,!i in2o; -,ngo"a# &ata; sist,ko-unikasi satu a!a# (4/*) aga! ti&ak si-ang siu! atau ti&ak t,!sa-aikan 5 P!og!a- "ayanan P.*; gii s,i-7ang; kons,"ing; trauma healing &,ngan play therapy; ,!awatan "uka 7aka!; kons,"ing i7u #a-i"; ,-antauan ka&a! gu"a &a!a#; ,nyu"u#an t,ntang 4*PA; assessment ; ,ngo7atan k,a&a su!io!; ,n&i!ian 7a!ak ,ngungsian 6 P,!an %s A&i t,!gantung &a!i ko-an&o; ,n&a-ing siko"ogis; ,akuasi; -,nangani ko!7an "angsung k,&a!u!atan; &aat -,-7antu &i 7agian "ain s,suai ko-an&o; -,"akukan t!ias,; -,-7,!i ,!"in&ungan t,!#a&a k,"o-ok !,ntan t,!uta-a untuk ,akuasi; trauma healing ; ,!awatan -ini-a"; kaji ,at; -,n&ata *DA &an *DM yang a&a; -,"akukan *A'; ,-,nu#an k,7utu#an; ,n&a-ingan si!itua"; -,"akukan L* >ika !,"awan ti&ak -,"aksanakan tanggungjawa7 &aat &i7,!i t,gu!an s,a!a "isan; t,!tu"is; skorsing ; ,-7,!#,ntian sa-ai &,ngan ,-7,!ian sanksi #uku- 8 Ko-,t,nsi yang #a!us &i-i"iki s,o!ang !,"awan -,&is a&a"a# -a-u -,"akukan t!ias,; -,-7,!ikan ,!to"ongan ,!ta-a; -,"akukan t!anso!tasi &an delivery; -a-u -,"akukan ,nyu"u#an; ,"ati#an; ,ngu!angan 2akto! !isiko; -a-u -,"akukan trauma healing ; 7,!ko-unikasi yang 7aik; 7,!koo!&inasi a&a 2as, preparedness; -a-u -,-,!ta#ankan gii su!io! 9 Akunta7i"itas a&a"a# ,!tanggungjawa7an atas tin&akan yang &i7,!ikan t,!#a&a ko!7an &an &aat &i,!tanggungjawa7kan k,a&a #uku- 10 O!ganisasi yang 7,!,!an &a"a- ,nanganan 7,nana s,,!ti MDM/; "a"u &i"ao!kan k, PD s,"anjutnya &i"akukan ,"ao!an k, %P aga! &iatat &a"a- database &an -,-unyai no-o! anggota
STEP 4 M%! M#%!*
Syarat
Apa saja yang harus dipersiapkan (kompetensi, skill, pengetahuan, dll)
Relawan
Pra Bencana
Bencana
Kolaborasi
Pasca Bencana
Peran
Berhasil
agal
Penghargaan
Sanksi
STEP 3 P!!&'#! LO
1 Aa saja kont!i7usi ,!awat &a"a- !og!a- 7,nana< $ agai-ana ko"a7o!asi -asing=-asing 7i&ang &i &a"a- 7,nana< + Aa saja ,ny,7a7 P*D a&a !,"awan< STEP 6 M!"#$% $$!5% % $'#7 8+'$!#(9 ','9 / $5%:
STEP ; P##$#! LO
1 Kont!i7usi ,!awat &a"a- !og!a- 7,nana Mitigation an& !,a!,&n,ss -,asu!,s go #an& in #an& 2o! u"n,!a7i"ity !,&ution an& !ai& !o2,ssiona" !,sons, to &isast,!s #, #uj ,a!t#?uak, in >anua!y; $001 7!oug#t out s,,!a" ina&,?uai,s in t#, syst,- #, s,a!# an& !,su, t,a-s #a& not 7,,n t!ain,& !o2,ssiona""y@ s,ia"i,& &og s?ua& to "ook 2o! "i, 7o&i,s un&,! t#, &,7!is w,!, not aai"a7",@ an& t#,!, was no ,nt!a"i,& !,sou!, in,nto!y 2o! ,-,!g,ny !,sons, A"t#oug# a!-y "ay,& a iota" !o", in s,a!# an& !,su, an& a"so s,t u t#,i! #osita" a2t,! t#, o""as, o2 o,!n-,nt #osita" at #uj; t#, n,,& 2o! 2u""y ,?ui,& -o7i", #osita"s wit# t!ain,& ,!sonn," was 2,"t aut,"y D,sit, t#,s, onst!aints; t#, !,sons, was 2ai!"y w,"" o!gani,& .ow,,!; #a& t#,s, onst!aints 7,,n tak,n a!, o2 7,2o!, #an&; t#, !,sons, wou"& #a, 7,,n ,,n -o!, !o2,ssiona" an& !ai& w#i# -ay #a, !,&u,& t#, "oss o2 "i,s *,ia"ist s,a!# an& !,su, t,a-s 2!o- ot#,! ount!i,s &i& !,a# #uj .ow,,!; !,ious ti-, was "ost an& ,,n wit# t#,s, s,ia"ist t,a-s it was not ossi7", to o,! a"" s,,!,"y a22,t,& a!,as as ?uik"y as t#, o,!n-,nt wou"& #a, &,si!,& 4t was; t#,!,2o!,; &,i&,& t#at w, s#ou"& !,-o, t#,s, ina&,?uai,s an& 7, in a stag, o2 !,a!,&n,ss at a"" ti-,s #, /,nt!a" o,!n-,nt a!, now in t#, !o,ss o2 t!aining an& ,?uiing 96 s,ia"ist s,a!# an& !,su, t,a-s; wit# ,a# t,a- onsisting o2 5 ,!sonn," in"u&ing &oto!s; a!a-,&is; st!utu!a" ,ngin,,!s ,t ,n t,a-s #a, a"!,a&y 7,,n t!ain,& #,s, t,a-s wi"" 7, "oat,& at a!ious ,nt!,s a!oun& t#, ount!y 2o! s,ia"is,& !,sons, #,s, t,a-s wi"" #a, t#, "at,st ,?ui-,nt as a"so &og s?ua&s 2o! "oating su!io!s in t#, &,7!isS'$< D%5#5&$ M#!#*!& %! I!%# C=$7!5%> D%5#5&$ M#!#*!& P$=*$# P7#5 II
N'$5 I!>=(>!&
%u!s, ino",-,nt !,?ui!,s un&,!stan&ing t#, 7asi on,ts o2 !a&iation ,Bosu!, ,!sus onta-ination; an awa!,n,ss o2 t#, signs an& sy-to-s o2 aut, !a&iation syn&!o-, an& t#, ski""s an& a7i"iti,s to a!tiiat, in ou"ation=7as,& !a&iation s!,,ning .osita"=7as,& nu!s, !,,i,!s wi"" n,,& to un&,!stan& t#, un&,!"ying at#o#ysio"ogy an& -,&ia" an& nu!sing int,!,ntions 2o! !a&iation oisoning; an& t#,i! s,iC !o", in t#, t!,at-,nt o2 iti-s #, i--,&iat, !o", o2 nu!s,s in a !a&iation &isast,! wi"" 7, &,t,!-in,& 7y s,,!a" 2ato!s in"u&ing t#,i! u!!,nt "a, o2 ,-"oy-,nt an& w#,t#,! t#,y a!, on s,n, at t#, !,sons,; at t#,i! "a, o2 wo!k; o! w#,t#,! t#,y go out in t#, o--unity as a!t o2 t#, 7!oa&,! u7"i #,a"t# !,sons, 4n any as,; at a -ini-u-; nu!s,s wi"" n,,& to 7, awa!, o2 t#,i! institutiona" !a&iation &isast,! !,sons, "an; t#,i! !o", wit#in t#, 4ni&,nt /o--an& *yst,- an& t#, ,!sona" !ot,ti, ,?ui-,nt (PPE@ ,g; !ot,ti, g"o,s; s#o, o,!s; out,! !ot,ti, "ot#ing; an& ,y, o,!ing; 7as,& on u!!,nt Ouationa" *a2,ty an& .,a"t# A&-inist!ation
gui&,"in,s) aai"a7", to t#,- 2o! t#,i! own sa2,ty 4t is on"y w#,n nu!s,s a!, sa2, t#at t#,y a!, a7", to !,n&,! a!, to ot#,!s O!)S"! A55%5&#!"
%u!s,s an& ot#,! #,a"t# a!, ,!sonn," at t#, s,n, -ay 7, a"",& on to t!,at o! t!iag, iti-s su22,!ing 2!o- t#, ,22,ts o2 ,Bosu!, to #ig# ",,"s o2 !a&iation %u!s,s s#ou"& tak, a"" ossi7", !,autions to aoi& ai&,nta" ,Bosu!, o! utak, o2 !a&ioati, -at,!ia"s #,s, !,=autions in"u&, not ,ating o! &!inking in onta-ination on,s; !o-t"y i!!igating an& o,!ing o,n woun&s; an& t#o!oug#"y swa77ing ati,nts skin 7,2o!, giing inj,tions o! &!awing 7"oo& %u!s,s ,nt,!ing a onta-inat,& a!,a -ust w,a! a!o!iat, PPE at a"" ti-,s %u!s,s ",aing a onta-inat,& a!,a s#ou"& !,-o, t#,i! !ot,ti, "ot#ing (in"u&ing g"o,s an& s#o, o,!s) 7,2o!, ,Biting t#, a!,a W#,n,,! ossi7", in &isast,! situations (i,; w#,n ati,nt a!, wi"" not 7, o-!o-is,&); a"" ,!sonn," ati,nts in"u&,& s#ou"& 7, su!,y,& 2o! onta-ination 7,2o!, ,Biting any onta-ination a!,a 4n 2at; nu!s,s -ust su!,y t#,-s,",s 7,2o!, ",aing an a!,a a!o,& to #o"& !a&ioatiity as it is st!it"y !,?ui!,& an& -onito!,& 7y t#, %u",a! ',gu"ato!y /o--ission (%'/; $01) A"" ,?ui-,nt ,Biting t#, a!,a s#ou"& a"so 7, su!,y,& 7,2o!, !,",as, o! s#ou"& 7, !o,!"y "a7,",&; s,a",& in "asti 7ags; an& sto!,& in a!o!iat,"y s#i,"&,& ontain,!s 2o! "at,! su!,y an& !,",as, (42 onta-inat,& 7ut not sto!,& in !o,!"y s#i,"&,& ontain,!s; t#, ,?ui-,nt wou"& 7, !a&iating anyon, n,a!7y; ,o", t!anso!ting it; o! anyon, wo!king wit# it "at,!) P='(#&%=! S"$!%!* P$=*$#5
*!,,ning !og!a-s -ust 7, i-",-,nt,& as a !i-a!y u7"i #,a"t# !,sons, w#,n "a!g, nu-7,!s o2 ,o", a!, ot,ntia""y ,Bos,& to !a&iation%u!s,swi"" in a"" "ik,"i#oo& a!tiiat, as -,-7,!s o2 t#, !a&iation ,Bosu!, s!,,ningou"ation -onito!ing t,ain onjuntion wit# !a&iation sa2,ty ,B,!ts an& ot#,! #,a"t# a!, !oi&,!s #, /,nt,!s 2o! Dis,as, /ont!o" an& P!,,ntion (/D/) a&oat,s ,sta7"is#ing /o--unity ',,tion /,nt,!s (/'/s) in t#, a2t,!-at# o2 a su2Ci,nt"y "a!g, !a&io"ogi ,,nt #, u!os, o2 a /'/ is to !oi&, !a&io"ogi s!,,ning 2o! uninju!,& o! "ig#t"y inju!,& ,o",; to !oi&, &,onta-ination w#,n n,,ssa!y; an& to !,2,! t#os, wit# "ik,"y int,!na" onta-ination on 2o! !a&io"ogi ass,ss-,nt an& (i2 a!o!iat,) -,&ia" ount,!-,asu!,s (/,nt,!s 2o! Dis,as, /ont!o" an& P!,,ntion; $01) %u!s,s -ay 7, ask,& to !oi&, s!,,ning an& C!st ai& in /'/s (i2 ,sta7"is#,&); an& a i!tua" o--unity !,,tion ,nt,! ,&uationa" -o&u", (/'/) is aai"a7", on t#, /D/ w,7 sit, 42 /'/s a!, not ,sta7"is#,& in t#, a2t,!-at# o2 a !a&io"ogi o! nu",a! ,,nt; -,-7,!s o2 t#, u7"i wi"" a,a! at #osita"s
!,?u,sting !a&io"ogi s!,,ning; ?uik"y o,! w#,"-ing aai"a7", !,sou!,s an& "ogging ,-,!g,ny &,a!t-,nts W#,n s!,,ning in&ii&ua"s 2o! !a&iation ,Bosu!,; nu!s,s s#ou"& w,a! PPE at a"" ti-,s an& &osi-,t,!s to -onito! ,!sona" ,Bosu!, /a!, -ust 7, tak,n to ,sta7"is# ",a!"y &,"in,at,& "in,s 2o! ,nt!y an& ,Bit into t#, s!,,ning a!,a to !,,nt !oss onta-ination 4t s#ou"& 7, antiiat,& t#at "in,s wi"" 7, "ong an& t#at ao--o&ations wi"" n,,& to 7, -a&, 2o! t#os, wit# "i-it,& -o7i"ity; t#, ,"&,!"y; an& 2a-i"i,s wit# young #i"&!,n ,ig,!=MF u"",! ount,!s wi"" 7, us,& to san t#, ,nti!, 7o&y o,! "ot#,s 7as,& on a !,&,t,!-in,& s!,,ning ",," 4n&ii&ua"s w#o ,B,,& t#, -aBi-u- a,ta7", ",," wi"" !,?ui!, ,it#,! a!tia" ,Bt,!na" ",ansing (!,-oa" o2 "ot#ing an& s#ow,! an& s#a-oo) o! 2u"" 7o&y &,onta-ination ',-oa" o2 "ot#ing an& s#ow,! an& s#a-oo wi"" !,-o, u to 90G o2 t#, !a&iation in ,Bos,& in&ii&ua"s (H,,n,-a; $01$) #, goa"s o2 skin &,onta-ination a!, to &,!,as, t#, !isk o2 &,!-a" inju!y; "ow,! t#, !isk 2o! int,!na" onta-ination; an& to !,&u, t#, onta-ination o2 #,a"t# a!, ,!sonn," an& t#, ,ni!on-,nt (#tt:www!,--n"-go,BtIonta-ination#t-J,!sonn,") An 4nt,!na" /onta-ination /"inia" ',2,!,n, a"iation is aai"a7", 2o! An&!oi& an& iO* &,i,s t#at ,sti-at,s !,2,!,n, !a&ionu"i&,s in u!in, an& an 7, &own"oa&,& 2!o- t#, /D/ w,7 sit, C#$ = C7%($!
,tus,s; in2ants; an& young #i"&!,n a!, t#, -ost u"n,!a7", to t#, n,gati, ,22,ts o2 !a&iation ,Bosu!,; 7ot# s#o!t an& "ong t,!- o! t#is !,ason; on, ou"& a!gu, t#at #i"&!,n an& !,gnant wo-,n &,s,!, a #ig#,! !io!ity 2o! s!,,ning .ig#"y !o"i2,!ati, ,""s a!, t#, -ost !on, to &a-ag, 2!o- !a&ioatiity 4n a&u"ts; t#,s, a!, t#, w#it, 7"oo& ,""s; !,& 7"oo& ,""s; ,it#,"ia" t!at; an& so on@ 7ut in #i"&!,n; t#is an 7, n,a!"y ,,!y 7o&y syst,- &,,n&ing on t#,i! ag, an& stag, in &,,"o-,nt 7,aus, a"-ost a"" t#,i! ,""s a!, g!owing&ii&ing /#i"&!,n wi"" 7, ,Bt!,-,"y 2,a!2u" o2 s!,,ning 7y #,a"t# a!, !oi&,!s &!,ss,& in 2u"" PPE *,ia" a= o--o&ations s#ou"& 7, -a&, to k,, #i"&!,n wit# t#,i! a!,nts o! a!,gi,!s as -u# as ossi7", 4n t,!-s o2 t!,at-,nt!,,ntion o2 !a&iation=in&u,& an,! o2 t#, t#y!oi&; K4 is on"y us,2u" 2o! ini&,nts ino"ing t#, !,",as, o2 !a&ioati, io&in,; su# as a nu",a! ow,! "ant ai&,nt o! a nu",a! ,B"osion #, us, o2 K4 wi"" 7, !,o--,n&,& 7y t#, stat, o! 2,&,!a" go,!n-,nt i2 it is a!o!iat, K4 is usua""y !,o--,n&,& on"y 2o! #i"&!,n (an& oasiona""y young a&u"ts) an& on"y w#,n t#,
!oj,t,& !a&iation &os, to 7, a,!t,& is in ,B,ss o2 5 !,- to t#, t#y!oi& %u!s,s s#ou"& know t#at a&-inist,!ing K4 a!!i,s a s"ig#t !isk o2 a"",!gi !,ation&it s#ou"& on"y 7, a&-inist,!,& w#,n t#, !isk 2!o- t#, !a&iation ,Bosu!, is g!,at,! t#an t#, !isk o2 a&-inist,!ing K4 E5&#(%57!& = S7(&$5 #! H#(&7 S%& A"&%>%&%5
Manag,-,nt o2 int,!na""y &is"a,& ,!sons was a -ajo! issu, at /#,!no7y" (Da""as; $01$) an& wou"& 7, si-i"a!"y #,!, in t#, nit,& *tat,s i2 a "a!g,=sa", !a&iation ,,nt o! nu",a! wa! w,!, to ou! Massi, ,auations in w#i# t#ousan&s to s,,!a" -i""ions ou"& 7, s,,n as ,o", s,,k to ,sa, ,Bosu!, As was s,,n a2t,! t#, ukus#i-a &isast,!; -any ,o", ",2t wit# on"y t#, "ot#,s on t#,i! 7aks an& t#, 7,"ongings t#at t#,y w,!, a7", to tak, wit# t#,- 2!o- t#,i! #o-,s w,!, "i-it,& (%oto ,t a"; $01+) Eau,,s wi"" n,,& to 7, s#,"t,!,& in a sa2, "oation t#at is outsi&, o2 an& uwin& 2!ot#, !isk on, an& t#at #as s,u!, ,",t!iity an& wat,! aai"a7", 2o! &!inking an& 7at#ing #,y wi"" n,,& 2oo&; #a!-a,utia"s; non=2oo& it,-s; an& #,a"t# a!, s,!i,s #,y wi"" n,,& to #a, t#,i! 2untiona" n,,&s -,t in o-"ian, wit# t#, ,&,!a" E-,!g,ny Manag,-,nt Ag,ny; $010 untiona" %,,&s *uo!t *,!i,s ui&,"in,s (,&,!a" E-,!g,ny Manag,-,nt Ag,ny; $010) *#,"t,!s wi"" n,,& to ao--o&at, in&ii&ua"s !,s,nting wit# "ow=",," !a&iation ,Bosu!, A"" o!ganiations w#o !oi&, s#,"t,! an& -ass a!, in t#, nit,& *tat,s un&,! E-,!g,ny *uo!t untion J6 o2 t#, %ationa" ',sons, !a-,wo!k (,&,!a" E-,!g,ny Manag,-,nt Ag,ny; $01+) s#ou"& #a, a w!itt,n "an 2o! s#,"t,!ing a2t,! a "a!g,=sa", !a&iation ,,nt #is in"u&,s t#, A-,!ian ',& /!oss an& t#os, a!tiiating -,-7,!s in t#, %ationa" Ho"unta!y O!ganiations Ati, in Disast,!s (%ationa" Ho"unta!y O!ganiations Ati, in Disast,!s; $01) At a -ini-u-; t#is "an s#ou"& in"u&, "ot#ing o"",tion an& !,"a,-,nt an& s#ow,!ing 2ai"iti,s to ao--o&at, a su&&,n su!g, o2 ,Bos,& in&ii&ua"s P5-"7=5="%#( S'=$&
Disast,!s aus, a "a!g, sy#o"ogi an& -,nta" #,a"t# 7u!&,n to in&ii&ua"s 7,aus, o2 t#,i! su&&,n ons,t an& un!,&ita7", natu!, #, -,nta" #,a"t# n,,&s o2 a22,t,& ,!sons a!, #ig#,! in nu",a! &isast,!s 7,aus, on,ts o2 nu",a! si,n, a!, -isun&,!stoo& an& 2!ig#t,ning to "ay,!sons; an& ,,n -o!, o-oun&,& i2 t#, nu",a! ,,nt is t#, !,su"t o2 an attak on t#, nit,& *tat,s as wa! !,s,nts its own uni?u, s,t o2 sy#o"ogi insu"ts %u!s,s !,son&ing to nu",a! &isast,!s -ust 7, a7", to in"u&, sy#o"ogi suo!t into a"" as,ts o2 t#,i! a!, &u!ing i--,&iat,; s#o!t=t,!-; an& "ong=t,!- !,sons,s to t#,
ini&,nt *u!io!s an& !,si&,nts o2 #!,, Mi", 4s"an& an& /#,!no7y" #a, !,o!t,& in!,as,& sy#o"ogi ,22,ts y,a!s a2t,! t#, ,,nt %u!s,s !,son&ing to nu",a! &isast,!s a"so !,o!t in!,as,& sy#osoia" st!,ss 7,aus, t#,y -ust 7a"an, t#, !o",s o2 7,ing a !,son&,! an& a!,tak,! w#i", a"so 7,ing a iti- o2 t#, &isast,! Pu7"i #,a"t# nu!s,s !,son&ing to t#, &isast,! in >aan !,o!t,& sy#o"ogi st!ain 7,aus, t#,y 2,"t un&,!!,a!,& as ii" s,!ants an& w,!, ino",& in t#, ini&,nt (Kaya-a ,t a"; $01) .,a"t# a!, wo!k,!s -ust 7, awa!, o2 t#, sy#o"ogi i-at t#at a &isast,! an #a, on t#,- an& s,,k #," w#,n in&iat,& %u!s,s annot t,n& to t#, n,,&s o2 ot#,!s i2 t#,y a!, ,B,ssi,"y 7u!&,n,& t#,-s,",s@ 7ut 7y !,a!ing 2o! &isast,!s an& s,,king assistan, w#,n n,,&,&; t#,y an ",ss,n t#,i! own 7u!&,n to 7,o-, -o!, ,22,ti, #,a"t# a!, !oi&,!s P!oi&ing sy#osoia" suo!t to iti-s is i-,!ati, to -itigat, t#, "ong=t,!-,nta" #,a"t# 7u!&,n o2 t#, ,,nt (',i2,"s ,t a"; $01+) A#i,ing an a""=,no-assing sy#osoia" suo!t to ou"ations a22,t,& 7y &isast,!s !,?ui!,s -u"ti",," suo!t st!at,gi,s an& an int,!&isi"ina!y t,a- %u!s,s -ust 7, awa!, o2 t#,i! !o", in t#is t,a-; t#, in2!ast!utu!,; an& !,sou!,s aai"a7", in t#, a!,a in w#i# t#,y wo!k; an& t#,i! !,sonsi7i"iti,s wit#in t#,i! so, o2 !ati, %u!s,s a!, t!ain,& in-,nta" #,a"t# ass,ss-,nt an& int,!,ntions #,y s#ou"& a"so 7, o-2o!ta7", in a"ying sy#o"ogi C!st ai&w#,n n,,&,& o! !,2,!!ing an in&ii&ua" to t!au-a=2ous,& ogniti, 7,#aio!a" t#,!ay as in&iat,& (',i2,"s ,t a"; $01+) ,aus, t#,-,nta" #,a"t# ,22,ts o2 &isast,!s ,Bist o,! ti-,; u7"i #,a"t# nu!s,s -ust ontinuous"y ass,ss t#,i! o--uniti,s 2o! "ongstan&ing n,,&s Wo!king wit# o--unity ",a&,!s an& o!ganiations to 7ui"& !,si"i,n, wi"" ,as, t#, -,nta" #,a"t# 7u!&,n o2 t#, &isast,! (Wi,-ann; ',,,; A"t,ogt; $01+); 7ut nu!s,s -ust a"so a&oat, 2o! an& 7ui"& syst,-s t#at wi"" a&&!,ss t#, sy#osoia" i-at nu",a! &isast,!s a!!y H,,n,-a; ; #o!nton; / P ($015) n&,!stan&ing nu!sings !o", in #,a"t# syst,-s !,sons, to "a!g,=sa", !a&io"ogi &isast,!s Journal of Radiology Nursing ; 34($); 6+$ #tts:&oio!g101016jj!a&nu$0111005
$ Ko"a7o!asi -u"ti &isi"in Disast,! Manag,-,nt #as to 7, a -u"ti=&isi"ina!y an& !o=ati, a!oa# ,si&,s a!ious -,asu!,s 2o! utting in "a, institutiona" an& o"iy 2!a-,wo!k; &isast,! !,,ntion; -itigation an& !,a!,&n,ss ,nuniat,& in t#is a,! an& initiati,s 7,ing tak,n 7y t#, /,nt!a" an& *tat, o,!n-,nts; t#, o--unity; ii" soi,ty o!ganisations
an& -,&ia a"so #a, a k,y !o", to "ay in a#i,ing ou! goa" o2 -oing tog,t#,!; towa!&s a sa2,! 4n&ia #, -,ssag, 7,ing ut a!oss is t#at; in o!&,! to -o, towa!&s sa2,! an& sustaina7", nationa" &,,"o-,nt; &,,"o-,nt !oj,ts s#ou"& 7, s,nsiti, towa!&s &isast,! -itigation 4nt,!=o!ganiationa" o""a7o!ation a-ong &isast,! -anag,-,nt o!ganiations is ,ss,ntia" !ust an& ont!o" a!, i,w,& as o!, as,ts 2o! 7ui"&ing on2i&,n, a-ong o""a7o!ation a!tn,!s #is a!ti", s#,&s -o!, "ig#t on t#is t!ust ont!o" n,Bus 7y stu&ying int,!=o!ganiationa" &isast,! !,sons, an& !,o,!y in t#, %,t#,!"an&s On t#, 7asis o2 &ou-,nts an& int,!i,ws; t#, !o",s o2 t!ust an& ont!o" in t#, !,"ations 7,tw,,n t#, Dut# a!-,& 2o!,s an& t!a&itiona" !,son&,!s a!, ,Ba-in,& in&ings sugg,st t#at t!ust an& ont!o" a!, o-",-,nta!y an& -utua""y !,in2o!ing; w#i", 7ot# on,ts !,?ui!, -u"ti=",," stu&i,s to &istinguis# 7,tw,,n int,!=,!sona" an& int,!=o!ganiationa" t!ust an& ont!o" !ust an& ont!o" a!, i,w,& as t#, o!, as,ts 2o! 7ui"&ing on2i&,n, in n,two!k a!tn,!s an& an 7, i,w,& as o-",-,nta!y an& -utua""y !,in2o!ing #is stu&y s#,&s -o!, "ig#t on t#, t!ust=ont!o" n,Bus in o""a7o!ati, &isast,! !,sons, an& !,o,!y in t#, Dut# ont,Bt On t#, 7asis o2 ana"ysis o2 &ou-,ntations an& a s,!i,s o2 int,!i,ws wit# -i"ita!y "iaisons; t#, !o",s o2 t!ust an& ont!o" in t#, !,"ation 7,tw,,n t#, Dut# -i"ita!y an& t!a&itiona" &isast,! !,son&,!s w,!, "a!i2i,& #, &ata s#ows not on"y #ow t!ust an& ont!o" &,,"o o,! ti-,; 7ut a"so t#at t!ust an& ont!o" n,,& to 7, 7a"an,& to ,nsu!, onsist,ny an& 2",Bi7i"ity in t#, o""a7o!ation #, in2"u,n, t#at t#, in&ii&ua" "iaisons ,B,!is, o,! t#, int,!=o!ganiationa" !,"ations is a!tiu"a!"y not,wo!t#y #, 2in&ings t#,!,2o!, ,-#asi, t#at 2utu!, stu&i,s n,,& to tak, into aount t#, &i22,!,nt #i,!a!#ia" ",,"s o2 o""a7o!ating o!ganiations Last"y; a&&itiona" !,s,a!# n,,&s to 7, on&ut,& on t#, !o", o2 ow,! to un!a," t#, in2"u,n, o2 o!ganiationa" int,!,sts an& ow,! st!ugg",s in int,!=o!ganiationa" &isast,! !,sons, an& !,o,!y I!&$)=$*#!%?#&%=!#( %5#5&$ #!#*!& $=+"&5< F%!%!* &7 %( /#- &/! &$'5& #! "=!&$=( J=$% P#5"#( K#(,#! E$%, J. W##$9 2016
%O ',sons, to 1999 /y"on, %Os ati, in O!issa !,son&,& to t#, 1999 y"on, in t#!,, #as,s: i--,&iat,; s#o!t=t,!-; an& "ong t,!- 4n t#, i--,&iat, #as,; t#, %O !,sons, 2ous,& on ,-,!g,ny 2oo& !,"i,2; a!ass &isosa"; t,-o!a!y s#,"t,!; ,-,!g,ny -,&ia" ai&; &,7!is !,-oa" an& #a7itat !,sto!ation; t!au-a ouns,""ing; an& !aising awa!,n,ss 2o! !,onst!ution s,on& #as,; atua""y an ,Bt,nsion o2 t#, initia" !,"i,2 #as,; 2ous,& on int,!i- 2oo& s,u!ity; !,sto!ation o2 o--unity ass,ts; !,ia" o2 s#oo"s; soia" -o7i"isation an& g!ou 2o!-ation #, t#i!& #as, 2ouss,& on "i,"i#oo&
!,sto!ation; -u"ti=u!os, y"on, s#,"t,!s; an& o--unity 7as,& &isast,! !,a!,&n,ss 4--,&iat, P#as,: A2t,! t#, /y"on,; %Os ati, in O!issa a!!i,& out !,"i,2 o,!ations an& su",-,nt,& go,!n-,nt ,22o!ts in &,a"ing wit# t#, un!,,&,nt,& &isast,! A7out 0 "oa" an& int,!nationa" %Os s,t u an ,-,!g,ny !,sons, n,two!k a"",& O!issa Disast,! Mitigation Mission (ODMM) to t#,i! oo!&inat, !,"i,2 an& !,sto!ation wo!k ODMM !an a ont!o" !oo- at t#, stat, aita" an& s#a!,& in2o!-ation wit# t#, go,!n-,nt !,ga!&ing !o7",-s 2a,& in a22,t,& a!,as Anot#,! %O n,two!k 2o!-,& ,a!"i,! a"",& O!issa D,,"o-,nt Ation o!u- a"so "ay,& an ati, a!t in ,-,!g,ny !,sons, %Os !an o--unity kit#,ns in #un&!,&s o2 i""ag,s !oi&ing ook,& 2oo& to ,o", P!o2,ssiona" %Os uti"is,& su# 2oo& !,"i,2 to initiat, i--,&iat, !,sto!ation atiiti,s in a!tn,!s#i wit# "oa" o--uniti,s; w#i# in"u&,& ",a!ing i""ag, !oa&s; s#oo"s; ",aning wat,! sou!,s; &isosing a!ass,s; ,t A"ongsi&, t#, *tat, .,a"t# D,a!t-,nt an& isiting -,&ia" t,a-s 2!o- ot#,! a!ts o2 t#, ount!y; %Os !oi&,& -,&ia" ai& to t#, ai"ing y"on, iti-s 7y !unning -o7i", #,a"t# a-s P!,,nti, -,asu!,s tak,n 7y %Os in"u&,& &ist!i7ution o2 -,&iin,; an& ,22o!ts to !ais, &isast,! #,a"t# awa!,n,ss a-ongst ,o", 7y o!ganising o--unity #,a"t# a-s #, go,!n-,nt !oi&,& t,-o!a!y s#,"t,! 7ui"&ing -at,!ia"s to a"" a22,t,& 2a-i"i,s *o-, %Os a"so &ist!i7ut,& t,-o!a!y s#,"t,! -at,!ia"s a-ong ,o", soon a2t,! t#, y"on, ',ju,nating ,o",s si!its an& !aising awa!,n,ss a7out !,onst!ution #a"",ng,s was an i-o!tant a!t o2 %O int,!,ntion D,at# an& &,astation #a& 2i"",& t#, iti-s wit# a s,ns, o2 g"oo- /as,s o2 &,!,ssion an& t!au-a w,!, !,o!t,& in -any a22,t,& i""ag,s *o-, %Os t!i,& to !ais, ,o",s &,!,ss,& si!its 7y o!ganising st!,,t t#,at!,s an& a!tiiato!y u"tu!a" s#ows; w#i", so-, ot#,!s s,t u !au-a /a!, /,nt!,s an& un&,!took t!au-a ouns,""ing in wo!st a22,t,& i""ag,s *o-, %Os !an L,ga" Ai& /,nt!,s to s,nsitis, ,o", a7out t#,i! !ig#ts to o-,nsation o22,!,& 7y t#, ot %Os a"so "ay,& a !uia" !o", -o7i"ising o"unt,,!s 2o! !,"i,2 wo!k ODMM s,t u a Ho"unt,,!s .u7 at t#, stat, aita" an& !an a o"unt,,!s 7as, a- at E!asa-a; t#, wo!st #it a!,a to 2ai"itat, o"unt,,!s a!tiiation in !,"i,2 atiiti,s W#i", s-a"",! %Os wit#&!,w 2!o- t#, a22,t,& a!,a a2t,! t#, !,"i,2 #as,; t#, 7igg,! an& sin,!, %Os ontinu,& t#,i! !,#a7i"itation ,22o!ts in t#, y"on,=#it a!,as 7,yon& t#, i--,&iat, #as, P!o7",-s ,B,!i,n,& in ,nsu!ing O=%O oo!&ination &u!ing !,"i,2 o,!ations ou"& 7, att!i7ut,& to s,,!a" 2ato!s #, go,!n-,nt #a& no !,ious ,B,!i,n, o2 wo!king wit# so -any %Os in a &isast,! situation as %Os n,,! 7,2o!, took a!t in &isast,! !,sons, on su# a "a!g, sa", #, a7s,n, o2 a ",a! 2!a-,wo!k 2o!
in2o!-ation s#a!ing an& oo!&ination o2 %O atiiti,s -a&, it &i22iu"t 2o! t#, go,!n-,nt to i&,nti2y w#o &,s,!,& 2ai"itati, suo!t an& w#o not G=>$!!& ) NGO C=((#=$#&%=! =$ D%5#5&$ R'"&%=! #! R5=!5< T7 I!%# 8O$%55#: E@$%!". M$. A'$=%!= B7$# M#!#*%!* D%$"&=$9 O$%55# S&#& D%5#5&$ M#!#*!& A'&7=$%&-
M,nya; A A; KAku-u; O A ($016) 4nt,!=ag,ny o""a7o!ation 2o! 2i!, &isast,! -anag,-,nt in %ai!o7i /ity Journal of Urban Management ; 5(1); +$+8 #tts:&oio!g101016jju-$01608001 + P*D a&a !,"awan P$)%5#5&$ O""'#&%=!#( #"&=$5
nsu!!ising"y; &i22,!,nt ouationa" g!ous!o2,ssiona" ",,"s !,son& &i22,!,nt"y to &isast,! *,,!a" stu&i,s &,-onst!at,& signi2iant &i22,!,n,s in st!,ss !,ations 7,tw,,n
!o2,ssiona" an& non=!o2,ssiona" (o"unt,,!) !,son&,!s 4n s,,!a" stu&i,s !o2,ssiona"s #a& "ow,! ",,"s o2 ost=t!au-ati st!,ss &iso!&,! (P*D); !,ouation an& un",asant t#oug#ts; an& 2oun& it ,asi,! to ta"k a7out t#,i! ,B,!i,n,s t#an non=!o2,ssiona"s a"t#oug# on, stu&y 2oun& t#at !o2,ssiona" 2i!,=2ig#t,!s #a& g!,at,! ",,"s o2 P*D t#an o"unt,,!s A s-a"" nu-7,! o2 stu&i,s s#ow,& &i22,!,n,s 7,tw,,n ouationa" g!ous o! ,Ba-",; on, stu&y 2oun& &i22,!,n,s in P*D !at,s 7,tw,,n &i22,!,nt 7!an#,s o2 t#, ,-,!g,ny s,!i,s; anot#,! !,o!t,& g!,at,! !,si"i,n, in nu!s,s t#an ii"ians an& anot#,! !,o!t,& #ig#,! P*D in #,a"t# s,!i, sta22 w#o a!!i,& out &o-,sti #o-, #," &uti,s t#an in -,&ia" sta22 *,,!a" stu&i,s 2oun& t#at "ong,! ,-"oy-,nt at,& as a !ot,ti, 2ato!; assoiat,& wit# "ow,! st!,ss; &,!,ssion; 7u!nout an& P*D .ow,,! t#,!, w,!, t#!,, stu&i,s w#i# 2oun& t#at in&ii&ua"s wit# "ong,! ,-"oy-,nt !,o!t,& g!,at,! sy#iat!i an& ost=t!au-ati -o!7i&ity an& 2ou! 2u!t#,! stu&i,s s#owing nosigni2iant assoiation /#ang ,t a" sugg,st t#at !,su, wo!k,!s wit# -o!, y,a!s o2 s,!i, a!, -o!, "ik,"y to #a, #a& t!au-ati ,B,!i,n,s (an& ,!#as !,si&ua" sy-to-s 2!o- !,ious ,B,!i,n,s) *o; it -ay 7, t#at t#, on2"iting !,su"ts a!, &u, to !,ious wo!k ,B,!i,n,s: t#os, wit# "ong ,-"oy-,nt an& su,ss2u" ,B,!i,n,s -ay #a, ositi, outo-,s; w#i", t#os, wit# "ong ,-"oy-,nt an& ,B,!i,n, o2 t!au-ati ini&,nts o! unsu,ss2u" o,!ations -ay #a, oo! w,""7,ing ,n,!a" ,!,tions o2 on,s wo!k"a, an& !o", !,=&isast,! a"so a,a!,& to in2"u,n, w,""7,ing outo-,s ost=&isast,! in a s-a"" nu-7,! o2 stu&i,s Low jo7 satis2ation an& "ak o2 !i&, in t#, jo7 w,!, assoiat,& wit# P*D in two stu&i,s S"%#(%5 &$#%!%!* #! $#$!55
Many stu&i,s 2oun& t#at !oision o2 !,=&isast,! t!aining an& in2o!-ation ,na7",& in&ii&ua"s to 7, ,-otiona""y an& ogniti,"y !,a&y 2o! t#, !,a"iti,s o2 w#at t#,y -ay 2a,; ",a&ing to 7,tt,! w,""7,ing outo-,s ',su"ting 2!o- !,a!,&n,ss; on2i&,n, in on,s o-,t,n, an& know",&g, a,a!,& to i-at ost=&isast,! w,""7,ing .ig# s,ns, o2 !o2,ssiona" -ast,!y an& assu!an, in ,!sona" an& t,a- aa7i"iti,s w,!, 2oun& to !,&u, &ist!,ss w#i", 2,,"ing t#at t!aining #a& not !,a!,& t#,- w,"" was assoiat,& wit# g!,at,! &ist!,ss On, stu&y !,,a",& no signi2iant &i22,!,n, in &ist!,ss 7,tw,,n ,-,!g,ny a!, wo!k,!s w#o #a& !,,i,& t!aining (!,"at,& to sy#o"ogia" !,ations to t!au-a) an& t#os, w#o #a& not@ #ow,,!; !at#,! t#an sugg,sting t#at t!aining in g,n,!a" is not us,2u"; t#, aut#o!s sugg,st t#at t#, t!aining !,,i,& was ina&,?uat,
Ei&,n, !,ga!&ing t#, 7,n,2its o2 !,ious &isast,! ,B,!i,n, was inonsist,nt *o-, stu&i,s 2oun& !io! ,B,!i,n, was assoiat,& wit# g!,at,! &ist!,ss .ow,,! s,,!a" stu&i,s 2oun& no signi2iant w,""7,ing &i22,!,n,s 7,tw,,n t#os, w#o w,!, ino",& in !,ious &isast,!s an& t#os, w#o w,!, not an& on, stu&y 2oun& t#at !,ious ,B,!i,n, was a !ot,ti, 2ato! 4t -ay 7, t#at t#, i-at o2 !,ious &isast,! ,B,!i,n, is -itigat,& 7y ot#,! 2ato!s: 2o! ,Ba-",; on, stu&y sugg,st,& t#at 7o&y #an&",!s a!, a !,si"i,nt g!ou an& #a, !ot,ti, 2ato!s su# as a st!ong s,ns, o2 o--unity L% >!&5 #! 7#(&7
*igni2iant !,=&isast,! "i2, ,,nts; in"u&ing ,!sona" t!au-as an& sy#iat!i #isto!y; w,!, onsist,nt"y 2oun& to 7, a !isk 2o! ost=&isast,! -,nta" #,a"t# !o7",-s Past -,nta" #,a"t# &iagnos,s in!,as,& t#, "ik,"i#oo& o2 !,o!ting -,nta" #,a"t# sy-to-s ost=&isast,!: it s#ou"& 7, not,& t#at -any stu&i,s &,s!i7,& t#is as Nsy#iat!i #isto!y o! N!,=,Bisting sy#oat#o"ogy an& &i& not &,s!i7, w#i# a!tiu"a! -,nta" #,a"t# &iagnos,s w,!, !,o!t,& On, stu&y 2oun& t#at !,ious sy#iat!i i""n,ss !,&it,& anBi,ty 7ut not signi2iant"y *,,!a" stu&i,s 2oun& t#, !isk o2 !o7a7", -,nta" #,a"t# !o7",-s to in!,as, wit# in!,asing nu-7,! o2 !,=&isast,! "i2, ,,nts 4t s#ou"& 7, not,& t#at w#i", -ost stu&i,s s,i2i,& t#at Nn,gati, "i2, ,,nts o! Na&,!sity !,&it,& oo!,! w,""7,ing; s,,!a" stu&i,s si-"y !,o!t,& on N!io! "i2, ,,nts wit#out s,i2ying w#,t#,! t#,s, w,!, a&,!s, ,,nts On, stu&y !,o!t,& no signi2iant &i22,!,n,s 7,tw,,n t#os, wit# #isto!y o2 su7stan, a7us, an& t#os, wit#out w#i", anot#,!2oun& t#at ,B,!i,n,s &u!ing t#, &isast,! #a& a 7igg,! i-at on w,""7,ing t#an !,=&isast,! ,,nts wo ot#,! stu&i,s s#ow,& no signi2iant ,22,t o2 !,ious t!au-a #isto!y D'$%!*)%5#5&$ E@=5'$
A su7stantia" 7o&y o2 !,s,a!# #as 2oun& t#at &isast,! ,Bosu!, (in t,!-s o2 s,,!ity an& ty, o2 ,Bosu!,) #as -u"ti2a,t,& i-"iations 2o! sy#o"ogia" w,""7,ing Many a,!s !,o!t,& t#at t!au-ati ,Bosu!, a"on, (i!!,s,ti, o2 ,Bosu!, ty,) !,&it,& a !ang, o2 sy#o"ogia" o-"aints an& &iso!&,!s; in"u&ing anBi,ty; &,!,ssion; g,n,!a" &ist!,ss an& P*D On, stu&y 2oun& t#at &isast,!=,Bos,& nu!s,s #a& #ig#,! ",,"s o2 P*D; &,!,ssion an& sy#oso-ati sy-to-s &u!ing t#, &isast,! t#an non=,Bos,& nu!s,s; 7ut "ow,! sy#oso-ati sy-to-s a2t,! t#, &isast,! 'at,s o2 &ist!,ss w,!, #ig#,! a-ong t#os, wit#
!,,at,& o! #ig# ,Bosu!, an& t#,!, was a &os,!,sons, !,"ations#i 7,tw,,n t#, nu-7,! o2 t!au-ati ,,nts ,B,!i,n,& &u!ing a &isast,! an& &,!,ssion o! P*D On, stu&y 2oun& t#at ,Bosu!, was o!!,"at,& wit# &ist!,ss 7ut t#is was not signi2iant in !,g!,ssion ana"ysis; w#i", 2ou! stu&i,s s#ow,& no signi2iant ,22,t o2 ,Bosu!, on sy#o"ogia" w,""7,ing P!oBi-ity to t#, ,i,nt!, o2 t#, &isast,! a,a!,& to "ay an i-o!tant !o", in sy#o"ogia" w,""7,ing Wit# t#, ,B,tion o2 2i!,=2ig#t,!s; !,su,!s !,son&ing to iti-s in t#, ,i,nt!, o2 a &isast,! a,a!,& to su22,! -o!, P*D sy-to-s t#an t#os, 2a!t#,! out D,a"ing wit# s,!ious inju!y o! &,a& 7o&i,s a,a!,& 7, a !isk 2ato! 2o! sy#o"ogia" &ist!,ss an& ost=t!au-ati st!,ss !,sons,s Wo!k,!s wit# su# ,Bosu!, ,B,!i,n,& st!,ss; so-ati o-"aints; 2atigu, sy-to-s; an& w,!, -o!, "ik,"y to &,,"o P*D; &,!,ssion; a"o#o" !o7",-s an& anBi,ty *o-, !,s,a!# sugg,st,& t#at t#, ty, o2 ,Bosu!, -a&, a &i22,!,n,; wit# ,Bosu!, to 7u!ns an& #i"& iti-s in!,asing t#, "ik,"i#oo& o2 P*D /on,!s,"y; s,,!a" stu&i,s &i& not &,-onst!at, assoiations 7,tw,,n ,Bosu!, to 7o&i,sinju!i,s an& -,nta" i""=#,a"t# Again t#is inonsist,ny o2 ,i&,n, sugg,sts t#,!, -ay 7, i-o!tant -itigating 2ato!s -aking ,!tain g!ous -o!, !,si"i,nt@ on, stu&y sugg,st,& t#at goo& Nt,a- si!it an& -o!a", -ay ,B"ain "ow ",,"s o2 sy#iat!i -o!7i&ity in o"i, 7o&y=#an&",!s ,w stu&i,s ,B"o!,& t#, !,"ations#i 7,tw,,n &isast,! t!au-a ,Bosu!, an& ositi, outo-,s; !,o!ting t#at ost=t!au-ati g!owt# (P) was assoiat,& wit# #ig#,! ",,"s o2 t!au-a ,Bosu!, D'$#&%=! =! 5%& #! #$$%>#( &%
Du!ation on sit, an& nu-7,! o2 #ou!s s,nt in on, s#i2t g,n,!a""y a,a!,& to 7, !isk 2ato!s 2o! -,nta" i"" #,a"t#; a"t#oug# t#,!, was so-, inonsist,ny in t#, 2in&ings Wo!king "ong #ou!s on t#, &isast,! sit, an& not taking a &ay o22 ,a# w,,k signi2iant"y in!,as,& t#, !isk o2 -,nta" &ist!,ss; jo7 &issatis2ation an& su7j,ti, #,a"t# o-"aints 18; +6; 8; 5; 8; 9$; 9+ wit# in!,as,& "ik,"i#oo& in non=!o2,ssiona" o! non=t!a&itiona" wo!k,!s w#o -ay "ak a!o!iat, #ysia"; -,nta" an& ,-otiona" !,a!ation E?ua""y; !o"ong,& ti-, s,nt at a &isast,! sit, a"so signi2iant"y !o-ot,& &ist!,ss On, stu&y 2oun& t#at t#, nu-7,! o2 &ays s,nt on sit, was !,&iti, o2 P*D an& &,!,ssion; wit# ,i&,n, o2 -o!, t#an $8 &ays; 90 &ays an& 1$0 &ays -ost signi2iant"y in!,asing t#, "ik,"i#oo& .ow,,!; so-, stu&i,s 2oun& ,i&,n, ont!a!y to t#, a7o,; wit# n,it#,! nu-7,! o2 #ou!s no! nu-7,! o2 &ays 7,ing assoiat,& wit# sy#o"ogia" &ist!,ss 4t -ay 7, t#, as, t#at t#, a!tiiants in t#,s, stu&i,s w,!, a!tiu"a!"y !,si"i,nt: 2o! ,Ba-",; on, 2oun& t#at t#,i! a!tiiants w,!, g,n,!a""y a
!,si"i,nt g!ou wit# 810 G -,,ting t#, stu&ys !it,!ia 2o! N!,si"i,nt (i, not -,,ting P*D !it,!ia at any o2 t#, stu&ys ti-, oints)@ si-i"a!"y on"y a s-a"" ,!,ntag, o2 a!tiiants in anot#,! stu&y -,t t#, !it,!ia 2o! 2u"" (as oos,& to su7syn&!o-a") P*D sugg,sting t#,y w,!, a!tiu"a!"y !,si"i,nt *,,!a" stu&i,s 2oun& t#at ,a!"i,! a!!ia"s on t#, &isast,! sit, i, 7,ing on, o2 t#, 2i!st on t#, s,n, w,!, signi2iant"y assoiat,& wit# g!,at,! P*D an& &,!,ssion #, i-at o2 t#, a!!ia" ti-, a,a!,& ?uit, s,i2i o! ,Ba-",; a!!iing at t#, Wo!"& !a&, /,nt,! in t#, -o!ning o2 911 ",& to an in!,as,& !isk 2o! P*D an& &,!,ssion t#at was signi2iant"y g!,at,! t#an ,,n a!!iing in t#, a2t,!noon o2 911 A!!ia" in t#, a2t,!noon was o2 a si-i"a! !isk to a!!ia" s,,!a" &ays a2t,! t#, attak *i-i"a!"y; ot#,! stu&i,s 2oun& t#at t#, ,a!"i,st o2 a!!ia"s in!,as,& t#, "ik,"i#oo& o2 P*D 7y as -u# as siB ti-,s On, stu&y &,-onst!at,& t#at t#, !,a",n, o2 P*D in t#, 2o""owing 510 y,a!s was &,t,!-in,& 7y ti-, o2 a!!ia" /on,!s,"y; s,,!a" stu&i,s 2oun& no signi2iant assoiations 7,tw,,n a!!ia" ti-, an& sy#o"ogia" &ist!,ss ost=&isast,! #is inonsist,ny in t#, "it,!atu!, -ay 7, &u, to -any stu&i,s not ont!o""ing 2o! t!aining; !,a!ation; ,?ui-,nt; o! s,,!ity o2 &isast,! ,Bosu!,: it is "ik,"y t#at t#os, 2i!st on t#, s,n, wi"" 7, ",ss !,a!,&; t#, ,o"ing situation -ay 7, -o!, a-7iguous an& t#,y -ay 7, ",ss w,""=,?ui,& an& going into a -o!, &ang,!ous ,ni!on-,nt t#an t#os, a!!iing "at,! On, stu&y 2oun& t#at (in non=t!a&itiona" !,son&,!s on"y) ,a!"i,! a!!ia" ti-, was n,gati,"y o!!,"at,& wit# P*D #, aut#o!s aknow",&g, t#at t#is ont!a&its ot#,! !,s,a!#; an& att!i7ut, it to t#, #,t,!og,n,ous ouationa" o-osition o2 t#, sa-", an& &,"ay,& t!au-ati ,Bosu!, inwo!k,!s wit#out t!aining w#o join,& t#, !,o,!y ,22o!ts "at, E=&%=!#( %!>=(>!&
*,,!a" stu&i,s !,o!t,& t#at ,-"oy,,s i&,nti2i,& wit# iti-s an& 7,a-, o,!"y ,-otiona""y ino",& in t#, &isast,! On, stu&y 2oun& t#at st!,ss in!,as,& a"ong wit# t#, st!,ss o2 t#, su!io!s 7,ing &,a"t wit#; w#i", anot#,! 2oun& t#at wo!k,!s wit# a #ig# ",," o2 i&,nti2iation wit# su!io!s #a& g!,at,! int!usi,; o7s,ssi, an& o-u"si, t#oug#ts 4&,nti2iation wit# iti-s as a N2!i,n& (i, ,nisaging t#, &,,as,& as a 2!i,n&@ Nt#is ou"& #a, 7,,n -y 2!i,n&); as on,s,"2; o! as a 2a-i"y -,-7,! w,!, assoiat,& wit# P*D P$%)&$#'#&%" %5&$55%55="%#&%=!
P,!i=t!au-ati &issoiation &u!ing an ini&,nt in!,as,& t#, "ik,"i#oo& o2 aut, st!,ss &iso!&,!; P*D an& a"o#o" !o7",-s; w#i", t#, nu-7,! o2 &issoiati, sy-to-s 2u!t#,! in!,as,& t#at "ik,"i#oo& .ig# ",,"s o2 ,!i=t!au-ati &ist!,ss w,!, assoiat,& wit# g!,at,! 7u!nout an& &,!,ssion; sy#iat!i i-ai!-,nt an& P*D On, stu&y 2oun& no signi2iant o!!,"ations 7,tw,,n ,!i=t!au-ati &issoiation an& ost=t!au-ati st!,ss sy-to-s@ #ow,,! it s#ou"& 7, not,& t#at t#is was 7as,& on a s-a"" sa-", (n Q $5) A 2u!t#,! stu&y 7y t#, sa-, aut#o!s not,& t#at !,su, ,!sonn," ,B,!i,n,& ,!i=t!au-ati &issoiation 7ut not any ost=t!au-ati !,ations; t#oug# t#,y sugg,st t#at ,!#as t#, ost=t!au-ati !,sons, 7,gins "at,!; an& sugg,st t#at t#, ",," o2 &issoiation s#ou"& 7, -a,& 2!o- an ,a!"y stag, to !,&it w#,t#,! it a22,ts ost=t!au-ati st!,ss in t#, "ong t,!- R=()$(#& 5&$55=$5
Wo!k=!,"at,& st!,sso!s w,!, 2oun& to !,&it P*D 'o", a-7iguity an& #aing insu22ii,nt jo7=!,"at,& in2o!-ation w,!, assoiat,& wit# in!,as,& anBi,ty; s,on&a!y t!au-atisation an& jo7 7u!nout ,ing ino",& in tasks outsi&, o2 usua" !,-it; su# as !oi&ing su,!ision w#,n not in a ",a&,!s#i !o", an& o"i, o22i,!s 2ig#ting 2i!,s; in!,as,& t#, !isk o2 P*D Ot#,! stu&i,s 2oun& t#at wo!king on &a-ag,& !oo2tos -o!, t#an on, an& 2i!,=2ig#t,!s ,!2o!-ing onst!ution &uti,s in!,as,& t#, !o7a7i"ity o2 sy#oso-ati &iso!&,!s an& P*D !,s,ti,"y u!t#,!-o!,; &i!,t iti- an& "oa" o--unity ontat su7stantia""y a&&,& to st!,ss an& &ist!,ss /,!tain tasks su# as !,j,ting iti-s in n,,& o2 #," &u, to "ak o2 !,sou!,s o! -anow,!; t!,ating ,o", w#o #a& 7,,n inju!,&; ",aning u &,st!oy,& a!,as; #an&"ing !,si&,nts o-"aints an& 7,ing ino",& in !ow& ont!o" w,!, assoiat,& wit# P*D an& sy#o"ogia" &ist!,ss %ot 7,ing a7", to !,&it o! ont!o" ,,nts; as w,"" as 2,,"ing a "ak o2 ont!o" o,! t#, natu!, an& ,Bt,nt o2 iti- inju!i,s; w,!, assoiat,& wit# ost=t!au-ati st!,ss in 2i!,=2ig#t,!s Ot#,! jo7=!,"at,& !,&ito!s o2 oo! -,nta" #,a"t# outo-,s in"u&,&: "ong,! assign-,nts; in!,as,& ti-, wit# #i"& "i,nts; wo!king wit# 2i!,=2ig#t,!s; an& "i,nts w#o &isuss,& -o!7i& -at,!ia"; 2o! &isast,! -,nta" #,a"t# wo!k,!s@ an& ?ua"itati,"y #,ay wo!k"oa& 2o! ,-,!g,ny s,!i, ,!sonn," *o-, stu&i,s !,o!t,& no signi2iant assoiations 7,tw,,n jo7=!,"at,& st!,sso!s an& outo-,s o! ,Ba-",; on, stu&y +0 2oun& no assoiation 7,tw,,n #ig# as, "oa& an& sy#o"ogia" &ist!,ss in soia" wo!k,!s o22,!ing sy#o"ogia" suo!t to &isast,! iti-s@
anot#,! s#ow,& t#at #ig# wo!k &,-an& was assoiat,& wit# in!,as,& a"o#o" an& to7ao us, in u7"i #,a"t# wo!k,!s !,son&ing to #u!!ian,s 7ut not wit# P*D o! &,!,ssion P$"&%=!5 = 5#&-9 &7$#& #! $%5,
Many a,!s s#ow,& a !,"ations#i 7,tw,,n w,""7,ing an& ,!,i,& sa2,ty (o! !isk) &u!ing t#, &isast,! Low ,!,i,& sa2,ty (i, g!,at,! ,!,i,& !isk to on,s,"2 ) was assoiat,& wit# anBi,ty; &,!,ssion; g,n,!a" sy#iat!i sy-to-s an& ost=t!au-ati st!,ss *u7j,ti, ,!,tion o2 &ang,! to on,s,"2 was t#, sing", 7,st !,&ito! o2 P*D in uti"ity wo!k,!s On, stu&y 2oun& t#at wo!!i,s a7out ,!sona" sa2,ty w,!, !,&iti, o2 P*D; w#i", 2,,"ing not ,noug# sa2,ty -,asu!,s w,!, in "a, an& on,!n a7out ,?ui-,nt ?ua"ity w,!, assoiat,& wit# anBi,ty wo stu&i,s !,o!t,& non=signi2iant 2in&ings !,ga!&ing ,!,tions o2 ,!sona" sa2,ty; 7ot# 7y t#, sa-, aut#o! an& "ooking at 2i!,=2ig#t,!s P,!,i,& t#!,at was signi2iant"y o!!,"at,& wit# &ist!,ss 7ut &i& not !,-ain signi2iant a2t,! ot#,! 2ato!s w,!, ont!o"",& 2o! in !,g!,ssion ana"ysis; w#i", anot#,! stu&y 7y t#, sa-, aut#o! 2oun& t#at o"unt,,! 2i!,= 2ig#t,!s wit# an& wit#out P*D &i& not &i22,! in t,!-s o2 ,!,i,& t#!,at H#$ &= 5( =$ "(=5 =&7$5
.aing a n,a!=&,at# ,B,!i,n,; 7,ing s,!ious"y inju!,& o! #aing a Ns,,!, -,nta" t!au-a &u!ing t#, !,su, !,&it,& P*D in !,su, wo!k,!s a2t,! an ,a!t#?uak,: t#os, w#o ,B,!i,n,& on, o2 t#,s, #a& a !at, o2 P*D $56 ti-,s #ig#,! t#an t#os, w#o #a& not D,,"oing "ow,! !,si!ato!y sy-to-s o! skin !as# w,!, signi2iant"y assoiat,& wit# P*D an& &,!,ssi, sy-to-s ,ing inju!,& !,&it,& P*D; &,!,ssion; ani attaks an& g,n,!a" anBi,ty .ow,,!; s,,!a" stu&i,s s#ow,& no signi2iant !,"ations#i 7,tw,,n #ysia" inju!y to t#, s,"2 an& -,nta" #,a"t# outo-,s Knowing so-,on, inju!,& o! ki"",& &u!ing t#, &isast,! was !,&iti, o2 outo-,s in -any stu&i,s Loss o2 so-,on, "os, was assoiat,& wit# P*D an& &ist!,ss *,,!a" stu&i,s a"so sugg,st,& t#at s,i2i !,"ations#is (i, w#,t#,! t#, ,!son was a 2a-i"y -,-7,!; o"",agu,; 2!i,n& o! a?uaintan,) -ig#t !,&it outo-,s &i22,!,nt"y On, stu&y 2oun& an in!,as, in P*D !isk 2o! ,a# a&&itiona" &,at# o2 a o"",agu, 9 w#i", anot#,! 2oun& t#at "oss o2 a o=wo!k,! ",& to a n,a! =2o"& in!,as, in ,",at,& P*D an& -o!, t#an a $=2o"& in!,as, in us, o2 a ouns,""ing s,!i, .aing 2a-i"y -,-7,!s w#o &i,& o! w,!, inju!,&
was assoiat,& wit# P*D an& &,!,ssion an& "osing a 2a-i"y -,-7,! a,a!,& to #a, a g!,at,! i-at t#an "osing a 2!i,n& On"y on, stu&y 2oun& no !,"ations#i 7,tw,,n knowing anyon, ki"",& o! inju!,& an& ost=t!au-ati st!,ss S="%#( 5'=$&
Many stu&i,s ,B"o!,& soia" suo!t; g,n,!a""y 2in&ing t#at oo! suo!t was assoiat,& wit# !,"utan, to s,,k t!,at-,nt@ P*D; anBi,ty an& &,!,ssion@ st!,ss an& i""n,ss@ s,on&a!y t!au-atisation an& 7u!nout@ an& g!,at,! o7s,ssi,o-u"si, an& !,oui,& sy-to-s On, stu&y s#ow,& t#at g,n,!a" soia" suo!t was not assoiat,& wit# ,it#,! ,!i=t!au-ati &issoiation o! P*D *,,!a" stu&i,s 2ous,& on o!ganisationa" suo!t in a!tiu"a! Wo!k u"tu!, suo!t an& su,!iso!
suo!t
a,a!,& assoiat,& wit#
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satis2ation;
wo!k
,ngag,-,nt;
sy#o"ogia" st!ain an& tu!no,! int,ntions /on,!s,"y; oo! !,"ations#is wit# "in, -anag,!s an& o=wo!k,!s !,&it,& P*D an& &issatis2ation wit# su,!iso!y suo!t was assoiat,& wit# &,!,ssion; w#i", oo! wo!k"a, o--uniation signi2iant"y in!,as,& t#, !isk o2 -,nta" &ist!,ss .ig# n,,& 2o! suo!t an& "ak o2 o!ganisationa" suo!t in t#, &isast,! a2t,!-at# w,!, t#, st!ong,st ont!i7uto!s o2 &,!,ssion in ',& /!oss o"unt,,!s .ow,,! so-, stu&i,s 2oun& no signi2iant assoiations 7,tw,,n o!ganisationa" suo!t an& outo-,s #,!, w,!, -iB,& !,su"ts on t#, ,22,t o2 2!i,n&s2a-i"y suo!t *atis2ation wit# #o-, suo!t was not o!!,"at,& wit# ost=t!au-ati st!,ss in on, stu&y w#i", 2a-i"y suo!t was 2oun& to 7, !ot,ti, in anot#,! Ot#,! stu&i,s 2oun& -iB,& !,su"ts: 2o! ,Ba-",; on, stu&y 2oun& t#at soia" suo!t 2!o- 2!i,n&s at,& as a signi2iant -o&,!ato! on t#, !,"ations#i 7,tw,,n t!au-a ,Bosu!, an& int!usion sy-to-s 2o! % so"&i,!s 7ut not 2o! !,"i,2 wo!k,!s; w#i", in anot#,! stu&y nu-7,! o2 sou!,s o2 2a-i"y suo!t !,&it,& 2u"" P*D; 7ut not su7syn&!o-a" P*D %,gati, soia" 7,#aiou!s w,!, g,n,!a""y assoiat,& wit# oo! w,""7,ing: 7,ing a ta!g,t o2 #a!ass-,nt was assoiat,& wit# st!,ss an& 7,ing assau"t,& (,g &u!ing !ow& ont!o" atiiti,s) was a !isk 2ato! 2o! P*D in o"i, P=5&)%5#5&$
P$=55%=!#( 5'=$&
#oug# s,,!a" stu&i,s ,Ba-in,& w#,t#,! ,-"oy,,s 2,"t i--,&iat, !o2,ssiona" #," (a!tiu"a!"y &,7!i,2ing) was #,"2u"; on"y 2,w ,Ba-in,& w#,t#,! !,,it o2 !o2,ssiona" #," in2"u,n,& -,nta" #,a"t# outo-,s #,!, w,!, -iB,& 2in&ings 2!o- t#os, w#i# &i& %ot !,,iing sy#o"ogia" ouns,""ing &u!ing t#, !,su, -ission was !,&iti, o2 P*D in -i"ita!y !,son&,!s 2o""owing an ,a!t#?uak, w#i", /!itia" 4ni&,nt *t!,ss D,7!i,2ing (/4*D) was 2oun& to #," ,-,!g,ny -,&ia" wo!k,!s o, *atis2ation wit# wo!k"a, &,7!i,2ings was not assoiat,& wit# P*D in 2i!,=2ig#t,!s@ #ow,,!; a!tiiants wit# ot#,! non=P*D &iso!&,!s w,!, ",ss "ik,"y to !,o!t satis2ation wit# t#, &,7!i,2ings o! !,o--,n& t#,- to ot#,!s Pa!tiiation in a g!ou ouns,""ing s,!i, was not assoiat,& wit# &,!,ssi, sy-to-s On, stu&y 2oun& t#at /4*D ",& to #ig#,! aoi&an,; t#oug# t#is &i& not !,-ain signi2iant in -u"tia!iat, ana"ysis *in, so 2,w stu&i,s ,B"o!,& t#, i-at o2 &,7!i,2ing on outo-,s it is &i22iu"t to &!aw 2i!- on"usions I#"& =! (%
#,!, w,!, -iB,& !,su"ts !,ga!&ing t#, ,22,t o2 #aing on,s ,!sona" "i2, a22,t,& 7y t#, &isast,! .aing to s,n& nig#ts away 2!o- on,s own #o-, in t#, &ays 2o""owing &isast,! &i& not !,&it P*D in o--unity o"unt,,!s a2t,! an ,a!t#?uak,; 7ut n,,&ing 2oo& wat,! ai&; "ot#,s ai& an& 2inania" assistan, w,!, !,&iti, o2 P*D; as was su22,!ing 2inania" &i22iu"ti,s &u, to t#, &isast,! 4n a stu&y o2 ',& /!oss o"unt,,!s; "oss o2 t#,i! own !,sou!,s (#o-,; 2oo&; wat,!;"ot#ing o! ino-,) was t#, -ost in2"u,ntia" ,Bosu!, a!ia7", 2o! &,!,ssion Anot#,! stu&y 2oun& t#at !a!, 2a-i"y ontat an& unin#a7ita7", #o-, w,!, assoiat,& wit# &,!,ssion .ow,,!; s,,!a" stu&i,s s#ow,& t#at ,!sona" "oss was not signi2iant"y assoiat,& wit# -,nta" #,a"t# outo-,s Losing on,s own !o,!ty was a !,&ito! o2 &ist!,ss in s,,!a" stu&i,s wit# on"y on, stu&y 2in&ing no assoiation 7,tw,,n "oss,s an& P*D .aing on,s !o2,ssiona" "i2, a22,t,& 7y t#, &isast,! a,a!,& to 7, !,&iti, o2 w,""7,ing /#ang,s in t#, ti-, an& "a, o2 wo!k; i--,!sion in !o2,ssiona" !o", an& !o", ,Bansion w,!, o!!,"at,& wit# ost=t!au-ati g!owt# Di22iu"ty 2untioning at wo!k ost= &isast,! was assoiat,& wit# P*D an& aut, st!,ss; w#i", jo7 "oss was a"so assoiat,& wit# P*D untiona" jo7 i-ai!-,nt an& taking -,nta" #,a"t#=!,"at,& -,&ia" ",a, w,!, assoiat,& wit# P*D
L% >!&5
EBosu!, to signi2iant ost=&isast,! "i2, ,,nts (,g &io!,; !,"ations#i 7!,ak=u) was signi2iant"y assoiat,& wit# &ist!,ss; P*D; anBi,ty an& &,!,ssion .ow,,! in on, stu&y; ,Bosu!, to su7s,?u,nt 2i!,s &i& not in2"u,n, -,nta" #,a"t# outo-,s in o"unt,,! 2i!,= 2ig#t,!s M%#
Wat#ing t,",ision 2o! R #ou!s ,! &ay; 1 -ont# ost=&isast,!; was !,&iti, o2 P*D sy-to-s in !,su, wo!k,!s w#i", anot#,! stu&y 2oun& t#at o"unt,,! 2i!,=2ig#t,!s wit# ,!sist,nt &,"ay,&=ons,t; ,!sist,nt #!oni an& !,so",& #!oni P*D w,!, a"" signi2iant"y -o!, &ist!,ss,& 7y t,",ision !,-in&,!s o2 t#, &isast,! A t#i!& stu&y a"so !,o!t,& a ositi, o!!,"ation 7,tw,,n anBi,ty an& wat#ing t,",ision /on,!s,"y; wat#ing +R #ou!s o2 &ai"y -,&ia o,!ag, was not assoiat,& wit# ,-otiona" &ist!,ss in ,-,!g,ny a!, wo!k,!s C=%!* 5&$#&*%5
*,,!a" stu&i,s ,B"o!,& t#, !,"ations#i 7,tw,,n w,""=7,ing an& 7ot# ositi, an& n,gati, oing st!at,gi,s Most o--on"y; t#, stu&i,s onsi&,!,& aoi&an, o! &,nia" NAoi&an, oing; i, &,"i7,!at, aoi&an, o2 t!au-ati t#oug#ts; was assoiat,& wit# g!,at,! sy#o"ogia" &ist!,ss an& !,&it,& t!au-ati st!,ss Aoi&ant t#oug#ts a,a!,& to !,&it P*D -o!, st!ong"y in 2i!,=2ig#t,!s wit# "ow ,Bosu!, t#an int,ns, ,Bosu!, 4n t,!-s o2 ositi, oing -,#anis-s; N!oati, oing an& ositi, t#inking w,!, assoiat,& wit# ost=t!au-ati g!owt#
Anot#,! stu&y 2oun& t#at on2!onti, oing;
&istaning an& "ann,& !o7",-=so"ing signi2iant"y !,&u,& t#, ,22,t o2 &i!,t !,su, ,22o!t ino",-,nt on g,n,!a" sy#iat!i -o!7i&ity On"y on, stu&y 2oun& no signi2iant !,"ations#i 7,tw,,n oing st!at,gi,s an& outo-,s a7", $ s#ows t#, !,a",n, o2 !,sou!, "oss a-ongst t#, o"unt,,!s; in&iating t#at !,sou!, "oss was a"ways !,"at,& to #ig#,! a"u, o2 P*D sy-to-s; signiCant"y in 5 out o2 6 ti-,s #, sa-, ou"& 7, sai& 2o! su7j,ti, #,a"t# o-"aints a"t#oug# it on"y was signiCant in + out o2 6 ?u,stions 4n a&&ition to !,sou!, "oss; 9G o2
t#, o"unt,,!s !,o!t,& #aing #a& &a-ag, to t#,i! #o-, an& ++G n,,&,& to !,"oat, as t#,i! #ous, was st!utu!a""y unsa2,; 5G w,!, #ysia""y inju!,& in t#, ?uak,; $G #a& 2a-i"y -,-7,!s #ysia""y inju!,& an& $5G #a& 2a-i"y -,-7,!s o! so-,on, "os, to t#,- 7u!i,& un&,! !u77", u!t#,!-o!,; G o2 t#, o"unt,,!s !,o!t,& un,!tainty a7out t#, w,"2a!, o2 t#,i! "o,& on,s EBosu!, to &,a& 7o&i,s o! 7o&y a!ts was !,o!t,& 7y 58G o2 t#, o"unt,,!s an& +G #,a!& !i,s o2 t!a,& ,o", #, a7o, ty,s o2 ,Bosu!, Ct !it,!ion A1 o2 P*D sy-to-s (D*M=H) At 6 -ont#s ost=,a!t#?uak,; $8G o2 t#, o"unt,,!s !,o!t,& a #ig# ",," (a7o, ut o22 so!, o2 ++) o2 P*D sy-to- s,,!ity an& $05G at 18 -ont#s At 18 -ont#s t#, su7j,ti, #,a"t# o-"aints w,!, 198 (*D Q 1+$) #, su7sa",s #a& t#, 2o""owing !,su"ts: "u $0+ (151)@ Musu"osk,",ta" (50$)@ Ps,u&o %,u!o"ogia" 569 (5)@ ast!o int,stina" +1 (+9)
!ooks; * K; Dunn; '; A-"St; '; !,,n7,!g; %; 'u7in; > ($016) *oia" an& ouationa" 2ato!s assoiat,& wit# sy#o"ogia" &ist!,ss an& &iso!&,! a-ong &isast,! !,son&,!s : a syst,-ati !,i,w BM !sychology; 11+ #tts:&oio!g101186s0+59=016=01$0=9 #o!-a!; * ; ,!sons; P '; >u,n; ; Djaka7a7a; M %; Ka!"sson; ; O"22; M ($01) #, i-at o2 &isast,! wo!k on o--unity o"unt,,!s: #, !o", o2 ,!i= t!au-ati &ist!,ss; ",," o2 ,!sona" a22,t,&n,ss; s",, ?ua"ity an& !,sou!, "oss; on ost=t!au-ati st!,ss &iso!&,! sy-to-s an& su7j,ti, #,a"t# Journal of "n#iety $isorders; %&(8); 919 #tts:&oio!g101016jjanB&is$0110006
