'Low intensity' war and mental trauma in Nicaragua: a study in a rural community.

'Low intensity' warfare, with its key psychological element, aimed to terrorize the rural population of Nicaragua during the 1980s. A survey of ex-refugees still living in the war zone revealed 62% of men and 91% of women as 'cases' of psychological disturbance on the General Health Questionnaire. Somatization was central to the subjective experience and communication of the distress caused by the Contra war. Sustained sleep disturbance, hyperalertness and other anxiety-based symptomatology and poor concentration were very common and were exacerbated by war-related cues. 25% of men and 50% of women merited a diagnosis of posttraumatic stress disorder. Some distress reflected unresolved grief states. The longer term mental and social costs of terrorization have been insufficiently documented in the Third World.