This study examined whether familiarity with the physical environment and verbal/pictorial exposure to a tsunami also inducted posttraumatic stress symptoms in adolescents. The Impact of Event Scale (IES) and Pediatric Emotional Distress Scale (PEDS) were administered to 231 subjects (130 directly exposed and 101 indirectly exposed). The directly exposed group scored high on the IES and PEDS. A significant sex difference was observed on all three dimensions of the IES, and fearful and traumatic event-related dimensions of PEDS, with females at a higher risk compared to males. In the indirectly exposed group, no sex difference was observed for the IES (avoidance and total impact score) or the fearful, acting out, or traumatic experience related dimensions of the PEDS. Significant sex differences were observed in this group on the IES intrusion and PEDS withdrawal scores, with males higher on intrusion and females higher on withdrawal. (Contains 3 tables.)