Phases of Traumatic Stress Reactions in a Disaster
A National Center for PTSD Fact Sheet
Disasters and terrorist attacks are often widespread with many people who
directly experience the event and many more who may witness or be indirectly
impacted.
Many people may encounter behavioral and emotional readjustment
problems. Many posttraumatic stress symptoms are normal responses to
overwhelming stressors. Exposure to these overwhelming stressors may change our
assumptions about life and create distress, but the intensity of this distress
will subside with time. Experts agree that the amount of time it takes people
to recover depends both on what happened to them and on what meaning they give
to those events.
Terroristic acts may result in a whole society questioning the fundamental
view of the world as a predictable, just, and meaningful place to live. This
questioning is amplified by the fact that organized violence is intentional; it
often has a political agenda; and it is meant to create terror, destroy, and
hurt. Studies have shown that deliberate violence creates longer lasting
mental-health effects than natural disasters or accidents. The consequences for
individuals and the community are long lasting and survivors often feel that
injustice has been done to them. This can lead to anger, frustration,
helplessness, fear, and a desire for revenge. Reestablishing meaningful
patterns of interactions in the community after a trauma may facilitate
reconstruction of a sense of meaning and purpose.
Prior research into terroristic events and disasters has shown that
reactions to these events may be categorized into different phases.
Impact phase
Most people respond appropriately during the impact of a disaster and react
to protect their own lives and the lives of others. This is a natural and basic
reaction. A range of such behaviors can occur, and these may also need to be
dealt with and understood in the postdisaster period. After the fact, people
may judge their actions during the disaster as not having fulfilled their own
or others' expectations of themselves.
During the impact phase, some people respond in a way that is disorganized
and stunned, and they may not be able to respond appropriately to protect
themselves. Such disorganized or apathetic behavior may be transient or may
extend into the postdisaster period, so that people may be found wandering
helpless in the devastation afterwards. These reactions may reflect cognitive
distortions in response to the severe disaster stressors and may for some indicate
a level of dissociation.
Several stressors may occur during impact, which may subsequently have
consequences for the person:
- Threat to life and encounter with death
- Feelings of helplessness and powerlessness
- Loss (e.g., loved ones, home, possessions)
- Dislocation (i.e., separation from loved ones, home,
familiar settings, neighborhood, community)
- Feeling responsible (e.g., feeling as though could have
done more)
- Inescapable horror (e.g., being trapped or tortured)
- Human malevolence (It is particularly difficult to cope
with a disaster if it is seen as the result of deliberate human actions.)
Immediate postdisaster phase: recoil and rescue
This is the phase where there is recoil from the impact and the initial
rescue activities commence. Initial mental-health effects may appear (e.g.,
people show confusion, are stunned, or demonstrate high anxiety levels).
Emotional reactions will be variable and depend on the individual's perceptions
and experience of the different stressor elements noted earlier. Necessary
activities of the rescue phase may delay these reactions, and they may appear
more as the recovery processes get under way. Reactions may include:
- Numbness
- Denial or shock
- Flashbacks and nightmares
- Grief reactions to loss
- Anger
- Despair
- Sadness
- Hopelessness
Conversely, relief and survival may lead to feelings of elation, which may
be difficult to accept in the face of the destruction the disaster has wrought.
Recovery phase
The recovery phase is the prolonged period of adjustment or return to
equilibrium that the community and individuals must go through. It commences as
rescue is completed and individuals and communities face the task of bringing
their lives and activities back to normal. Much will depend on the extent of
devastation and destruction that has occurred as well as injuries and lives
lost (Raphael, 1993).
This period may be associated with a honeymoon phase deriving from the
altruistic and therapeutic community response immediately following the
disaster. A disillusionment phase may soon follow when the disaster is no
longer on the front pages of newspapers, organized support starts to be
withdrawn, and the realities of losses, bureaucratic constraints, and the
changes wrought by the disaster must be faced and resolved (Raphael, 1986).
During the stage of acute danger the priority for all is basic safety and
survival. Once this is relatively secured, other needs emerge that are both
existential and psychological. And once manifest, these needs are typically
left frustrated and unfulfilled for a prolonged period of time. Many times,
through the media, retribution, or continued violence, the community in
question is exposed to further traumatic events.
It is particularly important to remember that emotional needs may be very
significant, especially for those who have been severely affected. They may
only start to appear during this phase. People may also be hesitant to express
distress, concern, or dissatisfaction, feeling they should be grateful for the
aid given or because they have suffered less than others have. It should be
noted that sometimes emotional reactions may present as physical health
symptoms, such as sleep disturbance, indigestion, and fatigue, or they may
present as social effects such as relationship or work difficulties.
Related Fact Sheets
Effects
of disaster
A summary of common traumatic stress reactions including PTSD and Acute Stress
Disorder (ASD)
Magnitude of
PTSD
Empirical review of the literature examining the magnitude, range, and duration
of the effects of disasters over the past 20 years
Symptoms of PTSD
Learn about how traumatic experiences affect people, what survivors need to know,
and the common symptoms of PTSD
What is
PTSD?
Answers basic questions about the signs and symptoms of PTSD, who gets it,
how common it is, and what treatments are available
Excerpted from Raphael, Disaster Mental Health Response Handbook, NSW
Health, 2000
Copies available from:
The NSW Institute of Psychiatry
Telephone: (02) 9840 3833
Fax: (02) 9840 3838
Email: inspsy@magna.com.au
Website: www.nswiop.nsw.edu.au
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