National Center for Post-Traumatic Stress Disorder
Phases of Traumatic Stress Reactions in a Disaster
A National Center for PTSD Fact Sheet
The thousands of Americans who directly experienced the terror attacks on New York and Washington, and the millions who saw the resulting death and destruction on television, may encounter behavioral and emotional re-adjustment problems. Many post-traumatic stress symptoms are normal responses to an overwhelming stressor which may change our assumptions and create distress, but will reside in intensity 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 gave 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 is amplified by the fact that organised violence is intentional, it has a political agenda, and is meant to destroy, hurt and create terror. Studies have shown that deliberate violence creates longer lasting mental health effects than natural disasters or accidents. The consequences both 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. The re-establishment of meaningful patterns of interactions in the community after 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 often fall 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 post-disaster period. People may see these as not having fulfilled their own or others expectations of themselves.
Some people respond in the immediate phase of impact, in a way that is disorganized and stunned and may not be able to respond appropriately to protect themselves. Such disorganized or alternatively apathetic behavior may be transient or may extend into the post-disaster period, so that people are found wandering helpless in the devastation afterwards. These reactions may reflect cognitive distortions in responses to the severe disaster stressors and may for some indicate a level of dissociation.
Several stressors may occur during impact which may have consequences for the person subsequently:
Immediate post-disaster period: 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 eg. people show confusion, are stunned or demonstrate high anxiety levels. Emotional reactions will be variable and depend on the individuals perceptions and experience of the different stressor elements noted earlier. Necessary activities of the rescue phase may mean these reactions are delayed, appearing more as recovery processes get under way. Reactions may include:
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 return to community and individual adjustment or equilibrium. 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 usually begins in the weeks post-impact. It may be associated with a honeymoon phase deriving from the altruistic and 'therapeutic community' response in the period immediately following the disaster. A disillusionment phase may soon follow when a disaster is off the front pages, organized support starts to be withdrawn, and the realities of losses, bureaucratic constraints, and the changes wrought by the disaster must now 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. And many times, through media, retribution, or continued violence, the society in question is re-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 at this time. People may also be hesitant to express distress or 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, eg. sleep disturbance, indigestion, fatigue, as well as social effects such as relationship or work difficulties.
The Effects of Traumatic Stress After Disasters explains in more detail both short and long-term effects of disasters on individuals
Excerpted from Raphael, Disaster Mental Health Response Handbook, NSW Health, 2000
Copies Available from:
The NSW Institue 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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